Lesson

This chapter includes information on the last three Medical and Surgical-Related sections: Osteopathic (7), Other Procedures (8), and Chiropractic (9) sections. Many of the procedures included in these sections may not be coded in the inpatient setting. Because there is a fairly small amount of procedures coded in these sections, it may be more effective to code directly from the tables. Recall that OGCR A7 allows for coding directly from the tables without consulting the alphabetic index first.

• Osteopathic—This section contains only a single body system, Anatomical Regions (W), and a single root operation, Treatment (0). Because of this, you can easily determine that all of the Osteopathic procedure codes will begin with 7W0, making it easy to quickly reference the table, bypassing the index. You will also notice in the snapshot of the table below, the fifth character value is always X for External, and the seventh character value is always Z for None.

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  Image Description

The character values for this section are described below.

It’s not that the methods reflected by the sixth-character value are not defined in ICD-10-PCS and rely on the customary definitions used in this specialty. Some of the common methods are described in your textbook.

• Other Procedures—This section includes codes only for those procedures that are not included in the other Medical and Surgical-Related sections. As a result, there are only a few procedures coded within this section. There is only one root operation within this section, Other Procedures (0), which is described as “Methodologies which attempt to remediate or cure a disorder or disease.”
  • Character 1: Section
  • Character 2: Body System
  • Character 3: Root Operation
  • Character 4: Body Region
  • Character 5: Approach
  • Character 6: Method
  • Character 7: Qualifier

• Chiropractic—This section contains only a single body system, Anatomical Regions (W), and a single root operation, Manipulation (B).   

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Image Description

• Character 1: Section
• Character 2: Body System
• Character 3: Root Operation
• Character 4: Body Region
• Character 5: Approach
• Character 6: Method
• Character 7: Qualifier

There are six Ancillary sections in ICD-10-PCS. This chapter includes information on the first three sections: Imaging (B), Nuclear Medicine (C), and Radiation Therapy (D) sections. Most of you should be fairly familiar with the types of procedures coded within these sections, such as X-rays, CT scans, MRIs, and so forth. However, codes in these sections do contain some characters that have not been previously defined, so be sure to review the information on character definitions, root types, modalities, contrast radionuclides, isotopes, and qualifiers as relevant from each of these Ancillary sections.

• Imaging—This section follows the same conventions established in the Medical and Surgical sections for the characters of section, body system, and body part. The third character defines root type rather than root operation, and the fifth character defines contrast if used. The root types that are used in this section include Plain Radiography (0), Fluoroscopy (1), Computerized Tomography (2), Magnetic Resonance Imaging (3), and Ultrasonography (4). Character 6 and Character 7 are both qualifiers.  
  • Character 1: Section
  • Character 2: Body System
  • Character 3: Root Type
  • Character 4: Body Part
  • Character 5: Contrast
  • Character 6: Qualifier
  • Character 7: Qualifier

• Nuclear Medicine—This section is organized very similarly to the Imaging section. The only significant difference is seen in the fifth character, which defines the radionuclide rather than the contrast used. For Character 3, the root types that are used in this section include Planar Nuclear Medicine Imaging (1), Tomographic Nuclear Medicine Imaging (2), Positron Emission Tomography (PET) (3), Nonimaging Nuclear Medicine Uptake (4), Nonimaging Nuclear Medicine Probe (5), Nonimaging Nuclear Medicine Assay (6), and Systemic Nuclear Medicine Therapy (7).
  • Character 1: Section
  • Character 2: Body System
  • Character 3: Root Type
  • Character 4: Body Part
  • Character 5: Radionuclide
  • Character 6: Qualifier
  • Character 7: Qualifier

• Radiation Therapy —This section covers radiation procedures performed to treat and kill tumor cells. The third character in this section defines the treatment modality. The modaliities that are used in this section include Beam Radiation (0), Brachytherapy (1), Stereotactic Radiosurgery (2), and Other Radiation (Y).
  • Character 1: Section
  • Character 2: Body System
  • Character 3: Modality
  • Character 4: Treatment Site
  • Character 5: Modality Qualifier
  • Character 6: Isotope
  • Character 7: Qualifier

This chapter covers the last three Ancillary sections: Physical Rehabilitation and Diagnostic Audiology (F), Mental Health (G), and Substance Abuse Treatment (H).

• Physical Rehabilitation and Diagnostic Audiology—This section involves character definitions unlike the other sections in ICD-10-PCS.  
  • Character 1: Section
  • Character 2: Section Qualifier—This specifies whether the procedure is a rehabilitation or diagnostic audiology procedure.
  • Character 3: Root Type—This defines the general procedure root type. There are 14 different root types in this section.
  • Character 4: Body System and Region—This defines the body system and body region combined, where applicable.
  • Character 5: Type Qualifier—This further specifies the procedure type.
  • Character 6: Equipment—This specifies the equipment used, if any.
  • Character 7: Qualifier

• Mental Health—The values in the third and fourth characters in this section are used to describe mental health procedures. The rest of the characters are used as placeholders only. As a result, the second, fifth, sixth, and seventh characters are assigned a value of Z and function as a placeholder only. These characters do not express specific details about the procedure. The Mental Health section contains 11 root type values, so review and become familiar with each of them.
  • Character 1: Section
  • Character 2: Body System—always Z
  • Character 3: Root Type
  • Character 4: Type Qualifier
  • Character 5: Qualifier—always Z
  • Character 6: Qualifier—always Z
  • Character 7: Qualifier—always Z

• Substance Abuse Treatment—This section is formatted like the Mental Health section. It is smaller though, because there are only seven root type values in this section. You will find procedures such as detox and pharmacotherapy coded in this section.
  
  • Character 1: Section
  • Character 2: Body System—always Z
  • Character 3: Root Type
  • Character 4: Type Qualifier
  • Character 5: Qualifier—always Z
  • Character 6: Qualifier—always Z
  • Character 7: Qualifier—always Z

Well, you all should be feeling a sense of accomplishment by now. Hopefully, you have a good understanding of the ICD-10-PCS code-building process. You have learned how a detailed knowledge of anatomy and medical terminology is critical to accurate coding, as well as comprehension of operative reports and how to effectively dissect them in order to parse out the details needed for building your codes. An understanding of the ICD-10-PCS concepts, conventions, guidelines, and definitions is also necessary. Understanding the physician query process and when it may or may not be appropriate to query the clinician is another important factor. Keep practicing and reviewing each of these areas.    

Let’s do a little review. As of October 1, 2014, the United States will transition from using ICD-9-CM Volumes 1, 2, and 3 for diagnostic and procedure coding to ICD-10-CM and ICD-10-PCS. ICD-10-CM takes the place of Volumes 1 and 2 of ICD-9-CM and will be used to code diagnoses and conditions, and ICD-10-PCS will replace Volume 3 of ICD-9-CM for coding inpatient operations and procedures.

Why the switch? ICD-10-PCS offers a vast improvement in that the system is complete and expandable, allowing for easy updates. It is a multiaxial system, meaning that each of the seven characters comprising a code retains its meaning throughout the range of codes whenever possible, and it uses standardized terminology. ICD-10-PCS was designed to permit each code to have a standard structure and be very descriptive, yet flexible enough to accommodate future needs.

As we discussed in Week 1, payment for inpatient services requires establishing a diagnosis and procedure relationship. The primary reason for admitting the patient (ICD-10-CM codes) drives the total reimbursement that the facility can expect based on the Medicare Severity-Diagnosis Related Groups, or MS-DRGs assigned. Remember that coding accuracy is of the utmost importance. Data quality is a key component of the coding process. In addition to reimbursement, coded data is also used for other purposes, such as disease tracking, research, planning, decision support, and various data mining activities. HIT205 will be your next coding course in which you will be instructed on ICD-10-CM diagnosis coding. Putting what you have learned in this course together with ICD-10-CM coding in HIT205, you will see how it all comes together and how the MS-DRGs are calculated. I wish you all the best of luck as you continue your journey through the world of coding.