Full Answer
The 2021 ICD-10 Procedure Coding System (ICD-10-PCS) files below contain information on the ICD-10-PCS updates for FY 2021. These 2021 ICD-10-PCS codes are to be used for discharges occurring from October 1, 2020 through September 30, 2021. There is no GEMs file.
ICD-10-PCS Draft Coding Guideline B5.3b indicates that procedures performed indirectly by the application of external force through the intervening body layers are coded to approach value X. Therefore, when coding a closed reduction of a fracture, the fifth character of the code would be X.
This article will focus on the definitions of three root operations in the Medical and Surgical section of ICD-10-PCS: These three root operations define procedures that take out solids/fluids/gases from a body part. Their corresponding character in ICD-10-CM is:
All ICD-10-PCS codes are seven characters long, with the fifth character from the medical and surgical section identifying the approach. The approach is defined as the technique used to reach the site of the procedure.
Excision of Prostate, Percutaneous Approach ICD-10-PCS 0VB03ZZ is a specific/billable code that can be used to indicate a procedure.
0DH63UZICD-10-PCS 0DH63UZ converts approximately to: 2015 ICD-9-CM Procedure 43.11 Percutaneous [endoscopic] gastrostomy [PEG]
Percutaneous endoscopic approach (character value 4) is defined as entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure.
Looking at these approaches you may be asking "Both open and percutaneous approaches seem to be so similar, what's the difference?" The biggest difference is that in an open procedure sutures will be required for the entry point to heal, and a percutaneous procedure will only need a band-aid.
Summary. 43246 is probably the most appropriate code if you are looking for a true percutaneous endoscopic gastrostomy(PEG) tube.
Encounter for fitting and adjustment of other gastrointestinal appliance and device. Z46. 59 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
(per-kyoo-TAY-nee-us) Passing through the skin, as an injection or a topical medicine.
A percutaneous approach is entry by puncture or minor incision of instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach the site of the procedure. Examples: needle biopsy of liver, peritoneal drainage.
percutaneousThe term “burr hole” is almost always indicative of a percutaneous procedure. However, in some cases, the surgeon will make multiple burr holes and then remove the skull bone that is between the burr holes (like in a triangle) to actually get down to the operative site of the brain.
The open technique involves dissection of the anterior pretracheal tissue and insertion of a tracheostomy tube under direct visualization. The percutaneous technique can be performed quickly and safely at the bedside with the use of a modified Seldinger technique and bronchoscopic guidance.
Definition. Cutaneous relates to or affects the skin. Subcutaneous refers to being below the skin (as in a penetrating injury, injection or intravenous line). Percutaneous refers to being passed, done or effected through the skin.
Percutaneous endoscopic-assisted procedures are coded to the open approach as stated above. Percutaneous approach is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach the site of the procedure.
Group 1CodeDescription43246Egd place gastrostomy tube43247Egd remove foreign body43248Egd guide wire insertion43249Esoph egd dilation <30 mm60 more rows
43762 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance: not requiring revision of gastrostomy tract.
The Stamm gastrostomy is an open technique, requiring an upper midline laparotomy and gastrotomy, with the catheter brought out in the left hypochondrium. It was first devised in 1894 by the American Gastric Surgeon, Martin Stamm (1847–1918), who was educated greatly in surgery when he visited Germany.
43762For CPT 2019, code 43760 will be deleted and replaced with two new codes (43762, 43763). Gastrostomy tubes (G-tubes) may be inadvertently removed if traction is placed on the tube.
One of ICD-10-PCS’s goals is to ensure a complete picture of a patient’s procedure. Completeness means that there is a unique code for all substantially different procedures, including the same procedure performed using a different approach.
ICD-10-PCS Draft Coding Guideline B5.4a states that procedures performed via an indwelling device are coded to approach value 3, percutaneous. Fragmentation of kidney stone performed via percutaneous nephrostomy illustrates the use of this guideline, and the approach value for this procedure is 3.
An approach made via natural or artificial opening with percutaneous endoscopic assistance (character value F) is defined as the entry of instrumentation through a natural or artificial external opening and entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure.
Percutaneous endoscopic approach (character value 4) is defined as entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure. The access location for this approach is the skin or mucous membrane with visualization instrumentation being used to reach the operative site.
A procedure performed via a percutaneous approach (character value 3) is one in which there is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure.
The ICD-10-PCS code for a diagnostic percutaneous paracentesis for ascites is 0W9G3ZX, with the fifth character (3) indicating a percutaneous approach. During this procedure a small incision is made and a needle or catheter is inserted into the peritoneal cavity to obtain ascitic fluid. Another example would be a PTCA of the right coronary artery with the insertion of a stent, which codes to 02703DZ.
An endoscopic retrograde cholangiopancreatography with lithotripsy of the common bile duct (code 0FF98ZZ) is performed via a scope (visualization instrumentation) entering through the mouth (natural opening) for access to the biliary system via the duodenum. Therefore, the approach value is 8.
ICD-10-PCS Guideline B3.9. If an autograft is obtained from a different body part in order to complete the objective of the procedure, a separate procedure is coded.
Bypass: This root operation is most commonly used for coronary artery bypass graft (CABG) procedures.
Two codes are necessary to fully explain the CABG x4 with three vessels being bypassed with the LIMA and one vessel treated using the saphenous vein graft. The excision of the saphenous vein is coded separately and the documentation needs to indicate both laterality and greater or lesser saphenous vein. This is a documentation opportunity, which can be addressed with the provider.
Supplement: This root operation can often be difficult to apply, but with cardiovascular procedures, surgeries such as mitral valve annuloplasty would be coded to supplement.
While these root operations are not the only ones applicable to cardiovascular procedures, they are some of the most common.
Editor’s note: This is the third in a series of 10 articles discussing the 31 root operations of ICD-10-PCS.
Consider the example of a percutaneous thrombectomy of the left radial artery, which is coded to 03CC3ZZ:
The definition for the root operation Extirpation provided in the 2013 ICD-10-PCS Reference Manual is “Taking or cutting out solid matter from a body part.” The solid matter contained in the definition may be an abnormal byproduct of a biological function or a foreign body. It may be imbedded in a body part, or in the lumen of a tubular body part. The solid matter may or may not have been previously broken into pieces.
There is a body part for “kidney pelvis” which is further defined by left and right. The correct code for this procedure is 0TC43ZZ, percutaneous removal of a staghorn calculus from the left renal pelvis.
The correct code for a diagnostic lumbar puncture in ICD-10-PCS is 009U3ZX.
If a diagnostic Excision, Extraction, or Drainage procedure (biopsy) is followed by a more definitive procedure, such as Destruction, Excision, or Resection, at the same procedure site, both the biopsy and the more definitive treatment are coded. For example, for a biopsy of a breast followed by partial mastectomy at the same procedure site, both the biopsy and the partial mastectomy are coded.
It is important to note that fragmentation cannot be coded with extirpation. For additional information, review the procedure coding for an ESWL of the bilateral ureters. This procedure requires two codes, 0TF7XZZ and 0TF6XZZ, as there is not a bilateral body part value for the ureter.
Editor's note: This is the second in a series of 10 articles discussing the 31 root operations of ICD-10-PCS.
In ICD-9-CM, the Alphabetic Index entry main term Amputation, subterm midtarsal identifies code 84.12, Amputation through foot. This code is assigned for amputations of forefoot, amputation through middle of foot, midtarsal amputation, and transmetatarsal amputation of either the right or left foot.
In ICD-9-CM, the Alphabetic Index entry main term Ablation, subterm endometrium identifies code 68.23, Endometrial ablation. Code 68.23 would be assigned whether or not a scope was utilized during the procedure.
The Alphabetic Index entry main term Extraction, subterm Bone Marrow refers the coding professional to Table 07D. The ICD-10-PCS code for this procedure is 07DR3ZX. The fourth character (R) identifies the body part as bone marrow, iliac. Unlike ICD-9-CM, the code specifies the specific location of the bone marrow biopsy.
The ICD-10-PCS code for this procedure is 0Y6N0ZF. The fourth character (N) identifies the body part as the left foot and the seventh character (F) identifies the level of detachment as partial fifth ray. The definition for partial fifth ray is amputation anywhere along the shaft or head of the fifth metatarsal bone of the foot. The fifth character identifies the technique to reach the operative site or approach. The procedural approach was open (0) because an incision was made to reach the operative site.
The fifth character of the code identifies the technique used to reach the operative site. The approach for the bone marrow biopsy was percutaneous (3). In ICD-10-PCS the fifth character always identifies the specific approach utilized to reach the operative site.
The definition for the root operation Extraction provided in the ICD-10-PCS Reference Manual is "Pulling or stripping out or off all or a portion of a body part by the use of force." Extraction is coded when the method employed to take out the body part is pulling or stripping, and any minor cutting-such as that used in vein stripping procedures-is included in the Extraction.