Inpatient Facility Coding & Compliance Alert

Familiarize yourself with the 28 possible numbers and letters.

Still facing the added challenge of handling ICD-10- PCS codes, apart from the ICD-10-CM codes?

“Over time hospitals and coding personnel will hone their skills in PCS coding,” feels Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA. “This will take time, training, and practice. Additional training in anatomy and physiology may be necessary and certainly coding staff will need to work even more closely with physicians and practitioners.”

Let us help: ICD-10-PCS has a unique code for all the procedures that are currently performed. It has a seven character alphanumeric code structure. Each character can acquire up to 34 different values, ranging from digits zero to nine and all alphabets except “O” and “I,” lest one may confuse those with numerals one or zero.

Refresh Your Anatomy of an ICD-10-PCS Code

The first character in the code denotes a section. Sections are the general broad categories in which procedures are organized. There are 16 in total, such as Medical and Surgical, Imaging, or Physical Medicine. The second character denotes the specific body system that the provider will work on. The third character specifies the procedure, and the rest of the characters give additional information as needed.

Know More About the Body Systems

The “Medical and Surgical” or “0” section of the ICD-10-PCS manual is the largest section. When you choose the appropriate PCS code from this section, you have to look for the body system to get to your code’s second digit.

Definition: The “body system,” according to the ICD-10-PCS guidelines, is a “general physiological system or anatomical region involved. Body systems are a collection or grouping of organs or contiguous body parts, shared (adjacent) body parts.” You will find 28 body systems and three general anatomical regions as given in the table. See how it works with the following example.

Suppose your surgeon performs a lysis of adhesions of the large intestine. You know that this code will come from the “0” section of your PCS manual. Your next step is to identify the second digit. Because the procedure took place in the large intestine, you should look at “D,” the gastrointestinal system.

Here’s how: Go to the PCS Index > Release > see Intestine > Large > 0DNE > Locate table 0DNE and then go across the row to finish building the code:

Your full code is 0DNE0ZZ.

On the other hand, suppose your surgeon performs a change of a sinus drain­age tube. Again, this procedure will come from the “0” section of your PCS manual, but what should you report for the second digit? Because this procedure occurred in the sinuses, you should look at “9,” which is for the ear, nose, and sinus.

Body Systems:

0 - Central Nervous System 
1 - Peripheral Nervous System 
2 - Heart and Great Vessels 
3 - Upper Arteries 
4 - Lower Arteries 
5 - Upper Veins 
6 - Lower Veins 
7 - Lymphatic and Hemic Systems 
8 - Eye 
9 - Ear, Nose, Sinus 
B - Respiratory System 
C - Mouth and Throat 
D - Gastrointestinal System 
F - Hepatobiliary System & Pancreas 
G - Endocrine System 
H - Skin and Breast 
J - Subcutaneous Tissue and Fascia 
K - Muscles 
L - Tendons 
M - Bursae and Ligaments 
N - Head and Facial Bones 
P - Upper Bones 
Q - Lower Bones 
R - Upper Joints 
S - Lower Joints 
T - Urinary System 
U - Female Reproductive System 
V - Male Reproductive System 

General Anatomical Regions:

W - Anatomical Regions, General 
X - Anatomical Regions, Upper Ex
Y - Anatomical Regions, Lower Ext

Here’s how: PCS Index > Change device in > see Sinus > 092YX > Locate table 092YX and then go across the row to finish building the code:

Your full code will be 092YX0Z.

Remember: “Most coders will be using some sort of computer system for this,” says Abbey. “However, it is important to keep in mind that coders must be able to do this manually as well as through a computer systems in order to be assured that the coding is correctly performed.”

Go systematically, learning about the ramifications of each character one by one.

Caveat: In a bigger picture, “probably the biggest concern is that hospitals will lose experienced coding staff who were very proficient in ICD-9 coding, but will not be able or willing to make the change to ICD-10,” cautions Abbey. However, physicians, suppliers, outpatient facilities, and hospital outpatient departments will continue to report and receive payments for furnished services, including physician visits to inpatients, based on CPT^® and HCPCS codes; and use only ICD-10-CM (diagnosis) codes, not ICD-10-PCS (procedure) codes, on claims, to the relief of those experienced coding staff.

Editor’s note: In upcoming issues, we shall continue to discuss more examples to help you get better acclimatized to ICD-10-PCS codes.