crossing the bridge preparing for icd-10-pcs crystal clack, ms, rhia, ccs ahima approved...
TRANSCRIPT
Crossing the Bridge
Preparing for ICD-10-PCS
Crystal Clack, MS, RHIA, CCSAHIMA Approved ICD-10-CM/PCS Trainer
OrHIMA Fall Conference 2013
Objectives A Brief History ICD-9-CM, Vol. 3 to ICD-10-PCS Format and Structure of ICD-10-PCS Spotlight: Root Operations Practice Preparing for the Great Transition Conclusion Resources
A Brief History
Why Now?
ICD-10-PCS is completely different from ICD-9-CM, Vol. 3
•Multi-axial structure
•Completeness
•Expandability
•Standardized terminology
•Standardized level of specificity
•No explicit options of “NOS” and limited use of “NEC”
code
ICD-9-CM Vol. 3 vs ICD-10-PCS
ICD-9-CM Volume 3 ICD-10-PCS
Follows ICD structure (designed for DX coding)
Designed and developed to meet healthcare needs for a procedure coding system
Codes available as fixed and finite set in list form
Codes constructed from flexible code components using Table
Codes are 3 to 4 digits long with a decimal point places after the second digit
Codes are 7 characters long
Codes are numeric Codes are alphanumeric
Number of Codes in ICD-10-PCS at the time of printing the 2014 Official Draft Code Set manual:
71,924
For 2014, seven new technology codes were added to the system, and three were deleted.
Format & Structure
Manual contains an Index and Table section
Codes may be found in the index based on the general type
of procedure. Based on the first three values of the code
provided in the Index, the table that corresponds to the
procedure can be referenced to complete the entire code.
Tables and characters are arranged as follows:
•Number
•Letter for each character, with a total of 7 characters
IMPORTANT: The Tables must be used to paint a complete and accurate
picture!
ICD-10-PCS Format & Structure
• Each code is seven characters and can be alphabetical
or numeric
• Ten digits 0-9 and 24 letters A-H, J-N, and P-Z are used
• Each of the characters has a well-defined meaning
Section ~ Character 1
• All Codes in PCS are seven characters
• Letters O and I are not used – 0 and 1 are used
• Each number has a meaning
• Meanings change depending on sections
• Section provides first character value
Section
Medical procedures are divided into sections that identify
the general type of procedure. The first character of the
procedure code always specifies the section – or where
you can locate the code in the book.
Sections of ICD-10-PCS as follows:
Value Section Value Section0 Medical & Surgical 9 Chiropractic
1 Obstetrics B Imaging
2 Placement C Nuclear Med
3 Administration D Radiation Tx
4 Measuring & Monitoring FPhysical Rehab &
Diagnostic Audiology
5Extracorporeal Assistance & Performance
G Mental Health
6Extracorporeal
TherapiesH
Substance Abuse Treatment
7 OsteopathicBOLD italics =
Ancillary
8 Other Procedures
Body System~ Character 2
• Second character
• Body System, general physiological system or anatomical
region involved
• Review Body Systems in training manual
• Appendix G
Body System0 - Central Nervous Sys.
C – Mouth & Throat Q – Lower Bones
1 – Peripheral Nervous Sys
D – Gastro System R – Upper Joints
2 – Heart & Great Vessels
F – Hepatobiliary System & Pancreas
S – Lower Joints
3 – Upper Arteries G – Endocrine System T – Urinary System
4 – Lower Arteries H – Skin & BreastU – Female Reproductive System
5 – Upper Veins J – SQ Tissue & FasciaV – Male Reproductive System
6 – Lower Veins K – MusclesW – Anatomical Regions, General
7 – Lymphatic & Hemic L - TendonsX – Anatomical Regions, Upper Extremities
8 – Eye M – Bursae & LigamentsY – Anatomical Regions, Lower Extremities
9 – Ear Nose & Sinus N – Head & Facial Bones
B – Respiratory System P – Upper Bones
Root Operations ~ Character 3
• Objective of Procedure
• 31 root operations
• Arranged by similar attributes
• Multiple codes
Examples of Root Operations
Bypass
Drainage
Reattachment
Resection
Inspection
Root Operations
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
There are 31 different root operations! The root is the reason, or objective, for the procedure
Body Part ~ Character 4
• Fourth character
• Anatomical site for procedure
• 34 possible values per body system
Examples of Body Parts
Liver
Kidney
Thalamus
Ascending Colon
Optic Nerve
Tonsil
Axillary vein, left
Radial nerve
Cerebellum
Upper lung lobe
(R)
Approach ~ Character 5
• Fifth character – approach or technique used to reach
procedure
• Seven different approach values
• May be through: skin, mucous membrane, orifice or
external
Examples of Approaches Skin or Mucous Membranes
~ Open, percutaneous or percutaneous endoscopic
Through an Orifice~ Via Natural or Artificial Opening~ Via Natural or Artificial Opening
Endoscopically~ Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance
External
Root Operations~ Character 5
Approach contains three components:
•Access location
•Method
•Type of instrumentation
Types of approaches:
•Open
•Percutaneous & percutaneous endoscopic
•Via natural/artificial Opening
•Natural/Artificial Opening Endoscopic
•Natural/Artificial Opening with Percutaneous Endoscopic Assistance
•External
Device ~ Character 6
Only procedures with a remaining device after the procedure will have a
specific device value. All codes require seven characters. The default
value to indicate that NO device was involved is Z.
Materials incidental to the procedure (clips and sutures)
are not considered devices.
Four Groups of Devices
Grafts
Prostheses
Implants
Simple or Mechanical Appliances
Electronic Appliances
Qualifier ~ Character 7
• Provides additional information
• May have narrow application
• There are NO specific guidelines for qualifiers
Most procedures will not have an
applicable qualifier…the default value to
indicate that NO qualifier
is necessary is…… Z
TIP!
Simple Way to Remember the Seven Character
Meanings!Sally = Selection
Bought = Body System
Root = Root Operation
Beer = Body Part
At = Approach
Dairy = Device
Queen = Qualifier
True or False?
A biological or synthetic material that takes the place of all or a portion of a body part such as a joint prosthesis would qualify as a device in ICD-10-PCS.
A: True
Rationale: A device is specified in the sixth character and is used to identify devices that remain after the procedure is complete
Test Your Knowledge
1. All ICD-10-PCS codes have _____________ characters.a. 3 to 5b. 3 to 7c. 5 to 7d. 7
2. Materials such as sutures, ligatures, radiological markers, and temporary postop wound drains should be coded separately using ICD-10-PCS device codes
a. Trueb. False
3. When coding in ICD-10-PCS, it is necessary to consult the Alphabetic Index and then proceed to the Tables.
a. Trueb. False
Medical and Surgical Section (0):
Root Operations
ROOT OPERATIONS
There are 31 root operations in ICD-10-PCS; each
identifies the objective of a procedure and holds the key
to the highly specific details and precision of the code
values.
Root Operation GuidelinesB3. Root Operation - General guidelines
B3.1a. In order to determine the appropriate root operation, the full definition of the root operation as contained in the PCS Tables must be applied
B3.1b Components of a procedure specified in the root operation definition are not coded separately. Procedural steps necessary to reach the operative site and close the operative site are also not coded separately.
EXAMPLES:
Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately. Laparotomy performed to reach the site of an open liver biopsy is not coded separately. In a resection of sigmoid colon with anastomosis of descending colon to rectum, the anastomosis is not coded separately.
B3. Root Operation - General guidelines continued:
B3.2. Multiple Procedures:During the same operative episode, multiple procedures are coded if:
a. The same root operation is performed on different body parts as defined by distinct values of the body part character.
b. The same root operation is repeated at different body sites that are included in the same body part value.
c. Multiple root operations with distinct objectives are performed on the same
body partd. The intended root operation is attempted using
one approach, but it converted to a different approach
B3. Root Operation - General guidelines continued:
B3.3. Discontinued Procedures:If the intended procedure is discontinued, code the procedure to the root operation performed. If a procedure is discontinued before any other root operation is performed, code the root operation inspection of the body part or anatomical region inspected
B3.4a. Biopsy Procedures:Are coded using the root operations, Extraction, or Drainage and the qualifier Diagnostic. The qualifier Diagnostic is ONLY used for biopsies
B3.4b. Biopsy followed by a more definitive treatment:If a diagnostic Excision, Extraction, or Drainage procedure is followed by a more definitive procedure, such as Destruction, Excision or Resection at the same procedure site, both the biopsy and more definitive treatment are coded
Medical & Surgical Section:Root Operations That Take Out
Some/All of a Body Part
Excision B:
Definition: Cutting out or off, without replacement, a portion of a body part
Explanation: The qualifier DIAGNOSTIC is used to identify excision procedures that are biopsies
Examples: Partial Nephrectomy, Liver biopsy
Example Case One
A 32-year-old female patient experienced melena gradually worsening over the last five days. Patient complains of weakness and dizziness to the point of passing out at work. She was admitted to the hospital for observation and an EGD. An EGD of the duodenum was performed the following morning.
What is the ICD-10-PCS code for this procedure?
Root operation: _________________________________Specific Body Part: _________________________________Seventh Character: _________________________________
ICD-10-PCS Code: _________________________________
Example Case One Snapshot of PCS Coding Book
Answer Case One
What is the ICD-10-PCS code for this procedure?
Root operation: Excision
Specific Body Part: Duodenum identified with 4th character
Seventh Character: “X” for diagnostic
ICD-10-PCS Code: 0DB98ZX
Medical & Surgical Section:Root Operation - Resection
Resection - T:
Definition: Cutting out, or off, without replacement, all of a body part
Explanation: N/A
Examples: Total Nephrectomy, total lobectomy of lung
Example Case TwoA 45-year-old male patient was diagnoses with acquired hemolytic anemia, autoimmune type with warm-reactive antibodies, and has been treated with glucocoricoids. Given the aggressive nature of his anemia, he was advised to have a total splenectomy to eliminate the body’s further destruction of red blood cells. Open splenectomy was performed without complications.
What is the ICD-10-PCS code for this procedure?
Root operation: _________________________________Specific Body Part: _________________________________Seventh Character: _________________________________
ICD-10-PCS Code: _________________________________
Example Case Two Snapshot of PCS Coding Book
Answer Case Two
What is the ICD-10-PCS code for this procedure?
Root operation: Resection
Specific Body Part: No device
Seventh Character: No qualifier
ICD-10-PCS Code: 07TP0ZZ
Medical & Surgical Section:Root Operations That Always Involve a
DeviceB6. Device
B6.1a. A device is coded only if a device remains after the procedure is completed, if no device remains, the device value No Device is coded.
B6.1b. Materials such a sutures, ligatures, radiological markers and temporary post-operative wound drains are considered integral to the performance of a procedure and not coded as devices.
B6.1.c.Procedures performed on a device only and not on a body part are specified in the root operations
Change, Irrigation, Removal and Revision and are coded to the procedure performed.
Medical & Surgical Section:Root Operation - Replacement
Replacement - R:
Definition: Putting in or on a biological or synthetic material that physically takes the place and/or
function of all or a portion of the body part.
Explanation: The body part may have been taken out or replaced, or may be taken out, physically eradicated or rendered nonfunctional. A Removal procedure is coded for taking out the device used in previous replacement procedure.
Example Case Three
The patient had a total right knee replacement 9 years ago. The patient was found to have an aseptic loosening and it was recommended to have total knee revision arthroplasty. The patient was taken to the OR where a ® TKR revision was carried out. During the procedure the previous prosthetic device was removed and a new cemented prosthetic device was inserted.
What is the ICD-10-PCS code for this procedure?
Root operation: _________________________________Specific Body Part: _________________________________Seventh Character: _________________________________
ICD-10-PCS Code: _________________________________
Example Case Three Snapshot of PCS Coding Book
What is the ICD-10-PCS code for this procedure?
Root operation: Replacement
Specific Body Part: Knee component and laterality
Seventh Character: cemented
ICD-10-PCS Code: 0SRC0J9
Answer Case Three
DO WE HAVE TO CLIMB THAT?!
Preparing for the
Inevitable:
10/01/2014
Don’t be a Fish out of Water!
Brush up on your anatomy
Review your pathophysiology
Don’t procrastinate!
START NOW
Many, Many Web Resources!
1. http://www.ahima.org/icd10/
2. http://www.aapc.com/icd-10/
3. http://www.cms.gov/Medicare/Coding/ICD10/
index.html?redirect=/icd10
4. http://www.himss.org/library/icd-10/playbook?
navItemNumber=13480
5. http://health-information.advanceweb.com/ICD-10-Resource-
Center/default.aspx
6. www.fortherecordmag.com
Application of ICD-10-PCS Root Operations, Audio Seminar, October 23, 2012
AHIMA
ICD-10-CM Official Guidelines for Coding and Reporting 2014:
http://www.cdc.gov/nchs/data/icd9/icd10cm_guidelines_2014.pdf
ICD-10-PCS Code Set: http://www.cdc.gov/nchs/icd/icd10cm.htm/
ICD-10-PCS, The Complete Official Draft Code Set 2014, Optum
Root Operations: Key to Procedure Coding in ICD-10-PCS, Ann Barta & Ann
Zeisset, AHIMA, 2011
Resources Used
Summer, 2015…..Life is Good!