Coding Tidbits Written By: Linda Kobayashi
Edited and Posted By: Andrea Wong
Hi There, Busters. Andrea and Linda wish you the best as you prepare for ICD-10. For the past few months we have focused on problems in the Med/Surg section. We thought it would be helpful to review other sections of the PCS coding book. Over the next several weeks we will cover Placement, Administration, Measuring and Monitoring and Extracorporeal Assistance and Performance. Today’s lesson focuses on the Placement section.
This Week’s Coding Problem:
The patient, an avid skier, slammed into a tree and sustained a nondisplaced comminuted fracture of the shaft of his left fibula. His physician ordered traction to ease the pain while waiting for surgery. His physician noted that surgery might possibly be avoided by the application of mechanical traction in which a traction apparatus is applied.
- S82.455A = Nondisplaced comminuted fracture of shaft of left fibula, initial encounter for closed fracture.
- 2W6RX0Z = Traction of left lower leg using traction apparatus
Breakdown of S82.455A:
- S82 = Fracture of lower leg, including ankle
- S82.4 = Fracture of shaft of fibula
- S82.45 = Comminuted fracture of shaft of fibula
- S82.455 = Nondisplaced comminuted fracture of shaft of left fibula
- S82.455A = Initial encounter for closed fracture
To locate S82.455A: Disease Index > Fracture, traumatic > fibula (shaft, styloid) > comminuted > nondisplaced > S82.45- > Comminuted fracture of shaft of fibula > S82.455 > Nondisplaced comminuted fracture of left fibula > 7th character required > S82.455A > Initial encounter.
- Non-displaced fractures are typically clean breaks to the bone; usually only a crack in the bone that does not go all the way through. They differ from displaced fractures because a displaced fracture normally results in a complete break and shifts the bone from its original place, sometimes so much that it protrudes from the body (open fracture).
- A comminuted fracture is a fracture in which the bone involved in the fracture is broken into several pieces. At least three separate pieces of bone must be present for a fracture to be classified as comminuted.
To locate 2W6RX0Z: PCS Index > Traction > Leg > Lower > Left > 2W6RX > locate table 2W6 and go across the row to verify that the characters RX are correct and then finish building the code:
Traction of Left Lower Leg Using Traction Apparatus
- Placement procedures involve services performed without making any incision or puncture.
- Definition of traction: Exerting a pulling force on a body region in a distal direction.
- Traction is the use of weights, ropes and pulleys to apply force to tissues surrounding a broken bone.
- It’s sometimes used to keep a broken leg in the correct position during the early stages of healing, or to ease the pain of a fracture while a person is waiting for surgery.
- All 7 characters retain the same meaning in both the Med/Surg section and the Placement section, but the root operations in the Placement section differ from those in the Med/Surg section.
- The root operations in the Placement section include only those procedures that are performed without making an incision or a puncture.
Directions for Locating the Codes by Going Directly to the Tables
Traction of Left Lower Leg
- Step #1 is to locate the correct section in your PCS coding book. You know that the root operation is traction. This is a tough one. Go to the beginning of your PCS coding book (I’m basing this on the Optum PCS coding book) in which the various sections are explained and look for the Placement section. The character value is always 2.
- Step 2: Determine the correct Body System. Stay in the Placement section. Under the Placement section, the character meanings are given. The Body System for the Placement section states that the second character contains two values specifying either Anatomical Regions or Anatomical Orifices. Obviously it isn’t anatomical orifices, so that leaves us with Anatomical Regions with a character value of W. We have our first two characters, 2W.
- Step 3: Determined the root operation. The root operations are listed alphabetically. Go through all the tables that start with 2W, looking for the root operation, Traction. This is a fairly easy step because all you have to do to find Traction is to scan through all the tables starting with 2W. Traction has a character value of 6. We now have 2W6, our first 3 characters.
- Step 4: Determine the body part. That should be easy enough because you know it involves the lower leg, which has a character value of R. We’re up to 4 characters, 2W6R.
- Step 5: Determine the approach. As you now know, root operations in the Placement section include only those procedures that are performed without making an incision or a puncture. Therefore the approach is external. Also note that the approach in table 2W6 only lists External. We are now up to 5 characters, 2W6RX
- Step 6: Determine if there is a device left in place. Yes there is the traction apparatus, with a character value of 0. We now have 6 characters, 2W6RX0.
- Step 7: Determine the qualifier. In our scenario, there is no qualifier, so once again we assign the placeholder of Z for a code of 2W6RX0Z.