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ICD-10-PCS: Guidelines Spotlight
June 2011
ICD-10-PCS is a completely new classification system that does not include any of the familiar ICD-9-CM Volume 3 procedures coding guidelines. A new ICD-10-PCS guideline will be discussed in detail with a brief coding scenario to demonstrate the correct application of the guidance.
Medical and Surgical Section Guidelines
The Body System is the first of five subsections within this category that include guidelines for Root operation, Body Part, Approach and Device. As previously mentioned in the General guidelines, topics are numbered sequentially within each category. There are two subjects under this subsection identified by B2.1a and B2.1b which we will discuss below.
B. Medical and Surgical Guidelines (Section 0)
Body System Guidelines
Remember: Body System is defined as a general physiological system or anatomical region involved. Body systems are a collection or grouping of organs or contiguous body parts, shared (adjacent) body parts. There are 28 body systems and 3 general anatomical regions.
The specific body system is identified with a value from the following list in the second character position.
Body Systems:
0 Central Nervous System
1 Peripheral Nervous System
2 Heart and Great Vessels
3 Upper Arteries
4 Lower Arteries
5 Upper Veins
6 Lower Veins
7 Lymphatic and Hemic Systems
8 Eye
9 Ear, Nose, Sinus
B Respiratory System
C Mouth and Throat
D Gastrointestinal System
F Hepatobiliary System and Pancreas
G Endocrine System
H Skin and Breast
J Subcutaneous Tissue and Fascia
K Muscles
L Tendons
M Bursae and Ligaments
N Head and Facial Bones
P Upper Bones
Q Lower Bones
R Upper Joints
S Lower Joints
T Urinary System
U Female Reproductive System
V Male Reproductive System
General Anatomical Regions:
W Anatomical Regions, General
X Anatomical Regions, Upper Extremities
Y Anatomical Regions, Lower Extremities
General Body Part is defined as a body part that includes contiguous body parts for which there are unique body part values (Character 4) available.
Example:
Esophagus, Upper 1
Esophagus, Middle 2
Esophagus, Lower 3
Esophagus, Junction 4
Esophagus 5
B. Medical and Surgical Guidelines (Section 0)
General Guidelines
B2.1a
The procedure codes in the general anatomical regions body systems should only 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.
Example: Control of postoperative hemorrhage is coded to the root operation. Control found in the general anatomical regions body systems.
Percutaneous endoscopic control of abdominal postoperative hemorrhage Code: 0W3G4ZZ
When a procedure is performed on the general body part as a whole
Example: Exploratory laparotomy is defined as an Inspection procedure performed on a general body part value –Peritoneum which is also considered a general anatomical region or a collection or grouping of organs each of which would have unique.
Exploratory laparotomy Code: 0WJG4ZZ
When the specific body part cannot be determined.
Example: Lysis of adhesions of the large intestines is defined as a Release procedure performed on a general body part value Large Intestine. No specific body part is identified such as Large Intestine, Right (F) or Large Intestine, Left (G).
Open lysis of adhesions of large intestines Code 0DNE 0ZZ
In the root operations Change, Removal, and Revision, when the specific body part value is not in the table.
Example: Change, Removal, and Revision are procedures that always involve devices.
Change of a sinus drainage tube Code 092YXX
Sinus is a general body part value. Under Drainage (taking or letting out fluids and/or gases from a body part) of body part values are available for the specific sinus (mastoid, maxillary, ethmoid, frontal, and sphenoid).
B2.1b
Body systems designated as upper or lower contain 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.
Open repair of gastric vein Code:06Q20ZZ
Example: Upper joints body parts above the diaphragm; lower joints body parts are below the diaphragm.
Percutaneouis drainage of right knee joint: Code 0S9C3ZZ
Root Operations guidelines will be reviewed next.
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