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Page 1: I Applying the Applying CD-10-PCS Guidelines ICD-10-PCS

Power up your codingoptum360coding.com

2 0 2 0

2020

Applying ICD-10-PCS Guidelines llustrated guide and practical examples of ICD-10-PCS coding guidelines and conventions

Applying the

ICD

-10-PCS G

uidelines

ICD-10 ESSENTIALS

ITEP_ITEP20_CVR.indd 1 11/20/18 2:18 PM

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Contents

Case Studies ................................................................................................................................ iii

Case Studies (Alphabetical Listing) .............................................................................................. ix

Figures ....................................................................................................................................... xv

Tables ........................................................................................................................................ xix

Introduction ................................................................................................................................. 1How to Use ICD-10 Essentials: Applying ICD-10-PCS Guidelines ............................................................. 1

Chapter 1. ICD-10-PCS Overview ................................................................................................... 7History of ICD-10-PCS ..................................................................................................................................... 7Documentation Needs ................................................................................................................................... 8PCS Organization ............................................................................................................................................ 9Tables ...............................................................................................................................................................18Index .................................................................................................................................................................20List of Codes ...................................................................................................................................................21Hierarchy of Coding Advice ........................................................................................................................21

Chapter 2. PCS Conventions ........................................................................................................ 23General ICD-10-PCS Coding Conventions ...............................................................................................23

Chapter 3. Body System Guidelines ............................................................................................ 33Body System Overview ................................................................................................................................33General Guidelines .......................................................................................................................................34

Chapter 4. Root Operation Guidelines ........................................................................................ 59Root Operation Overview ...........................................................................................................................59General Guidelines .......................................................................................................................................60Multiple Procedures .....................................................................................................................................70Discontinued or Incomplete Procedures ................................................................................................86Biopsy Procedures ........................................................................................................................................90Biopsy Followed by More Definitive Treatment ................................................................................. 100Overlapping Body Layers ......................................................................................................................... 106Bypass Procedures ..................................................................................................................................... 112Control Versus More Definitive Root Operations ............................................................................... 127Excision Versus Resection ........................................................................................................................ 132Excision for Graft ........................................................................................................................................ 143Fusion Procedures of the Spine .............................................................................................................. 150Inspection Procedures .............................................................................................................................. 168Occlusion Versus Restriction for Vessel Embolization Procedures ................................................ 181Release Procedures .................................................................................................................................... 192Release Versus Division ............................................................................................................................ 197Reposition for Fracture Treatment ........................................................................................................ 200Transplantation Versus Administration ................................................................................................ 209Transfer Procedures using Multiple Tissue Layers ............................................................................. 211

Chapter 5. Body Part Guidelines ............................................................................................... 215Body Part Overview ................................................................................................................................... 215General Guidelines .................................................................................................................................... 216Branches of Body Parts ............................................................................................................................. 230Bilateral Body Part Values ........................................................................................................................ 238

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Contents ICD-10 Essentials: Applying ICD-10-PCS Guidelines

Coronary Arteries ....................................................................................................................................... 244Tendons, Ligaments, Bursae, and Fascia Near a Joint ...................................................................... 261Skin, Subcutaneous Tissue, and Fascia Overlying a Joint ................................................................ 269Fingers and Toes ........................................................................................................................................ 275Upper and Lower Intestinal Tract .......................................................................................................... 280

Chapter 6. Approach Guidelines ................................................................................................287Approach Overview ................................................................................................................................... 287Open Approach with Percutaneous Endoscopic Assistance ........................................................... 292External Approach ..................................................................................................................................... 297Percutaneous Procedure via Device ...................................................................................................... 305

Chapter 7. Device Guidelines .....................................................................................................317Device Overview ......................................................................................................................................... 317General Guidelines .................................................................................................................................... 322Drainage Device ......................................................................................................................................... 349

Chapter 8. Obstetrics Section Guidelines ...................................................................................353Obstetrics Section Overview ................................................................................................................... 353Products of Conception ............................................................................................................................ 357Procedures Following Delivery or Abortion ........................................................................................ 365

Chapter 9. New Technology Guidelines .....................................................................................375New Technology Overview ...................................................................................................................... 375General Guidelines .................................................................................................................................... 379

Appendix A. ICD-10-PCS Official Guidelines for Coding and Reporting 2019 ..............................385Medical and Surgical Section Guidelines (section 0) ........................................................................ 386Obstetric Section Guidelines (section 1) .............................................................................................. 392New Technology Section Guidelines (section X) ................................................................................ 393Selection of Principal Procedure ............................................................................................................ 393

Appendix B. Components of the Medical and Surgical Approach Definitions ............................395

Appendix C. Root Operation Definitions ...................................................................................397

Appendix D. Body Part Key ........................................................................................................403

Appendix E. Body Part Definitions ............................................................................................421

Appendix F. Device Key and Aggregation Table ........................................................................435

Appendix G. Device Definitions .................................................................................................445

Appendix H. Substance Key/Substance Definitions ...................................................................453

Appendix I. Character Meanings ...............................................................................................455Sample

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Case Studies

Case Study 3.1. Hemorrhage, Postop Rectal ....................................................................................................36Case Study 3.2. Hemorrhage, Postoperative, Urethral Anastomosis ........................................................37Case Study 3.3. Hemorrhage, Postoperative, Status Post-pancreatic Tumor Removal ........................37Case Study 3.4. Hemorrhage, After Cesarean Delivery .................................................................................38Case Study 3.5. Amputation, Right Elbow Level .............................................................................................40Case Study 3.6. Amputation, Right Leg and Hip through Upper Ischium ................................................40Case Study 3.7. Amputation, Right Forequarter .............................................................................................40Case Study 3.8. Disarticulation, Left Knee Joint ..............................................................................................40Case Study 3.9. Amputation, Right Forearm, Mid-shaft ...............................................................................42Case Study 3.10. Amputation, Right Below-knee Proximal Tibia/Fibula ..................................................42Case Study 3.11. Amputation, Midshaft Right Humerus ..............................................................................42Case Study 3.12. Amputation, Right Above-knee Distal Femur .................................................................42Case Study 3.13. Amputation, Second Ray Carpometacarpal Joint Left Hand .......................................44Case Study 3.14. Disarticulation, Tarsometatarsal Joint of the Right Small Toe .....................................44Case Study 3.15. Amputation, Right Wrist Joint .............................................................................................45Case Study 3.16. Amputation, Transmetatarsal of Foot at Left Big Toe ...................................................45Case Study 3.17. Disarticulation, DIP Joint, Right Thumb ............................................................................45Case Study 3.18. Amputation, Left Fourth Toe Mid-proximal Phalanx .....................................................45Case Study 3.19. Disarticulation, Right Ring Finger, PIP Joint .....................................................................46Case Study 3.20. Amputation, Left Index Finger at Metacarpal-phalangeal Joint .................................46Case Study 3.21. Amputation, Below the Knee (BKA) ...................................................................................46Case Study 3.22. Amputation, Transmetatarsal (Ray) Toe ...........................................................................47Case Study 3.23. Paracentesis for Ascites .........................................................................................................47Case Study 3.24. Thoracentesis, Right Pleural Space ....................................................................................48Case Study 3.25. Endarterectomy, Right Carotid Arteries ............................................................................52Case Study 3.26. Transjugular Intrahepatic Portosystemic Shunt (TIPS) ..................................................54Case Study 4.1. Mastectomy with Reconstruction .........................................................................................63Case Study 4.2. Revision, Left Knee ....................................................................................................................65Case Study 4.3. Takedown, Hartmann Ostomy ...............................................................................................68Case Study 4.4. Removal, Hardware from Left Humerus ..............................................................................69Case Study 4.5. Lysis, Adhesions, Ileum and Jejunum ..................................................................................71Case Study 4.6. Repair, Skin of Left Ear and Repair of Subcutaneous Tissue of Face ............................71Case Study 4.7. Upper Endoscopy with Biopsy ...............................................................................................72Case Study 4.8. Tonsilloadenoidectomy ...........................................................................................................73Case Study 4.9. Stripping, Greater Saphenous Veins, Right and Left Leg ................................................74Case Study 4.10. Transplant, Pancreas and Kidney ........................................................................................75Case Study 4.11. Bronchoscopy with Pulmonary Toilet ...............................................................................76Case Study 4.12. Fracture Repair, Orbital Bone ...............................................................................................79Case Study 4.13. Angioplasty, Pulmonary Vein ..............................................................................................80Case Study 4.14. Annuloplasty ............................................................................................................................81Case Study 4.15. Delivery with Fetal Rotation .................................................................................................82Case Study 4.16. Cholecystectomy, Laparoscopic, Converted to Open ...................................................83Case Study 4.17. Cystolithotomy, Laparoscopic, Converted to Open .......................................................84Case Study 4.18. Cystoureteroscopy with Unsuccessful Removal of Calculus ........................................87Case Study 4.19. Colonoscopy, Partial ..............................................................................................................88Case Study 4.20. Foreign Body, Unsuccessful Removal ................................................................................89Case Study 4.21. Biopsy, Endometrial ...............................................................................................................91Case Study 4.22. Biopsy, Shave ...........................................................................................................................91Case Study 4.23. Biopsy, Needle Core of Thyroid Nodule ............................................................................92Case Study 4.24. Biopsy, Aspiration Needle .....................................................................................................92Case Study 4.25. Biopsy, Transthoracic Needle ...............................................................................................93Case Study 4.26. Biopsy, Burr Hole, Brain .........................................................................................................94

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Case Studies (Alphabetical Listing)

Ablation, AV Junction, Transcatheter ............................................................................................................. 308Abortion, Spontaneous Manually Assisted.................................................................................................... 357Abortion, Vacuum Aspiration............................................................................................................................ 358Achilles Tendon Release ..................................................................................................................................... 197AICD Upgrade with Revision to CRT-D............................................................................................................ 341Amniocentesis..........................................................................................................................................................95Amniocentesis for Genetic Testing .................................................................................................................. 359Amnioscopy........................................................................................................................................................... 359Amputation, Below the Knee (BKA)....................................................................................................................46Amputation, Left Fourth Toe Mid-proximal Phalanx .....................................................................................45Amputation, Left Index Finger at Metacarpal-phalangeal Joint .................................................................46Amputation, Midshaft Right Humerus...............................................................................................................42Amputation, Right Above-knee Distal Femur..................................................................................................42Amputation, Right Below-knee Proximal Tibia/Fibula ..................................................................................42Amputation, Right Elbow Level ...........................................................................................................................40Amputation, Right Forearm, Mid-shaft..............................................................................................................42Amputation, Right Forequarter ...........................................................................................................................40Amputation, Right Leg and Hip through Upper Ischium..............................................................................40Amputation, Right Wrist Joint..............................................................................................................................45Amputation, Second Ray Carpometacarpal Joint Left Hand........................................................................44Amputation, Transmetatarsal of Foot at Left Big Toe ....................................................................................45Amputation, Transmetatarsal (Ray) Toe............................................................................................................47Aneurysm Clipping .............................................................................................................................................. 186Angiography Diagnostic, Fractional Flow Reserve (FFR) and Intravascular Ultrasonography

(IVUS) ................................................................................................................................................ 260Angioplasty, Pulmonary Vein...............................................................................................................................80Annuloplasty ............................................................................................................................................................81Aortobifemoral Bypass........................................................................................................................................ 118Arthroscopy, Diagnostic Shoulder ................................................................................................................... 107Arthroscopy with Knee Derangement Repair ............................................................................................... 177Artificial Rupture of Membranes (AROM)....................................................................................................... 367Artificial Rupture of Membranes for Induction of Labor ............................................................................ 359Aspiration, CSF from Lumbar Drainage Catheter Port ................................................................................ 307Aspiration, Knee.................................................................................................................................................... 274Atherectomy, Bifurcation with Stent Placement and IVUS........................................................................ 258Atherectomy, Lower Arteries ............................................................................................................................ 226Atherectomy with External Heart Assist......................................................................................................... 331Biopsy, Aspiration Needle .....................................................................................................................................92Biopsy, Bone Marrow..............................................................................................................................................99Biopsy, Bronchoscopy ............................................................................................................................................96Biopsy, Burr Hole, Brain..........................................................................................................................................94Biopsy, Endometrial................................................................................................................................................91Biopsy, Laparoscopic Liver and Evacuation of Ascites ...................................................................................98Biopsy, Needle Core of Thyroid Nodule.............................................................................................................92Biopsy, Shave............................................................................................................................................................91Biopsy, Spinal Tap ...................................................................................................................................................96Biopsy, Transthoracic Needle ...............................................................................................................................93Biopsy and Brain Tumor Removal .................................................................................................................... 101Biopsy and Polyp Removal via Colonoscopy................................................................................................. 105Blepharoplasty, Cosmetic................................................................................................................................... 242Brachytherapy....................................................................................................................................................... 335Bronchoalveolar Lavage (BAL) .......................................................................................................................... 228

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Figures

Figure 1.1. Coding Advice Hierarchy ..................................................................................................................21Figure 3.1. Detachment Forequarter .................................................................................................................39Figure 3.2. Detachment Hindquarter ................................................................................................................39Figure 3.3. Detachment of Humerus and Radius/Ulna .................................................................................41Figure 3.4. Detachment of Femur and Tibia/Fibula .......................................................................................41Figure 3.5. Detachment Hand, Fingers, and Thumb ......................................................................................44Figure 3.6. Detachment Foot and Toes .............................................................................................................45Figure 3.7. Diaphragm ...........................................................................................................................................49Figure 3.8. Map of Upper Arteries ......................................................................................................................50Figure 3.9. Map of Upper Veins ...........................................................................................................................51Figure 3.10. Carotid Arteries ................................................................................................................................53Figure 3.11. Endarterectomy ...............................................................................................................................54Figure 3.12. Transjugular Intrahepatic Portosystemic Shunt (TIPS) ..........................................................56Figure 4.1. Tonsils and Adenoids ........................................................................................................................74Figure 4.2. Tracheobronchial Tree ......................................................................................................................77Figure 4.3. Orbital Structures ...............................................................................................................................79Figure 4.4. Mediastinum .......................................................................................................................................87Figure 4.5. Urinary Tract ........................................................................................................................................88Figure 4.6. Large Intestine ....................................................................................................................................89Figure 4.7. Fine Needle Biopsy ............................................................................................................................93Figure 4.8. Bronchoscopy .....................................................................................................................................97Figure 4.9. Pleural Fluid Sample ...................................................................................................................... 102Figure 4.10. Shoulder Anatomy ....................................................................................................................... 108Figure 4.11. Roux-en-Y Gastric Bypass ........................................................................................................... 116Figure 4.12. Subclavian/Carotid Artery Transposition ............................................................................... 120Figure 4.13. CABG Decision Tree ..................................................................................................................... 122Figure 4.14. Coronary Artery Bypass ............................................................................................................... 123Figure 4.15. Lung Lobes ..................................................................................................................................... 136Figure 4.16. Large Intestine .............................................................................................................................. 139Figure 4.17. Hierarchy of Large Intestine ...................................................................................................... 139Figure 4.18. Greater and Lesser Saphenous Veins ...................................................................................... 144Figure 4.19. LIMA Pedicle Graft, Radial Arterial Graft, and Saphenous Vein Graft .............................. 144Figure 4.20. External Ear .................................................................................................................................... 148Figure 4.21. Spine and Vertebra ...................................................................................................................... 153Figure 4.22. Fusion Device Hierarchy ............................................................................................................. 154Figure 4.23. Interbody Fusion Device ............................................................................................................. 154Figure 4.24. Supine, Lateral, and Prone Positions ....................................................................................... 156Figure 4.25. Posterior Lumbar Interbody Fusion (PLIF) ............................................................................. 157Figure 4.26. Laminotomy with Decompression ........................................................................................... 159Figure 4.27. Lumbar Artificial Disc Replacement ......................................................................................... 160Figure 4.28. Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement ...................................... 171Figure 4.29. Tracheobronchial Tree ................................................................................................................ 173Figure 4.30. Colposcopy .................................................................................................................................... 174Figure 4.31. Hysteroscopy ................................................................................................................................. 175Figure 4.32. Sleeve Gastrectomy ..................................................................................................................... 177Figure 4.33. Suture Reattachment of Patellar Tendon ............................................................................... 178Figure 4.34. Ateriovenous Malformation (AVM) .......................................................................................... 183Figure 4.35. Aneurysm Embolization with Coils .......................................................................................... 185Figure 4.36. Aneurysm Clipping ...................................................................................................................... 187Figure 4.37. Open Approach Using Burr Hole and Craniotome ............................................................... 188Figure 4.38. Abdominal Aorta Stent Graft ..................................................................................................... 189Figure 4.39. Nissen Fundoplication ................................................................................................................ 191

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Introduction

ICD-10 Essentials: Applying ICD-10-PCS Guidelines is a coding reference for ICD-10-PCS focusing on application of the coding guidelines. This book provides a comprehensive look at each ICD-10-PCS guideline along with supporting examples, case studies, and in-depth coding rationale designed to ensure accurate application of the guideline in real-life coding situations. New and veteran coding professionals will find this book to be a valuable resource that explains and clarifies key coding concepts related to ICD-10-PCS.

The coding guidance found in ICD-10 Essentials: Applying ICD-10-PCS Guidelines is based on the official version of the ICD-10 Procedure Coding System (ICD-10-PCS), effective October 1, 2019.

Changes reflecting the dynamic world of coding are ongoing, and Optum encourages input for inclusion in future editions of the book.

How to Use ICD-10 Essentials: Applying ICD-10-PCS GuidelinesThe organization of ICD-10 Essentials: Applying ICD-10-PCS Guidelines follows the format of ICD-10-PCS Official Guidelines for Coding and Reporting. There is a chapter devoted to each of the topics covered in the guidelines as follows:

• PCS Conventions

• Medical and Surgical Body System Guidelines

• Medical and Surgical Root Operation Guidelines

• Medical and Surgical Body Part Guidelines

• Medical and Surgical Approach Guidelines

• Medical and Surgical Device Guidelines

• Obstetrics Section Guidelines

• New Technology Section Guidelines

Shaded boxes in different colors allow the user to quickly differentiate the various components of each chapter. Blue boxes enclose the focus guideline in each section. Supporting guidelines included to assist in explaining case studies are shown in orange boxes. Spotlights in yellow boxes alert the user to key facts, important information, and coding advice, while pink boxes highlight definitions.

Valuable information has been provided in case studies, tables, and figures that include illustrations and decision trees, all of which are listed in the front of the book and are easily searchable. Located in the back of the book are appendixes to supplement the material contained in the chapters, as well as an alphabetical index to search pertinent information.Sam

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Introduction

PCS GuidelineAs each ICD-10-PCS guideline is examined, the full, official text is presented in a blue box followed by an overview of the guideline, helpful illustrations, as well as practical applications of the guideline.

Example:

IllustrationsIllustrations are included to provide visual support to text.

Example:The diaphragm is a sheet of fiber and muscle that rises and falls as we breathe. It neatly bisects the human body into upper and lower halves. PCS definitions indicate that body parts above the diaphragm are to be classified as “upper” and those below it are classified as “lower.”

Figure 3.7. Diaphragm

B2.1b Where the general body part values “upper” and “lower” are provided as an option in the Upper Arteries, Lower Arteries, Upper Veins, Lower Veins, Muscles and Tendons body systems, “upper” or “lower “specifies body parts located above or below the diaphragm respectively.

Example: Vein body parts above the diaphragm are found in the Upper Veins body system; vein body parts below the diaphragm are found in the Lower Veins body system.

Diaphragm

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Introduction

AHA Coding ClinicOfficial citations from AHA’s Coding Clinic for ICD-10-PCS have been provided for conventions and guidelines, as applicable. The citations appear in red type with the year, quarter, and page of the reference, as well as the title of the question as it appears in that AHA Coding Clinic table of contents. AHA Coding Clinic citations included in this edition have been updated through second quarter 2018.

Example:

AHA Coding Clinic2014, 3Q, 25 Revision of Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Practical Application for GuidelinesCase studies in purple boxes are supplied along with full code assignment and rationale for each code with attribution of official sources used such as guidelines, official definitions, and AHA Coding Clinic.

Example:

Code(s):0UDB8ZX Extraction of Endometrium, Via Natural or Artificial Opening Endoscopic,

Diagnostic

Rationale:A dilation and curettage (D&C) is considered an extraction since the lining of the endometrium is stripped away by force. Although the initial response may be to code this biopsy using the root operation Excision, there is no body part endometrium listed in Table 0UB. Root operation Extraction (D) is the appropriate assignment.

Consulting the ICD-10-PCS index for Extraction, the entry for Endometrium lists table 0UDB. This table is found in the body system Female Reproductive System (U) with Endometrium (B) as the body part value. Endometrial biopsies are done by passing the instruments through the cervix into the uterine cavity. The hysteroscope provides the endoscopic approach Via Natural or Artificial Opening (8).

The qualifier Diagnostic (X) is used since the sample was taken to diagnose the cause of bleeding.

Root Operation TablesTo provide quick access to the root operation definitions, case studies include root operation tables that apply to the particular example.

Example:

Case Study 4.21. Endometrial Biopsy

The patient experienced postmenopausal uterine bleeding. A diagnostic D&C was performed through a hysteroscope to determine the cause of bleeding.

Root Operation

Extraction (D) Definition: Pulling or stripping out or off all or a portion of a body part by the use of force

Explanation: The qualifier DIAGNOSTIC is used to identify extraction procedures that are biopsies

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Chapter 2. PCS Conventions

General ICD-10-PCS Coding ConventionsThis chapter provides the fundamentals behind the construction of ICD-10-PCS codes. Each official convention and any corresponding example, contained in the ICD-10-PCS Official Guidelines for Coding and Reporting 2019 is provided, followed by additional and supplementary information to further interpret the convention. It should be noted that the instructions and conventions of the classification take precedence over guidelines.

The following illustration is provided to assist in learning each of the axes of classification in the Medical and Surgical section, where most of the invasive PCS procedure codes reside.

Convention A1

As shown in the following table (097), although there are multiple values listed, character 4 always represents Body Part, character 5 Approach, and character 6 Device.

Regardless of whether the specific character values represent clinical concepts or function as placeholders (e.g., No Device (Z) or No Qualifier (Z)), all seven characters must be assigned for each PCS code.

Character1

Character2

Character3

Character4

Character5

Character6

Character7

Section Body System

Root Operation Body Part Approach Device Qualifier

A1 ICD-10-PCS codes are composed of seven characters. Each character is an axis of classification that specifies information about the procedure performed. Within a defined code range, a character specifies the same type of information in that axis of classification.

Example: The fifth axis of classification specifies the approach in sections 0 through 4 and 7 through 9 of the system.

0 Medical and Surgical9 Ear, Nose, Sinus7 Dilation Definition: Expanding an orifice or the lumen of a tubular body part

Body PartCharacter 4

ApproachCharacter 5

DeviceCharacter 6

QualifierCharacter 7

F Eustachian Tube, RightG Eustachian Tube, Left

0 Open7 Via Natural or Artificial

Opening8 Via Natural or Artificial

Opening Endoscopic

D Intraluminal DeviceZ No Device

Z No Qualifier

F Eustachian Tube, RightG Eustachian Tube, Left

3 Percutaneous4 Percutaneous

Endoscopic

Z No Device Z No Qualifier

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Chapter 3. Body System Guidelines

Body System Overview

Body System: Character 2

The second character in each PCS code from the Medical and Surgical (0) section is the body system. This character designates the general body system, such as Central Nervous System and Cranial Nerves, Respiratory System, or Subcutaneous Tissue and Fascia. The body part value (character 4) is dependent upon the assignment of the body system value; therefore, the most appropriate body system value should be assigned.

It is important to understand that PCS is not separated into the same body systems as its counterpart ICD-10-CM. In ICD-10-CM, the body classification system is based on disease processes. ICD-10-PCS uses the anatomy of the human body, dividing it into specific body systems. For example, in ICD-10-CM only one chapter focuses on the diseases of the circulatory system, while ICD-10-PCS breaks the circulatory system into five separate chapters.

The Medical and Surgical section has 31 values that represent defined PCS body systems. These body system values represent a specific anatomical/physiological system, such as Upper Bones, or a broader anatomical region, such as Anatomical Regions, Upper Extremities. For a full list of the 31 different body system values, see chapter 1 of this book.

Character1

Character2

Character3

Character4

Character5

Character6

Character 7

SectionBody

SystemRoot

Operation Body Part Approach Device Qualifier

ICD-10-CM ICD-10-PCS

Diseases of the Circulatory System Heart and Great Vessels

Upper Arteries

Lower Arteries

Upper Veins

Lower Veins

Spotlight

The body part that is the focus of the procedure is important to note when selecting the correct body system. If the focus is the shoulder bursae or ligament, code to the body system Bursae and Ligaments. If the focus is a shoulder tendon, use body system Tendons. Cartilage does not have a body system or body part designated; it is considered part of the joint structure and is coded to the nearest joint body system.

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Chapter 3. Body System Guidelines

General GuidelinesThere are two guidelines associated with character 2 Body System. The first guideline discusses the appropriate use of the Anatomical Regions body systems (General, Upper Extremities, and Lower Extremities) and why specific root operations can only be found in these sections. The other guideline clarifies how PCS defines the upper and lower body system anatomy.

Guideline B2.1a

AHA Coding Clinic2017, 2Q, 3 Qualifiers for the Root Operation Detachment2017, 2Q, 18 Removal of Polydactyl Digits2017, 1Q, 22 Chopart Amputation of Foot2017, 1Q, 52 Further Distal Phalangeal Amputation2016, 4Q, 99 Root Operation Control2016, 4Q, 134 Changes to the ICD-10-PCS Official Guidelines for Coding and Reporting2016, 3Q, 33 Traumatic Amputation of Fingers with Further Revision Amputation2016, 1Q, 21 Excision of Urachal Mass2015, 3Q, 23 Incision and Drainage of Multiple Abscess Cavities Using Vessel Loop2015, 2Q, 25 Partial Amputation of Hallux at Interphalangeal Joint2015, 1Q, 28 Mid-Foot Amputation2015, 1Q, 35 Evacuation of Hematoma for Control of Postprocedural Bleeding2013, 4Q, 119 Excision of Inclusion Cyst of Perineum

Of the 31 body systems in the Medical and Surgical section, there are three body systems designated as Anatomical Regions: General, Upper Extremities, and Lower Extremities. These body systems are only assigned in certain circumstances. A table from any of these three body systems should not be used if the procedure is performed on a location that can be designated to a more specific physiological body system. Although many of the root operations found in the more specific physiological body systems are also found in the Anatomical Regions body systems, there are two root operations almost exclusively found in the Anatomical Regions body systems: Control and Detachment.

B2.1a The procedure codes in the general anatomical regions body systems can be used when the procedure is performed on an anatomical region rather than a specific body part (e.g., root operations Control and Detachment, Drainage of a body cavity) or on the rare occasion when no information is available to support assignment of a code to a specific body part.

Examples: Control of postoperative hemorrhage is coded to the root operation Control found in the general anatomical regions body systems.

Chest tube drainage of the pleural cavity is coded to the root operation Drainage found in the general anatomical regions body systems. Suture repair of the abdominal wall is coded to the root operation Repair in the general anatomical regions body system.

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