Coding Tidbits Written By: Linda Kobayashi
Edited and Posted By: Andrea Wong
Problem for this week:
The patient, a 10-year-old boy, sustained a severe injury to his little finger. As he was getting out of the car someone inadvertently slammed the door on him. Due to the severity of the injury, the finger on his left hand could not be saved. He underwent a fifth ray carpometacarpal joint amputation, left hand, open approach.
S68.117A – Complete traumatic transphalangeal amputation of left little finger
0X6K0Z8 – Detachment at left hand, complete 5th ray, open approach
Breakdown of S68.117:
- S68 = Traumatic amputation of wrist, hand and fingers
- S68.1 = Traumatic metacarpophalangeal amputation of other and unspecified finger
- S68.11 = Complete traumatic metacarpophalangeal amputation of other and unspecified finger
- S68.117 = Complete traumatic metacarpophalangeal amputation of left little finger
To locate S68.117A: Disease Index > Wound, open > finger(s) > with > amputation > see Amputation, traumatic, finger (complete) (metacarpophalangeal) > little finger > S68.11- > go to Tabular to assign 7th character > A (initial encounter) > S68.117A.
- I found this one with some difficulty, as there are many main terms from which to select the most appropriate one.
- A dash immediately following the partial code in the Disease Index means that one or more characters are needed to complete the code. How do you know which encounter to assign?
- There is a 7th character box just below category S68 listing the encounters: “A” for initial encounter; “D” for subsequent encounter; “S” for sequela. There is nothing in the diagnostic statement to indicate that this is for a subsequent encounter.
To locate 0X6K0Z8: PCS Index > Amputation > see Detachment > Hand > Left > 0X6K0Z > locate table 0X6 and then go across the row to (1) Verify that the 6 digits are correct > (2) Assign the 7th digit:
Detachment at Left Hand, Complete, Open Approach
- Here we have another example of some of ICD-10-CM’s terminology changes, with Detachment replacing Amputation.
- Definition of Detachment: Cutting off all or a portion of the upper or lower extremities.
- A complete ray amputation is through the carpometacarpal joint.
Directions for Locating Codes from the Tables
Amputation of Left Little Finger
- Step #1 is to locate the correct section in your PCS coding book. You know that surgery was performed, so the most logical selection is the Med/Surg section. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
- Step 2: Determine the correct Body System. The Body System and the Body Part should reinforce each other. We know it involves the hand and the hand is an upper extremity. You should now have two characters, 0X.
- Step 3: Determined the root operation. The root operations are listed alphabetically. Go through the all the tables that start with 0X and look for the root operation, Detachment. We now have the first three characters, 0X6, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Anatomical Regions/Upper Extremities; the root operation, Detachment.
- Step 4: Identify the Body Part to determine the 4th character value. The Body Part, hand, should relate to the root operation, Detachment because it was the little finger of the left hand that was detached. We now have 4 character values 0X6K.
- Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done via an open approach. We should now have 5 characters, 0X6K0
- Step 6: Determine whether or not a device was left in the patient postoperatively. No device was left in place, so assign Z, the placeholder, as the character value. We should now have 6 characters, 0VT00Z.
- Step 7: The qualifier, 8, indicates that the entire 5th ray/little finger was detached. We now have our code, 0X6K0Z8.