ICD-10-PCS

The Lessons We Learned

Who are we? Health Language has been at the forefront of

healthcare terminology for 14 years.

We were acquired by Wolters Kluwer in 2013 aspart of the Clinical Solutions division.

Our core business is Healthcare TerminologyManagement, ICD-10 Remediation, andmeaningful Use Preparation.

Our clients are providers, payers, and the HITvendor market.

We have ICD-10 Experience: Health Language hasbeen working with organizations internationallyand domestically on ICD-10 conversions for over10 years.

We have a diverse team of industry experts. Ourteam consists of coders, nurses, doctors,pharmacists, and informaticists.

ACCESS/OUTPUTMANAGE

Model

MapCrosswalk

Index

SearchHL

LanguageEngine

Manage

Load andUpdate

Local ContentLocal lab catalogs, dischargesummary, encounter notes

Standards

ICD-9, ICD-10, SNOMED CT,LOINC, RxNorm, HCPCS

INPUT

API or webservices returncorrect terms,codes, maps

Runtime Access

HLI tools:LExScape,

LEAP, LEAP I-10, CodeExplorer

User Interface

Flat filesto populate

customapplication

tables

Export & Distribute

The HL Language Engine®

2013, the year we learned about ICD-10 PCS!

In the spring of 2013, Health Language embarked on a project for aclient who requested a functional crosswalk between CPT-4 andICD-10-PCS. The project took us 8 months, and we mapped morethan 70,000 individual maps!

This project allowed us to learn and work with ICD-10 PCSintimately. We moved through every section of the PCS book withour mappings and had intense discussions regarding usage andmeaning of ICD-10-PCS codes. In the end, our entire team wasgrateful to learn what we did with ICD-10-PCS, and we hope toshare our insight with you today regarding some potential problemareas.

KS1KS2

Slide 4

KS1 Katie Sutton, 7/24/2014

KS2 Katie Sutton, 7/24/2014

History of ICD-10-PCS and GeneralStructureIn 1992, the Centers for Medicare and Medicaid Services (CMS) funded theproject to develop the International Classification of Diseases, Tenth Revision,Procedure Coding System (ICD-10-PCS), with 3M Health Information Systems.ICD-10-PCS is scheduled to be implemented in the United States on or afterOctober 1, 2015. ICD-10-PCS has a multiaxial seven-character alphanumeric codestructure, providing unique codes for procedures.

Key attributes of ICD-10-PCS

Completeness- A unique code for each substantially different procedure

Expandability- Structure should allow easy expansion

Multiaxial- Should contain independent characters and an individual axis thatmaintains its meaning across ranges of codes

Standardized Terminology- Definitions are well defined, with no multiplemeanings and each term is assigned a specific meaning

ICD-10-PCS Section

All codes in PCS are seven characters

Letters O and I not used in PCS Numbers 0 and 1 used

Each character has a meaning

Meanings change by sections

Section provides first character value

6

Character1

Character2

Character3

Character

4Character

5Character

6Character

7

Section BodySystem

RootOperation

Body Part Approach Device Qualifier

Do you want to know more about ICD-10-PCS?

2014 ICD-10-PCS available at www.cms.hhs.gov/ICD10

2014 Code Tables and Index

ICD-10-PCS 2014 Tables

Definitions

Index

ICD-10-PCS: The Complete Official Draft Code Set2012 (OptumInsight, formerly Ingenix),https://www.optumcoding.com/

Alternative to Paper Book: MediRegsElectronic CodeBook

All sections from print book integrated with Medicare information.

Easy search highlights terms to make finding appropriate characters easy

7 character reportable code shown with full long descriptions

See also: Integrated ICD-9, ICD-10 and GEMs mapping with ICD Explorer.

See Study Guide for screenshots and links!

Lesson #1 No eponyms in PCS

A person after whom a discovery, invention, place,

Disease or medical procedure etc., is named or thought

to be named.

The ICD-9-CM alpha index for both diagnoses and

procedures contains numerous eponyms. This

is still true for ICD-10-CM, but not for ICD-10-PCS. All

surgical eponyms have been removed from the

content set.

Instead, root terms describe the objective of each procedure

performed. So you now will need to know the actual objective

of the procedure, as well as how and to what extent it is being performed.

Eponym example-

The Whipple Procedure A Whipple procedure is known as a pancreaticoduodenectomy.

In ICD-9-CM, this procedure is coded to 52.7, radicalpancreaticoduodenectomy. This one ICD-9 code includes all components ofthe procedure: the pancreaticojejunal anastomosis, choledochojejunalanastomosis, and gastrojejunostomy.

In ICD-10-PCS, the a “Whipple”procedure will require the assignment of fiveseparate procedure codes

0FBG0ZZ for the excision of the pancreas, open approach

0DBA0ZZ for the excision of the jejunum, open approach

0DB90ZZ for the excision of the duodenum, open approach

0F1G0ZB for the bypass of the pancreas to the small intestine, open approach

0D160ZA for the bypass of the stomach to jejunum, open approach.

So what were they thinking? One code iseasier than five, right?

The same eponym may apply to more than one procedure. This makes itdifficult to share data between different providers, cities, states and globally.

An eponym provides no valuable information about the procedure objective,technique or approach. Remember we are striving for clarity!

The use of eponyms can be biased based on the country of creation.

ICD-10-PCS is about clarity. So by focusing on the intent of the procedurerather than the antiquated eponym, we can paint a clearer picture of patientcare.

Lesson # 2 Excision vs. ResectionExcision is defined as cutting out or off, without replacement, a PORTION of abody part. Examples of excision procedures:

Diagnostic percutaneous needle core biopsy of the left breast

Partial nephrectomy, left kidney

Excision of malignant melanoma from skin of right shoulder

Resection is defined as cutting out or off, without replacement, ALL of a bodypart. Examples of resection procedures:

Total right-sided nephrectomy

Lobectomy, right lobe of liver

Laparoscopic cholecystectomy

Lobectomy, left lower lobe of lung

How does PCS define a body part?Excision used to be a catch all for a biopsy or removal of a body part. Now it ismore specific. In ICD-10-PCS, certain body parts that you thought would bepieces are now subdivided into their own complete parts.

Coding Guideline B3.8 Subdivisions of a body part

PCS contains specific body parts for anatomical subdivisions of a body part, suchas lobes of the lungs or liver and regions of the intestine. Resection of thespecific body part is coded whenever all of the body part is cut out or off, ratherthan coding Excision of a less specific body part.

Example: Left upper lung lobectomy is coded to Resection of Upper Lung Lobe,Left rather than Excision of Lung, Left.

Lesson #3 Occlusion Vs. RestrictionOcclusion is defined as completely closing an orifice or lumen of a tubular bodypart.

Ligation of inferior vena cava

Fallopian tube ligation with bands or tied and cut

Complete embolization of internal carotid-cavernous fistula

Restriction is defined as partially closing an orifice or lumen of a tubular bodypart.

Gastric banding (Lap band)

Restriction of thoracic duct with intraluminal stent

Cervical cerclage

Lesson #4- Revision VS. Change

Revision is defined as correcting, to the extent possible, a portion of amalfunctioning DEVICE or the position of a displaced device..

Adjustment of a pacemaker lead

Revision of VAD reservoir placement in chest wall, open

Taking out a loose screw and putting in a larger screw in fracture repair plate,right fibula

Change is defined as taking out or off a device from a body part and putting backan IDENTICAL OR SIMILAR device in or on the same body part without cutting orpuncturing the skin or mucous membrane.

Percutaneous endoscopic gastrostomy (PEG) tube exchange

Urinary catheter change

Exchange of a drainage tube from a joint

Remember!

When it comes to Revision a complete re-do of the original root operation iscoded to the root operation that is performed and not to revision. Don’t fallinto the trap!

If you are unsure of your root operation always refer back to the index andread the descriptions of the root operations. Because this is new to everyone,it is okay to check and recheck.

The index if not perfect but it can be very helpful. Go to the index, look up“revision of device in….” Procedures are listed by the body part where thedevice is located.

The root operation Change represents only those procedures where a similardevice is exchanged without making a new incision or puncture. Typicalchange procedures include exchange of drainage devices and feeding devices.

Lesson #5 Control Vs. Definitive rootoperation

Control is defined as stopping or attempting to stop, post procedural bleeding.

Control of post-prostatectomy hemorrhage

Control of post-tonsillectomy hemorrhage

Control is used to represent a small range of procedures performed to treat postprocedural bleeding. If another procedure with a definite root operation isperformed to stop the bleeding then Control is not coded separately.

Coding Guideline B3.7

The root operation Control is defined as, "Stopping, or attempting to stop, postprocedural bleeding." If an attempt to stop post procedural bleeding is initiallyunsuccessful, and to stop the bleeding requires performing any of the definitiveroot operations Bypass, Detachment, Excision, Extraction, Reposition,Replacement, or Resection, then that root operation is coded instead of Control.

Example: Resection of spleen to stop post procedural bleeding is coded toResection instead of Control.

Lesson #6 Transplantation Vs. Transfusion

Transplantation is defined as putting in or on all or a portion of a living body parttaken from another individual or animal to physically take the place and/orfunction of all or a portion of a similar body part.

Kidney transplant

Heart transplant

Transfusion is defined as putting in Blood or Blood Products

Transfusion of cell saver red cells into central venous line

Bone marrow transplant

Example of transfusion:

Autologous bone marrow transplant via central venous line

Go to the index Look up bone marrow transplant Directs you to “see transfusion” Index directs you to table 302

3-Administration0- Circulatory2-Transfusion4-Central Vein3-PercutaneousG-Bone Marrow0-Autologous

Transfusion table example:

Other helpful tools for ICD-10-PCS

Body part Illustrations in APPENDIX I of the coding book

There is a body part key in APPENDIX C

Medi Regs- http://wk.mediregs.com/cgi-bin/_trial/index_gen?page=q

AHIMA- www.ahima.org- Wonderful education tools and articles

ICD-10 Monitor- www.icd10monitor.com

Preparation is the key to success!

Refresh your anatomy knowledge now! ICD-10-PCS focuses on anatomy so it is important torefresh and hone your skills beforeimplementation.

Implement lunch and learn sessions based on rootoperations.

Practice, practice, practice.

Questions?