ICD-10-PCS Character Analysis: Test Your Knowledge of Character 7 – Qualifier

Official Qualifier Guidelines:

Biopsy Procedures: Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage, and the qualifier Diagnostic. The qualifier Diagnostic is used only for biopsies (ICD-10-PCS Guideline B3.4a).

Bypass Procedures: Bypass procedures are coded by identifying the body part bypassed “from” and the body part bypassed “to.” The fourth-character body part specifies the body part bypassed from, and the qualifier specifies the body part bypassed to (ICD-10-PCS Guideline B3.6a).

Coronary Artery Bypass Procedures are coded differently. The body part value identifies the number of coronary artery sites bypassed. The qualifier value identifies the origin of the bypass. Multiple coronary artery bypass requires a separate procedure code for each coronary artery site that uses a different device and/or qualifier (ICD-10-PCS Guidelines B3.6b and c.).

• Aortocoronary graft – brings blood from the aorta using a segment of free graft material (such as saphenous vein). See qualifier value W (Aorta).
• Internal mammary artery – an internal thoracic artery, which arises from a subclavian artery, is harvested as a pedicled graft and is sewn to the coronary artery below the site of the blockage. See qualifier value 8 (Internal Mammary, Right) or 9 (Internal Mammary, Left).
• Saphenous vein graft – is removed from the leg and sewn from the aorta to the coronary artery below the site of blockage. See qualifier value W (Aorta).
• Thoracic artery – an internal thoracic artery, which arises from a subclavian artery, is harvested by itself and is sewn to the coronary artery below the site of blockage. See qualifier value C (Thoracic Artery).
• Abdominal artery graft (gastroepiploic artery from the stomach). See qualifier value F (Abdominal Artery).

Detachment: cutting off all or a portion of the upper or lower extremities. The body part value is the site of the detachment, with a qualifier if applicable to further specify the level where the extremity was detached. Detachment is used exclusively for amputation procedures (below-knee amputation, above-elbow amputation, disarticulation of shoulder, etc.).

• Complete – amputation through the carpo- metacarpal joint of the hand, or through the tarsal-metatarsal joint of the foot.
• Partial – amputation anywhere along the shaft or head of the metacarpal bone of the hand, or the metatarsal bone of the foot.
• Complete Ray – involves removal of the entire finger and metacarpal bone of the hand, or removal of the entire toe and metatarsal bone of the foot.
• Partial Ray or Trans-metacarpal – involves extending the finger amputation to include part of the metacarpal (the hand).
• Partial Ray or Trans-metatarsal – is assigned when a surgeon uses the word “toe” to describe the amputation but the operative report says he extends the amputation to the midshaft of the metatarsal (the foot).
• Forequarter - describes the entire upper limb plus the scapula and clavicle.
• Hindquarter - describes the entire lower limb including all of the pelvic girdle and the buttock.
• High - amputation at the proximal portion of the shaft of the humerus or femur.
• Mid – amputation at the middle portion of the shaft of the humerus or femur.
• Low – amputation at the distal portion of the shaft of the humerus or femur.

Transplantation: putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part. The native body part may or may not be taken out, and the transplanted body part may take over all or a portion of its function (kidney transplant, heart transplant, etc.).

• Allogeneic – tissues taken from different individuals of the same species.
• Syngeneic – individuals or tissues that have identical genes, such as identical twins.
• Zooplastic – tissues transferred from an animal to a human.

Exercises

Using the ICD-10-PCS root operation tables, identify the ICD-10-PCS root operation table(s) where each of these seventh-character qualifier values are located; please note that some values are repeated because they appear in multiple root operation tables (the answer key appears at the end of this article):

To access the 2014 ICD-10-PCS electronic files, go online to: http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html, then 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 root operation tables):