Updated on: March 16, 2016

100 Tips for ICD-10-PCS Coding: Tips 91-100

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Original story posted on: November 20, 2013

ICD-10-PCS represents a major departure from ICD-9-CM procedure coding, and as such, many coding specialists find ICD-10-PCS much more challenging to learn than ICD-10-CM (which still shares many similarities with ICD-9-CM). In order to ease the transition from one code set to the other, we are providing tips for coding under this system.

 

To download the newly released 2014 ICD-10-PCS root operation tables and resources, go online to http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html.

Tip No. 91 

Electroconvulsive therapy (ECT) involves the therapeutic induction of a seizure by passing a controlled electrical current through the brain via electrodes placed on a patient’s scalp. ECT is reported using ICD-10-PCS table GZB, and the qualifiers listed in this table are defined as follows:

 

  • Unilateral – placement of the electrodes on the same side of the head;
  • Bilateral – standard placement of electrodes at the temples on opposite sides of the head;
  • Single seizure – inducing one seizure; and
  • Multiple seizures – inducing multiple seizures.

Source: http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/images/DepBulletin407_ECT_extract.pdf

Section

G

Mental Health

Body System

Z

None

Type

B

Electroconvulsive therapy: The application of controlled electrical voltages to treat a mental health disorder

 

Qualifier

Qualifier

Qualifier

Qualifier

0 Unilateral-Single Seizure

1 Unilateral-Multiple Seizure

2 Bilateral-Single Seizure

3 Bilateral-Multiple Seizure

4 Other Electroconvulsive Therapy

 

 

 

Z None

 

 

 

 

Z None

 

 

 

Z None

 

Tip No. 92

Spinal discectomy documentation must clearly indicate that the discectomy was either partial or complete (e.g., total L4-5 discectomy). A partial spinal discectomy will be coded as an excision, and a complete spinal discectomy will be coded as a resection. See the ICD-10-PCS Index excerpt below:

Discectomy, diskectomy

       See Excision, Upper Joints 0RB

       See Resection, Upper Joints 0RT


 

Tip No. 93

Implement an interim internal coding policy that explains when the “Lungs, Bilateral” body part value should be assigned (for example, see ICD-10-PCS table 0B9). 

While the right lung consists of three lobes (upper, middle, and lower), the left lung consists of two lobes (upper and lower) – yet there are no ICD-10-PCS instructions to explain if “Lungs, Bilateral” applies to all five lobes, the bilateral upper lobes, or the bilateral lower lobes.

See below for an excerpt from ICD-10-PCS table 0B9.

Section

0

Medical and Surgical

Body System

B

Respiratory System

Type

9

Drainage: Taking or letting out fluids and/or gases from a body part

 

Body Part

Approach

Device

Qualifier

C Upper Lung Lobe, Right

D Middle Lung Lobe, Right

F Lower Lung Lobe, Right

G Upper Lung Lobe, Left

H Lung Lingula

J Lower Lung Lobe, Left

K Lung, Right

L Lung, Left

M Lungs, Bilateral

 

 

 

0 Open

3 Percutaneous

4 Percutaneous Endoscopic

7 Via Natural or Artificial Opening

8 Via Natural or Artificial Opening Endoscopic

 

 

 

 

 

 

Z No Device

 

 

 

X Diagnostic

 Z No Qualifier

 

 

Tip No. 94

For mechanical ventilation, the duration value must be assigned based on consecutive hours. Do not combine the hours if the patient has separate and distinct sessions of mechanical ventilation during a hospitalization. 

For example, if during a lengthy hospitalization, a patient is weaned completely from mechanical ventilation and is subsequently re-connected to a mechanical ventilator, these are two separate sessions, and the hours should not be considered consecutive hours when assigning an ICD-10-PCS code.

Below is an excerpt from ICD-10-PCS table 5A1:

Section

5

Extracorporeal Assistance and Performance

Body System

A

Physiological Systems

Type

1

Performance: Completely taking over a physiological function by extracorporeal means

 

Body System

Duration

Function

Qualifier

 

9 Respiratory

 

3 Less than 24 Consecutive Hours

4 24-96 Consecutive Hours

5 Greater than 96 Consecutive Hours

 

 

5 Ventilation

 

 

Z No Qualifier

 

 


 

Tip No. 95

A new ligament – the anterolateral ligament of the knee – recently was discovered by two Belgian surgeons. Since this is a new ligament, it does not appear in the ICD-10-PCS Body Part Key. Please consider implementing a policy in which the “Knee Bursa and Ligament” body part value is used to classify any procedures performed on the anterolateral ligament of the knee. 

(Source: http://www.ncbi.nlm.nih.gov/pubmed/23906341)

Tip No. 96

The 2014 updates to the ICD-10-PCS Body Part Key were recently published, and they are reproduced below:

Body Part

Applicable  ICD-10-PCS Body Part Value

Denticulate ligament

 

Use:

Spinal meninges

Femoropatellar joint

 

Use:

Knee Joint, Right

Knee Joint, Left

Knee Joint, Femoral Surface, Right

Knee Joint, Femoral Surface, Left

Femorotibial joint

 

Use:

Knee Joint, Right

Knee Joint, Left

Knee Joint, Tibial Surface, Right

Knee Joint, Tibial Surface, Left

Patellofemoral joint

 

Use:

Knee Joint, Right

Knee Joint, Left

Knee Joint, Femoral Surface, Right

Knee Joint, Femoral Surface, Left

Spinal nerve, cervical

 

Use:

Cervical Nerve

Spinal nerve, lumbar

 

Use:

Lumbar nerve

Spinal nerve, sacral

 

Use:

Spinal nerve

Spinal nerve, thoracic

 

Use:

Thoracic nerve

Tibiofemoral joint

 

Use:

Knee Joint, Right

Knee Joint, Left

Knee Joint, Tibial Surface, Right

Knee Joint, Tibial Surface, Left 


 

Tip No. 97

The 2014 updates to the ICD-10-PCS Device Key were recently published, and they are reproduced below:

Device

Applicable  ICD-10-PCS Device Value

Epiretinal visual prosthesis

 

Use:

Epiretinal Visual Prosthesis in Eye

Impella® (2.5)(5.0)(LD) cardiac assist device

 

Use:

Intraluminal Device

MicroMed HeartAssist

 

Use:

Implantable Heart Assist System in Heart and Great Vessels

TandemHeart® System

 

Use:

External Heart Assist System in Heart and Great Vessels

Thoratec Paracorporeal Ventricular Assist Device

 

Use:

External Heart Assist System in Heart and Great Vessels


 

Tip No. 98

The Center for Medicare & Medicaid Services (CMS) is in the process of developing an ICD-10-PCS Substance Key that will include both the common names and proprietary names of substances. Monitor the CMS website for publication of this. Substance values are found in several ICD-10-PCS tables, such as 3E0.

See below for an excerpt from table 3E0:

Section

3

Administration

Body System

E

Physiological Systems and Anatomical Regions

Operation

0

Introduction: Putting in or on a therapeutic, diagnostic, nutritional, physiological, or prophylactic substance except blood or blood products

 

Body System/Region

Approach

Substance

Qualifier

L Pleural Cavity

M Peritoneal Cavity

0 Open

 

5 Adhesion Barrier

 

Z No Qualifier

L Pleural Cavity

M Peritoneal Cavity

3 Percutaneous

 

0 Antineoplastic

 

4 Liquid Brachytherapy Radioisotope

5 Other Antineoplastic

M Monoclonal Antibody

 

L Pleural Cavity

M Peritoneal Cavity

3 Percutaneous

 

2 Anti-infective

 

8 Oxazolidinones

9 Other Anti-infective

 

L Pleural Cavity

M Peritoneal Cavity

3 Percutaneous

 

3 Anti-inflammatory

6 Nutritional Substance

7 Electrolytic and Water Balance Substance

B Local Anesthetic

H Radioactive Substance

K Other Diagnostic Substance

N Analgesics, Hypnotics, Sedatives

T Destructive Agent

 

 

Z No Qualifier

 

L Pleural Cavity

M Peritoneal Cavity

3 Percutaneous

 

G Other Therapeutic Substance

 

C Other Substance

 

L Pleural Cavity

M Peritoneal Cavity

3 Percutaneous

 

S Gas

 

F Other Gas

 

L Pleural Cavity

M Peritoneal Cavity

7 Via Natural or Artificial Opening

 

0 Antineoplastic

 

4 Liquid Brachytherapy Radioisotope 5 Other Antineoplastic

M Monoclonal Antibody

 


 

Tip No. 99

When reporting ICD-10-PCS codes, continue complying with the Uniform Hospital Discharge Data Set (UHDDS), which was published in the July 31, 1985 Federal Register. The UHDDS includes data items for hospital reporting procedures. The definitions included in UHDDS can be used to determine which inpatient procedures should be reported under ICD-10-PCS.

Item 12 of UHDDS states that all significant procedures are to be reported, with a significant procedure defined as one that is:

  • Surgical in nature, or;
  • Carrying a procedural risk, or;
  • Carrying an anesthetic risk; or
  • Requiring specialized training.

Under UHDDS, surgical procedures include:

  • Incision
  • Excision
  • Amputation
  • Introduction
  • Endoscopy
  • Repair
  • Destruction
  • Suture
  • Manipulation.

(Source: Federal Register, Volume 50, Number 147, July 31, 1985).

Tip No. 100

Use the UHDDS definitions to prepare a list of procedures that will be coded when performed on inpatients. Require health information management (HIM) coding specialists to assign an ICD-10-PCS code whenever a procedure on the list is performed on an inpatient.   

Also remember that the UHDDS is a regulatory mandate, and continued compliance is imperative.

 

Read all previous coding tips

Read Coding Tips 81-90

Read Coding Tips 71-80

Read Coding Tips 61-70

Read Coding Tips 51-60

Read Coding Tips 41-50

Read Coding Tips 31-40

Read Coding Tips 21-30

Read Coding Tips 11-20

Read Coding Tips 1-10

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Lolita M. Jones, MSHS, RHIA, CCS

Lolita M. Jones, MSHS, RHIA, CCS has provided Product Consultant services to a warehousing and analytics start-up that developed and marketed decision support software, health outcomes services, and regulatory compliance toolsets. Her goal is to combine her medical coding expertise with data mining-pattern recognition, to help improve data accuracy and compliance in medical coding and reimbursement (i.e., ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, modifiers, DRGs, APCs, and eAPGs). Ms. Jones also provides remote and on-site training/consulting in her newly developed Healthcare Data Mining Clinic educational series. She is currently pursuing a Graduate Certificate in Healthcare Data Analytics from a top university. Ms. Jones is based in New York and can be reached at .