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.” 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).
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