Understanding ICD10-CM PCS
Let me just start by saying “I love PCS!” Why do I say that? Well when I first started coding, Inpatient codes were foreign to me. I started on the Professional fee side of coding. What is professional fee coding you ask? Well that is the area of reimbursement where the focus is on capturing the Physicians professional part of the service. In an inpatient coders world they are capturing so much more. Including ICD10-PCS for inpatient reporting of procedures.
In this blog my goal is to give you a basic understanding of ICD10-PCS but do not worry we will cover more on PCS in our upcoming Season 3 podcast episodes as well as at our Fall Virtual Summit you will not want to miss!! You can purchase tickets HERE
ICD10-PCS is alpha numeric and unlike it’s diagnosis partner CM it required 7 digits. I mean REQUIRES! So yes you will have to report 7 digits to complete your code. Just like in CM we have to use placeholders with our X, in PCS we use the Z to act as a placeholder when the information for that digit is not applicable. There are 16 sections in PCS using the numbers 0–9 and the letters B–D and F–H. The majority of coders use section 0 for Medical and Surgical and this is the largest section so I will focus on explaining this section. I will tell you that once you understand the basic structure for this section the other sections will be easy to follow if you plug your data in the correct places.
So most of the time the first three digits 1-Section 2-Body System 3-Root Operation will be available by procedure lookup in the index. Now this is crucial! You must know and understand your Root Operations. Body systems are something that you can learn but most of the time they are simple to know if you are well versed in anatomy. This also comes with research and study. You can do it! In our Inpatient Coding workshop we dive into examples of Root Operations so I highly recommend you check it out at www.ccscoder.com
Next you have 4-Body Part 5-Approach 6-Device 7-Qualifier. Now these I will tell you are my favorite part. Especially digit 5. Why? Well as a historically CPT coder many times I was unable to find a code to describe my procedure or a single code described many different things but in PCS it is so direct!! You tell the complete story in 1 code! Which of course is needed to capture the correct DRG assignment. Don’t worry I will discuss my take on DRG in a later blog. With the approach I found it fascinating when they separate Percutaneous Endoscopic Approach, Via Natural or Artificial Opening Approach, Via Natural or Artificial Opening Endoscopic Approach. When you really understand approaches in CPT in makes so much sense why they separate a natural opening approach from percutaneous Endoscopic. We have certain natural openings in the body that an endoscope is inserted and then we have surgically created endoscopic approaches, like an Arthroscopy. I am telling you once you learn them it will really make your world come alive and you will love how it teaches you so much even to help you better code in CPT.
Ok so now for 6 and 7. These are the ones that will usually require a Z placeholder as they do not always have a value for all procedures. For 6 this is the device, so we think of this if they use a device and maybe leave it in. An example would be: Grafts and Prostheses, Implants, Simple or Mechanical Appliances, Electronic Appliances etc. An example of a qualifier for 7 is when you have to explain that a procedure for a Biopsy, with root operation Excision was Diagnostic. In fact the qualifier Diagnostic is used to identify excision procedures that ARE biopsies. Another example is the term Stereotactic. I think of qualifiers as like a Modifier. It tells you more info about the procedure that may change the meaning in some way.
Ok let’s look at an example with my favorite Root operations Excision vs Resection. The difference in these is Resection is similar to excision but refers to cutting out or off, without replacement, ALL of a body part. Resection includes all of a body part or any subdivision of a body part having its own body part value in ICD-10-PCS, while excision includes only a portion of a body part. So here is a example using the table in PCS and how I would code it:
So as you can see this is a Laparoscopic Appendectomy and so we have our first three digits. Our section is of course 0-Medical and Surgical. Now when you look at your index you know that looking up the procedure is of course where we start and once there the index directs us to see Excision or Resection. Looking at our root operations definitions we see that excision is just a portion of a body part and resection is all of a body part. For our example this is a total appendectomy so we will select resection and go to the table starting with 0DT. Now we can move to our Table right? So this is where we choose our body part for digit 4 which is of course J for appendix. Then for 5-Approach we see my favorite part, Percutaneous endoscopic because a scope is used but it’s not an artificial opening so 4 is the correct option as you see. For 6 and 7 we see our options are only ZZ because no value is applicable. This of course gives us our code of ODTJ4ZZ! We did it! I promise it will get easier when you practice. At Ozark Coding Alliance we are here to help you prep for your CCS exam or CIC exam that require you understand PCS. Join us for our On demand course anytime all year and into next spring.
I hope you enjoyed this overview and helps you get excited about learning PCS!
Differentiating Procedure Approach in ICD-10-PCS