ICD 10 Coding Alert

Hint: If your doc performs two root operations, report two PCS codes.

When you build a PCS code from the "0" section (the largest one), you must first identify the body system -- but your second step is to choose the root operation. This will be the third character of your PCS code, but be aware: your selection can be tricky, because you need to distinguish between similar root operation attributes.

Remember: A PCS code consists of seven characters -- and will always include seven characters, unlike ICD-10-CM. Here is a break down of what each character means:

Editor's Note: To start at the beginning, refer to The ICD-10 Coding Alert, Volume 2, Number 3 article entitled, "ICD-10-PCS: Step 1 to Coding Section '0' ICD-10-PCS? Identify the Body System." That will help you choose your second character.

Take a Broad Overview of 3^rd Character

You will find 31 root operations in the medical and surgical section, and they are arranged into the following groupings:

• Root operations that take out some/all of a body part
• Root operations that take out solids/fluids/gasses from a body part
• Root operations involving cutting or separation only
• Root operations that put in/put back or move some/all of a body part
• Root operations that alter the diameter/route of a tubular body part
• Root operations that always involve a device
• Root operations involving examination only
• Root operations that include other repairs
• Root operations that include other objectives

Note: If your physician performs multiple root operations with distinct objectives, you should submit multiple PCS codes.

Your root operations are (in alphabetic order):

• Alteration
• Bypass
• Change
• Control
• Creation
• Destruction
• Detachment
• Dilation
• Division
• Drainage
• Excision
• Extirpation
• Extraction
• Fragmentation
• Fusion
• Insertion
• Inspection
• Map
• Occlusion
• Reattachment
• Release
• Removal
• Repair
• Replacement
• Reposition
• Resection
• Restriction
• Revision
• Supplement
• Transfer
• Transplantation

Watch out: Some of these root operations are similar. For instance, "resection" has a subtle distinction from "excision."

An "excision" means the physician used a sharp instrument to cut out or off a portion of body part without replacement. Examples of "excision" procedures are a breast lumpectomy or liver biopsy.

On the other hand, a "resection" means the physician cut out or off, without replacement, all of a body system. Examples of "resection" procedures are a total mastectomy or a cholecystectomy.

Difference: "Excision" refers to the removal of a portion of a body part, whereas "resection" refers to the removal of all of a body system.

Suppose your physician performs an insertion of an infusion pump into the patient's chest. Using a percutaneous approach, he inserts the pump underneath the subcutaneous tissue.

Step 1: First of all, you know this is part of the Medical and Surgical section of the PCS manual. Then, you should identify the body system. This would be the subcutaneous tissue and fascia.

Step 2: The physician inserted the infusion pump. Because this is an insertion, you would use root operation "H" (meaning insertion) as your third character.

Here is what your chart looks like: