ICD-10-PCS: Guideline Spotlight

ICD-10-PCS is a completely new classification system with specified coding guidelines that are revised annually, just as the coding guidelines for ICD-10-CM are revised annually. One of the most significant changes to ICD-10-PCS for fiscal 2012 is an effort to make reporting surgically placed devices more clear and consistent. Although section B6 of the ICD-10-PCS Coding Guidelines provides guidance that is both general and specific to drainage devices, additional detailed information and examples are included in the updated ICD-10-PCS Reference Manual.

 

The 2012 ICD-10-PCS Reference Manual contains new appendix C, the “ICD-10-PCS Device and Substance Classification.” This new appendix discusses the distinguishing features of devices, substances, and equipment within the classification and provides PCS definitions to help differentiate between these materials and to define their applications. The following table summarizes the definitions of device, substance, and equipment and provides procedure examples:

 

PCS 6th character	Procedure objective	Location	Removability	Procedure example
Device	Material or appliance put in or on the body is central to accomplishing the procedure objective	Resides at the site of the procedure; not intended to change location	Capable of being removed from the procedure site	Neurostimulator lead insertion
Substance	Liquid or blood component is central to accomplishing the procedure objective	No fixed position; intended to be absorbed or dispersed	Not removable once dispersed or absorbed	Antibiotic injection
Equipment	Machinery or other aid used to perform a procedure	Resides primarily outside the body	Temporary; used for the duration of the procedure only	Mechanical ventilation

 

Remember, in PCS the sixth character varies between sections, and the definition of device, substance, and equipment becomes important within each section. The bottom line is that if the device, substance, or equipment is the means by which the procedure objective is accomplished, then that specific device, substance, or equipment value is coded as the sixth character.

 

In the majority of PCS codes, the sixth character is used to describe “the material or appliance used to accomplish the objective of the procedure that remains in or on the procedure site at the end of the procedure.” For the Medical and Surgical section, ICD-10-PCS Draft Coding Guideline section B6 Device provides both general guidance and guidance specific to drainage devices. Guideline B.6.1a states that “a device is coded only if a device remains after the procedure is completed. If no device remains, the value NO DEVICE is coded”—therefore, if no device is used to accomplish the objective of the procedure, the device value is not coded in ICD-10-PCS.

 

Appendix C of the 2012 ICD-10-PCS Reference Manual discusses reportable devices in PCS as they relate to the procedure objective, device removability, and device distribution in the PCS classification. This appendix includes a table summarizing the PCS device value distribution specific to root operations. An excerpt of this table is listed below:

 

PCS section	Root operation	Device value example	Procedure example
Medical and Surgical	Alteration	Autologous tissue substitute	Nasal tip elevation using fat autograft
Medical and Surgical	Bypass	Synthetic substitute	Femoral-popliteal bypass using synthetic graft
Medical and Surgical	Change	Drainage device	Foley catheter exchange
Medical and Surgical	Creation	Nonautologous tissue substitute	Sex change operation using tissue bank graft material
Medical and Surgical	Dilation	Intraluminal device	Percutaneous coronary

 

In addition to Device value classification, appendix C includes a detailed discussion of substance classifications. In the Administration and certain Ancillary sections (such as Imaging, Nuclear Medicine, and Radiation Oncology), the sixth-character Substance value “defines the blood component or other liquid put in or on the body to accomplish the objective of the procedure.”

 

The Administration section is the only section in which a substance is classified as a separate character value, as opposed to being included as information in the definitive procedure code. In the Ancillary sections, Substance values are included in the primary definitive procedure, to be reported when the Substance is used to support the objective of the procedure.

 

The following table is listed in appendix C to illustrate the use of the sixth character Substance value in the Administration section of ICD-10-PCS:

 

Root operation	Substance value example	Procedure example
Introduction	Nutritional substance	Infusion of total parenteral nutrition
Irrigation	Irrigating substance	Irrigation of eye
Transfusion	Frozen plasma	Transfusion of frozen plasma

 

The following table is listed in appendix C to illustrate the use of the sixth character

 

PCS section	Substance classified	Substance value example	Procedure example
Imaging	Contrast (5th character)	Low osmolar contrast	Left heart ventriculography using low osmolar contrast
Nuclear Medicine	Radionuclide (5th character)	Fluorine 18	PET scan of brain using fluorine 18
Radiation Oncology	Isotope (6th character)	Iodine 125	HDR brachytherapy of thyroid using iodine 125

 

Substance value in the Ancillary procedure section of ICD-10-PCS:

 

The final section in appendix C of the 2012 ICD-10-PCS Reference Manual provides details equipment as classified within the Physical Rehabilitation and Diagnostic Audiology section. In this section, the sixth character Equipment captures information about the machine, physical aid, or other equipment used to help perform the procedure.

 

It is important to note, however, that the application of this sixth-character value is an exception to ICD-10-PCS; in which equipment used to help perform a procedure is generally not coded. Appendix C provides information not yet included in the 2012 ICD-10-PCS Draft Coding Guidelines, which at this time, exclusive of general conventions, does not include guidance related to PCS sections beyond Obstetrics (section 1) in the classification.

 

The 2012 ICD-10-PCS Reference Manual was developed as a companion, instructional resource to the ICD-10-PCS with the support of the Centers for Medicare and Medicaid Services, under contract nos. 90-1138, 91-22300, 500-95-0005, and HHSM-500-2004-00011C to 3M Health Information Systems. The ICD-10-PCS Reference Manual is posted on the CMS website at the following address: http://www.cms.gov/ICD10/11b_2011_ICD10PCS.asp#TopOfPage.