ICD-10-PCS CHARACTER ANALYSIS: Test Your Knowledge of Character 5 – Approach

By Lolita M. Jones, RHIA, CCS, AHIMA-Approved ICD-10-CM/PCS Trainer
Original story posted on: September 8, 2014

The process of constructing codes in ICD-10-PCS is designed to be logical and consistent: individual letters and numbers, called “values,” are selected in sequence to occupy the seven spaces of the code, called “characters.” 

In ICD-10-PCS sections 0 through 4, 7, 8, and 9,the fifth character defines the approach—i.e., the technique used to reach the procedure site. 

For the following ICD-10-PCS sections Character 5 classifies the following:

  • section 5 (Extracorporeal Assistance and Performance) – duration
  • section 6 (Extracorporeal Therapies) – duration
  • section B (Imaging) – contrast
  • section C (Nuclear Medicine) – radionuclide
  • section D (Radiation Therapy) – modality qualifier
  • section F (Physical Rehabilitation and Diagnostic Audiology) – type qualifier
  • section G (Mental Health) – qualifier
  • section H (Substance Abuse Treatment) – qualifier.

Instrumentation used to visualize the procedure site is not specified in the Device value—this information is specified in the Approach value. The definitions for each approach are provided below (they can also be found in the ICD-10-PCS Tables and Index*):

External: Procedures performed directly on the skin or mucous membrane and procedures performed indirectly by the application of external force through the skin or mucous membrane.

  • External Approachincludes procedures performed within an orifice on structures that are visible without the aid of any instrumentation (ICD-10-PCS Official Guideline B5.3a).
    • External Approach includes procedures performed indirectly by the application of external force through the intervening body layers (ICD-10-PCS Official Guideline B5.3b).

Open: Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure.

  • Open Approachincludes procedures performed using the open approach with percutaneous endoscopic assistance (ICD-10-PCS Official Guideline B5.2).

Percutaneous: Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure.

  • Percutaneous Approach includes procedures performed percutaneously via a device placed for the procedure (ICD-10-PCS Official Guideline B5.4).

Percutaneous Endoscopic: Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure.

Via Natural or Artificial Opening: Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure.

Via Natural or Artificial Opening Endoscopic: Entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure.

Via Natural or Artificial Opening With Percutaneous Endoscopic Assistance: Entry of instrumentation through a natural or artificial external opening and entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure.

Using the above listing of Approach definitions,identify the approach for each of the following surgical techniques (the Answer Key appears at the end of this article):

Surgical Technique

ICD-10-PCS Approach

Artificial Rupture of Membranes (AROM)

Via Natural or Artificial Opening

Arthroscopy

 

Bronchoscopy

 

Closed Reduction of Fracture

 

Cystoscopy

 

Laparoscopy

 

Manually Assisted Delivery

 

Mediastinoscopy

 

Open Reduction of Fracture

 

Peritoneoscopy

 

Spinal Blood Patch

 

*To access the 2014 ICD-10-PCS electronic files, go to: http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html, scroll down and download the folder titled “2014 Code Tables and Index.” When you open the folder, you will see the following file:“PCS_2014.” This PDF file is the “ICD-10-PCS 2014 Tables and Index.”

 


 

ANSWER KEY (source is the ICD-10-PCS 2014 Body Part Key):

Surgical Technique

ICD-10-PCS Approach

Artificial Rupture of Membranes (AROM)

Via Natural or Artificial Opening

Arthroscopy

Percutaneous Endoscopic

Bronchoscopy

Via Natural or Artificial Opening Endoscopic

Closed Reduction of Fracture

External

Cystoscopy

Via Natural or Artificial Opening Endoscopic

Laparoscopy

Percutaneous Endoscopic

Manually Assisted Delivery

External

Mediastinoscopy

Percutaneous Endoscopic

Open Reduction of Fracture

Open

Peritoneoscopy

Percutaneous Endoscopic

Spinal Blood Patch

Percutaneous

About the Author

Lolita M. Jones, RHIA, CCS is an AHIMA-Approved ICD-10-CM/PCS Trainer who writes the monthly newsletter titled ICD-10-PCS Solutions (published by MedLearn). 

Contact the Author

www.EZMedEd.com

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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.