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ICD-10-PCS Reference Manual
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iii
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THE INTERNATIONAL CLASSIFICATION OF DISEASES Tenth
Revision Procedure Coding System (ICD-10-PCS) was developed
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.
Rhonda R. Butler, CCS, CCS-P
Robert L. Mullin, M.D.
Thelma M. Grant, MBA, RHIA
Richard F. Averill, M.S.
Barbara A. Steinbeck, RHIT
The opinions expressed are solely those of the authors, and do
not necessarily represent those of the Centers for Medicare and
Medicaid Services.
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Preface
THE INTERNATIONAL CLASSIFICATION OF DISEASES Tenth
Revision Procedure Coding System (ICD-10-PCS) is a new sys-
tem for coding inpatient procedures, developed for the Centers
for Medicare and Medicaid Services (CMS).
This manual is written as a general introduction for data manag-
ers, payers, administrators, and medical record coders. For
readers who do not need a detailed understanding of
ICD-10-PCS but would like a general introduction, the material
in chapter 1 and the appendices is recommended.
Manual organization The manual is organized into the following chapters and appen-
dices. A glossary also provides a list of terms introduced in the
manual.
Chapter 1
Overview. Includes a general introduction to ICD-10-PCS, a
brief history of its development, and a presentation of the code
structure, organization, and characteristics. The first part of the
overview contains basic information; the second and third parts
discuss structure, characteristics, and applications in more detail.
Chapter 2
Procedures in the Medical and Surgical section. Provides
reference material for each root operation in the M
EDICAL AND
S
URGICAL section (0), with the full definition, additional explana-
tion as needed, a code example, and coding exercises for each
root operation.
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Chapter 3
Procedures in the Medical and Surgical-related sections.
Provides reference material for each of the Medical and
Surgical-related sections (1–9), with definitions, additional
explanation as needed, a code example, and coding exercises
for each section.
Chapter 4
Procedures in the ancillary sections. Provides reference
material for each of the ancillary sections (B–D, F–H), with defi-
nitions, additional explanation as needed, a code example, and
coding exercises for each section.
Appendix A
ICD-10-PCS definitions. Tables listing the full definitions of all
root operations and approaches in the M
EDICAL AND SURGICAL
section.
Appendix B
ICD-10-PCS draft coding guidelines. Contains draft guide-
lines for coding procedures with ICD-10-PCS.
Conventions used This manual uses several conventions throughout, as described
below.
Small capital letters
Small capital letters are used to distinguish words that define
code components, as in the root operation T
RANSPLANTATION.
Root operation boxes
Root operation boxes are used to present the full definition of
root operations in the M
EDICAL AND SURGICAL section, including
explanation and examples. A root operation box is shown
below. Root operation boxes are used in chapter 2.
Table ex cer pts
Table excerpts present a single code in the ICD-10-PCS Table
format, identifying all components of the code. Text descrip-
tions are truncated as needed to fit the compressed format, as in
the example below.
Drainage Definition Taking or letting out fluids and/or gases from a body part
9 Explanation The fluids or gases may be normal or abnormal
Examples Incision and drainage, thoracentesis
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
RESPIRATORY EXCISION LOWER LOBE
B
RONCHUS, RT
OPEN NO DEVICE DIAGNOSTIC
0BB60ZX
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Root operation groups
This table is used only in chapter 2 to organize root operations
in the M
EDICAL AND SURGICAL section, highlighting distinguish-
ing features.
.
Root operation Procedure Objective Procedure Site Example
Drainage Taking/letting out fluids/gases Within a body part I&D of perinephric cyst
Extirpation Taking/cutting out solid matter Within a body part Taking out a kidney stone
Fragmentation Breaking solid matter into pieces
without removal
Within a body part Lithotripsy of kidney stone
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Contents ix
Contents
Chapter 1 ICD-10-PCS overview 1.3
What is ICD-10-PCS? 1.4
History of ICD-10-PCS 1.4
ICD-9-CM Volume 3 compared with ICD-10-PCS 1.4
ICD-10-PCS code structure 1.6
Characters 1.6
Values 1.6
Code structure: Medical and Surgical section 1.7
Character 1: Section 1.7
Character 2: Body system 1.7
Character 3: Root operation 1.8
Character 4: Body part 1.8
Character 5: Approach 1.8
Character 6: Device 1.9
Character 7: Qualifier 1.9
ICD-10-PCS system organization 1.11
Medical and Surgical section 1.11
Medical and Surgical-related sections 1.11
Ancillary sections 1.12
Tables 1.13
Index 1.15
List of Codes 1.17
ICD-10-PCS design 1.18
Multiaxial structure 1.18
Completeness 1.19
Expandability 1.21
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ICD-10-PCS additional characteristics 1.23
Standardized terminology 1.23
Standardized level of specificity 1.24
Diagnosis information excluded 1.25
NOS code options restricted 1.25
Limited NEC code options 1.25
ICD-10-PCS applications 1.26
Optimal search capability 1.26
Consistent characters and values 1.27
Code readability 1.28
Chapter 2 Procedures in the Medical and Surgical section 2.5
Root operation groups 2.6
Root operations that take out some or all of a body part 2.8
Excision—Root operation B
2.9
Resection—Root operation T
2.11
Detachment—Root operation 6
2.13
Destruction—Root operation 5
2.16
Extraction—Root operation D
2.18
Root operations that take out solids/fluids/gases from a body
part 2.20
Drainage—Root operation 9
2.21
Extirpation—Root operation C
2.23
Fragmentation—Root operation F
2.25
Root operations involving cutting or separation only 2.27
Division—Root operation 8
2.28
Release—Root operation N
2.29
Root operations that put in/put back or move some/all of a body
part 2.31
Transplantation—Root operation Y
2.32
Reattachment—Root operation M
2.34
Transfer—Root operation X
2.36
Reposition—Root operation S
2.38
Root operations that alter the diameter/route of a tubular body
part 2.40
Restriction—Root operation V
2.41
Occlusion—Root operation L
2.43
Dilation—Root operation 7
2.45
Bypass—Root operation 1
2.47
Root operations that always involve a device 2.49
Insertion—Root operation H
2.50
Replacement—Root operation R
2.52
Change—Root operation 2
2.54
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Removal—Root operation P
2.55
Revision—Root operation W
2.57
Root operations involving examination only 2.58
Inspection—Root operation J
2.59
Map—Root operation K
2.60
Root operations that define other repairs 2.61
Control—Root operation 3
2.62
Repair—Root operation Q
2.63
Root operations that define other objectives 2.65
Fusion—Root operation G
2.66
Alteration—Root operation 0
2.68
Creation—Root operation 4
2.70
Chapter 3 Procedures in the Medical and Surgical-related
sections
3.3
List of Medical and Surgical-related sections of ICD-10-PCS 3.4
Obstetrics—Section 1 3.5
Root operations 3.5
Placement—Section 2 3.7
Root operations 3.7
Administration—Section 3 3.10
Root operations 3.10
Measurement and Monitoring—Section 4 3.12
Root operations 3.12
Extracorporeal Assistance and Performance—Section 5 3.14
Root operations 3.14
Extracorporeal Therapies—Section 6 3.16
Root operations 3.16
Osteopathic—Section 7 3.19
Other Procedures—Section 8 3.20
Chiropractic—Section 9 3.22
Chapter 4 Procedures in the ancillary sections 4.3
List of ancillary sections in ICD-10-PCS 4.4
Imaging—Section B 4.5
Root types 4.5
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Nuclear Medicine—Section C 4.8
Root types 4.8
Radiation Oncology—Section D 4.11
Root type 4.11
Physical Rehabilitation and Diagnostic Audiology—Section F 4.13
Root types 4.13
Mental Health—Section G 4.17
Root Type 4.17
Substance Abuse Treatment—Section H 4.19
Root Types 4.19
Appendix A ICD-10-PCS definitions A.3
Root operations A.4
Approaches A.8
Appendix B ICD-10-PCS draft coding guidelines B.3
A. General
B.3
B. Medical and Surgical section (section 0)
B.4
Body system guidelines B.4
Root operation guidelines B.4
Body part guidelines B.7
Approach guidelines B.9
Device guidelines B.10
C. Other medical and surgical-related sections (sections 1–9)
B.11
Index Alphabetical index I.1
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Chapter 1
1ICD-10-PCS overview
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Contents ICD-10-PCS overview 1.3
What is ICD-10-PCS? 1.4
History of ICD-10-PCS 1.4
ICD-9-CM Volume 3 compared with ICD-10-PCS 1.4
ICD-10-PCS code structure 1.6
Characters 1.6
Values 1.6
Code structure: Medical and Surgical section 1.7
Character 1: Section 1.7
Character 2: Body system 1.7
Character 3: Root operation 1.8
Character 4: Body part 1.8
Character 5: Approach 1.8
Character 6: Device 1.9
Character 7: Qualifier 1.9
ICD-10-PCS system organization 1.11
Medical and Surgical section 1.11
Medical and Surgical-related sections 1.11
Ancillary sections 1.12
Tables 1.13
Index 1.15
List of Codes 1.17
ICD-10-PCS design 1.18
Multiaxial structure 1.18
Completeness 1.19
Expandability 1.21
ICD-10-PCS additional characteristics 1.23
Standardized terminology 1.23
Standardized level of specificity 1.24
Diagnosis information excluded 1.25
NOS code options restricted 1.25
Limited NEC code options 1.25
ICD-10-PCS applications 1.26
Optimal search capability 1.26
Consistent characters and values 1.27
Code readability 1.28
ICD-10-PCS overview 1.3
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Chapter 1
ICD-10-PCS overview
THE INTERNATIONAL CLASSIFICATION OF DISEASES Tenth
Revision Procedure Coding System (ICD-10-PCS) was created to
accompany the World Health Organization’s (WHO) ICD-10
diagnosis classification. The new procedure coding system was
developed to replace ICD-9-CM procedure codes for reporting
inpatient procedures.
Unlike the ICD-9-CM classification, ICD-10-PCS was designed to
enable each code to have a standard structure and be very
descriptive, and yet flexible enough to accommodate future
needs. Information about the structure, organization, and appli-
cation of ICD-10-PCS codes, along with reference material for
coding with ICD-10-PCS, is provided in this manual.
This chapter contains the following parts:
◆ What is ICD-10-PCS?
◆ ICD-10-PCS code structure
◆ ICD-10-PCS system organization
◆ ICD-10-PCS design
◆ ICD-10-PCS additional characteristics
◆ ICD-10-PCS applications
More specific information on coding with ICD-10-PCS is found
in chapters 2–4 of this manual.
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What is ICD-10-PCS?
ICD-10-PCS is a procedure coding system that will be used to
collect data, determine payment, and support the electronic
health record for all inpatient procedures performed in the
United States.
History of ICD-10-PCS The World Health Organization has maintained the International
Classification of Diseases (ICD) for recording cause of death
since 1893. It has updated the ICD periodically to reflect new
discoveries in epidemiology and changes in medical understand-
ing of disease.
The International Classification of Diseases Tenth Revision
(ICD-10), published in 1992, is the latest revision of the ICD. The
WHO authorized the National Center for Health Statistics (NCHS)
to develop a clinical modification of ICD-10 for use in the United
States. This version of ICD-10 is called ICD-10-CM. ICD-10-CM is
intended to replace the previous U.S. clinical modification,
ICD-9-CM, that has been in use since 1979. ICD-9-CM contains a
procedure classification; ICD-10-CM does not.
The Centers for Medicare and Medicaid Services, the agency
responsible for maintaining the inpatient procedure code set in
the U.S., contracted with 3M Health Information Systems in 1993
to design and then develop a procedure classification system to
replace Volume 3 of ICD-9-CM. ICD-10-PCS is the result.
ICD-10-PCS was initially released in 1998. It has been updated
annually since that time.
ICD-9-CM Volume 3 compared
with ICD-10-PCS
With ICD-10 implementation, the U.S. clinical modification of the
ICD will not include a procedure classification based on the
same principles of organization as the diagnosis classification.
Instead, a separate procedure coding system has been devel-
oped to meet the rigorous and varied demands that are made of
coded data in the healthcare industry. This represents a signifi-
cant step toward building a health information infrastructure that
functions optimally in the electronic age.
The following table highlights basic differences between
ICD-9-CM Volume 3 and ICD-10-PCS.
What is ICD-10-PCS?
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Table 1–1. Comparison of ICD-9-CM and ICD-10-PCS
ICD-9-CM Volume 3 ICD-10-PCS
Follows ICD structure (designed
for diagnosis coding)
Designed/developed to meet healthcare
needs for a procedure code system
Codes available as a fixed/finite
set in list form
Codes constructed from flexible code
components (values) using tables
Codes are numeric Codes are alphanumeric
Codes are 3–4 digits long All codes are seven characters long
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ICD-10-PCS code structure
Undergirding ICD-10-PCS is a logical, consistent structure that
informs the system as a whole, down to the level of a single
code. This means that the process of constructing codes in
ICD-10-PCS is also logical and consistent: individual letters and
numbers, called “values,” are selected in sequence to occupy
the seven spaces of the code, called “characters.”
Characters All codes in ICD-10-PCS are seven characters long. Each character
in the seven-character code represents an aspect of the proce-
dure, as shown in the following diagram of characters from the
main section of ICD-10-PCS, called M
EDICAL AND SURGICAL.
An ICD-10-PCS code is best understood as the result of a process
rather than as an isolated, fixed quantity. The process consists of
assigning values from among the valid choices for that part of the
system, according to the rules governing the construction of
codes.
Values One of 34 possible values can be assigned to each character in
a code: the numbers 0–9 and the alphabet (except I and O,
because they are easily confused with the numbers 1 and 0). A
finished code looks like the example below.
02100Z4
This code is derived by choosing a specific value for each of the
seven characters. Based on details about the procedure per-
formed, values for each character specifying the section, body
system, root operation, body part, approach, device, and quali-
fier are assigned.
Because the definition of each character is a function of its
physical position in the code, the same value placed in a differ-
1
2
34 56 7
Section
Body system
Root operation
Body part
Approach
Device
Qualifier
Characters:
ICD-10-PCS code structure
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ent position in the code means something different. The value 0
in the first character means something different than 0 in the
second character, or 0 in the third character, and so on.
Code structure: Medical and
Surgical section
The following pages define each character using the code
0LB50ZZ, “Excision of right lower arm and wrist tendon, open
approach” as an example. This example comes from the M
EDICAL
AND SURGICAL section of ICD-10-PCS.
Character 1: Section The first character in the code determines the broad procedure
category, or section, where the code is found. In this example,
the section is M
EDICAL AND SURGICAL. 0 is the value that repre-
sents M
EDICAL AND SURGICAL in the first character.
For definitions of characters used in the Medical and Surgical
section, please refer to the Glossary.
The sample code looks like this so far:
Character 2: Body system The second character defines the body system—the general
physiological system or anatomical region involved. Examples
of body systems include L
OWER ARTERIES, CENTRAL NERVOUS
S
YSTEM, and RESPIRATORY SYSTEM. In this example, the body
system is T
ENDONS, represented by the value L.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
0
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
TENDONS
0L
ICD-10-PCS code structure
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Character 3: Root operation The third character defines the root operation, or the objective
of the procedure. Some examples of root operations are B
YPASS,
D
RAINAGE, and REATTACHMENT. In the sample code below, the
root operation is E
XCISION. When used in the third character of
the code, the value B represents E
XCISION.
For the complete list of root operations and their definitions,
please refer to appendix A.
Character 4: Body part The fourth character defines the body part, or specific anatomi-
cal site where the procedure was performed. The body system
(second character) provides only a general indication of the
procedure site. The the body part and body system values
together provide a precise description of the procedure site.
Examples of body parts are K
IDNEY, TONSILS, and THYMUS. In this
example, the body part value is 5, L
OWER ARM AND WRIST, RIGHT.
When the second character is L, the value 5 when used in the
fourth character of the code represents the right lower arm and
wrist tendon.
Character 5: Approach The fifth character defines the approach, or the technique used
to reach the procedure site. Eight different approach values are
used in the M
EDICAL AND SURGICAL section to define the
approach. Examples of approaches include O
PEN and
P
ERCUTANEOUS ENDOSCOPIC.
In the sample code below, the approach is O
PEN and is
represented by the value 0.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
TENDONS EXCISION
0LB
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
TENDONS EXCISION LOWER ARM AND
W
RIST, RIGHT
0LB 5
ICD-10-PCS code structure
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For the complete list of approaches and their definitions, please
refer to appendix A.
Character 6: Device Depending on the procedure performed, there may or may not
be a device left in place at the end of the procedure. The sixth
character defines the device. Device values fall into four basic
categories:
◆ Grafts and Prostheses
◆ Implants
◆ Simple or Mechanical Appliances
◆ Electronic Appliances
In this example, there is no device used in the procedure. The
value Z is used to represent N
O DEVICE, as shown below.
Character 7: Qualifier The seventh character defines a qualifier for the code. A quali-
fier specifies an additional attribute of the procedure, if
applicable.
Examples of qualifiers include D
IAGNOSTIC and STEREOTACTIC.
Qualifier choices vary depending on the previous values
selected. In this example, there is no specific qualifier applica-
ble to this procedure, so the value is N
O QUALIFIER, represented
by the letter Z.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
TENDONS EXCISION LOWER ARM AND
W
RIST, RIGHT
OPEN
0LB 5 0
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
TENDONS EXCISION LOWER ARM AND
W
RIST, RIGHT
OPEN NO DEVICE
0LB 5 0Z
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0LB50ZZ is the complete specification of the procedure
“Excision of right lower arm and wrist tendon, open approach.”
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
TENDONS EXCISION LOWER ARM AND
W
RIST, RIGHT
OPEN NO DEVICE NO QUALIFIER
0LB 5 0ZZ
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ICD-10-PCS system organization
ICD-10-PCS is composed of 16 sections, represented by the
numbers 0–9 and the letters B–D and F–H. The broad proce-
dure categories contained in these sections range from surgical
procedures to substance abuse treatment.
Medical and Surgical section The first section, MEDICAL AND SURGICAL, contains the great
majority of procedures typically reported in an inpatient setting.
As shown in the previous section discussing ICD-10-PCS code
structure, all procedure codes in the M
EDICAL AND SURGICAL
section begin with the section value 0.
More complete information on coding procedures in the Medi-
cal and Surgical section is found in chapter 2 of this manual.
Medical and Surgical-related
sections
Sections 1–9 of ICD-10-PCS comprise the Medical and Surgi-
cal-related sections. These sections include obstetrical
procedures, administration of substances, measurement and
monitoring of body functions, and extracorporeal therapies, as
listed in the table below.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
TENDONS EXCISION LOWER ARM AND
W
RIST, RIGHT
OPEN NO DEVICE NO QUALIFIER
0LB 5 0ZZ
Section value Description
1 Obstetrics
2Placement
3 Administration
4 Measurement and Monitoring
5 Extracorporeal Assistance and Performance
6 Extracorporeal Therapies
7 Osteopathic
8 Other Procedures
9 Chiropractic
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In sections 1 and 2, all seven characters define the same aspects
of the procedure as in the M
EDICAL AND SURGICAL section.
Codes in sections 3–9 are structured for the most part like their
counterparts in the M
EDICAL AND SURGICAL section, with a few
exceptions. For example, in sections 5 and 6, the fifth character
is defined as duration instead of approach, as in this code for
intra-aortic balloon pump (IABP):
Additional differences include these uses of the sixth character:
◆ Section 3 defines the sixth character as substance.
◆ Sections 4 and 5 define the sixth character as function.
◆ Sections 7–9 define the sixth character as method.
More complete information on coding procedures in the Medical
and Surgical-related sections is found in chapter 3 of this manual.
Ancillary sections Sections B–D and F–H comprise the ancillary sections of
ICD-10-PCS. These six sections include imaging procedures,
nuclear medicine, and substance abuse treatment, as listed in
the following table.
The definitions of some characters in the ancillary sections dif-
fers from that seen in previous sections. In the I
MAGING section,
the third character is defined as type, and the fifth and sixth
characters define contrast and contrast/qualifier respectively, as
in the CT scan example below.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Function
Character 7
Qualifier
EXTRACORP.
A
SSIST. AND
P
ERFORMANCE
PHYSIOLOGICAL
S
YSTEMS
ASSISTANCE CARDIAC CONTINUOUS OUTPUT BALLOON PUMP
5A02210
Section value Description
B Imaging
C Nuclear Medicine
D Radiation Oncology
F Physical Rehabilitation and Diagnostic Audiology
G Mental Health
H Substance Abuse Treatment
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Additional differences include:
◆ Section C defines the fifth character as radionuclide.
◆ Section D defines the fifth character as modality qualifier
and the sixth character as isotope.
◆ Section F defines the tdefines the fifth character as type
qualifier and the sixth character as equipment.
◆ Sections G and H define the third character as a type
qualifier.
More complete information on coding procedures in the
ancillary sections is found in chapter 4 of this manual.
Tables The complete ICD-10-PCS is presented in three parts: the
Tables, the Index, and the List of Codes.
The Tables are organized in a series, beginning with section 0,
M
EDICAL AND SURGICAL, and body system 0, CENTRAL NERVOUS,
and proceeding in numerical order. Sections 0–9 are followed
by sections B–D and F–H. The same convention is followed
within each table for the second through the seventh charac-
ters—numeric values in order first, followed by alphabetical
values in order.
The following examples use the M
EDICAL AND SURGICAL section to
describe the organization and format of the ICD-10-PCS Tables.
The M
EDICAL AND SURGICAL section (first character 0) is orga-
nized by its 31 body system values. Each body system
subdivision in the
M
EDICAL AND SURGICAL section contains an introductory table
that lists the possible values for the remaining characters, given
that body system.
The following example shows the introductory table for the
U
RINARY system.
Character 1
Section
Character 2
Body System
Character 3
Typ e
Character 4
Body Part
Character 5
Contrast
Character 6
Qualifier
Character 7
Qualifier
IMAGING CENTRAL
N
ERVOUS
C
OMPUTERIZED
T
OMOGRAPHY
BRAIN HIGH OSMOLAR UNENHANCED
AND ENHANCED
NONE
B02000Z
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Following the introductory table are the root operation tables.
These tables provide the valid choices of values available to
construct a code.
Table 1–2. Introductory table of values for the Medical and Surgical section Urinary body system (characters 3–7)
Operation
Character 3
Body Part
Character 4
Approach
Character 5
Device
Character 6
Qualifier
Character 7
1 Bypass 0 Kidney, Right 0 Open 0 Drainage Device 0 Allogeneic
2 Change 1 Kidney, Left 2 Open Endoscopic 1 Radioactive
Element
1 Syngeneic
5 Destruction 2 Kidneys, Bilateral 3 Percutaneous 2 Monitoring
Device
2 Zooplastic
7 Dilation 3 Kidney Pelvis, Right 4 Percutaneous
Endoscopic
3 Infusion Device 3 Kidney Pelvis,
Right
8 Division 4 Kidney Pelvis, Left 7 Via Natural or Artificial
Opening
7 Autologous
Tissue Substitute
4 Kidney Pelvis,
Left
9 Drainage 5 Kidney 8 Via Natural or Artificial
Opening Endoscopic
C Extraluminal
Device
6 Ureter, Right
B Excision 6 Ureter, Right X External D Intraluminal
Device
7 Ureter, Left
C Extirpation 7 Ureter, Left J Synthetic
Substitute
8 Colon
F
Fragmentation 8 Ureters, Bilateral K Nonautologous
Tissue Substitute
9 Colocutaneous
H Insertion 9 Ureter L Artificial
Sphincter
A Ileum
J Inspection B Bladder M Electrode B Bladder
L Occlusion C Bladder Neck Y Other Device C Ileocutaneous
M Reattachment D Urethra Z No Device D Cutaneous
N Release X Diagnostic
P Removal Z No Qualifier
Q Repair
R Replacement
S Reposition
T Resection
V Restriction
W Revision
Y Transplantation
ICD-10-PCS system organization
ICD-10-PCS overview 1.15
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The root operation tables consist of four columns and a varying
number of rows, as in the following example of the root opera-
tion B
YPASS, in the CENTRAL NERVOUS body system.
The values for characters 1–3 are provided at the top of each
table. Four columns contain the applicable values for charac-
ters 4–7, given the values in characters 1–3.
A table may be separated into rows to specify the valid choices
of values in characters 4–7. A built using values from more than
one row of a table is not a valid code.
For the complete list of ICD-10-PCS draft coding guidelines,
please refer to appendix B.
Index The ICD-10-PCS Index can be used to access the Tables. The
Index mirrors the structure of the Tables, so it follows a consis-
tent pattern of organization and use of hierarchies.
The Index is organized as an alphabetic lookup. Two types of
main terms are listed in the Index:
◆ Based on the value of the third character
◆ Common procedure terms
0: MEDICAL AND SURGICAL
0: CENTRAL NERVOUS
1: BYPASS: Altering the route of passage of the contents of a tubular body part
Body Part
Character 4
Approach
Character 5
Device
Character 6
Qualifier
Character 7
6 Cerebral Ventricle 0 Open 7 Autologous Tissue
Substitute
J Synthetic Substitute
K Nonautologous Tissue
Substitute
0 Nasopharynx
1 Mastoid Sinus
2 Atrium
3 Blood Vessel
4 Pleural Cavity
5 Intestine
6 Peritoneal Cavity
7 Urinary Tract
8 Bone Marrow
B Cerebral Cisterns
U Spinal Canal 0 Open 7 Autologous Tissue
Substitute
J Synthetic Substitute
K Nonautologous Tissue
Substitute
4 Pleural Cavity
6 Peritoneal Cavity
7 Urinary Tract
9 Fallopian Tube
Section
Body system
Root operation
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Main terms
For the MEDICAL AND SURGICAL and related sections, the root
operation values are used as main terms in the Index. In other
sections, the values representing the general type of procedure
performed, such as nuclear medicine or imaging type, are listed
as main terms.
For the M
EDICAL AND SURGICAL and related sections, values such
as E
XCISION, BYPASS, and TRANSPLANTATION are included as main
terms in the Index. The applicable body system entries are
listed beneath the main term, and refer to a specific table. For
the ancillary sections, values such as F
LUOROSCOPY and
P
OSITRON EMISSION TOMOGRAPHY are listed as main terms.
In the example below, the index entry “Bypass” refers to the
M
EDICAL AND SURGICAL section tables for all applicable body sys-
tems, including A
NATOMICAL REGIONS and CENTRAL NERVOUS
S
YSTEM.
Bypass
by Body System
Anatomical Regions 0W1....
Central Nervous System 001....
The body system listings may be followed by entries for specific
body parts, as in the excerpt below. In the root operations
C
HANGE, INSERTION, REMOVAL, and REVISION, the device entries
follow the body system listings.
by Body Part
Artery
Aorta, Abdominal 0410...
Aorta, Thoracic 021W...
Axillary 031....
Brachial 031....
Common Carotid 031....
Common procedure terms
The second type of term listed in the Index uses procedure
names, such as “appendectomy” or “fundoplication.” These
entries are listed as main terms, and refer to a table or tables
from which a valid code can be constructed, as shown in the
following example.
Cholecystectomy
– see Excision, Hepatobiliary System & Pancreas 0FB....
– see Resection, Hepatobiliary System & Pancreas 0FT....
ICD-10-PCS system organization
ICD-10-PCS overview 1.17
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List of Codes The ICD-10-PCS List of Codes is a resource that displays all
valid codes in alphanumeric order. Each entry begins with the
seven-character code, followed by the full text description.
The code descriptions are generated using rules that produce
standardized, complete, and easy-to-read code descriptions.
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ICD-10-PCS design
ICD-10-PCS is fundamentally different from ICD-9-CM in its
structure, organization, and capabilities. It was designed and
developed to adhere to recommendations made by the National
Committee on Vital and Health Statistics (NCVHS). It also incor-
porates input from a wide range of organizations, individual
physicians, healthcare professionals, and researchers.
Several structural attributes were recommended for a new
procedure coding system. These attributes include
◆ Multiaxial structure
◆ Completeness
◆ Expandability
Multiaxial structure The key attribute that provides the framework for all other
structural attributes is multiaxial code structure. Multiaxial code
structure makes it possible for the ICD-10-PCS to be complete,
expandable, and to provide a high degree of flexibility and
functionality.
As mentioned earlier, ICD-10-PCS codes are composed of seven
characters. Each character represents a category of information
that can be specified about the procedure performed.
A character defines both the category of information and its
physical position in the code.
A character’s position can be understood as a semi-indepen-
dent axis of classification that allows different specific values to
be inserted into that space, and whose physical position
remains stable. Within a defined code range, a character retains
the general meaning that it confers on any value in that posi-
tion. For example, the fifth character retains the general
meaning “approach” in sections 0–4 and 7–9 of the system. Any
1
2
34 56 7
Section
Body system
Root operation
Body part
Approach
Device
Qualifier
Characters:
ICD-10-PCS design
ICD-10-PCS overview 1.19
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specific value in the fifth character will define a specific
approach, such as O
PEN.
Each group of values for a character contains all of the valid
choices in relation to the other characters of the code, giving
the system completeness. In the fifth character, for example,
each significantly distinct approach is assigned its own
approach value and all applicable approach values are included
to represent the possible versions of a procedure.
Each group of values for a character can be added to as
needed, giving the system expandability. If a significantly dis-
tinct approach is used to perform procedures, a new approach
value can be added to the system.
Each group of values is confined to its own character, giving
ICD-10-PCS a stable, predictable readability across a wide range
of codes. In sections 0–4 and 7–9 of the system, for example,
the fifth character always represents the approach.
ICD-10-PCS’ multiaxial structure houses its capacity for com-
pleteness, expandability, and flexibility, giving it a high degree
of functionality for multiple uses.
Completeness Completeness is considered a key structural attribute for a new
procedure coding system. The specific recommendation for
completeness includes these characteristics:
◆ A unique code is available for each significantly different
procedure.
◆ Each code retains its unique definition. Codes are not
reused.
In Volume 3 of ICD-9-CM, procedures performed on many dif-
ferent body parts using different approaches or devices may be
assigned to the same procedure code. In ICD-10-PCS, a unique
code can be constructed for every significantly different
procedure.
Within each section, a character defines a consistent component
of a code, and contains all applicable values for that character.
The values define individual expressions (open, percutaneous)
of the character’s general meaning (approach) that are then used
to construct unique procedure codes.
Because all approaches by which a procedure is performed are
assigned a separate approach value in the system, every proce-
dure which uses a different approach will have its own unique
code. This is true of the other characters as well. The same pro-
cedure performed on a different body part has its own unique
ICD-10-PCS design
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code, the same procedure performed using a different device
has its own unique code, and so on.
Coronary bypass example
In the case of the coronary artery bypass graft (CABG),
ICD-9-CM contains a total of nine codes to describe different
versions of the
procedure. These codes specify the version based on one
aspect of the procedure, and the aspect defined is not consis-
tent for all nine codes. Four of the codes specify the number of
coronary arteries bypassed, four specify the source of the new
blood flow, and one is an “unspecified” choice.
By contrast, ICD-10-PCS components can be combined to pro-
duce 34 unique codes defining all significantly different versions
of the comparable CABG procedure. All 34 codes specify the
same four aspects of the procedure: the number of coronary
artery sites bypassed, the approach to the procedure site, the
type of graft if used, and the origin of the bypass (source of the
new blood flow). The differences are summarized in the table
below.
Table 1–3. Comparison of CABG procedure codes
Unique definitions
Because ICD-10-PCS codes are constructed of individual values
rather than lists of fixed codes and text descriptions, the unique,
stable definition of a code in the system is retained. New val-
ues may be added to the system to represent a specific new
approach or device or qualifier, but whole codes by design can-
not be given new meanings and reused.
ICD-9-CM Volume 3 ICD-10-PCS
36.11
Aortocoronary Bypass of One
Coronary Artery (1 of 4)
021009W
Bypass Coronary Artery, One Site to
Aorta with Autologous Venous Tissue,
Open Approach(1 of 8)
36.15
Single Internal Mammary-
Coronary Artery Bypass (1 of 2)
02100Z8
Bypass Coronary Artery, One Site to
Right Internal Mammary, Open
Approach (1 of 16)
36.17
Abdominal-Coronary Artery
Bypass (1 of 2)
02100AF
Bypass Coronary Artery, One Site to
Abdominal Artery with Autologous
Arterial Tissue, Open Approach (1 of
10)
36.10
Aortocoronary Bypass for Heart
Revascularization, Not
Otherwise Specified (1 of 1)
No Equivalent
ICD-10-PCS codes all contain a
minimum level of specificity
ICD-10-PCS design
ICD-10-PCS overview 1.21
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Expandability Expandability was also recommended as a key structural
attribute. The specific recommendation for expandability
includes these characteristics:
◆ Accommodate new procedures and technologies
◆ Add new codes without disrupting the existing structure
ICD-10-PCS is designed to be easily updated as new codes are
required for new procedures and new techniques. Changes to
ICD-10-PCS can all be made within the existing structure, because
whole codes are not added. Instead, one of two possible changes
is made to the system:
◆ A new value for a character is added as needed to the
system.
◆ An existing value for a character is added to a table(s) in the
system.
ICD-10-PCS update: PICVA
An example of how the updating of ICD-10-PCS works can be
seen in the coronary artery bypass procedure called Percutane-
ous in-situ coronary venous arterialization (PICVA). This
procedure is no more invasive than a percutaneous coronary
angioplasty, but achieves the benefits of a bypass procedure by
placing a specialized stent into the diseased coronary artery,
through its wall into the adjacent coronary vein, and diverting
blood flow through the stent into the artery past the blockage.
ICD-10-PCS was updated in 2004 to include an appropriate
range of codes for the PICVA procedure (16 possible codes).
This was accomplished simply by adding another row to the
relevant table (see table 021, B
YPASS, HEART AND GREAT VESSELS)
containing two approach values for the non-invasive approach,
two device values for the possible types of stent, and a single
qualifier defining the coronary vein as the source of the new
blood flow, as in the example below.
0: MEDICAL AND SURGICAL
2: HEART AND GREAT VESSELS
1: BYPASS: Altering the route of passage of the contents of a tubular body part
Body Part
Character 4
Approach
Character 5
Device
Character 6
Qualifier
Character 7
0 Coronary Artery, One
Site
1 Coronary Artery, Two
Sites
2 Coronary Artery, Three
Sites
3 Coronary Artery, Four
or More Sites
3 Percutaneous
4 Percutaneous
Endoscopic
4 Drug-eluting
Intraluminal Device
D Intraluminal Device
D Coronary Vein
ICD-10-PCS design
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Structural integrity
As shown in the previous example, ICD-10-PCS can be easily
expanded without disrupting the structure of the system.
In the PICVA example, one new value—the qualifier value
C
ORONARY VEIN—was added to the system to effect this change.
All other values in the new row are existing values used to cre-
ate unique, new codes.
This type of updating can be replicated anywhere in the system
when a change is required. ICD-10-PCS allows unique new
codes to be added to the system because values for the seven
characters that make up a code can be combined as needed.
The system can evolve as medical technology and clinical prac-
tice evolve, without disrupting the ICD-10-PCS structure.
ICD-10-PCS overview 1.23
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ICD-10-PCS additional characteristics
ICD-10-PCS possesses several additional characteristics in
response to government and industry recommendations. These
characteristics are
◆ Standardized terminology within the coding system
◆ Standardized level of specificity
◆ No diagnostic information
◆ No explicit “not otherwise specified” (NOS) code options
◆ Limited use of “not elsewhere classified” (NEC) code
options
Standardized terminology Words commonly used in clinical vocabularies may have multi-
ple meanings. This can cause confusion and result in inaccurate
data. ICD-10-PCS is standardized and self-contained. Characters
and values used in the system are defined in the system.
For example, the word “excision” is used to describe a wide vari-
ety of surgical procedures. In ICD-10-PCS, the word “excision”
describes a single, precise surgical objective, defined as “Cutting
out or off, without replacement, a portion of a body part.”
For the complete list of root operations and their definitions,
please refer to appendix A.
No eponyms or common
procedure names
The terminology used in ICD-10-PCS is standardized to provide
precise and stable definitions of all procedures performed. This
standardized terminology is used in all ICD-10-PCS code
descriptions.
As a result, ICD-10-PCS code descriptions do not include
eponyms or common procedure names. Two examples from
ICD-9-CM are 22.61, “Excision of lesion of maxillary sinus with
Caldwell-Luc approach,” and 51.10, “Endoscopic retrograde
cholangiopancreatography [ERCP].” In ICD-10-PCS, physicians’
names are not included in a code description, nor are proce-
dures identified by common terms or acronyms such as
appendectomy or CABG. Instead, such procedures are coded to
the root operation that accurately identifies the objective of the
procedure.
The procedures described in the preceding paragraph by
ICD-9-CM codes are coded in ICD-10-PCS according to the root
operation that matches the objective of the procedure. Here the
ICD-10-PCS equivalents would be E
XCISION and INSPECTION
respectively. By relying on the universal objectives defined in
ICD-10-PCS additional characteristics
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root operations rather than eponyms or specific procedure titles
that change or become obsolete, ICD-10-PCS preserves the
capacity to define past, present, and future procedures accu-
rately using stable terminology in the form of characters and
values.
No combination codes
With rare exceptions, ICD-10-PCS does not define multiple pro-
cedures with one code. This is to preserve standardized
terminology and consistency across the system. Procedures that
are typically performed together but are distinct procedures may
be defined by a single “combination code” in ICD-9-CM. An
example of a combination code in ICD-9-CM is 28.3, “Tonsillec-
tomy with adenoidectomy.”
A procedure that meets the reporting criteria for a separate pro-
cedure is coded separately in ICD-10-PCS. This allows the
system to respond to changes in technology and medical prac-
tice with the maximum degree of stability and flexibility.
Standardized level of
specificity
In ICD-9-CM, one code with its description and includes notes
may encompass a vast number of procedure variations while
another code defines a single specific procedure. ICD-10-PCS
provides a standardized level of specificity for each code, so
that each code represents a single procedure variation.
The ICD-9-CM code 39.31, “Suture of artery,” does not specify
the artery, whereas the code range 38.40–38.49, “Resection of
artery with replacement,” provides a fourth-digit subclassifica-
tion for specifying the artery by anatomical region (thoracic,
abdominal, etc.).
In ICD-10-PCS, the codes identifying all artery suture and artery
replacement procedures possess the same degree of specificity.
The ICD-9-CM examples above coded to their ICD-10-PCS
equivalents would use the same artery body part values in all
codes identifying the respective procedures.
In general, ICD-10-PCS code descriptions are much more spe-
cific than their ICD-9-CM counterparts, but sometimes an
ICD-10-PCS code description is actually less specific. In most
cases this is because the ICD-9-CM code contains diagnosis
information. The standardized level of code specificity in
ICD-10-PCS cannot always take account of these fluctuations in
ICD-9-CM level of specificity. Instead, ICD-10-PCS provides a
standardized level of specificity that can be predicted across the
system.
ICD-10-PCS additional characteristics
ICD-10-PCS overview 1.25
Preliminary
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Diagnosis information
excluded
Another key feature of ICD-10-PCS is that information pertaining
to a diagnosis is excluded from the code descriptions.
ICD-9-CM often contains information about the diagnosis in its
procedure codes. Adding diagnosis information limits the flexi-
bility and functionality of a procedure coding system. It has the
effect of placing a code “off limits” because the diagnosis in the
medical record does not match the diagnosis in the procedure
code description. The code cannot be used even though the
procedural part of the code description precisely matches the
procedure performed.
Diagnosis information is not contained in any ICD-10-PCS code.
The diagnosis codes, not the procedure codes, will specify the
reason the procedure is performed.
NOS code options restricted ICD-9-CM often designates codes as “unspecified” or “not other-
wise specified” codes. By contrast, the standardized level of
specificity designed into ICD-10-PCS restricts the use of broadly
applicable NOS or unspecified code options in the system. A
minimal level of specificity is required to construct a valid code.
In ICD-10-PCS, each character defines information about the
procedure and all seven characters must contain a specific value
obtained from a single row of a table to build a valid code.
Even values such as the sixth-character value Z, N
O DEVICE and
the seventh-character value Z, N
O QUALIFIER, provide important
information about the procedure performed.
Limited NEC code options ICD-9-CM often designates codes as “not elsewhere classified”
or “other specified” versions of a procedure throughout the
code set. NEC options are also provided in ICD-10-PCS, but
only for specific, limited use.
In the M
EDICAL AND SURGICAL section, two significant “not else-
where classified” options are the root operation value Q, R
EPAIR
and the device value Y, O
THER DEVICE.
The root operation R
EPAIR is a true NEC value. It is used only
when the procedure performed is not one of the other root
operations in the M
EDICAL AND SURGICAL section.
OTHER DEVICE, on the other hand, is intended to be used to
temporarily define new devices that do not have a specific
value assigned, until one can be added to the system. No cate-
gories of medical or surgical devices are permanently classified
to O
THER DEVICE.
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ICD-10-PCS applications
ICD-10-PCS code structure results in qualities that optimize the
performance of the system in electronic applications, and maxi-
mize the usefulness of the coded healthcare data. These
qualities include
◆ Optimal search capability
◆ Consistent character definitions
◆ Consistent values wherever possible
◆ Code readability
Some have argued that, in the world of the electronic health
record, the classification system as we know it is outmoded, that
classification doesn’t matter because a computer is able to find a
code with equal ease whether the code has been generated at
random or is part of a classification scheme. While this may be
true from an IT perspective, assignment of randomly generated
code numbers makes it impossible to aggregate data according
to related ranges of codes. This is a critical capability for provid-
ers, payers, and researchers to make meaningful use of the data.
Optimal search capability ICD-10-PCS is designed for maximum versatility in the ability to
aggregate coded data. Values belonging to the same character
as defined in a section or sections can be easily compared,
since they occupy the same position in a code. This provides a
high degree of flexibility and functionality for data mining.
For example, the body part value 6, S
TOMACH, retains its mean-
ing for all codes in the M
EDICAL AND SURGICAL section that define
procedures performed on the stomach. Because the body part
value is dependent for its meaning on the body system in which
it is found, the body system value D, G
ASTROINTESTINAL, must
also be included in the search.
A person wishing to examine data regarding all medical and
surgical procedures performed on the stomach could do so sim-
ply by searching the code range below.
0D*6***
ICD-10-PCS applications
ICD-10-PCS overview 1.27
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Consistent characters and
values
In the previous example, the value 6 means STOMACH only
when the body system value is D, G
ASTROINTESTINAL. In many
other cases, values retain their meaning across a much broader
range of codes. This provides consistency and readability.
For example, the value 0 in the fifth character defines the
approach O
PEN and the value 3 in the fifth character defines the
approach P
ERCUTANEOUS across sections 0–4 and 7–9, where
applicable. As a result, all open and percutaneous procedures
represented by codes in sections 0-4 and 7-9 can be compared
based on a single character—approach—by conducting a query
on the code ranges below.
[0–4,7-9]***0** vs. [0–4,7-9]***3**
Searches can be progressively refined by adding specific val-
ues. For example, one could search on a body system value or
range of body system values, plus a body part value or range of
body part values, plus a root operation value or range of root
operation values.
To refine the search above, one could add the body system
value for G
ASTROINTESTINAL and the body part value for STOM-
ACH to limit the search to open vs. percutaneous procedures
performed on the stomach:
0D*60** vs. 0D*63**
To refine the search even further and limit the comparison to
open and percutaneous biopsies of the stomach, one could add
the third-character value for the root operation E
XCISION and the
seventh-character qualifier D
IAGNOSTIC, as below.
0DB60*X vs. 0DB63*X
Stability of characters and values across vast ranges of codes
provides the maximum degree of functionality and flexibility for
the collection and analysis of data. The search capabilities dem-
onstrated above function equally well for all uses of healthcare
data: investigating quality of care, resource utilization, risk man-
agement, conducting research, determining reimbursement, and
many others.
Because the character definition is consistent, and only the indi-
vidual values assigned to that character differ as needed,
meaningful comparisons of data over time can be conducted
across a virtually infinite range of procedures.
ICD-10-PCS applications
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Code readability ICD-10-PCS resembles a language in the sense that it is made
up of semi-independent values combined by following the rules
of the system, much the way a sentence is formed by combin-
ing words and following the rules of grammar and syntax. As
with words in their context, the meaning of any single value is a
combination of its position in the code and any preceding val-
ues on which it may be dependent.
For example, in the M
EDICAL AND SURGICAL section, a body part
value is always dependent for its meaning on the body system
in which it is found. It cannot stand alone as a letter or a num-
ber and be meaningful. A fourth-character value of 6 by itself
can mean 31 different things, but a fourth-character value of 6
in the context of a second-character value of D means one thing
only—S
TOMACH.
On the other hand, a root operation value is not dependent on
any character but the section for its meaning, and identifies a
single consistent objective wherever the third character is
defined as root operation. For example, the third-character
value T identifies the root operation R
ESECTION in both the MED-
ICAL AND SURGICAL and OBSTETRICS sections.
The approach value also identifies a single consistent approach
wherever the fifth character is defined as approach. The
fifth-character value 3 identifies the approach P
ERCUTANEOUS in
the M
EDICAL AND SURGICAL section, the OBSTETRICS section, the
A
DMINISTRATION section, and others.
The sixth-character device value or seventh-character qualifier
value identifies the same device or qualifier in the context of
the body system where it is found. Although there may be con-
sistencies across body systems or within whole sections, this is
not true in all cases.
Values in their designated context have a precise meaning, like
words in a language. As seen in the code example which began
this chapter, 0LB50ZZ represents the text description of the spe-
cific procedure “Excision of right lower arm and wrist tendon,
open approach.” Since ICD-10-PCS values in context have a sin-
gle, precise meaning, a complete, valid code can be read and
understood without its accompanying text description, much
like one would read a sentence.
Preliminary
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Chapter 2
2Procedures in the Medical and
Surgical section
2.2 ICD-10-PCS Reference Manual
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Preliminary
Contents Procedures in the Medical and Surgical section 2.5
Root operation groups 2.6
Root operations that take out some or all of a body part 2.8
Excision—Root operation B
2.9
Resection—Root operation T
2.11
Detachment—Root operation 6
2.13
Destruction—Root operation 5
2.16
Extraction—Root operation D
2.18
Root operations that take out solids/fluids/gases from a body
part 2.20
Drainage—Root operation 9
2.21
Extirpation—Root operation C
2.23
Fragmentation—Root operation F
2.25
Root operations involving cutting or separation only 2.27
Division—Root operation 8
2.28
Release—Root operation N
2.29
Root operations that put in/put back or move some/all of a body
part 2.31
Transplantation—Root operation Y
2.32
Reattachment—Root operation M
2.34
Transfer—Root operation X
2.36
Reposition—Root operation S
2.38
Root operations that alter the diameter/route of a tubular body
part 2.40
Restriction—Root operation V
2.41
Occlusion—Root operation L
2.43
Dilation—Root operation 7
2.45
Bypass—Root operation 1
2.47
Root operations that always involve a device 2.49
Insertion—Root operation H
2.50
Replacement—Root operation R
2.52
Change—Root operation 2
2.54
Removal—Root operation P
2.55
Revision—Root operation W
2.57
Procedures in the Medical and Surgical section 2.3
Preliminary
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Root operations involving examination only 2.58
Inspection—Root operation J
2.59
Map—Root operation K
2.60
Root operations that define other repairs 2.61
Control—Root operation 3
2.62
Repair—Root operation Q
2.63
Root operations that define other objectives 2.65
Fusion—Root operation G
2.66
Alteration—Root operation 0
2.68
Creation—Root operation 4
2.70
Preliminary
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Procedures in the Medical and Surgical section 2.5
Preliminary
12/10/07
Chapter 2
Procedures in the Medical and
Surgical section
THIS CHAPTER PROVIDES reference material for the root
operations in the M
EDICAL AND SURGICAL section of ICD-10-PCS.
The vast majority of codes reported in an inpatient setting are
found in this section.
First, a table presents all root operations in the M
EDICAL AND
S
URGICAL section, organized into logical groups. Following the
table are definitions of each root operation, presented in the
order shown in the table. Material on each root operation
includes
◆ Definition, explanation, and examples of the root operation
◆ Coding notes as needed
◆ A representative procedure excerpt for each root operation,
followed by the correct code for the procedure. The code is
provided in table excerpt format, along with explanatory
notes as needed.
◆ Coding exercises that provide example procedures and their
corresponding ICD-10-PCS codes, with explanatory notes as
needed
2.6 ICD-10-PCS Reference Manual
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Preliminary
Root operation groups
The MEDICAL AND SURGICAL root operations are divided into
groups that share similar attributes. These groups, and the root
operations in each, are listed in the table below. Subsequent
pages of this chapter provide a definition of each root operation
in a group.
Root
operation
Objective of procedure Site of procedure Example
Root operations that take out some/all of a body part
Excision Cutting out/off without replacement Some of a body part Breast lumpectomy
Resection Cutting out/off without replacement All of a body part Total mastectomy
Detachment Cutting out/off without replacement Extremity only, any level Amputation above elbow
Destruction Eradicating without replacement Some/all of a body part Fulguration of endometrium
Extraction Pulling out or off without replacement Some/all of a body part Suction D&C
Root operations that take out solids/fluids/gases from a body part
Drainage Taking/letting out fluids/gases Within a body part Incision and drainage
Extirpation Taking/cutting out solid matter Within a body part Thrombectomy
Fragmentation Breaking solid matter into pieces Within a body part Lithotripsy
Root operations involving cutting or separation only
Division Cutting into/separating a body part Within a body part Neurotomy
Release Freeing a body part from constraint Around a body part Adhesiolysis
Root operations that put in/put back or move some/all of a body part
Transplantation Putting in a living body part from a
person/animal
Some/all of a body part Kidney transplant
Reattachment Putting back a detached body part Some/all of a body part Reattach severed finger
Transfer Moving, to function for a similar body part Some/all of a body part Skin transfer flap
Reposition Moving, to normal or other suitable
location
Some/all of a body part Move undescended testicle
Root operation groups
Procedures in the Medical and Surgical section 2.7
Preliminary
12/10/07
Root operations that alter the diameter/route of a tubular body part
Restriction Partially closing orifice/lumen Tubular body part Gastroesophageal
fundoplication
Occlusion Completely closing orifice/lumen Tubular body part Fallopian tube ligation
Dilation Expanding orifice/lumen Tubular body part Percutaneous transluminal
coronary angioplasty (PTCA)
Bypass Altering route of passage Tubular body part Coronary artery bypass graft
(CABG)
Root operations that always involve a device
Insertion Putting in non-biological device In/on a body part Central line insertion
Replacement Putting in device that replaces a body
part
Some/all of a body part Total hip replacement
Change Exchanging device w/out cutting/
puncturing
In/on a body part Drainage tube change
Removal Taking out device In/on a body part Central line removal
Revision Correcting a malfunctioning/displaced
device
In/on a body part Revision of pacemaker
insertion
Root operations involving examination only
Inspection Visual/manual exploration Some/all of a body part Diagnostic cystoscopy
Map Locating electrical impulses/functional
areas
Brain/cardiac conduction
mechanism
Cardiac electrophysiological
study
Root operations that include other repairs
Repair Restoring body part to its normal
structure
Some/all of a body part Suture laceration
Control Stopping/attempting to stop
postprocedural bleed
Anatomical region Post-prostatectomy bleeding
Root operations that include other objectives
Fusion Rendering joint immobile Joint Spinal fusion
Alteration Modifying body part for cosmetic
purposes without affecting function
Some/all of a body part Face lift
Creation Making new structure for sex change
operation
Perineum Artificial vagina/penis
Root
operation
Objective of procedure Site of procedure Example
2.8 ICD-10-PCS Reference Manual
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Preliminary
Root operations that take out some or all of a
body part
Five root operations represent procedures for taking out or oth-
erwise eradicating some or all of a body part. These root
operations are listed in the table below and described in detail
in the pages that follow.
Root operation Objective of procedure Site of procedure Example
Excision Cutting out/off without
replacement
Some of a body part Breast lumpectomy
Resection Cutting out/off without
replacement
All of a body part Total mastectomy
Detachment Cutting out/off without
replacement
Extremity only, any level Amputation above elbow
Destruction Eradicating without replacement Some/all of a body part Fulguration of endometrium
Extraction Pulling out or off without
replacement
Some/all of a body part Suction D&C
Root operations that take out some or all of a body part
Procedures in the Medical and Surgical section 2.9
Preliminary
12/10/07
Excision—Root operation B
———————————————————————————————————————————————————————————
EXCISION is coded when a portion of a body part is cut out or
off using a sharp instrument. All root operations that employ
cutting to accomplish the objective allow the use of any sharp
instrument, including but not limited to
◆ Scalpel
◆ Wire
◆ Scissors
◆ Bone saw
◆ Electrocautery tip
Coding note: Bone marrow and
endometrial biopsies
Bone marrow and endometrial biopsies are not coded to the
root operation
EXCISION. They are coded to EXTRACTION, with the
qualifier D
IAGNOSTIC (see page 2.18).
Example: Excision of sebaceous cyst (right buttock)
...the patient was brought in the room and placed on the table in
jack knife, prone position and a spinal block was used for anesthe-
sia. She was prepped and draped in the usual sterile manner. A
digital rectal examination was performed and we did not notice
any communication between mass and rectum. The mass was
palpated and a radial transcerse incision was made over the mass.
Using blunt and sharp dissection the top of the mass was identi-
fied and shown to be a sebaceous cyst. The sebaceous cyst was
freed from the surrounding tissue using blunt dissection. The
entire cyst was removed. Hemostasis was obtained and the skin
was closed using 5-0 Dexon interrupted sutures...
Excision Definition Cutting out or off, without replacement, a portion of a body part
B Explanation The qualifier DIAGNOSTIC is used to identify excision procedures that are biopsies.
Examples Partial nephrectomy, liver biopsy
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
SKIN EXCISION BUTTOCK EXTERNAL NO DEVICE NO QUALIFIER
0HB8XZZ
Root operations that take out some or all of a body part
2.10 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Excision of malignant melanoma from skin of right ear 0HB2XZZ
Laparoscopy with excision of endometrial implant from left ovary 0UB14ZZ
Percutaneous needle core biopsy of right kidney 0TB03ZX
EGD with gastric biopsy 0DB68ZX
Open endarterectomy of left common carotid artery 03BJ0ZZ
Excision of basal cell carcinoma of lower lip 0CB1XZZ
Open excision of tail of pancreas 0FBG0ZZ
Percutaneous biopsy of right gastrocnemius muscle 0KBS3ZX
Sigmoidoscopy with sigmoid polypectomy 0DBN8ZZ
Open excision of lesion from right Achilles tendon 0LBN0ZZ
Root operations that take out some or all of a body part
Procedures in the Medical and Surgical section 2.11
Preliminary
12/10/07
Resection—Root operation T
—————————————————————————————————————————————————————————
RESECTION is similar to EXCISION (see page 2.9), except
R
ESECTION includes all of a body part, or any subdivision of a
body part that has its own body part value in ICD-10-PCS, while
E
XCISION includes only a portion of a body part.
Coding note: Lymph nodes
When an entire lymph node chain is cut out, the appropriate
root operation is R
ESECTION. When a lymph node(s) is cut out,
the root operation is E
XCISION.
Example: Right hemicolectomy
...a vertical midline incision was used to enter the abdominal cav-
ity. There was noted to be a mass in the region of the cecum. The
mass was easily mobilized and it was felt that a right hemicolec-
tomy was indicated. The right colon was mobilized by incising the
white line of Toldt and reflecting colon medially. The loose tissue
was taken down bluntly with a hand and adhesions were taken
down sharply.
The colon was mobilized to the left end up to the level of the
hepatic flexure. The mesentery was incised sharply with a knife
and down to the level of the root of the mesentery. The mesentery
of the right colon and the distal ileum was then taken down
between Kellys and tied with #2-0 silk, down to the level of the
takeoff vessels.
After removing the right colon specimen off the field, a primary
anastomosis was planned...
Resection Definition Cutting out or off, without replacement, all of a body part
T Explanation None
Examples Total nephrectomy, total lobectomy of lung
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
GASTROINTEST
S
YSTEM
RESECTION LARGE
I
NTESTINE, RT
OPEN NO DEVICE NO QUALIFIER
0DTF0ZZ
Root operations that take out some or all of a body part
2.12 ICD-10-PCS Reference Manual
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Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Open resection of cecum 0DTH0ZZ
Total excision of pituitary gland, open 0GT00ZZ
Explantation of left failed kidney, open 0TT10ZZ
Open left axillary total lymphadenectomy 07T60ZZ R
ESECTION is coded for cutting out a chain of lymph
nodes.
Laparoscopic-assisted total vaginal hysterectomy 0UT9FZZ
Right total mastectomy, open 0HTT0ZZ
Open resection of papillary muscle 02TD0ZZ The papillary muscle refers to the heart and is found
in the H
EART AND GREAT VESSELS body system.
Radical retropubic prostatectomy, open 0VT00ZZ
Laparoscopic cholecystectomy 0FT44ZZ
Endoscopic bilateral total maxillary sinusectomy 09TQ4ZZ, 09TR4ZZ
Root operations that take out some or all of a body part
Procedures in the Medical and Surgical section 2.13
Preliminary
12/10/07
Detachment—Root operation 6
——————————————————————————————————————————————————————
DETACHMENT represents a narrow range of procedures; it is used
exclusively for amputation procedures. D
ETACHMENT procedure
codes are found only in body systems X and Y, because ampu-
tations are performed on extremities, across overlapping body
layers.
Detachment qualifiers
The specific qualifiers used for DETACHMENT are dependent on
the body part value.
Detachment Definition Cutting off all or a portion of an extremity
6 Explanation Cutting off all or part of the upper or lower extremities
Examples Below knee amputation, disarticulation of shoulder
Body Part Qualifier
Value
Definition
Upper arm
and upper leg
0 High: Amputation at the proximal portion of the
shaft of the humerus or femur
1 Mid: Amputation at the middle portion of the
shaft of the humerus or femur
2 Low: Amputation at the distal portion of the shaft
of the humerus or femur
Hand and foot 0 Complete
4 Complete 1st Ray
5 Complete 2nd Ray
6 Complete 3rd Ray
7 Complete 4th Ray
8 Complete 5th Ray
9 Partial 1st Ray
B Partial 2nd Ray
C Partial 3rd Ray
D Partial 4th Ray
F Partial 5th Ray
Complete: Amputation through the carpometacarpal joint of the hand, or
through the tarsal-metatarsal joint of the foot
Partial: Amputation anywhere along the shaft or head of the metacarpal
bone of the hand, or of the metatarsal bone of the foot
Root operations that take out some or all of a body part
2.14 ICD-10-PCS Reference Manual
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Preliminary
Example: Fifth toe ray amputation
...a semi-elliptical incision was made around the base of the left
toe with a #15 blade without difficulty. Careful sharp dissection
was made down to the bone, and care was taken to avoid the
fourth toe’s neurovascular bundle. There was obvious osteomy-
elitis of the proximal phalanx of the fifth toe and the toe itself
was disarticulated, the proximal head of the fifth lower extremity
metatarsal, without difficulty. Specimens were sent to pathology
for culture and examination.
Next, both sharp and blunt dissection were used to adequately
expose the head of the fifth metatarsal, and this was done with-
out difficulty. A small rongeur was then used to remove the head
of the fifth metatarsal, and soft spongy bone was felt beneath this
area.
Examination of the patient’s x-rays revealed that there was an
area of cortical lucency at the base of the head of the fifth meta-
tarsal, and the decision was made to extend the amputation to
the midshaft of the fifth metatarsal, and this was done without
difficulty using a rongeur. The wound was then flushed with
normal saline, and bleeding viable tissue was observed through-
out the wound. There was adequate flap coverage of the
remaining fifth metatarsal...
Thumb, finger,
or toe
0 Complete: Amputation at the
metacarpophalangeal/metatarsal-phalangeal
joint
1 High: Amputation anywhere along the proximal
phalanx
2 Mid: Amputation through the proximal
interphalangeal joint or anywhere along the
middle phalanx
3 Low: Amputation through the distal
interphalangeal joint or anywhere along the
distal phalanx
Body Part Qualifier
Value
Definition
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
LOWER
E
XTREMITIES
DETACHMENT FOOT, LEFT OPEN NO DEVICE PARTIAL 5TH
R
AY
0Y6N0ZF
Root operations that take out some or all of a body part
Procedures in the Medical and Surgical section 2.15
Preliminary
12/10/07
Coding note: Qualifier value
The surgeon uses the word “toe” to describe the amputation, but
the operative report says he extends the amputation to the
midshaft of the fifth metatarsal, which is the foot, so the qualifier
is P
ARTIAL 5TH RAY.
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Amputation at right elbow level 0X6B0ZZ
Right below-knee amputation, proximal tibia/fibula 0Y6H0Z1 The qualifier H
IGH here means the portion of the
tib/fib closest to the knee.
Fifth ray carpometacarpal joint amputation, left hand 0X6K0Z8 A COMPLETE ray amputation is through the
carpometacarpal joint.
Right leg and hip amputation through ischium 0Y620ZZ The HINDQUARTER body part includes amputation
along any part of the hip bone.
DIP joint amputation of right thumb 0X6L0Z3 The qualifier LOW here means through the distal
interphalangeal joint.
Right wrist joint amputation 0X6J0Z0 Amputation at the wrist joint is actually complete
amputation of the hand.
Trans-metatarsal amputation of foot at left big toe 0Y6N0Z9 A PARTIAL amputation is through the shaft of the
metatarsal bone.
Mid-shaft amputation, right humerus 0X680Z2
Left fourth toe amputation, mid-proximal phalanx 0Y6W0Z1 The qualifier H
IGH here means anywhere along
the proximal phalanx.
Right above-knee amputation, distal femur 0Y6C0Z3
Root operations that take out some or all of a body part
2.16 ICD-10-PCS Reference Manual
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Preliminary
Destruction—Root operation 5
———————————————————————————————————————————————————————
DESTRUCTION “takes out” a body part in the sense that it obliter-
ates the body part so it is no longer there. This root operation
defines a broad range of common procedures, since it can be
used anywhere in the body to treat a variety of conditions,
including:
◆ Skin and genital warts
◆ Nasal and colon polyps
◆ Esophageal varices
◆ Endometrial implants
◆ Nerve lesions
Example: Radiofrequency coagulation of the trigeminal nerve
...The right cheek was infiltrated dermally with Xylocaine, and a
small nick in the skin 2.5 cm lateral to the corner of the mouth
was performed with an 18 gauge needle. The radiofrequency
needle with 2 mm exposed tip was then introduced using the
known anatomical landmarks and under lateral fluoroscopy
guidance into the foramen ovale.
Confirmation of the placement of the needle was done by the
patient grimacing to pain and by the lateral x-ray. The first
treatment, 90 seconds in length, was administered with the tip of
the needle 3 mm below the clival line at a temperature of 75
degrees C.
The needle was then advanced further to the mid clival line and
another treatment of similar strength and duration was also
administered. Finally the third and last treatment was adminis-
tered with the tip of the needle about 3 cm above the line. The
needle was removed. The patient tolerated the procedure well...
Destruction Definition Eradicating all or a portion of a body part
5 Explanation Used for the actual physical destruction of all or a portion of a body part by the
direct use of energy, force or a destructive agent. None of the body part is taken
out.
Examples Fulguration of rectal polyp, cautery of skin lesion
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
CENTRAL
N
ERVOUS
DESTRUCTION TRIGEMINAL
N
ERVE
PERCUTANEOUS NO DEVICE NON-
STEREOTACTIC
005K3ZU
Root operations that take out some or all of a body part
Procedures in the Medical and Surgical section 2.17
Preliminary
12/10/07
Coding note: Approach value
The small nick in the skin does not constitute an open
approach. It was made to accommodate the radiofrequency
needle. The needle was advanced all the way to the operative
site, so the correct approach value is P
ERCUTANEOUS.
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Cryotherapy of wart on left hand 0H5GXZZ
Percutaneous radiofrequency ablation of right vocal
cord lesion
0C5T3ZZ
Left heart catheterization with laser destruction of
arrhythmogenic focus, A-V node
02583ZZ
Cautery of nosebleed 095KXZZ
Transurethral endoscopic laser ablation of prostate 0V508ZZ
Cautery of oozing varicose vein, left calf 065Y3ZZ The approach is coded P
ERCUTANEOUS because
that is the normal route to a vein. No mention is made of
approach, because likely the skin has eroded at that spot.
Laparoscopy with destruction of endometriosis,
bilateral ovaries
0U524ZZ
Laser coagulation of right retinal vessel hemorrhage,
percutaneous
085G3ZZ The R
ETINAL VESSEL body part values are in the
E
YE body system.
Talc injection pleurodesis, left side 0B5P3ZZ See section 3, A
DMINISTRATION, for applicable
injection code.
Sclerotherapy of brachial plexus lesion, alcohol
injection
01533ZZ See section 3, ADMINISTRATION, for applicable
injection code.
Root operations that take out some or all of a body part
2.18 ICD-10-PCS Reference Manual
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Preliminary
Extraction—Root operation D
—————————————————————————————————————————————————————————
EXTRACTION is coded when the method employed to take out
the body part is pulling or stripping. Minor cutting, such as that
used in vein stripping procedures, is included in E
XTRACTION if
the objective of the procedure is nevertheless met by pulling or
stripping. As with all applicable ICD-10-PCS codes, cutting used
to reach the procedure site is specified in the approach value.
Example: Suction dilation & curettage
...after induction of general anesthesia the patient was placed in
the dorsal lithotomy position and appropriately prepped and
draped. Successive dilators were placed until the cervix was ade-
quate for insertion of the suction cannula.
Suction cannula was placed and suction curettage performed
with no residual endometrial lining. The tissue was sent to
pathology to rule out endometrial cancer...
Extraction Definition Pulling or stripping out or off all or a portion of a body part
D Explanation The body part is pulled or stripped from its location by the use of force (e.g.,
manual, suction). The qualifier D
IAGNOSTIC is used to identify extraction
procedures that are biopsies.
Examples Dilation and curettage, vein stripping
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
FEMALE
R
EPRODUCTIVE
EXTRACTION ENDOMETRIUM VIA NAT./ARTIF.
O
PENING
NO DEVICE DIAGNOSTIC
0UDB7ZX
Root operations that take out some or all of a body part
Procedures in the Medical and Surgical section 2.19
Preliminary
12/10/07
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Forceps total mouth extraction, upper and lower teeth 0CDWXZ2, 0CDXXZ2
Removal of left thumbnail 0HDQXZZ No separate body part value is given for
thumbnail, so this is coded to F
INGERNAIL.
Extraction of right intraocular lens without replacement,
open
08DJ0ZZ
Laparoscopy with needle aspiration of ova for in-vitro
fertilization
0UDN4ZZ
Non-excisional debridement of skin ulcer, right foot 0HDMXZZ
Open stripping of abdominal fascia, right side 0JD80ZZ
Hysteroscopy with D&C, diagnostic 0UDB8ZX
Liposuction for medical purposes, left upper arm 0JDF3ZZ The P
ERCUTANEOUS approach is inherent in the
liposuction technique.
Removal of tattered right ear drum fragments with
tweezers
09D77ZZ
Microincisional phlebectomy of spider veins, right lower
leg
06DY3ZZ
2.20 ICD-10-PCS Reference Manual
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Preliminary
Root operations that take out solids/fluids/gases
from a body part
The table below lists the root operations that take out solids,
fluids, or gases from a body part. Each is described in detail in
the pages that follow.
Root operation Objective of procedure Site of procedure Example
Drainage Taking/letting out fluids/gases Within a body part Incision and drainage
Extirpation Taking/cutting out solid matter Within a body part Thrombectomy
Fragmentation Breaking solid matter into pieces Within a body part Lithotripsy
Root operations that take out solids/fluids/gases from a body part
Procedures in the Medical and Surgical section 2.21
Preliminary
12/10/07
Drainage—Root operation 9
———————————————————————————————————————————————————————————
The root operation DRAINAGE is coded for both diagnostic and
therapeutic drainage procedures. When drainage is accom-
plished by putting in a catheter, the device value D
RAINAGE
D
EVICE is coded in the sixth character.
Example: Urinary nephrostomy catheter placement
...using fluoroscopy and sterile technique a needle was placed
through the skin into a markedly dilated right renal collecting sys-
tem. Guidewire was inserted and an 8 French locking catheter
was positioned with the dilated right renal pelvis. It was attached
to a bag and immediate drainage of urine was evident...
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Drainage Definition Taking or letting out fluids and/or gases from a body part
9 Explanation The qualifier DIAGNOSTIC is used to identify drainage procedures that are
biopsies.
Examples Thoracentesis, incision and drainage
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
URINARY DRAINAGE KIDNEY PELVIS,
R
IGHT
PERCUTANEOUS DRAINAGE
D
EVICE
NO QUALIFIER
0T9330Z
Procedure Code
Routine Foley catheter placement 0T9B70Z
Incision and drainage of external perianal abscess 0D9QXZZ
Percutaneous drainage of ascites 0W9G3ZZ This is drainage of the cavity and
not the peritoneal membrane itself.
Laparoscopy with left ovarian cystotomy and drainage 0U914ZZ
Laparotomy with hepatotomy and drain placement for liver abscess,
caudate lobe
0F9300Z
Right knee arthrotomy with drain placement 0S9C00Z
Root operations that take out solids/fluids/gases from a body part
2.22 ICD-10-PCS Reference Manual
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Preliminary
Thoracentesis of left pleural effusion 0W9B3ZZ This is drainage of the pleural
cavity.
Phlebotomy of left median cubital vein for polycythemia vera 059F3ZZ The median cubital vein is a branch
of the cephalic vein.
Percutaneous chest tube placement for right pneumothorax 0W9930Z
Endoscopic drainage of left ethmoid sinus 099V4ZZ
Procedure Code
Root operations that take out solids/fluids/gases from a body part
Procedures in the Medical and Surgical section 2.23
Preliminary
12/10/07
Extirpation—Root operation C
———————————————————————————————————————————————————————
EXTIRPATION represents a range of procedures where the body
part itself is not the focus of the procedure. Instead, the objec-
tive is to remove solid material such as a foreign body,
thrombus, or calculus from the body part.
Example: De-clotting of AV dialysis graft
...the right upper extremity was properly prepped and draped.
Local anesthesia was used to explore the graft. A transverse inci-
sion in the previous site of the incision, 1 cm below the elbow
crease, was performed. The venous limb of the graft was dis-
sected free up to the venous anastomosis.
A small incision on the graft was performed. Then a #3 Fogarty
catheter was passed on the venous side. The cephalic vein was
found obstructed, not on the anastomotic site, but about 4 cm
proximal to the anastomosis. A large number of clots were
extracted. After the embolectomy a good back flow from the
venous side was obtained.
Then the embolectomy was performed throughout the limb on
the arterial side. More clots were extracted and a good arterial
flow was obtained.
The procedure was concluded, closing the incision on the graft
with 6-0 prolene...
Coding note: body part value
Do not code separate body parts based on the words “venous
side” and “arterial side” in the procedure report. They refer to
the two ends of the cephalic vein used to create the fistula.
Extirpation Definition Taking or cutting out solid matter from a body part
C Explanation The solid matter may be an abnormal byproduct of a biological function or a
foreign body. The solid matter is imbedded in a body part, or is in the lumen of a
tubular body part. The solid matter may or may not have been previously broken
into pieces. No appreciable amount of the body part is taken out.
Examples Thrombectomy, choledocholithotomy
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
UPPER VEINS EXTIRPATION CEPHALIC VEIN,
R
IGHT
OPEN NO DEVICE NO QUALIFIER
05CD0ZZ
Root operations that take out solids/fluids/gases from a body part
2.24 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Removal of foreign body, right cornea 08C8XZZ
Percutaneous mechanical thrombectomy, left
brachial artery
03C83ZZ
Esophagogastroscopy with removal of bezoar from
stomach
0DC68ZZ
Foreign body removal, skin of left thumb 0HCGXZZ There is no specific value for thumb skin, so the
procedure is coded to the hand.
Transurethral cystoscopy with removal of bladder
stone
0TCB8ZZ
Forceps removal of foreign body in right nostril 09CKXZZ Nostril is coded to the N
OSE body part value.
Laparoscopy with excision of old suture from
mesentery
0DCV4ZZ
Incision and removal of right lacrimal duct stone 08CX0ZZ
Non-incisional removal of intraluminal foreign body
from vagina
0UCG7ZZ The approach E
XTERNAL is also a possibility. It is
assumed here that since the patient went to the doctor to have
the object removed, that it was not in the vaginal orifice.
Open excision of retained sliver, subcutaneous
tissue of left foot
0JCR0ZZ
Root operations that take out solids/fluids/gases from a body part
Procedures in the Medical and Surgical section 2.25
Preliminary
12/10/07
Fragmentation—Root operation F
——————————————————————————————————————————————————
FRAGMENTATION is coded for procedures to break up, but not
remove, solid material such as a calculus or foreign body. This
root operation includes both direct and extracorporeal F
RAGMEN-
TATION procedures.
Example: ESWL of left kidney
With the patient having been identified, under satisfactory IV
sedation and using the MFL 1000 for extracorporeal shock wave
lithotripsy, 1000 shocks were delivered to the stone in the lower
pole of the left kidney, and 800 shocks were delivered to the stone
in the upper pole of the same, with change in shape and density
of the stone indicating fragmentation. The patient tolerated the
procedure well...
Fragmentation Definition Breaking solid matter in a body part into pieces
F Explanation The solid matter may be an abnormal byproduct of a biological function or a
foreign body. Physical force (e.g., manual, ultrasonic) applied directly or
indirectly through intervening body parts is used to break the solid matter into
pieces. The pieces of solid matter are not taken out, but are eliminated or
absorbed through normal biological functions.
Examples Extracorporeal shockwave lithotripsy, transurethral lithotripsy
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
URINARY FRAGMENT.KIDNEY PELVIS,
L
EFT
EXTERNAL NO DEVICE NO QUALIFIER
0TF4XZZ
Root operations that take out solids/fluids/gases from a body part
2.26 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Extracorporeal shock-wave lithotripsy (ESWL), bilateral
ureters
0TF6XZZ, 0TF7XZZ The bilateral ureter body part value is
not available for the root operation FRAGMENTATION, so the
procedures are coded separately.
Endoscopic Retrograde Cholangiopancreatography
(ERCP) with lithotripsy of common bile duct stone
0FF98ZZ ERCP is performed through the mouth to the
biliary system via the duodenum, so the approach value is
V
IA NATURAL OR ARTIFICIAL OPENING ENDOSCOPIC.
Thoracotomy with crushing of pericardial calcifications 02FN0ZZ
Transurethral cystoscopy with fragmentation of bladder
calculus
0TFB8ZZ
Hysteroscopy with intraluminal lithotripsy of left fallopian
tube calcification
0UF68ZZ
Procedures in the Medical and Surgical section 2.27
Preliminary
12/10/07
Root operations involving cutting or separation only
The table below lists the root operations that cut or separate a
body part. Each is described in detail in the pages that follow.
Root operation Objective of procedure Site of procedure Example
Division Cutting into/separating a body
part
Within a body part Neurotomy
Release Freeing a body part from
constraint
Around a body part Adhesiolysis
Root operations involving cutting or separation only
2.28 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Division—Root operation 8
————————————————————————————————————————————————————————————
The root operation DIVISION is coded when the objective of the
procedure is to cut into, transect, or otherwise separate all or a
portion of a body part. When the objective is to cut or separate
the area around a body part, the attachments to a body part, or
between subdivisions of a body part that are causing abnormal
constraint, then the root operation R
ELEASE is coded instead.
Example: Anal sphincterotomy
Manual examination of the rectum and anus was done, and
examination showed that the patient has an anterior anal fis-
sure. For that reason, lateral sphincterotomy was done at the 3
o’clock position using the closed approach, dividing only the
internal sphincter using the #11 blade...
Coding note: Approach value
This is coded to the PERCUTANEOUS approach, because the pro-
cedure report says that the sphincterotomy was done using the
closed approach, dividing only the internal sphincter.
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Division Definition Separating, without taking out, a body part
8 Explanation All or a portion of the body part is separated into two or more portions.
Examples Spinal cordotomy, osteotomy
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
GASTROINTEST.
S
YSTEM
DIVISION ANAL
S
PHINCTER
PERCUTANEOUS NO DEVICE NO QUALIFIER
0D8R3ZZ
Procedure Code
Division of right foot tendon, percutaneous 0L8V3ZZ
Left heart catheterization with division of bundle of HIS 02883ZZ
Open osteotomy of capitate, left hand 0P8N0ZZ The capitate is one of the carpal bones
of the hand.
EGD with sphincterotomy of pylorus 0D878ZZ
Sacral rhizotomy for pain control, percutaneous 018R3ZZ
Root operations involving cutting or separation only
Procedures in the Medical and Surgical section 2.29
Preliminary
12/10/07
Release—Root operation N
————————————————————————————————————————————————————————————
The objective of procedures represented in the root operation
R
ELEASE is to free a body part from abnormal constraint. RELEASE
procedures are coded to the body part being freed. The proce-
dure can be performed on the area around a body part, on the
attachments to a body part, or between subdivisions of a body
part that are causing the abnormal constraint.
Example: Release of median nerve
...the right arm was scrubbed with Betadine and prepped and
draped in the usual sterile fashion. A well-padded tourniquet
was fixed to the right proximal arm but not inflated until after
draping. After draping, the right arm was exsanguinated with a
combination of elevation and an Esmarch bandage, placing a
sponge in the palm. The tourniquet was inflated to 250.
A transverse incision was made at the level of the proximal wrist
crease between the palmaris longus and the flexor carpi ulnaris
sharply through the skin with a knife, and subcutaneous tissue
was dissected by blunt spreading.
The volar fascia was identified and a transverse incision was
made sharply with a knife. The flat synovial retractor was
pushed through the underneath of the transverse carpal
ligament, removing synovium from beneath the ligament.
The entire carpal tunnel and the fat pad distally was visualized.
The blade was inserted into the carpal tunnel, was elevated at
the distal edge of the transverse carpal ligament, and was pulled
proximally, spreading and cutting through the transverse carpal
ligament.
It was visualized that the entire median nerve had been released,
and that configuration of the end of the transverse carpal ligament
was a rectangle, denoting that both the deep and the superficial
fibers had been cut.
The wound was then copiously irrigated with saline...
Release Definition Freeing a body part
N Explanation Eliminating an abnormal constraint of a body part by cutting or by use of force.
Some of the restraining tissue may be taken out but none of the body part is
taken out.
Examples Adhesiolysis, carpal tunnel release
Root operations involving cutting or separation only
2.30 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding note: body part value
The body part value assigned is the structure released and not
the structure cut to obtain the release, where the two differ. The
transverse carpal ligament was cut to release the median nerve
and not for its own sake.
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
PERIPHERAL
N
ERVOUS
RELEASE MEDIAN NERVE OPEN NO DEVICE NO QUALIFIER
01N50ZZ
Procedure Code
Laparotomy with exploration and adhesiolysis of right
ureter
0TN60ZZ
Incision of scar contracture, right elbow 0HNDXZZ The skin of the elbow region is coded to the
lower arm.
Frenulotomy for treatment of tongue-tie syndrome 0CN7XZZ The frenulum is coded to the body part value
TONGUE.
Right shoulder arthroscopy with coracoacromial ligament
release
0MN14ZZ
Mitral valvulotomy for release of fused leaflets, open
approach
02NG0ZZ
Percutaneous left Achilles tendon release 0LNP3ZZ
Laparoscopy with lysis of peritoneal adhesions 0DNW4ZZ
Manual rupture of right shoulder joint adhesions under
general anesthesia
0RNJXZZ
Open posterior tarsal tunnel release 01NG0ZZ The nerve released in the posterior tarsal
tunnel is the tibial nerve.
Laparoscopy with freeing of left ovary and fallopian tube 0UN14ZZ, 0UN64ZZ
Procedures in the Medical and Surgical section 2.31
Preliminary
12/10/07
Root operations that put in/put back or move
some/all of a body part
The table below lists the root operations that put in, put back,
or move some or all of a body part. Each is described in detail
in the pages that follow.
Root operation Objective of procedure Site of procedure Example
Transplantation Putting in a living body part from
a person/animal
Some/all of a body part Kidney transplant
Reattachment Putting back a detached body
part
Some/all of a body part Reattach finger
Transfer Moving a body part to function
for a similar body part
Some/all of a body part Skin transfer flap
Reposition Moving a body part to normal or
other suitable location
Some/all of a body part Move undescended testicle
Root operations that put in/put back or move some/all of a body part
2.32 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Transplantation—Root operation Y
—————————————————————————————————————————————————
A small number of procedures is represented in the root opera-
tion T
RANSPLANTATION and includes only the body parts currently
being transplanted. Qualifier values specify the genetic compati-
bility of the body part transplanted.
Example: Right kidney transplant (syngeneic)
...the abdomen was sterilely prepped and draped in the usual
fashion and incision in the right flank, the Gibson technique,
performed. In doing so the right pelvis was entered and Book-
walter retractor appropriately positioned to provide exposure of
the external iliac artery and vein.
The artery was placed on vessel loop retraction. We then pro-
ceeded with the kidney transplant, and the kidney which was
trimmed on the back table was brought into the field. The right
renal vein was cut short without reconstruction of the inferior
vena cava, and single ureter was identified. Kidney was brought
up in an ice blanket and an end-to-end anastomosis was per-
formed in the usual fashion with 5-0 Prolene between donor
renal vein and external iliac vein on the right.
The long renal artery was brought into view, and end-to-side
anastomosis performed in the usual fashion with 5-0 Prolene.
We then turned our attention to performing the neoureterocys-
tostomy after appropriate positioning of the graft and evaluation
of the vessels.
After the anastomosis was completed there was no evidence of
leak. A Blake drain was brought out through a stab incision and
the tip of the drain placed near the neoureterocystostomy and
both wounds were closed. The infrainguinal wound was closed
with running 3-0 Vicryl and the kidney transplant wound was
closed with #1 PDS...
Transplantation
Y
Definition Putting in or on all or a portion of a living body part taken from another
individual or animal to physically take the place and/or function of all or a portion
of a similar body part
Explanation The native body part may or may not be taken out, and the transplanted body
part may take over all or a portion of its function.
Examples Kidney transplant, heart transplant
Root operations that put in/put back or move some/all of a body part
Procedures in the Medical and Surgical section 2.33
Preliminary
12/10/07
Coding note: bone marrow
transplant
Bone marrow transplant procedures are coded in section 3
ADMINISTRATION to the root operation 2 TRANSFUSION.
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
URINARY TRANSPLANT.KIDNEY, RIGHT OPEN NO DEVICE SYNGENEIC
0TY00Z1
Procedure Code
Left cornea transplant using organ donor matched cornea 08Y9XZ0
Orthotopic heart transplant using porcine heart 02YA0Z2 The donor heart comes from an animal (pig),
so the qualifier value is Z
OOPLASTIC.
Right lung transplant, open, using organ donor match 0BYK0Z0
Transplant of large intestine, organ donor match 0DYE0Z0
Left kidney/pancreas organ bank transplant 0FYG0Z0, 0TY10Z0
Root operations that put in/put back or move some/all of a body part
2.34 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Reattachment—Root operation M
———————————————————————————————————————————————————
Procedures coded to REATTACHMENT include putting back a body
part that has been cut off or avulsed. Nerves and blood vessels
may or may not be reconnected in a R
EATTACHMENT procedure.
Example: Complex reattachment, left index finger
A sharp debridement of grossly contaminated tissue was carried
out. It was noted that the extensor mechanism distal to the PIP
joint had been lost. There were circumferential lacerations about
the finger, save for a cutaneous bridge and ulnar vascular pedi-
cle present at the PIP level.
Nonviable bony fragments were removed and then the distal por-
tion of the PIP joint was reshaped with removal of cartilage
using double- rongeurs. It was noted that the fractures through
the proximal phalanx extended longintudinally. Stabilization
was then carried out, with 0.062 K-wire brought down through
the distal finger, out through the fingertip, and then back into
the proximal phalanx centrally.
The A2 pulley was restored, using figure of eight interrupted
sutures of 4 and 5-0 Vicryl, reapproximating the flexor tendons.
The extensor mechanisms and tendons were repaired using 4
and 5-0 Vicryl, and anchored to the periosteum on the middle
phalanx. A digital nerve was then carried out on the radial
aspect of the digit at the PIP joint level using interrupted sutures
of 9-0 Ethilon beneath the microscope.
At this point, the skin was trimmed, removing skin margins, and
then multiple lacerations were closed with 5-0 Prolene...
Reattachment
M
Definition Putting back in or on all or a portion of a separated body part to its normal
location or other suitable location
Explanation Vascular circulation and nervous pathways may or may not be reestablished.
Examples Reattachment of hand, reattachment of avulsed kidney
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
UPPER
E
XTREMITIES
REATTACHMENT INDEX FINGER,
L
EFT
OPEN NO DEVICE NO QUALIFIER
0XMP0ZZ
Root operations that put in/put back or move some/all of a body part
Procedures in the Medical and Surgical section 2.35
Preliminary
12/10/07
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Replantation of avulsed scalp 0HM0XZZ
Reattachment of severed right ear 09M0XZZ
Reattachment of traumatic left gastrocnemius avulsion, open 0KMT0ZZ
Closed replantation of three avulsed teeth, lower jaw 0CMXXZ1
Reattachment of severed left hand 0XMK0ZZ
Root operations that put in/put back or move some/all of a body part
2.36 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Transfer—Root operation X
————————————————————————————————————————————————————————————
The root operation TRANSFER is used to represent procedures
where a body part is moved to another location without disrupt-
ing its vascular and nervous supply. In select musculoskeletal
body systems, a qualifier is used to specify procedures involving
composite tissue transfers, such as musculocutaneous
flap transfer.
Example: Fasciocutaneous flap from scalp to cheek
...development of the plane of dissection was completed into the
superficial temporal fascia. Development of subgaleal dissection
posteriorly was then completed, a distance of 7-8 cm, with hemo-
stasis by electrocautery.
The flaps were advanced to the cheek defect and secured with
2-0 inverted PDS sutures and 3-0 inverted Monocryl...
Coding note: body system value
The body system value describes the deepest tissue layer in the
flap. The qualifier can be used to describe the other tissue lay-
ers, if any, being transferred.
Transfer
X
Definition Moving, without taking out, all or a portion of a body part to another location to
take over the function of all or a portion of a body part
Explanation The body part transferred remains connected to its vascular and nervous supply.
Examples Tendon transfer, skin pedicle flap transfer
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
SUBCU. TISSUE
AND FASCIA
TRANSFER SCALP OPEN NO DEVICE SKIN, SUBCU.
AND FASCIA
0JX00ZC
Root operations that put in/put back or move some/all of a body part
Procedures in the Medical and Surgical section 2.37
Preliminary
12/10/07
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Right hand open palmaris longus tendon transfer 0LX70ZZ
Endoscopic radial to median nerve transfer 01X64Z5
Fasciocutaneous flap closure of left thigh, open 0JXM0ZC The qualifier identifies the body layers
in addition to fascia included in the procedure.
Transfer left index finger to left thumb position, open 0XXP0ZM
Percutaneous fascia transfer to fill defect, anterior neck 0JX43ZZ
Trigeminal to facial nerve transfer, percutaneous endoscopic 00XK4ZM
Endoscopic left leg flexor hallucis longus tendon transfer 0LXP4ZZ
Right scalp advancement flap to right temple 0HX0XZZ
Bilateral TRAM pedicle flap reconstruction status post
mastectomy, muscle only, open
0KXK0ZZ, 0KXL0ZZ The transverse rectus
abdominus muscle (TRAM) flap is coded for
each flap developed.
Skin transfer flap closure of complex open wound, left lower back 0HX6XZZ
Root operations that put in/put back or move some/all of a body part
2.38 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Reposition—Root operation S
————————————————————————————————————————————————————————
REPOSITION represents procedures for moving a body part to a
new location. The range of R
EPOSITION procedures includes
moving a body part to its normal location, or moving a body
part to a new location to enhance its ability to function.
Example: Reposition of undescended right testicle from pelvic region to scrotum
...Following satisfactory induction of general anesthesia, an
incision was made in the inguinal region and dissection car-
ried down to the pelvic cavity, where the right testis was located
and mobilized.
The spermatic cord was located and freed from surrounding
tissue, and its length judged to be sufficient.
A one centimeter incision was made in the scrotum and a pouch
created in the usual fashion. The right testicle was mobilized
down through the inguinal canal into the scrotum, and stitched
in place.
Meticulous hemostasis was obtained, and the incisions closed in
layers…
Reposition
S
Definition Moving to its normal location or other suitable location all or a portion of a body
part
Explanation The body part is moved to a new location from an abnormal location, or from a
normal location where it is not functioning correctly. The body part may or may
not be cut out or off to be moved to the new location.
Examples Reposition of undescended testicle, fracture reduction
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
MALE
R
EPRODUCTIVE
REPOSITION TESTIS, RIGHT OPEN NO DEVICE NO QUALIFIER
0VS90ZZ
Root operations that put in/put back or move some/all of a body part
Procedures in the Medical and Surgical section 2.39
Preliminary
12/10/07
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Open fracture reduction, right tibia 0QSG0ZZ
Laparoscopy with gastropexy for malrotation 0DS64ZZ
Left knee arthroscopy with reposition of anterior cruciate
ligament
0MSP4ZZ
Open transposition of ulnar nerve 01S40ZZ
Closed reduction with percutaneous internal fixation of right
femoral neck fracture
0QS634Z
2.40 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Root operations that alter the diameter/route of a
tubular body part
The table below lists the root operations that alter the diameter
or route of a tubular body part. Tubular body parts are defined
in ICD-10-PCS as those hollow body parts that provide a route
of passage for solids, liquids, or gases. They include the cardio-
vascular system, and body parts such as those contained in the
gastrointestinal tract, genitourinary tract, biliary tract, and respi-
ratory tract.
Each root operation is described in detail in the pages that
follow.
Root operation Objective of procedure Site of procedure Example
Restriction Partially closing orifice/
lumen
Tubular body part Gastroesophageal fundoplication
Occlusion Completely closing orifice/
lumen
Tubular body part Fallopian tube ligation
Dilation Expanding orifice/lumen Tubular body part Percutaneous transluminal coronary
angioplasty (PTCA)
Bypass Altering route of passage Tubular body part Coronary artery bypass graft (CABG)
Root operations that alter the diameter/route of a tubular body part
Procedures in the Medical and Surgical section 2.41
Preliminary
12/10/07
Restriction—Root operation V
———————————————————————————————————————————————————————
The root operation RESTRICTION is coded when the objective of
the procedure is to narrow the diameter of a tubular body part
or orifice. R
ESTRICTION includes both intraluminal or extralumi-
nal methods for narrowing the diameter.
Example: Laparoscopic gastroesophageal fundoplication
…Insufflation was accomplished through a 5 infraumbilical
incision. Five separate 5 mm ports were placed under direct
visualization other than the initial port. Laparoscopy revealed a
large hiatal hernia. Electrocautery was used to free up adhesions
from the hernia sac to the stomach.
Next, the fundus which had been mobilized was brought down
into the stomach and it was felt there was enough mobilization
to perform a fundoplication. A generous loose fundoplication
was then performed by wrapping the fundus around the
esophagus. Interrupted 0 Ethibond sutures were used to secure
the stomach in this fashion.
There was generally good hemostasis throughout the case. All
instruments were removed and ports closed…
Restriction Definition Partially closing an orifice or the lumen of a tubular body part
V Explanation The orifice can be a natural orifice or an artificially created orifice.
Examples Esophagogastric fundoplication, cervical cerclage
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4 Body
Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
GASTROINTEST.
S
YSTEM
RESTRICTION ESOPHAGOGAST
J
UNCTION
PERCUTANEOUS
E
NDOSCOPIC
NO DEVICE NO QUALIFIER
0DV 4 4ZZ
Root operations that alter the diameter/route of a tubular body part
2.42 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Trans-vaginal intraluminal cervical cerclage 0UVC7DZ
Thoracotomy with banding of left pulmonary artery
using extraluminal device
02VR0CZ
Restriction of thoracic duct with intraluminal stent,
percutaneous
07VK3DZ
Craniotomy with clipping of cerebral aneurysm 03VG0CZ A clip is placed lengthwise on the outside wall of the
widened portion of the vessel.
Non-incisional, trans-nasal placement of restrictive
stent in right lacrimal duct
08VX7DZ
Root operations that alter the diameter/route of a tubular body part
Procedures in the Medical and Surgical section 2.43
Preliminary
12/10/07
Occlusion—Root operation L
—————————————————————————————————————————————————————————
The root operation OCCLUSION is coded when the objective of
the procedure is to close off a tubular body part or orifice.
O
CCLUSION includes both intraluminal or extraluminal methods
of closing off the body part. Division of the tubular body part
prior to closing it is an integral part of the O
CCLUSION
procedure.
Example: Uterine artery embolization
…catheter was advanced over a 0.18 Terumo gold guidewire and
advanced several centimeters superselectively into the left uterine
artery. Contrast injection was performed here, confirming filling
of the uterine artery and subsequent opacification of large vascu-
lar structures in the uterus compatible with uterine fibroids.
A syringe and a half of 500-700 micron biospheres was then
instilled slowly through the catheter, and at the conclusion of this
infusion there was cessation of flow through the uterine artery.
The catheter was then removed and hemostasis achieved...
Coding note: body part value
Because the uterine artery is not identified as a separate body
part value, it is coded to the closest proximal branch identified
as a body part value (Guideline B4.12)
For the complete list of draft coding guidelines, please refer to
appendix B.
Occlusion Definition Completely closing an orifice or the lumen of a tubular body part
L Explanation The orifice can be a natural orifice or an artificially created orifice.
Examples Fallopian tube ligation, ligation of inferior vena cava
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
LOWER
A
RTERIES
OCCLUSION COMMON ILIAC
A
RTERY, LEFT
PERCUTANEOUS INTRALUMINAL
D
EVICE
NO QUALIFIER
04LD3DZ
Root operations that alter the diameter/route of a tubular body part
2.44 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Percutaneous ligation of esophageal vein 06L33ZZ
Percutaneous embolization of left internal carotid-cavernous
fistula
03LL3DZ
Laparoscopy with bilateral occlusion of fallopian tubes using
Hulka extraluminal clips
0UL74CZ
Open suture ligation of failed AV graft, left brachial artery 03L80ZZ
Percutaneous embolization of vascular supply, intracranial
meningioma
03LG3DZ
Root operations that alter the diameter/route of a tubular body part
Procedures in the Medical and Surgical section 2.45
Preliminary
12/10/07
Dilation—Root operation 7
—————————————————————————————————————————————————————————————
The root operation DILATION is coded when the objective of the
procedure is to enlarge the diameter of a tubular body part or
orifice. D
ILATION includes both intraluminal or extraluminal
methods of enlarging the diameter. A device placed to maintain
the new diameter is an integral part of the D
ILATION procedure,
and is coded to a sixth-character device value in the D
ILATION
procedure code.
Example: PTCA of left anterior descending
…under 1% Lidocaine local anesthesia, the right femoral artery
was entered by the Seldinger technique and a #7 French sheath
was placed. A Judkins left guiding catheter was advanced to the
left coronary ostium and using a .014 Entrée wire and a 2.5 x
30 mm Panther balloon, it was easily placed across the lesion in
the left anterior descending.
The balloon was inflated times two for five minutes for up to 9
atmospheres. Angiography demonstrated an excellent result…
Dilation Definition Expanding an orifice or the lumen of a tubular body part
7 Explanation The orifice can be a natural orifice or an artificially created orifice.
Accomplished by stretching a tubular body part using intraluminal pressure or
by cutting part of the orifice or wall of the tubular body part.
Examples Percutaneous transluminal angioplasty, pyloromyotomy
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
HEART AND
G
R.VESSELS
DILATION CORONARY
A
RT., ONE SITE
PERCUTANEOUS NO DEVICE NO QUALIFIER
02703ZZ
Root operations that alter the diameter/route of a tubular body part
2.46 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
ERCP with balloon dilation of common bile duct 0F798ZZ
PTCA of two coronary arteries, LAD with stent placement, RCA
with no stent
02703DZ, 02703ZZ A separate procedure is
coded for each artery dilated, since the device
value differs for each artery.
Cystoscopy with intraluminal dilation of bladder neck stricture 0T7C8ZZ
Open dilation of old anastomosis, left femoral artery 047L0ZZ
Dilation of upper esophageal stricture, direct visualization, with
Bougie sound
0D717ZZ
PTA of right brachial artery stenosis 03773ZZ
Trans-nasal dilation and stent placement in right lacrimal duct 087X7DZ
Hysteroscopy with balloon dilation of bilateral fallopian tubes 0U778ZZ
Tracheoscopy with intraluminal dilation of tracheal stenosis 0B718ZZ
Cystoscopy with dilation of left ureteral stricture, with stent
placement
0T778DZ
Root operations that alter the diameter/route of a tubular body part
Procedures in the Medical and Surgical section 2.47
Preliminary
12/10/07
Bypass—Root operation 1
—————————————————————————————————————————————————————————————
BYPASS is coded when the objective of the procedure is to
reroute the contents of a tubular body part. The range of B
YPASS
procedures includes normal routes such as those made in coro-
nary artery bypass procedures, and abnormal routes such as
those made in colostomy formation procedures.
Example: Aorto-bifemoral bypass graft
…the patient was prepped and draped, and groin incisions were
opened. The common femoral vein and its branches were
isolated and Teflon tapes were placed around the vessels.
The aorta and iliacs were mobilized. Bleeding points were
controlled with electrocautery and Liga clips. Tapes were placed
around the vessel, the vessel measured, and the aorta was found
to be 12 mm. A 12 x 7 bifurcated microvelour graft was then
preclotted with the patient’s own blood.
An end-to-end anastomosis was made on the aorta and the graft
using a running suture of 2-0 Prolene. The limbs were taken
down through tunnels noting that the ureters were anterior, and
at this point an end-to-side anastomosis was made between the
graft and the femoral arteries with running suture of 4-0 Prolene.
The inguinal incisions were closed…
Bypass Definition Altering the route of passage of the contents of a tubular body part
1 Explanation Rerouting contents around an area of a body part to another distal
(downstream) area in the normal route; rerouting the contents to another
different but similar route and body part; or to an abnormal route and another
dissimilar body part. It includes one or more concurrent anastomoses with or
without the use of a device such as autografts, tissue substitutes and synthetic
substitutes.
Examples Coronary artery bypass, colostomy formation
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
LOWER
A
RTERIES
BYPASS ABDOMINAL
A
ORTA
OPEN SYNTHETIC
S
UBSTITUTE
BIL. FEMORAL
A
RTERIES
04100JK
Root operations that alter the diameter/route of a tubular body part
2.48 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Open gastric bypass with Roux-en-Y limb to jejunum 0D160ZA
Right temporal artery to intracranial artery bypass using
goretex graft, open
031S0JG
Tracheostomy formation with tracheostomy tube placement,
percutaneous
0B113F4
PICVA (Percutaneous in-situ coronary venous arterialization) of
single coronary artery
02103D4
Open left femoral-popliteal artery bypass using cadaver vein
graft
041L0KL
Shunting of intrathecal cerebrospinal fluid to peritoneal cavity
using synthetic shunt
00160J6
Colostomy formation, open, transverse colon to abdominal wall 0D1L0Z4
Open urinary diversion, left ureter, using ileal conduit to skin 0T170ZC
CABG of LAD using left internal mammary artery, open
off-bypass
02100Z9
Open pleuroperitoneal shunt, right pleural cavity, using
synthetic device
0W190JG
Procedures in the Medical and Surgical section 2.49
Preliminary
12/10/07
Root operations that always involve a device
The table below lists the root operations that always involve a
device. Each is described in detail in the pages that follow.
Root operation Objective of procedure Site of procedure Example
Insertion Putting in non-biological device In/on a body part Central line insertion
Replacement Putting in device that replaces a
body part
Some/all of a body part Total hip replacement
Change Exchanging device w/out cutting/
puncturing
In/on a body part Drainage tube change
Removal Taking out device In/on a body part Central line removal
Revision Correcting a malfunctioning/
displaced device
In/on a body part Revision of pacemaker
insertion
Root operations that always involve a device
2.50 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Insertion—Root operation H
———————————————————————————————————————————————————————————
The root operation INSERTION represents those procedures
where the sole objective is to put in a device without doing
anything else to a body part. Procedures typical of those coded
to I
NSERTION include putting in a vascular catheter, a pacemaker
lead, or a tissue expander.
Example: Port-a-cath placement
…the right chest and neck were prepped and draped in the usual
manner and 10 cc’s of 1% Lidocaine were injected in the right
infraclavicular area.
The right subclavian vein was then punctured and a wire was
passed through the needle into the superior vena cava. This was
documented by fluoroscopy. Introducer kit was introduced into
the subclavian vein and the Port-a-cath was placed through the
introducer and by fluoroscopy was placed down to the superior
vena cava.
The pocket was then made over the right pectoralis major muscle,
superior to the breast, and the Port-a-cath reservoir was placed
into this pocket and tacked down with #0 Prolene sutures.
The catheter was then tunneled through a subcutaneous tunnel
to this receptacle. Hemostasis was achieved and the subcutaneous
tissue closed…
Insertion
H
Definition Putting in a non-biological device that monitors, assists, performs or prevents a
physiological function but does not physically take the place of a body part
Explanation None
Examples Insertion of radioactive implant, insertion of central venous catheter
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
HEART AND GR.
V
ESSELS
INSERTION SUPERIOR
VENA CAVA
PERCUTANEOUS INFUSION
D
EVICE
NO QUALIFIER
02HV33Z
Root operations that always involve a device
Procedures in the Medical and Surgical section 2.51
Preliminary
12/10/07
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2 Body
System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
SUBCU.TISSUE
AND FASCIA
INSERTION CHEST OPEN RESERVOIR NO QUALIFIER
0JH60WZ
Procedure Code
Percutaneous insertion of spinal neurostimulator lead,
lumbar spinal cord
00HY3MZ
Percutaneous placement of pacemaker lead in left
atrium
02H73MZ
Open placement of dual chamber pacemaker
generator in chest wall
0JH60P2
Percutaneous placement of venous central line in
right internal jugular
05HM33Z
Open insertion of multiple channel cochlear implant,
left ear
09HE0S3
Percutaneous placement of Swan-Ganz catheter in
superior vena cava
02HV32Z The Swan-Ganz catheter is coded to the device
value MONITORING DEVICE because it monitors pulmonary
artery output.
Bronchoscopy with insertion of brachytherapy seeds,
right main bronchus
0BH381Z
Placement of intrathecal infusion pump for pain
management, percutaneous
0JH733Z The device resides principally in the subcutaneous
tissue of the back, so it is coded to body system J.
Open placement of bone growth stimulator, left
femoral shaft
0QH90MZ
Cystoscopy with placement of brachytherapy seeds in
prostate gland
0VH081Z
Root operations that always involve a device
2.52 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Replacement—Root operation R
—————————————————————————————————————————————————————
The objective of procedures coded to the root operation
R
EPLACEMENT is to put in a device that takes the place of some
or all of a body part. R
EPLACEMENT encompasses a wide range of
procedures, from joint replacements to grafts of all kinds.
Example: Prosthetic lens implantation
…a superior peritomy was made on the left eye and adequate
hemostasis was achieved using eraser cautery. A posterior
one-half thickness groove was placed posterior to the blue line.
This was beveled forward toward clear cornea.
The anterior chamber was entered at the 11:30 position with a
blade. The eye was filled with viscoelastic substance. A
can-opener type capsulotomy was performed with a cystotome.
Hydrodissection was carried out and the lens was rocked gently
with a cystotome to loosen it from the cortex.
The wound was then opened with corneal scleral scissors. The
lens was prolapsed in the anterior chamber and removed. The
anterior chamber was then temporarily closed with 8-0 Vicryl
sutures and cortical clean-up was performed.
One of the sutures was removed and a posterior chamber
intraocular lens (Alcon model #MZ50BD) was inspected, rinsed,
and placed into a capsular bag. Miochol was then instilled into
the anterior chamber. The conjunctiva was pulled over the inci-
sion and cauterized into place…
Replacement
R
Definition Putting in or on biological or synthetic material that physically takes the place of
all or a portion of a body part
Explanation The biological material is non-living, or the biological material is living and from
the same individual. The body part may have been previously taken out,
previously replaced, or may be taken out concomitantly with the Replacement
procedure. If the body part has been previously replaced, a separate Removal
procedure is coded for taking out the device used in the previous replacement.
Examples Total hip replacement, free skin graft
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
EYE REPLACEMENT LENS, LEFT OPEN SYNTHETIC
S
UBSTITUTE
NO QUALIFIER
08RK0JZ
Root operations that always involve a device
Procedures in the Medical and Surgical section 2.53
Preliminary
12/10/07
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Full-thickness skin graft to right lower arm, autograft (do not code
graft harvest for this exercise)
0HRDX73
Excision of necrosed left femoral head with bone bank bone graft to
fill the defect, open
0QR70KZ
Autograft nerve graft to right median nerve, percutaneous endoscopic
(do not code graft harvest for this exercise)
01R547Z
Bilateral mastectomy with concomitant breast implants, open 0HRV0JZ
Excision of abdominal aorta with goretex graft replacement, open 04R00JZ
Total right knee arthroplasty with insertion of total knee prosthesis 0SRC0JZ
Abdominal wall herniorrhaphy, open, using synthetic mesh 0WRF0JZ
Tendon graft to right ankle using cadaver graft, open 0LRS0KZ
Mitral valve replacement using porcine valve, open 02RG08Z
Percutaneous phacoemulsification of right eye cataract with prosthetic
lens insertion
08RJ3JZ
Root operations that always involve a device
2.54 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Change—Root operation 2
—————————————————————————————————————————————————————————————
The root operation CHANGE represents only those procedures
where a similar device is exchanged without making a new inci-
sion or puncture. Typical C
HANGE procedures include exchange
of drainage devices and feeding devices.
Coding note: Change
In the root operation CHANGE, general body part values are used
when the specific body part value is not in the table
Example: Percutaneous endoscopic gastrostomy (PEG) tube exchange
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Change
2
Definition Taking out or off a device from a body part and putting back an identical or
similar device in or on the same body part without cutting or puncturing the skin
or a mucous membrane
Explanation None
Examples Urinary catheter change, gastrostomy tube change
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
GASTROINTEST.
S
YSTEM
CHANGE UPPER INTEST.
T
RACT
EXTERNAL FEEDING
D
EVICE
NO QUALIFIER
0D20XUZ
Procedure Code
Exchange of drainage tube from right hip joint 0S2YX0Z
Tracheostomy tube exchange 0B21XFZ
Change chest tube for left pneumothorax 0W2BX0Z
Exchange of cerebral ventriculostomy drainage tube 0020X0Z
Foley urinary catheter exchange 0T2BX0Z This is coded to D
RAINAGE DEVICE because urine
is being drained.
Root operations that always involve a device
Procedures in the Medical and Surgical section 2.55
Preliminary
12/10/07
Removal—Root operation P
———————————————————————————————————————————————————————————
REMOVAL represents a much broader range of procedures than
those for removing the devices contained in the root operation
I
NSERTION. A procedure to remove a device is coded to REMOVAL
if it is not an integral part of another root operation, and regard-
less of the approach or the original root operation by which the
device was put in.
Coding note: Removal
In the root operation REMOVAL, general body part values are
used when the specific body part value is not in the table
Example: Removal of right forearm external fixator
…the right upper extremity was prepped and draped in a sterile
fashion. A tourniquet was placed at 250 mm of pressure.
The external fixator was removed using the appropriate wrench.
The four pins in the ulna were then removed manually, as well
as with the drill. The wounds were irrigated with antibiotic solu-
tion and a sterile dressing applied…
Removal Definition Taking out or off a device from a body part
P Explanation If taking out a device and putting in a similar device is performed with an
external approach, the procedure is coded to the root operation C
HANGE.
Otherwise, the procedure for taking out the device is coded to the root operation
R
EMOVAL and the procedure for putting in the new device is coded to the root
operation performed.
Examples Drainage tube removal, cardiac pacemaker removal
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
UPPER BONES REMOVAL ULNA, RIGHT EXTERNAL EXTERNAL
F
IXATION
NO QUALIFIER
0PPKX5Z
Root operations that always involve a device
2.56 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Open removal of lumbar sympathetic neurostimulator 01PY0MZ
Non-incisional removal of Swan-Ganz catheter from right
pulmonary artery
02PYX2Z
Laparotomy with removal of pancreatic drain 0FPG00Z
Extubation, endotracheal tube 0BP1XEZ
Non-incisional PEG tube removal 0DP6XUZ
Transvaginal removal of extraluminal cervical cerclage 0UPD7CZ
Incision with removal of K-wire fixation, right first metatarsal 0QPN04Z
Cystoscopy with retrieval of left ureteral stent 0TP98DZ
Removal of nasogastric drainage tube for decompression 0DP6X0Z
Removal of external fixator, left radial fracture 0PPJX5Z
Root operations that always involve a device
Procedures in the Medical and Surgical section 2.57
Preliminary
12/10/07
Revision—Root operation W
——————————————————————————————————————————————————————————
REVISION is coded when the objective of the procedure is to cor-
rect the positioning or function of a previously placed device. A
complete re-do of the original root operation is coded to the
root operation performed.
Coding note: Revision
In the root operation REVISION, general body part values are
used when the specific body part value is not in the table
Example: Revision of artificial anal sphincter
…Proceeding through a suprapubic incision, this was then
extended after injecting local anesthetic, thereby exposing the
underlying tubing, which was then delivered through the supra-
pubic region.
Meticulous hemostasis was achieved using electrocautery. At that
point the pump device was then repositioned in the left lower
quadrant abdominal wall region. The tubing was reinserted
using dilators, and the skin reapproximated using 2-0 Vicryl
sutures. Sterile dressing was then applied…
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Revision Definition Correcting, to the extent possible, a malfunctioning or displaced device
W Explanation Revision can include correcting a malfunctioning or displaced device by taking
out or putting in components of the device such as a screw or pin.
Examples Adjustment of pacemaker lead, adjustment of hip prosthesis
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
GASTROINTEST.
S
YSTEM
REVISION ANUS OPEN ARTIFICIAL
S
PHINCTER
NO QUALIFIER
0DWQ0LZ
Procedure Code
Reposition of Swan-Ganz catheter in superior vena cava 02WYX2Z
Open revision of right hip replacement, with readjustment of prosthesis 0SW90JZ
Adjustment of position, pacemaker lead in left ventricle, percutaneous 02WA3MZ
External repositioning of foley catheter to bladder 0TWBX0Z
Revision of VAD reservoir placement in chest wall, causing patient discomfort, open 0JWT0WZ
2.58 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Root operations involving examination only
The table below lists the root operations that involve examina-
tion of a body part. Each is described in detail in the pages that
follow.
Root operation Objective of procedure Site of procedure Example
Inspection Visual/manual exploration Some/all of a body part Diagnostic cystoscopy
Map Location electrical impulses/
functional areas
Brain/cardiac conduction
mechanism
Cardiac electrophysiological
study
Root operations involving examination only
Procedures in the Medical and Surgical section 2.59
Preliminary
12/10/07
Inspection—Root operation J
————————————————————————————————————————————————————————
The root operation INSPECTION represents procedures where the
sole objective is to examine a body part. Procedures that are
discontinued without any other root operation being performed
are also coded to I
NSPECTION.
Example: Diagnostic colposcopy with examination of cervix
…Colposcopy was done which revealed pseudo-white areas at 2
o’clock and 6 o’clock on the cervix, with abnormal cells and
irregular white borders noted on both…
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Inspection Definition Visually and/or manually exploring a body part
J Explanation Visual exploration may be performed with or without optical instrumentation.
Manual exploration may be performed directly or through intervening body
layers.
Examples Diagnostic arthroscopy, exploratory laparotomy
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
FEMALE
R
EPRODUCTIVE
INSPECTION CERVIX VIA NAT./ARTIF.
O
PENING ENDO
NO DEVICE NO QUALIFIER
0UJC8ZZ
Procedure Code
Thoracotomy with exploration of right pleural
cavity
0WJ90ZZ
Diagnostic laryngoscopy 0CJS8ZZ
Exploratory arthrotomy of left knee 0SJD0ZZ
Colposcopy with diagnostic hysteroscopy 0UJ98ZZ
Digital rectal exam 0DJP7ZZ
Diagnostic arthroscopy of right shoulder 0RJJ4ZZ
Endoscopy of bilateral maxillary sinus 09JQ4ZZ, 09JR4ZZ
Laparotomy with palpation of liver 0FJ00ZZ
Transurethral diagnostic cystoscopy 0TJB8ZZ
Colonoscopy, abandoned at sigmoid colon 0DJN8ZZ
Root operations involving examination only
2.60 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Map—Root operation K
——————————————————————————————————————————————————————————————————
MAPPING represents a very narrow range of procedures. Proce-
dures include only cardiac mapping and cortical mapping.
Example: Cardiac mapping
…under sterile technique arterial sheath was placed in the right
femoral artery. The electrical catheter was advanced up the
aorta and into the left atrium under fluoroscopic guidance and
mapping commenced. After adequate recordings were obtained
the catheter was withdrawn and hemostasis achieved with
manual pressure on the right femoral artery…
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Map
K
Definition Locating the route of passage of electrical impulses and/or locating functional
areas in a body part
Explanation Applicable only to the cardiac conduction mechanism and the central nervous
system
Examples Cardiac mapping, cortical mapping
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
HEART AND GR.
V
ESSELS
MAP CONDUCTION
M
ECHANISM
PERCUTANEOUS NO DEVICE NO QUALIFIER
02K83ZZ
Procedure Code
Percutaneous mapping of basal ganglia 00K83ZZ
Heart catheterization with cardiac mapping 02K83ZZ
Intraoperative whole brain mapping via craniotomy 00K00ZZ
Mapping of left cerebral hemisphere, percutaneous endoscopic 00K74ZZ
Intraoperative cardiac mapping during open heart surgery 02K80ZZ
Procedures in the Medical and Surgical section 2.61
Preliminary
12/10/07
Root operations that define other repairs
The table below lists the root operations that define other
repairs. C
ONTROL describes the effort to locate and stop postpro-
cedural hemorrhage. R
EPAIR is described in detail in the pages
that follow.
Root operation Objective of procedure Site of procedure Example
Control Stopping/attempting to stop
postprocedural bleed
Anatomical region Post-prostatectomy bleeding
control
Repair Restoring body part to its
normal structure
Some/all of a body part Suture laceration
Root operations that define other repairs
2.62 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Control—Root operation 3
——————————————————————————————————————————————————————————————
CONTROL is used to represent a small range of procedures per-
formed to treat postprocedural bleeding. If performing B
YPASS,
D
ETACHMENT, EXCISION, EXTRACTION, REPOSITION, REPLACEMENT, or
R
ESECTION is required to stop the bleeding, then CONTROL is not
coded separately.
Coding note: Control
CONTROL includes irrigation or evacuation of hematoma done at
the operative site. Both irrigation and evacuation may be neces-
sary to clear the operative field and effectively stop the bleeding.
Example: Re-opening of laparotomy site with ligation of arterial bleeder
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Control Definition Stopping, or attempting to stop, postprocedural bleeding
3 Explanation The site of the bleeding is coded as an anatomical region and not to a specific
body part.
Examples Control of post-prostatectomy hemorrhage, control of post-tonsillectomy
hemorrhage
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
ANATOMICAL
R
EGIONS, GEN.
C
ONTROL PERITONEAL
C
AVITY
OPEN NO DEVICE NO QUALIFIER
0W3G0 Z Z
Procedure Code
Hysteroscopy with cautery of post-hysterectomy oozing and evacuation of
clot
0W3R8ZZ
Open exploration and ligation of post-op arterial bleeder, left forearm 0X3F0ZZ
Control of post-operative retroperitoneal bleeding via laparotomy 0W3H0ZZ
Reopening of thoracotomy site with drainage and control of post-op
hemopericardium
0W3C0ZZ
Arthroscopy with drainage of hemarthrosis at previous operative site, right
knee
0Y3F4ZZ
Root operations that define other repairs
Procedures in the Medical and Surgical section 2.63
Preliminary
12/10/07
Repair—Root operation Q
——————————————————————————————————————————————————————————————
The root operation REPAIR represents a broad range of proce-
dures for restoring the anatomic structure of a body part such as
suture of lacerations. R
EPAIR also functions as the “not elsewhere
classified (NEC)” root operation, to be used when the procedure
performed does not meet the definition of one of the other root
operations. Fixation devices are included for procedures to
repair the bones and joints.
Example: Left open inguinal herniorrhaphy
…an incision in the left groin extending on the skin from the
internal to the external inguinal ring was made. The external
oblique aponeurosis was exposed.
The hernia sac was then ligated at the internal ring with
non-dissolving sutures. A hernia repair was then performed. The
internal oblique fascia was sutured in interrupted stitches to the
ilio-pubic fascia. The spermatic cord was then returned to its
anatomical position.
The external oblique aponeurosis was then repaired in inter-
rupted sutures. Complete hemostasis was obtained, and the skin
closed…
Repair Definition Restoring, to the extent possible, a body part to its normal anatomic structure
and function
Q Explanation Used only when the method to accomplish the repair is not one of the other root
operations
Examples Herniorrhaphy, suture of laceration
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
LOWER
E
XTREMITIES
REPAIR INGUINAL
R
EGION, LEFT
OPEN NO DEVICE NO QUALIFIER
0YQ60ZZ
Root operations that define other repairs
2.64 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Suture repair of left radial nerve laceration 01Q60ZZ The approach value is O
PEN, though the
surgical exposure may have been created by the
wound itself.
Laparotomy with suture repair of blunt force duodenal
laceration
0DQ90ZZ
Perineoplasty with repair of old obstetric laceration, open 0WQN0ZZ
Suture repair of right biceps tendon laceration, open 0LQ30ZZ
Closure of abdominal wall stab wound 0WQF0ZZ
Procedures in the Medical and Surgical section 2.65
Preliminary
12/10/07
Root operations that define other objectives
The last three root operations in the MEDICAL AND SURGICAL
section, F
USION, ALTERATION, and CREATION, describe procedures
performed for three distinct reasons. Beyond that they have little
in common. A F
USION procedure puts a dysfunctional joint out of
service rather than restoring function to the joint. A
LTERATION
encompasses a whole range of procedures that share only the
fact that they are done to improve the way the patient looks. C
RE-
ATION represents only two very specific sex change operations.
Root operation Objective of procedure Site of procedure Example
Fusion Rendering joint immobile Joint Spinal fusion
Alteration Modifying body part for cosmetic
purposes without affecting function
Some/all of a body part Face lift
Creation Making new structure for sex change
operation
Perineum Artificial vagina/penis
Root operations that define other objectives
2.66 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Fusion—Root operation G
——————————————————————————————————————————————————————————————
A limited range of procedures is represented in the root opera-
tion F
USION, because fusion procedures are by definition only
performed on the joints. Qualifier values are used to specify
whether a vertebral joint fusion is anterior or posterior.
Example: Anterior cervical fusion C-2 through C-4 with bone bank graft
…after skull tong traction was applied, incision was made in the
left neck, and Gardner retractors placed to separate the interver-
tebral muscles at the C-2 through C-4 levels.
Using the drill, a trough was incised on the anterior surface of the
C-2 vertebra, and the C-2/C-3 space evacuated with a rongeur,
and the accompanying cartilage removed. This procedure was
then repeated at the C-3/C-4 level.
Bone bank patella strut graft was trimmed with a saw and fash-
ioned to fit the C-2/C-3 interspace. After adequate adjustments in
the size and shape had been made, the graft was tapped securely
into place. The procedure was repeated for the C-3/C-4 level.
X-rays revealed good alignment and final position. Traction was
gradually decreased to maintain position. Retractors were
removed and the fascia was reapproximated with 0 Vicryl…
Fusion
G
Definition Joining together portions of an articular body part rendering the articular body
part immobile
Explanation The body part is joined together by fixation device, bone graft, or other means.
Examples Spinal fusion, ankle arthrodesis
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
UPPER JOINTS FUSION CERVICAL
V
ERTEB JT, 2-6
O
PEN NONAUTOLOG
T
ISSUE SUBST
ANTERIOR
0RG20K0
Root operations that define other objectives
Procedures in the Medical and Surgical section 2.67
Preliminary
12/10/07
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Radiocarpal fusion of left hand with internal fixation, open 0RGP04Z
Posterior spinal fusion at L1-L3 level with BAK cage interbody
fusion device, open
0SG1041
Intercarpal fusion of right hand with bone bank bone graft, open 0RGQ0KZ
Sacrococcygeal fusion with bone graft from same operative site,
open
0SG507Z
Interphalangeal fusion of left great toe, percutaneous pin fixation 0SGQ34Z
Root operations that define other objectives
2.68 ICD-10-PCS Reference Manual
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Preliminary
Alteration—Root operation 0
——————————————————————————————————————————————————————————
ALTERATION is coded for all procedures performed solely to
improve appearance. All methods, approaches, and devices used
for the objective of improving appearance are coded here.
Coding note: Alteration
Because some surgical procedures can be performed for either
medical or cosmetic purposes, coding for A
LTERATION requires
diagnostic confirmation that the surgery is in fact performed to
improve appearance.
Example: Cosmetic blepharoplasty
…attention was turned to the redundant upper eyelid skin. The
ellipse of skin as marked preoperatively was excised bilaterally.
The medial and lateral fat compartments were open bilaterally.
The medial compartment had severe fatty excess and periorbital
fat herniation. This was resected. The lateral fat compartment
was opened and the lateral fat tailored as well.
Subdermal closure was performed with interrupted 3-0 sutures
bilaterally. The skin was closed…
Alteration
0
Definition Modifying the natural anatomic structure of a body part without affecting the
function of the body part
Explanation Principal purpose is to improve appearance
Examples Face lift, breast augmentation
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
EYE ALTERATION UPPER EYELID,
L
EFT
OPEN NO DEVICE NO QUALIFIER
080P0ZZ
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
EYE ALTERATION UPPER EYELID,
R
IGHT
OPEN NO DEVICE NO QUALIFIER
080N0ZZ
Root operations that define other objectives
Procedures in the Medical and Surgical section 2.69
Preliminary
12/10/07
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Cosmetic face lift, open, no other information available 0W020ZZ
Bilateral breast augmentation with silicone implants, open 0H0V0JZ
Cosmetic rhinoplasty with septal reduction and tip elevation using
local tissue graft, open
090K07Z
Abdominoplasty (tummy tuck), open 0W0F0ZZ
Liposuction of bilateral thighs 0J0L3ZZ, 0J0M3ZZ
Root operations that define other objectives
2.70 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Creation—Root operation 4
————————————————————————————————————————————————————————————
CREATION is used to represent a very narrow range of procedures.
Only the procedures performed for sex change operations are
included here.
Coding note: Harvesting
autograft tissue
If a separate procedure is performed to harvest autograft tissue,
it is coded to the appropriate root operation in addition to the
primary procedure.
Example: Creating a vagina in a male patient using autograft
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Creation Definition Making a new structure that does not physically take the place of a body part
4 Explanation Used only for sex change operations where genitalia are made
Examples Creation of vagina in a male, creation of penis in a female
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEDICAL AND
S
URGICAL
ANATOMICAL
R
EGIONS, GEN.
C
REATION PERINEUM,
M
ALE
OPEN AUTOLOG.
T
ISSUE SUBST.
V
AGINA
0W4M0 7 0
Procedure Code
Creation of penis in female patient using tissue bank donor graft 0W4N0K1
Creation of vagina in male patient using synthetic material 0W4M0J0
Root operations that define other objectives
Procedures in the Medical and Surgical section 2.71
Preliminary
12/10/07
2.72 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Preliminary
12/10/07
Chapter 3
3Procedures in the Medical and
Surgical-related sections
3.2 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Contents Procedures in the Medical and Surgical-related sections 3.3
List of Medical and Surgical-related sections of ICD-10-PCS 3.4
Obstetrics—Section 1 3.5
Root operations 3.5
Placement—Section 2 3.7
Root operations 3.7
Administration—Section 3 3.10
Root operations 3.10
Measurement and Monitoring—Section 4 3.12
Root operations 3.12
Extracorporeal Assistance and Performance—Section 5 3.14
Root operations 3.14
Extracorporeal Therapies—Section 6 3.16
Root operations 3.16
Osteopathic—Section 7 3.19
Other Procedures—Section 8 3.20
Chiropractic—Section 9 3.22
Procedures in the Medical and Surgical-related sections 3.3
Preliminary
12/10/07
Chapter 3
Procedures in the Medical and
Surgical-related sections
THIS CHAPTER PROVIDES reference material for procedure
codes in sections 1–9 of ICD-10-PCS. These nine sections define
procedures related to the M
EDICAL AND SURGICAL section. Codes
in these sections contain characters not previously defined, such
as substance, function, and method.
First, a table is provided, listing the sections in order. Following
the table, reference material is provided for each section, and
includes
◆ General description of the section
◆ A table listing each root operation in the section, with its
corresponding definition
◆ Coding notes as needed
◆ Representative examples of procedures coded in that sec-
tion, in table excerpt format, with explanatory notes as
needed
◆ Coding exercises that provide example procedures and their
corresponding ICD-10-PCS codes, with explanatory notes as
needed
3.4 ICD-10-PCS Reference Manual
12/10/07
Preliminary
List of Medical and Surgical-related sections of
ICD-10-PCS
Nine additional sections of ICD-10-PCS include procedures
related to the M
EDICAL AND SURGICAL section, such as obstetrical
procedures, administration of substances, and extracorporeal
procedures.
Section value Description
1 Obstetrics
2Placement
3 Administration
4 Measurement and Monitoring
5 Extracorporeal Assistance and Performance
6 Extracorporeal Therapies
7 Osteopathic
8 Other Procedures
9 Chiropractic
Procedures in the Medical and Surgical-related sections 3.5
Preliminary
12/10/07
Obstetrics—Section 1
The OBSTETRICS section follows the same conventions established
in the M
EDICAL AND SURGICAL section, with all seven characters
retaining the same meaning, as shown in this example of a low
forceps extraction.
Root operations There are twelve root operations in the OBSTETRICS section. Ten
of these are also found in the M
EDICAL AND SURGICAL section.
For the complete list of root operations and their definitions,
please refer to appendix A.
The two root operations unique to O
BSTETRICS are defined below.
Coding note: Abortion
ABORTION is subdivided according to whether an additional
device such as a laminaria or abortifacient is used, or whether
the abortion was performed by mechanical means.
If either a laminaria or abortifacient is used, then the approach
is V
IA NATURAL OR ARTIFICIAL OPENING.
All other abortion procedures are those done by mechanical
means (the products of conception are physically removed
using instrumentation), and the device value is Z, N
O DEVICE.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
OBSTETRICS PREGNANCY EXTRACTION PRODUCTS OF
C
ONCEPTION
VIA N AT./ARTIF.
O
PENING
NO DEVICE LOW FORCEPS
10D07Z3
Value Description Definition
A Abortion Artificially terminating a pregnancy
E Delivery Assisting the passage of the products of
conception from the genital canal
Obstetrics—Section 1
3.6 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Example: Transvaginal abortion using vacuum aspiration technique
Coding note: Delivery
DELIVERY applies only to manually-assisted, vaginal delivery and
is defined as assisting the passage of the products of conception
from the genital canal. Cesarean deliveries are coded in this sec-
tion to the root operation E
XTRACTION.
Example: Manually-assisted delivery
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
OBSTETRICS PREGNANCY ABORTION PRODUCTS OF
C
ONCEPTION
V
IA N AT./ARTIF.
O
PENING
NO DEVICE NO QUALIFIER
10A07ZZ
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
OBSTETRICS PREGNANCY DELIVERY PRODUCTS OF
C
ONCEPTION
E
XTERNAL NO DEVICE NO QUALIFIER
10E0XZZ
Procedure Code
Abortion by dilation and evacuation following laminaria
insertion
10A07ZW
Manually assisted spontaneous abortion 10E0XZZ Since the pregnancy was not artificially
terminated, this is coded to DELIVERY, because it captures
the procedure objective. The fact that it was an abortion will
be identified in the diagnosis code.
Abortion by abortifacient insertion 10A07ZX
Bimanual pregnancy examination 10J07ZZ
Extraperitoneal c-section, low transverse incision 10D00Z2
Fetal spinal tap, percutaneous 10903ZA
Fetal kidney transplant, laparoscopic 10Y04ZS
Open in utero repair of congenital diaphragmatic hernia 10Q00ZK Diaphragm is classified to the R
ESPIRATORY body
system in the M
EDICAL AND SURGICAL section.
Laparoscopy with total excision of tubal pregnancy 10T24ZZ
Transvaginal removal of fetal monitoring electrode 10P073Z
Procedures in the Medical and Surgical-related sections 3.7
Preliminary
12/10/07
Placement—Section 2
The PLACEMENT section follows the same conventions established
in the M
EDICAL AND SURGICAL section, with all seven characters
retaining the same meaning, as in the example of cast change on
the right forearm below.
Root operations The root operations in the PLACEMENT section include only those
procedures performed without making an incision or a puncture.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Region
Character 5
Approach
Character 6
Device
Character 7
Qualifier
PLACEMENT ANATOMICAL
R
EGIONS
CHANGE LOWER ARM,
R
IGHT
EXTERNAL CAST NO QUALIFIER
2W0CX 2 Z
Value Description Definition
0 Change Taking out or off a device from a body
region and putting back an identical or
similar device in or on the same body
region without cutting or puncturing the skin
or a mucous membrane
1 Compression Putting pressure on a body region
2 Dressing Putting material on a body region for
protection
3 Immobilization Limiting or preventing motion of a body
region
4 Packing Putting material in a body region
5 Removal Taking out or off a device from a body
region
6 Traction Exerting a pulling force on a body region in
a distal direction
Placement—Section 2
3.8 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Example: Change of vaginal packing
Example: Placement of pressure dressing on abdominal wall
Example: Application of sterile dressing to head wound
Coding note: Immobilization
The procedures to fit a device, such as splints and braces, as
described in F0DZ6EZ and F0DZ7EZ, apply only to the rehabili-
tation setting. Splints and braces placed in other inpatient settings
are coded to I
MMOBILIZATION, table 2X3 in the PLACEMENT section.
Example: Placement of splint on left finger
Example: Placement of nasal packing
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Region
Character 5
Approach
Character 6
Device
Character 7
Qualifier
PLACEMENT ANATOMICAL
O
RIFICES
CHANGE FEMALE
G
ENITAL TRACT
EXTERNAL PACKING
M
ATERIAL
NO QUALIFIER
2Y04X5Z
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Region
Character 5
Approach
Character 6
Device
Character 7
Qualifier
PLACEMENT ANATOMICAL
R
EGIONS
COMPRESSION ABDOMINAL
W
ALL
EXTERNAL PRESSURE
D
RESSING
NO QUALIFIER
2W1 3 X 6 Z
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Region
Character 5
Approach
Character 6
Device
Character 7
Qualifier
PLACEMENT ANATOMICAL
R
EGIONS
DRESSING HEAD EXTERNAL BANDAGE NO QUALIFIER
2W2 0 X 4 Z
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Region
Character 5
Approach
Character 6
Device
Character 7
Qualifier
PLACEMENT ANATOMICAL
R
EGIONS
IMMOBILIZATION FINGER, LEFT EXTERNAL SPLINT NO QUALIFIER
2W3KX 1 Z
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Region
Character 5
Approach
Character 6
Device
Character 7
Qualifier
PLACEMENT ANATOMICAL
O
RIFICES
PACKING NASAL EXTERNAL PACKING
M
ATERIAL
NO QUALIFIER
2Y41X5Z
Placement—Section 2
Procedures in the Medical and Surgical-related sections 3.9
Preliminary
12/10/07
Example: Removal of stereotactic head frame
Coding note: Traction
TRACTION in this section includes only the task performed using
a mechanical traction apparatus. Manual traction performed by
a physical therapist is coded to M
ANUAL THERAPY TECHNIQUES in
section F, P
HYSICAL REHABILITATION AND DIAGNOSTIC AUDIOLOGY
(see page 4.13).
Example: Lumbar traction using motorized split-traction table
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Region
Character 5
Approach
Character 6
Device
Character 7
Qualifier
PLACEMENT ANATOMICAL
R
EGIONS
REMOVAL HEAD EXTERNAL STEREOTACTIC
A
PPARATUS
NO QUALIFIER
2W5 0 X 8 Z
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Region
Character 5
Approach
Character 6
Device
Character 7
Qualifier
PLACEMENT ANATOMICAL
R
EGIONS
TRACTION BACK EXTERNAL TRACTION
A
PPARATUS
NO QUALIFIER
2W6 5 X 0 Z
Procedure Code
Placement of packing material, right ear 2Y42X5Z
Mechanical traction of entire left leg 2W6MX0Z
Removal of splint, right shoulder 2W5AX1Z
Placement of neck brace 2W32X3Z
Change of vaginal packing 2Y04X5Z
Packing of wound, chest wall 2W44X5Z
Sterile dressing placement to left groin region 2W27X4Z
Removal of packing material from pharynx 2Y50X5Z
Placement of intermittent pneumatic compression device, covering
entire right arm
2W18X7Z
Exchange of pressure dressing to left thigh 2W0PX6Z
3.10 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Administration—Section 3
The ADMINISTRATION section includes infusions, injections, and
transfusions, as well as other related procedures, such as irriga-
tion and tattooing. All codes in this section define procedures
where a diagnostic or therapeutic substance is given to the
patient, as in the platelet transfusion example below.
Root operations Root operations in this section are classified according to the
broad category of substance administered. If the substance
given is a blood product or a cleansing substance, then the pro-
cedure is coded to T
RANSFUSION and IRRIGATION respectively. All
the other substances administered, such as anti-neoplastic sub-
stances, are coded to the root operation I
NTRODUCTION.
Example: Nerve block injection to median nerve
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Approach
Character 6
Substance
Character 7
Qualifier
ADMINISTRATION CIRCULATORY TRANSFUSION CENTRAL VEIN PERCUTANEOUS PLATELETS NONAUTO-
LOGOUS
30243R1
Value Description Definition
0 Introduction Putting in or on a therapeutic, diagnostic,
nutritional, physiological, or prophylactic
substance except blood or blood products
1 Irrigation Putting in or on a cleansing substance
2 Transfusion Putting in blood or blood products
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Approach
Character 6
Substance
Character 7
Qualifier
ADMINISTRATION PHYS. SYS. &
A
NAT. REGIONS
INTRODUCTION PERIPHERAL
N
ERVES
PERCUTANEOUS REGIONAL
A
NESTHETIC
NO QUALIFIER
3E0T3CZ
Administration—Section 3
Procedures in the Medical and Surgical-related sections 3.11
Preliminary
12/10/07
Example: Flushing of eye
Example: Transfusion of cell saver red cells into central venous line
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Approach
Character 6
Substance
Character 7
Qualifier
ADMINISTRATION PHYS. SYS. &
A
NAT. REGIONS
IRRIGATION EYE EXTERNAL IRRIGATING
S
UBSTANCE
NO QUALIFIER
3E1CX8Z
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Approach
Character 6
Substance
Character 7
Qualifier
ADMINISTRATION CIRCULATORY TRANSFUSION CENTRAL VEIN PERCUTANEOUS RED BLOOD
C
ELLS
AUTOLOGOUS
3 0243N0
Procedure Code
Peritoneal dialysis via indwelling catheter 3E1M39Z
Transvaginal artificial insemination 3E0P7LZ
Infusion of total parenteral nutrition via central
venous catheter
3E0436Z
Esophagogastroscopy with botox injection into
esophageal sphincter
3E0G8GC Botulinum toxin is a paralyzing agent with temporary
effects; it does not sclerose or destroy the nerve.
Percutaneous irrigation of knee joint 3E1U38Z
Epidural injection of mixed steroid and local
anesthetic for pain control
3E0S33Z This is coded to the substance value A
NTI-INFLAMMATORY.
The anesthetic is only added to lessen the pain of the injection.
Chemical pleurodesis using injection of
tetracycline
3E0L3TZ
Transfusion of antihemophilic factor,
(nonautologous) via arterial central line
30263V1
Transabdominal in-vitro fertilization,
implantation of donor ovum
3E0P3Q1
Autologous bone marrow transplant via
central venous line
30243G0
3.12 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Measurement and Monitoring—Section 4
There are two root operations in this section, and they differ in
only one respect: M
EASUREMENT defines one procedure and
M
ONITORING defines a series of procedures.
Root operations MEASUREMENT describes a single level taken, while MONITORING
describes a series of levels obtained at intervals. For example,
◆ A single temperature reading is considered MEASUREMENT.
◆ Temperature taken every half hour for 8 hours is considered
M
ONITORING.
Instead of defining a device, the sixth character defines the
physiological or physical function being tested.
Example: External electrocardiogram (EKG), single reading
Example: Urinary pressure monitoring
Value Description Definition
0 Measurement Determining the level of a physiological or
physical function at a point in time
1 Monitoring Determining the level of a physiological or
physical function repetitively over a period of
time
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Approach
Character 6
Function
Character 7
Qualifier
MEASUREMENT
& M
ONITORING
PHYSIOLOGICAL
S
YSTEMS
MEASUREMENT CARDIAC EXTERNAL ELECTRICAL
A
CTIVITY
NO QUALIFIER
4A02X4Z
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Approach
Character 6
Device
Character 7
Qualifier
MEASUREMENT
& M
ONITORING
PHYSIOLOGICAL
S
YSTEMS
MONITORING URINARY VIA NAT./ARTIF.
O
PENING
PRESSURE NO QUALIFIER
4A1D7BZ
Measurement and Monitoring—Section 4
Procedures in the Medical and Surgical-related sections 3.13
Preliminary
12/10/07
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Cardiac stress test, single measurement 4A02XM4
EGD with biliary flow measurement 4A0C85Z
Temperature monitoring, rectal 4A1G7KZ
Peripheral venous pulse, external, single measurement 4A04XJ1
Holter monitoring 4A12X45
Respiratory rate, external, single measurement 4A09XCZ
Fetal heart rate monitoring, transvaginal 4A1H7CZ
Visual mobility test, single measurement 4A07X7Z
Pulmonary artery wedge pressure monitoring from Swan-Ganz
catheter
4A133B3
Olfactory acuity test, single measurement 4A08X0Z
3.14 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Extracorporeal Assistance and Performance—
Section 5
This section includes procedures performed in a critical care
setting, such as mechanical ventilation and cardioversion. It also
includes other procedures, such as hemodialysis and hyper-
baric oxygen treatment. These procedures all use equipment to
support a physiological function in some way, whether it is
breathing, circulating the blood, or restoring the natural rhythm
of the heart.
The fifth and sixth characters in this section define duration and
function respectively. These characters describe the duration of
the procedure and the body function being acted upon, rather
than the approach and device used.
Root operations ASSISTANCE and PERFORMANCE are two variations of the same
kinds of procedures, varying only in the degree of control exer-
cised over the physiological function.
Coding note: Assistance
ASSISTANCE defines procedures that support a physiological
function but do not take complete control of it, such as
intra-aortic balloon pump to support cardiac output and hyper-
baric oxygen treatment.
Example: Hyperbaric oxygenation of wound
Value Description Definition
0 Assistance Taking over a portion of a physiological
function by extracorporeal means
1 Performance Completely taking over a physiological
function by extracorporeal means
2 Restoration Returning, or attempting to return, a
physiological function to its original state by
extracorporeal means
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Function
Character 7
Qualifier
EXTRACORP.
A
SSISTANCE &
P
ERFORMANCE
PHYSIOLOGICAL
S
YSTEMS
ASSISTANCE CIRCULATORY INTERMITTENT OXYGENATION HYPERBARIC
5A05121
Extracorporeal Assistance and Performance—Section 5
Procedures in the Medical and Surgical-related sections 3.15
Preliminary
12/10/07
Coding note: Performance
PERFORMANCE defines procedures where complete control is exer-
cised over a physiological function, such as total mechanical
ventilation, cardiac pacing, and cardiopulmonary bypass.
Example: Cardiopulmonary bypass in conjunction with CABG
Coding note: Restoration
RESTORATION defines only external cardioversion and defibrilla-
tion procedures. Failed cardioversion procedures are also
included in the definition of R
ESTORATION, and are coded the
same as successful procedures.
Example: Attempted cardiac defibrillation, unsuccessful
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Function
Character 7
Qualifier
EXTRACORP.
A
SSISTANCE &
P
ERFORMANCE
PHYSIOLOGICAL
S
YSTEMS
PERFORMANCE CARDIAC CONTINUOUS OUTPUT NO QUALIFIER
5A1221Z
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Function
Character 7
Qualifier
EXTRACORP.
A
SSIST. AND
P
ERFORMANCE
PHYSIOLOGICAL
S
YSTEMS
RESTORATION CARDIAC SINGLE RHYTHM NO QUALIFIER
5A2204Z
Procedure Code
Intermittent mechanical ventilation 5A0915Z
Liver dialysis, single encounter 5A1C00Z
Cardiac countershock with successful conversion to sinus rhythm 5A2204Z
IPPB (intermittent positive pressure breathing) for mobilization of
secretions
5A0915Z
Renal dialysis, series of encounters 5A1D60Z
IABP (intra-aortic balloon pump) continuous 5A02210
Intra-operative cardiac pacing, continuous 5A1223Z
ECMO (extracorporeal membrane oxygenation), continuous 5A15223
Controlled mechanical ventilation (CMV), 45 hours 5A1945Z
Pulsatile compression boot with intermittent inflation 5A02115 This is coded to the function value
C
ARDIAC OUTPUT, because the purpose of
such compression devices is to return blood to
the heart faster.
3.16 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Extracorporeal Therapies—Section 6
Section 6, EXTRACORPOREAL THERAPIES, describes other extra-
corporeal procedures that are not defined by A
SSISTANCE and
P
ERFORMANCE in section 5 (see page 3.14). Examples are bili-lite
phototherapy, apheresis, and whole body hypothermia.
The second character contains a single general body system
choice, P
HYSIOLOGICAL SYSTEMS, as in the phototherapy
example below. The sixth character is defined as a qualifier, but
contains no specific qualifier values. The seventh-character
qualifier identifies various blood components separated out in
pheresis procedures.
Root operations The meaning of each root operation is consistent with the term
as used in the medical community. D
ECOMPRESSION and HYPER-
THERMIA have a more specialized meaning. All are defined in the
table below.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Qualifier
Character 7
Qualifier
EXTRACORP.
T
HERAPIES
PHYSIOLOGICAL
S
YSTEMS
PHOTOTHERAPY SKIN SINGLE NO QUALIFIER NO QUALIFIER
6A600ZZ
Value Description Definition
0 Atmospheric
Control
Extracorporeal control of atmospheric
pressure and composition
1 Decompression Extracorporeal elimination of undissolved
gas from body fluids
2 Electromagnetic
Therapy
Extracorporeal treatment by
electromagnetic rays
3 Hyperthermia Extracorporeal raising of body
temperature
4 Hypothermia Extracorporeal lowering of body
temperature
5 Pheresis Extracorporeal separation of blood
products
Extracorporeal Therapies—Section 6
Procedures in the Medical and Surgical-related sections 3.17
Preliminary
12/10/07
Coding note: Decompression
DECOMPRESSION describes a single type of procedure—treatment
for decompression sickness (the bends) in a hyperbaric chamber.
Example: Hyperbaric decompression treatment, single
Coding note: Hyperthermia
HYPERTHERMIA is used both to treat temperature imbalance, and as
an adjunct radiation treatment for cancer. When performed to treat
temperature imbalance, the procedure is coded to this section.
When performed for cancer treatment, whole-body hyperther-
mia is classified as a modality qualifier in section D, R
ADIATION
O
NCOLOGY (see page 4.11).
Example: Whole body hypothermia treatment for temperature imbalance, series
Coding note: Pheresis
PHERESIS is used in medical practice for two main purposes: to
treat diseases where too much of a blood component is pro-
duced, such as leukemia, or to remove a blood product such as
platelets from a donor, for transfusion into a patient who needs
them.
6 Phototherapy Extracorporeal treatment by light rays
7 Ultrasound
Therapy
Extracorporeal treatment by ultrasound
8 Ultraviolet Light
Therapy
Extracorporeal treatment by ultraviolet
light
9 Shock Wave
Therapy
Extracorporeal treatment by shock waves
Value Description Definition
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Qualifier
Character 7
Qualifier
EXTRACORP.
T
HERAPIES
PHYSIOLOGICAL
S
YSTEMS
DECOM-
PRESSION
CIRCULATORY SINGLE NO QUALIFIER NO QUALIFIER
6A150ZZ
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Qualifier
Character 7
Qualifier
EXTRACORP.
T
HERAPIES
PHYSIOLOGICAL
S
YSTEMS
HYPOTHERMIA WHOLE BODY MULTIPLE NO QUALIFIER NO QUALIFIER
6A4G1ZZ
Extracorporeal Therapies—Section 6
3.18 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Example: Therapeutic leukapheresis, single treatment
Coding note: Phototherapy
PHOTOTHERAPY to the circulatory system means exposing the
blood to light rays outside the body, using a machine that recir-
culates the blood and returns it to the body after phototherapy.
Example: Phototherapy of circulatory system, series treatment
Example: Ultraviolet light phototherapy, series treatment
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Qualifier
Character 7
Qualifier
EXTRACORP.
T
HERAPIES
PHYSIOLOGICAL
S
YSTEMS
PHERESIS CIRCULATORY SINGLE NO QUALIFIER LEUKOCYTES
6A550Z1
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Qualifier
Character 7
Qualifier
EXTRACORP.
T
HERAPIES
PHYSIOLOGICAL
S
YSTEMS
PHOTOTHERAPY CIRCULATORY MULTIPLE NO QUALIFIER NO QUALIFIER
6A651ZZ
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body System
Character 5
Duration
Character 6
Qualifier
Character 7
Qualifier
EXTRACORP.
T
HERAPIES
PHYSIOLOGICAL
S
YSTEMS
UV LIGHT
P
HOTOTHERAPY
SKIN MULTIPLE NO QUALIFIER NO QUALIFIER
6A801ZZ
Procedure Code
Donor thrombocytapheresis, single encounter 6A550Z2
Bili-lite UV phototherapy, series treatment 6A801ZZ
Whole body hypothermia, single treatment 6A4G0ZZ
Circulatory phototherapy, single encounter 6A650ZZ
Shock wave therapy of plantar fascia, single treatment 6A930ZZ
Antigen-free air conditioning, series treatment 6A0G1ZZ
TMS (transcranial magnetic stimulation), series treatment 6A221ZZ
Therapeutic ultrasound of peripheral vessels, single treatment 6A750ZZ
Plasmapheresis, series treatment 6A551Z3
Extracorporeal electromagnetic stimulation (EMS) for urinary incontinence, single
treatment
6A210ZZ
Procedures in the Medical and Surgical-related sections 3.19
Preliminary
12/10/07
Osteopathic—Section 7
Section 7, OSTEOPATHIC, is one of the smallest sections in
ICD-10-PCS. There is a single body system, A
NATOMICAL
R
EGIONS, and a single root operation, TREATMENT.
The sixth-character methods such as L
YMPHATIC PUMP and FASCIAL
R
ELEASE are not explicitly defined in ICD-10-PCS, and rely on the
standard definitions as used in this specialty.
Example: Fascial release of abdomen, osteopathic treatment
Example: General osteopathic mobilization of legs
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Value Description Definition
0 Treatment Manual treatment to eliminate or alleviate
somatic dysfunction and related disorders
Character 1
Section
Character 2
Body System
Character 3
Operation
Character 4
Body Region
Character 5
Approach
Character 6
Method
Character 7
Qualifier
OSTEOPATHIC ANATOMICAL
R
EGIONS
TREATMENT ABDOMEN EXTERNAL FASCIAL
R
ELEASE
NO QUALIFIER
7W0 9 X 1 Z
Character 1
Section
Character 2
Body System
Character 3
Operation
Character 4
Body Region
Character 5
Approach
Character 6
Method
Character 7
Qualifier
OSTEOPATHIC ANATOMICAL
R
EGIONS
TREATMENT LOWER
E
XTREMITIES
EXTERNAL GENERAL
M
OBILIZATION
NO QUALIFIER
7W0 6 X 2 Z
Procedures Code
Isotonic muscle energy treatment of right leg 7W06X8Z
Low velocity-high amplitude osteopathic treatment of head 7W00X5Z
Lymphatic pump osteopathic treatment of left axilla 7W07X6Z
Indirect osteopathic treatment of sacrum 7W04X4Z
Articulatory osteopathic treatment of cervical region 7W01X0Z
3.20 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Other Procedures—Section 8
The OTHER PROCEDURES section contains codes for procedures
not included in the other medical and surgical-related sections.
A single root operation, O
THER PROCEDURES, is defined below.
There are relatively few procedure codes in this section, for
nontraditional, whole body therapies including acupuncture and
meditation. There is also a code for the fertilization portion of
an in-vitro
fertilization procedure.
Example: Acupuncture
Example: Yoga therapy
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Value Description Definition
0 Other Procedures 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
OTHER
P
ROCEDURES
ANATOMICAL
R
EGIONS
OTHER
P
ROCEDURES
WHOLE BODY PERCUTANEOUS ACUPUNCTURE NO QUALIFIER
8W0030Z
Character 1
Section
Character 2
Body System
Character 3
Root Operation
Character 4
Body Region
Character 5
Approach
Character 6
Method
Character 7
Qualifier
OTHER
P
ROCEDURES
ANATOMICAL
R
EGIONS
OTHER
P
ROCEDURES
WHOLE BODY EXTERNAL YOGA THERAPY NO QUALIFIER
8W0 0 X 2 Z
Procedure Code
Meditation therapy 8W00X3Z
Procedures in the Medical and Surgical-related sections 3.21
Preliminary
12/10/07
Therapeutic massage 8W00X1Z
Suture removal, abdominal wall 8W02X87
Isolation after infectious disease exposure 8W00X5Z
In-vitro fertilization, extracorporeal ovum
fertilization
8W0ZX41
Procedure Code
3.22 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Chiropractic—Section 9
The CHIROPRACTIC section consists of a single body system,
A
NATOMICAL REGIONS, and a single root operation, MANIPULATION,
defined below.
Example: Chiropractic treatment of cervical spine, short lever specific contact
Example: Non-manual chiropractic manipulation of pelvis
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Value Description Definition
B Manipulation Manual procedure that involves a directed
thrust to move a joint past the
physiological range of motion, without
exceeding the anatomical limit
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 ANATOMICAL
R
EGIONS
MANIPULATION CERVICAL EXTERNAL SHORT LEVER
S
P. CONTACT
NO QUALIFIER
9WB 1 XHZ
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 ANATOMICAL
R
EGIONS
MANIPULATION PELVIS EXTERNAL NON-MANUAL NO QUALIFIER
9WB 5 XBZ
Procedure Code
Chiropractic treatment of lumbar region using long lever specific contact 9WB3XGZ
Chiropractic manipulation of abdominal region, indirect visceral 9WB9XCZ
Chiropractic extra-articular treatment of hip region 9WB6XDZ
Chiropractic treatment of sacrum using long and short lever specific contact 9WB4XJZ
Mechanically-assisted chiropractic manipulation of head 9WB0XKZ
Chiropractic—Section 9
Procedures in the Medical and Surgical-related sections 3.23
Preliminary
12/10/07
Chiropractic—Section 9
3.24 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Preliminary
12/10/07
Chapter 4
4Procedures in the ancillary
sections
4.2 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Contents Procedures in the ancillary sections 4.3
List of ancillary sections in ICD-10-PCS 4.4
Imaging—Section B 4.5
Root types 4.5
Nuclear Medicine—Section C 4.8
Root types 4.8
Radiation Oncology—Section D 4.11
Root type 4.11
Physical Rehabilitation and Diagnostic Audiology—Section F 4.13
Root types 4.13
Mental Health—Section G 4.17
Root Type 4.17
Substance Abuse Treatment—Section H 4.19
Root Types 4.19
Procedures in the ancillary sections 4.3
Preliminary
12/10/07
Chapter 4
Procedures in the ancillary
sections
THIS CHAPTER PROVIDES reference material for procedure
codes in the six ancillary sections of ICD-10-PCS (B–D, F–H).
Codes in these sections contain characters not previously defined,
such as contrast, modality qualifier and equipment.
First, a table is provided, listing the sections in order. Following
the table, reference material is provided for each section, and
includes
◆ General description of the section
◆ A table listing each root type in the section, with its corre-
sponding definition (sections B, C and F only)
◆ Coding notes as needed
◆ Representative examples of procedures coded in that section,
in table excerpt format, with explanatory notes as needed
◆ Coding exercises that provide example procedures and their
corresponding ICD-10-PCS codes, with explanatory notes as
needed
4.4 ICD-10-PCS Reference Manual
12/10/07
Preliminary
List of ancillary sections in ICD-10-PCS
Six ancillary sections of ICD-10-PCS include procedures such as
imaging, radiation oncology, and rehabilitation.
Section value Description
B Imaging
C Nuclear Medicine
D Radiation Oncology
F Physical Rehabilitation and Diagnostic Audiology
G Mental Health
H Substance Abuse Treatment
Procedures in the ancillary sections 4.5
Preliminary
12/10/07
Imaging—Section B
IMAGING follows the same conventions established in the MEDI-
CAL AND SURGICAL section (see chapter 2), for the section, body
system, and body part characters. However, the third and fourth
characters introduce definitions not used in previous sections.
◆ Third character defines procedure by root type, instead of
root operation.
◆ Fifth character defines contrast if used.
◆ Sixth character is a qualifier that specifies an image taken
without contrast followed by one with contrast.
◆ Seventh character is a qualifier that is not specified in this
section.
Root types The IMAGING root types are defined in the following table.
Value Description Definition
0Plain
Radiography
Planar display of an image developed from
the capture of external ionizing radiation on
photographic or photoconductive plate
1 Fluoroscopy Single plane or bi-plane real time display
of an image developed from the capture of
external ionizing radiation on a fluorescent
screen. The image may also be stored by
either digital or analog means
2 Computerized
Tomography (CT
scan)
Computer reformatted digital display of
multiplanar images developed from the
capture of multiple exposures of external
ionizing radiation
3 Magnetic
Resonance
Imaging (MRI)
Computer reformatted digital display of
multiplanar images developed from the
capture of radio-frequency signals emitted
by nuclei in a body site excited within a
magnetic field
4 Ultrasonography Real time display of images of anatomy or
flow information developed from the
capture of reflected and attenuated high
frequency sound waves
Imaging—Section B
4.6 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Example: X-ray of right clavicle, limited study
Example: Fluoroscopy of renal dialysis shunt using CO2 contrast
Example: CT of brain without contrast followed by high osmolar contrast
Example: MRI of liver using Gadoteridol
Example: Ultrasound of prostate gland
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Body Part
Character 5
Contrast
Character 6
Qualifier
Character 7
Qualifier
IMAGING NON-AXIAL
U
PPER BONES
PLAIN
R
ADIOGRAPHY
CLAVICLE,
R
IGHT
NONE NONE NONE
BP04ZZZ
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Body Part
Character 5
Contrast
Character 6
Qualifier
Character 7
Qualifier
IMAGING VEINS FLUOROSCOPY DIALYSIS
S
HUNT/FISTULA
OTHER
C
ONTRAST
NONE NONE
B51WYZZ
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Body Part
Character 5
Contrast
Character 6
Qualifier
Character 7
Qualifier
IMAGING CENTRAL
N
ERVOUS
C
OMPUTERIZED
T
OMOGRAPHY
BRAIN HIGH OSMOLAR UNENHANCED
AND ENHANCED
NONE
B02000Z
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Body Part
Character 5
Contrast
Character 6
Qualifier
Character 7
Qualifier
IMAGING HEPATOBILIARY
& P
ANCREAS
M
AGNETIC
R
ESONANCE
I
MAGING
LIVER OTHER
C
ONTRAST
NONE NONE
BF35YZZ
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Body Part
Character 5
Contrast
Character 6
Qualifier
Character 7
Qualifier
IMAGING MALE
R
EPRODUCTIVE
U
LTRA-
SONOGRAPHY
PROSTATE AND
S
EMINAL
V
ESICLES
NONE NONE NONE
BV49ZZZ
Imaging—Section B
Procedures in the ancillary sections 4.7
Preliminary
12/10/07
Procedure Code
Non-contrast CT of abdomen and pelvis BW21ZZZ
Ultrasound guidance for catheter placement, left subclavian artery B342ZZZ
Chest X-ray, AP/PA and lateral views BW03ZZZ
Endoluminal ultrasound of gallbladder and bile ducts BF43ZZZ
MRI of thyroid gland, contrast unspecified BG34YZZ
Esophageal videofluoroscopy study with oral barium contrast BD11YZZ
Portable X-ray study of right radius/ulna shaft, standard series BP0JZZZ
Routine fetal ultrasound, second trimester twin gestation BY4DZZZ
CT scan of bilateral lungs, high osmolar contrast with densitometry BB240ZZ
Fluoroscopic guidance for percutaneous transluminal angioplasty (PTA) of left common
femoral artery, low osmolar contrast
B41G1ZZ
4.8 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Nuclear Medicine—Section C
NUCLEAR MEDICINE is organized like the IMAGING section (see
page 4.5). The only significant difference is that the fifth charac-
ter defines the radionuclide instead of the contrast material used
in the procedure, as described below.
◆ The fifth character specifies the radionuclide, the radiation
source used in the procedure. Choices are applicable for the
root procedure type.
◆ The sixth and seventh characters are qualifiers, and are not
specified in this section.
Root types The third character classifies the procedure by root type instead
of by root operation.
Value Description Definition
1 Planar Nuclear
Medicine Imaging
Introduction of radioactive materials into
the body for single plane display of images
developed from the capture of radioactive
emissions
2 Tomographic
(Tomo) Nuclear
Medicine Imaging
Introduction of radioactive materials into
the body for three-dimensional display of
images developed from the capture of
radioactive emissions
3 Positron Emission
To mo g ra p hy
(PET)
Introduction of radioactive materials into
the body for three-dimensional display of
images developed from the simultaneous
capture, 180 degrees apart, of radioactive
emissions
4 Nonimaging
Nuclear Medicine
Uptake
Introduction of radioactive materials into
the body for measurements of organ
function, from the detection of radioactive
emissions
Nuclear Medicine—Section C
Procedures in the ancillary sections 4.9
Preliminary
12/10/07
Example: Adenosine sestamibi (technetium) planar scan of heart muscle at rest
Example: Technetium tomo scan of liver
5 Nonimaging
Nuclear Medicine
Probe
Introduction of radioactive materials into
the body for the study of distribution and
fate of certain substances by the detection
of radioactive emissions from an external
source
6 Nonimaging
Nuclear medicine
Assay
Introduction of radioactive materials into
the body for the study of body fluids and
blood elements, by the detection of
radioactive emissions
7 Systemic Nuclear
Medicine Therapy
Introduction of unsealed radioactive
materials into the body for treatment
Value Description Definition
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Body Part
Character 5
Radionuclide
Character 6
Qualifier.
Character 7
Qualifier
NUCLEAR
M
EDICINE
HEART PLANAR
N
UCLEAR
I
MAGING
MYOCARDIUM TECHNETIUM
99
M
NONE NONE
C21G1ZZ
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Body Part
Character 5
Radionuclide
Character 6
Qualifier.
Character 7
Qualifier
NUCLEAR
M
EDICINE
HEPATOBILIARY
AND PANCREAS
TOMO N UCLEAR
I
MAGING
LIVER TECHNETIUM
99
M
NONE NONE
CF251ZZ
Nuclear Medicine—Section C
4.10 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Tomo scan of right and left heart, unspecified radiopharmaceutical, qualitative gated
rest
C226YZZ
Technetium pentetate assay of kidneys, ureters, and bladder CT631ZZ
Uniplanar scan of spine using technetium oxidronate, with first pass study CP151ZZ
Thallous chloride tomographic scan of bilateral breasts CH22SZZ
PET scan of myocardium using rubidium C23GQZZ
Gallium citrate scan of head and neck, single plane imaging CW1BLZZ
Xenon gas nonimaging probe of brain C050VZZ
Upper GI scan, radiopharmaceutical unspecified, for gastric emptying CD15YZZ
Carbon 11 PET scan of brain with quantification C030BZZ
Iodinated albumin nuclear medicine assay, blood plasma volume study C763HZZ
Procedures in the ancillary sections 4.11
Preliminary
12/10/07
Radiation Oncology—Section D
RADIATION ONCOLOGY contains the radiation procedures per-
formed for cancer treatment. Character meanings are described
below.
◆ Third character defines root type, which is the basic
modality.
◆ Fifth character further specifies treatment modality.
◆ Sixth character defines the radioactive isotope used, if
applicable.
◆ Seventh character is a qualifier, and is not specified in this
section.
Root type The third character defines the treatment modality as root type.
Examples are B
RACHYTHERAPY and STEREOTACTIC RADIOSURGERY.
Four different root types are used in this section, as listed in the
table below.
Example: LDR Brachytherapy of cervix using Iridium 192
Example: Intraoperative radiation therapy (IORT) of bladder
Value Description
0 Beam Radiation
1 Brachytherapy
2 Stereotactic Radiosurgery
Y Other Radiation
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Body Part
Character 5
Modal. Qualifier
Character 6
Isotope
Character 7
Qualifier
RADIATION
O
NCOLOGY
FEMALE
R
EPRODUCTIVE
BRACHY-
THERAPY
CERVIX LDR BRACHY-
THERAPY
IRIDIUM 192 NONE
DU1 1 B8 Z
Character 1
Section
Character 2
Body Sys
Character 3
Root Type
Character 4
Body Part
Character 5
Modal. Qualifier
Character 6
Isotope
Character 7
Qualifier
RADIATION
O
NCOLOGY
URINARY
S
YSTEM
OTHER
R
ADIATION
BLADDER IORT NONE NONE
DTY2CZZ
Radiation Oncology—Section D
4.12 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Plaque radiation of left eye, single port D8Y0FZZ
8 MeV photon beam radiation to brain D0011ZZ
IORT of colon, 3 ports DDY5CZZ
HDR Brachytherapy of prostate using Palladium 103 DV109BZ
Electron radiation treatment of right breast, custom device DM013ZZ
Hyperthermia oncology treatment of pelvic region DWY68ZZ
Contact radiation of tongue D9Y57ZZ
Heavy particle radiation treatment of pancreas, four risk sites DF034ZZ
LDR brachytherapy to spinal cord using iodine D016B9Z
Whole body Phosphorus 32 administration with risk to hematopoetic system DWY5GFZ
Procedures in the ancillary sections 4.13
Preliminary
12/10/07
Physical Rehabilitation and Diagnostic
Audiology—Section F
PHYSICAL REHABILITATION AND DIAGNOSTIC AUDIOLOGY contains
character definitions unlike the other sections in ICD-10-PCS.
They are described below.
◆ Second character is a section qualifier that specifies whether
the procedure is a rehabilitation or diagnostic audiology
procedure.
◆ Third character defines the general procedure root type.
◆ Fourth character defines the body system and body region
combined, where applicable
◆ Fifth character further specifies the procedure type.
◆ Sixth character specifies the equipment used, if any.
Root types This section uses the third character to classify procedures into
14 root types. They are defined in the table below.
Value Description Definition
0 Speech
Assessment
Measurement of speech and related
functions
1 Motor and/or
Nerve Function
Assessment
Measurement of motor, nerve, and related
functions
2 Activities of
Daily Living
Assessment
Measurement of functional level for
activities of daily living
3 Hearing
Assessment
Measurement of hearing and related
functions
4 Hearing Aid
Assessment
Measurement of the appropriateness and/or
effectiveness of a hearing device
5Vestibular
Assessment
Measurement of the vestibular system and
related functions
6 Speech
Treatment
Application of techniques to improve,
augment, or compensate for speech and
related functional impairment
7 Motor Treatment Exercise or activities to increase or facilitate
motor function
8 Activities of
Daily Living
Treatment
Exercise or activities to facilitate functional
competence for activities of daily living
Physical Rehabilitation and Diagnostic Audiology—Section F
4.14 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Coding note: Treatment
Treatment procedures include swallowing dysfunction exercises,
bathing and showering techniques, wound management, gait
training, and a host of activities typically associated with
rehabilitation.
Example: Wound care treatment of left calf ulcer using pulsatile lavage
Coding note: Assessment
ASSESSMENTS are further classified into more than 100 different
tests or methods. The majority of these focus on the faculties of
hearing and speech, but others focus on various aspects of body
function, and on the patient’s quality of life, such as muscle per-
formance, neuromotor development, and reintegration skills.
Example: Articulation and phonology assessment using spectrograph
9 Hearing
Treatment
Application of techniques to improve,
augment, or compensate for hearing and
related functional impairment
B Hearing Aid
Treatment
Application of techniques to improve the
communication abilities of individuals with
cochlear implant
CVestibular
Treatment
Application of techniques to improve,
augment, or compensate for vestibular and
related functional impairment
D Device Fitting Fitting of a device designed to facilitate or
support achievement of a higher level of
function
F Caregiver
Training
Training in activities to support patient’s
optimal level of function
Value Description Definition
Character 1
Section
Character 2
Section Qualifier
Character 3
Root Type
Character 4
Body System &
Region
Character 5 Type
Qualifier
Character 6
Equipment
Character 7
Qualifier
REHABILITATION
& D
IAGNOSTIC
A
UDIOLOGY
REHABILITATION ACTIVITIES OF
D
AILY LIVING
T
REATMENT
MUSCULOSKEL.
L
OWER
E
XTREMITY
WOUND
M
ANAGEMENT
PHYSICAL
A
GENTS
NONE
F08L5BZ
Character 1
Section
Character 2
Section Qualifier
Character 3
Root Type
Character 4
Body System &
Region
Character 5 Type
Qualifier
Character 6
Equipment
Character 7
Qualifier
REHABILITATION
& D
IAGNOSTIC
A
UDIOLOGY
REHABILITATION SPEECH
A
SSESSMENT
NONE ARTICULATION/
P
HONOLOGY
SPEECH
A
NALYSIS
NONE
F00Z9QZ
Physical Rehabilitation and Diagnostic Audiology—Section F
Procedures in the ancillary sections 4.15
Preliminary
12/10/07
Coding note: Device Fitting
The fifth character used in DEVICE FITTING describes the device
being fitted rather than the method used to fit the device.
Detailed descriptions of the devices are provided in the refer-
ence materials, the table specific to D
EVICE FITTING.
Example: Individual fitting of moveable brace, right knee
Coding note: Caregiver Training
CAREGIVER TRAINING is divided into eighteen different broad
subjects taught to help a caregiver provide proper patient care.
Example: Caregiver training in feeding, no special equipment used
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Character 1
Section
Character 2
Section Qualifier
Character 3
Root Type
Character 4
Body System &
Region
Character 5 Type
Qualifier
Character 6
Equipment
Character 7
Qualifier
REHABILITATION
& D
IAGNOSTIC
A
UDIOLOGY
REHABILITATION DEVICE FITTING NONE DYNAMIC
O
RTHOSIS
ORTHOSIS NONE
F0DZ6EZ
Character 1
Section
Character 2
Section Qualifier
Character 3
Root Type
Character 4
Body System &
Region
Character 5 Type
Qualifier
Character 6
Equipment
Character 7
Qualifier
REHABILITATION
& D
IAGNOSTIC
A
UDIOLOGY
REHABILITATION CAREGIVER
T
RAINING
NONE FEEDING AND
E
ATING
NONE NONE
F0FZ2ZZ
Procedure Code
Bekesy assessment using audiometer F13Z31Z
Individual fitting of left eye prosthesis F0DZ8UZ
Physical therapy for range of motion and mobility, patient
right hip, no special equipment
F07L0ZZ
Bedside swallow assessment using assessment kit F00ZHYZ
Caregiver training in airway clearance techniques F0FZ8ZZ
Application of short arm cast in rehabilitation setting F0DZ7EZ Inhibitory cast is listed in the equipment
reference table under E, O
RTHOSIS.
Physical Rehabilitation and Diagnostic Audiology—Section F
4.16 ICD-10-PCS Reference Manual
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Preliminary
Verbal assessment of patient’s pain level F02ZFZZ
Caregiver training in communication skills using manual
communication board
F0FZJMZ Manual communication board is listed in the
equipment reference table under M, AUGMENTATIVE/
A
LTERNATIVE COMMUNICATION.
Group musculoskeletal balance training exercises, whole
body, no special equipment
F07M6ZZ Balance training is included in the M
OTOR
T
REATMENT reference table under THERAPEUTIC EXERCISE.
Individual therapy for auditory processing using tape
recorder
F09Z2KZ Tape recorder is listed in the equipment
reference table under AUDIOVISUAL EQUIPMENT.
Procedure Code
Procedures in the ancillary sections 4.17
Preliminary
12/10/07
Mental Health—Section G
MENTAL HEALTH contains specific values in the third and fourth
characters to describe mental health procedures. The remaining
characters function as placeholders only. Character meanings
are described below.
◆ Third character describes the mental health procedure root
type.
◆ Fourth character further specifies the procedure type as
needed.
◆ Second, fifth, sixth, and seventh characters do not convey
specific information about the procedure. The value Z func-
tions as a placeholder in these characters.
Root Type The third character describes the mental health root type. There
are 11 root type values in this section, as listed in the table
below.
.
Example: Galvanic skin response (GSR) biofeedback
Value Description
1 Psychological Tests
2 Crisis Intervention
5 Individual Psychotherapy
6 Counseling
7 Family Psychotherapy
B Electroconvulsive Therapy
C Biofeedback
F Hypnosis
G Narcosynthesis
H Group Therapy
J Light Therapy
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Type Qualifier
Character 5
Qualifier
Character 6
Qualifier
Character 7
Qualifier
MENTAL
H
EALTH
NONE BIOFEEDBACK OTHER
BIOFEEDBACK
NONE NONE NONE
GZC9ZZZ
Mental Health—Section G
4.18 ICD-10-PCS Reference Manual
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Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Cognitive-behavioral psychotherapy, individual GZ58ZZZ
Narcosynthesis GZGZZZZ
Light therapy GZJZZZZ
ECT (Electroconvulsive therapy), unilateral, multiple seizure GZB1ZZZ
Crisis intervention GZ2ZZZZ
Neuropsychological testing GZ13ZZZ
Hypnosis GZFZZZZ
Developmental testing GZ10ZZZ
Vocational counseling GZ61ZZZ
Family psychotherapy GZ72ZZZ
Procedures in the ancillary sections 4.19
Preliminary
12/10/07
Substance Abuse Treatment—Section H
SUBSTANCE ABUSE TREATMENT is structured like a smaller version
of the M
ENTAL HEALTH section (see page 4.17). Character mean-
ings are described below.
◆ Third character describes the root type.
◆ Fourth character is a qualifier that further classifies the root
type.
◆ Second, fifth, sixth, and seventh characters do not convey
specific information about the procedure. The value Z func-
tions as a placeholder in these characters.
Root Types There are seven different root type values classified in this sec-
tion, as listed in the following table.
Example: Pharmacotherapy treatment with Antabuse for alcohol addiction
Value Description
2 Detoxification Services
3 Individual Counseling
4 Group Counseling
5 Individual Psychotherapy
6 Family Counseling
8 Medication Management
9 Pharmacotherapy
Character 1
Section
Character 2
Body System
Character 3
Root Type
Character 4
Type Qualifier
Character 5
Qualifier
Character 6
Qualifier
Character 7
Qualifier
SUBSTANCE
A
BUSE TRMNT.
N
ONE PHARMACO-
THERAPY
ANTABUSE NONE NONE NONE
HZ93ZZZ
Substance Abuse Treatment—Section H
4.20 ICD-10-PCS Reference Manual
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Preliminary
Coding exercises
Using the ICD-10-PCS Tables, construct the code that accurately
represents the procedure performed.
Procedure Code
Naltrexone treatment for drug dependency HZ94ZZZ
Substance abuse treatment family counseling HZ63ZZZ
Medication monitoring of patient on methadone maintenance HZ81ZZZ
Individual interpersonal psychotherapy for drug abuse HZ54ZZZ
Patient in for alcohol detoxification treatment HZ2ZZZZ
Group motivational counseling HZ47ZZZ
Individual 12-step psychotherapy for substance abuse HZ53ZZZ
Post-test infectious disease counseling for IV drug abuser HZ3CZZZ
Psychodynamic psychotherapy for drug dependent patient HZ5CZZZ
Group cognitive-behavioral counseling for substance abuse HZ42ZZZ
Preliminary
12/10/07
Appendix A
AICD-10-PCS definitions
ICD-10-PCS definitions A.3
Preliminary
12/10/07
Appendix A
ICD-10-PCS definitions
THIS APPENDIX CONTAINS reference tables listing the root
operations and approaches used in the M
EDICAL AND SURGICAL
section. The first table includes the definition of each root oper-
ation, with explanation and examples. The second table
includes the definition of each approach.
The root operations are listed by name in alphabetical order.
The approaches are listed by approach value, in numeric order
followed by alphabetical order.
A.4 ICD-10-PCS Reference Manual
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Preliminary
Root operations
Alteration Definition Modifying the anatomic structure of a body part without affecting the function of
the body part
Explanation Principal purpose is to improve appearance
Examples Face lift, breast augmentation
Bypass Definition Altering the route of passage of the contents of a tubular body part
Explanation Rerouting contents around an area of a body part to another distal (downstream)
area in the normal route; rerouting the contents to another different but similar
route and body part; or to an abnormal route and another dissimilar body part. It
includes one or more concurrent anastomoses with or without the use of a device
such as autografts, tissue substitutes and synthetic substitutes.
Examples Coronary artery bypass, colostomy formation
Change Definition Taking out or off a device from a body part and putting back an identical or similar
device in or on the same body part without cutting or puncturing the skin or a
mucous membrane
Explanation N/A
Examples Urinary catheter change, gastrostomy tube change
Control Definition Stopping, or attempting to stop, postprocedural bleeding
Explanation The site of the bleeding is coded as an anatomical region and not to a specific
body part.
Examples Control of post-prostatectomy hemorrhage, control of post-tonsillectomy
hemorrhage
Creation Definition Making a new structure that does not physically take the place of a body part
Explanation Used only for sex change operations where genitalia are made
Examples Creation of vagina in a male, creation of penis in a female
Destruction Definition Eradicating all or a portion of a body part
Explanation Used for the actual physical destruction of all or a portion of a body part by the
direct use of energy, force or a destructive agent. None of the body part is taken
out.
Examples Fulguration of rectal polyp, cautery of skin lesion
Detachment Definition Cutting off all or a portion of an extremity
Explanation Cutting off all or part of the upper or lower extremities
Examples Below knee amputation, disarticulation of shoulder
Dilation Definition Expanding an orifice or the lumen of a tubular body part
Explanation The orifice can be a natural orifice or an artificially created orifice. Accomplished
by stretching a tubular body part using intraluminal pressure or by cutting part of
the orifice or wall of the tubular body part.
Examples Percutaneous transluminal angioplasty, pyloromyotomy
Division Definition Separating, without taking out, a body part
Explanation All or a portion of the body part is separated into two or more portions.
Root operations
ICD-10-PCS definitions A.5
Preliminary
12/10/07
Examples Spinal cordotomy, osteotomy
Drainage Definition Taking or letting out fluids and/or gases from a body part
Explanation The qualifier DIAGNOSTIC is used to identify drainage procedures that are biopsies.
Examples Thoracentesis, incision and drainage
Excision Definition Cutting out or off, without replacement, a portion of a body part
Explanation The qualifier DIAGNOSTIC is used to identify excision procedures that are biopsies.
Examples Partial nephrectomy, liver biopsy
Extirpation Definition Taking or cutting out solid matter from a body part
Explanation The solid matter may be an abnormal byproduct of a biological function or a
foreign body. The solid matter is imbedded in a body part, or is in the lumen of a
tubular body part. The solid matter may or may not have been previously broken
into pieces. No appreciable amount of the body part is taken out.
Examples Thrombectomy, choledocholithotomy
Extraction Definition Pulling or stripping out or off all or a portion of a body part
Explanation The body part is pulled or stripped from its location by the use of force (e.g.,
manual, suction). The qualifier D
IAGNOSTIC is used to identify extraction
procedures that are biopsies.
Examples Dilation and curettage, vein stripping
Fragmentation Definition Breaking solid matter in a body part into pieces
Explanation The solid matter may be an abnormal byproduct of a biological function or a
foreign body. Physical force (e.g., manual, ultrasonic) applied directly or indirectly
through intervening body parts is used to break the solid matter into pieces. The
pieces of solid matter are not taken out, but are eliminated or absorbed through
normal biological functions.
Examples Extracorporeal shockwave lithotripsy, transurethral lithotripsy
Fusion Definition Joining together portions of an articular body part rendering the articular body
part immobile
Explanation The body part is joined together by fixation device, bone graft, or other means.
Examples Spinal fusion, ankle arthrodesis
Insertion Definition Putting in a non-biological device that monitors, assists, performs or prevents a
physiological function but does not physically take the place of a body part
Explanation N/A
Examples Insertion of radioactive implant, insertion of central venous catheter
Inspection Definition Visually and/or manually exploring a body part
Explanation Visual exploration may be performed with or without optical instrumentation.
Manual exploration may be performed directly or through intervening body layers.
Examples Diagnostic arthroscopy, exploratory laparotomy
Map Definition Locating the route of passage of electrical impulses and/or locating functional
areas in a body part
Explanation Applicable only to the cardiac conduction mechanism and the central nervous
system
Examples Cardiac mapping, cortical mapping
Occlusion Definition Completely closing an orifice or the lumen of a tubular body part
Root operations
A.6 ICD-10-PCS Reference Manual
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Preliminary
Explanation The orifice can be a natural orifice or an artificially created orifice.
Examples Fallopian tube ligation, ligation of inferior vena cava
Reattachment Definition Putting back in or on all or a portion of a separated body part to its normal
location or other suitable location
Explanation Vascular circulation and nervous pathways may or may not be reestablished.
Examples Reattachment of hand, reattachment of avulsed kidney
Release Definition Freeing a body part
Explanation Eliminating an abnormal constraint of a body part by cutting or by use of force.
Some of the restraining tissue may be taken out but none of the body part is taken
out.
Examples Adhesiolysis, carpal tunnel release
Removal Definition Taking out or off a device from a body part
Explanation If taking out a device and putting in a similar device is performed with an external
approach, the procedure is coded to the root operation C
HANGE. Otherwise, the
procedure for taking out the device is coded to the root operation R
EMOVAL and
the procedure for putting in the new device is coded to the root operation
performed.
Examples Drainage tube removal, cardiac pacemaker removal
Repair Definition Restoring, to the extent possible, a body part to its normal anatomic structure and
function
Explanation Used only when the method to accomplish the repair is not one of the other root
operations
Examples Herniorrhaphy, suture of laceration
Replacement Definition Putting in or on biological or synthetic material that physically takes the place of all
or a portion of a body part
Explanation The biological material is non-living, or the biological material is living and from
the same individual. The body part may have been previously taken out,
previously replaced, or may be taken out concomitantly with the Replacement
procedure. If the body part has been previously replaced, a separate Removal
procedure is coded for taking out the device used in the previous replacement.
Examples Total hip replacement, free skin graft
Reposition Definition Moving to its normal location or other suitable location all or a portion of a body
part
Explanation The body part is moved to a new location from an abnormal location, or from a
normal location where it is not functioning correctly. The body part may or may not
be cut out or off to be moved to the new location.
Examples Reposition of undescended testicle, fracture reduction
Resection Definition Cutting out or off, without replacement, all of a body part
Explanation None
Examples Total nephrectomy, total lobectomy of lung
Restriction Definition Partially closing an orifice or the lumen of a tubular body part
Explanation The orifice can be a natural orifice or an artificially created orifice.
Examples Esophagogastric fundoplication, cervical cerclage
Revision Definition Correcting, to the extent possible, a malfunctioning or displaced device
Root operations
ICD-10-PCS definitions A.7
Preliminary
12/10/07
Explanation Revision can include correcting a malfunctioning or displaced device by taking out
or putting in components of the device such as a screw or pin.
Examples Adjustment of pacemaker lead, adjustment of hip prosthesis
Transfer Definition Moving, without taking out, all or a portion of a body part to another location to
take over the function of all or a portion of a body part
Explanation The body part transferred remains connected to its vascular and nervous supply.
Examples Tendon transfer, skin pedicle flap transfer
Transplantation Definition Putting in or on all or a portion of a living body part taken from another individual
or animal to physically take the place and/or function of all or a portion of a similar
body part
Explanation The native body part may or may not be taken out, and the transplanted body part
may take over all or a portion of its function.
Examples Kidney transplant, heart transplant
A.8 ICD-10-PCS Reference Manual
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Preliminary
Approaches
Approach description Definition
Open Cutting through the skin or mucous membrane and any other body layers
necessary to expose the site of the procedure
Open Endoscopic Cutting through the skin or mucous membrane and any other body layers
necessary to expose a body part, and introduction of instrumentation to reach
and visualize the site of the procedure
Percutaneous 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
Percutaneous Endoscopic 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
Via Natural or Artificial Opening Entry of instrumentation through a natural or artificial external opening to reach
the site of the procedure
Via Natural or Artificial Opening
Endoscopic
Entry of instrumentation through a natural or artificial external opening to reach
and visualize the site of the procedure
Open with Percutaneous
Endoscopic Assistance
Cutting through the skin or mucous membrane and any other body layers
necessary to expose the site of the procedure, 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
External Procedures performed directly on the skin or mucous membrane and procedures
performed indirectly by the application of external force through the skin or
mucous membrane
Preliminary
12/10/07
Appendix B
BICD-10-PCS draft coding
guidelines
B.2 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Contents ICD-10-PCS draft coding guidelines B.3
A. General
B.3
B. Medical and Surgical section (section 0)
B.4
Body system guidelines B.4
Root operation guidelines B.4
Body part guidelines B.7
Approach guidelines B.9
Device guidelines B.10
C. Other medical and surgical-related sections (sections 1–9)
B.11
ICD-10-PCS draft coding guidelines B.3
Preliminary
12/10/07
Appendix B
ICD-10-PCS draft coding
guidelines
THIS APPENDIX LISTS the draft ICD-10-PCS guidelines. They
are grouped into general guidelines and guidelines that apply to
a section or sections. Guidelines for the Medical and Surgical
section are further grouped by character. The guidelines are
numbered sequentially within each category.
A. General
————————————————————————————————————————————————————————————————————————————————————
A.1. It is not possible to construct a procedure code from the
alphabetic index. The purpose of the alphabetic index is to
locate the appropriate table that contains all information neces-
sary to construct a procedure code.
A.2. All seven characters must contain valid values to be a valid
procedure code. If the documentation is incomplete for coding
purposes, the physician should be queried for the necessary
information.
A.3. The columns in the Tables contain the values for characters
four through seven. The rows delineate the valid combinations
of values. Any combination of values not contained in a single
row of the Tables is invalid.
A.4. “And,” when used in a code description, means “and/or.”
Example: Lower Arm and Wrist Muscle means lower arm and/or
wrist muscle.
B.4 ICD-10-PCS Reference Manual
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Preliminary
B. Medical and Surgical section (section 0)
—————————————————————————————————————
Body system guidelines B2.1. Body systems contain body part values that include con-
tiguous body parts. These general body part values are used:
a. When a procedure is performed on the general body part as
a whole.
b. When the specific body part cannot be determined.
c. In the root operations Change, Removal and Revision, when
the specific body part value is not in the table.
Example: Esophagus is a general body part value; Esopha-
gus, Upper is a specific body part value.
B2.2. Three body systems contain body part values that repre-
sent general anatomical regions, upper extremity anatomical
regions, and lower extremity anatomical regions respectively.
These body part values are used when a procedure is per-
formed on body layers that span more than one body system.
Example: Debridement of skin, muscle, and bone at a proce-
dure site is coded to the anatomical regions body systems.
Exception: Composite tissue transfers are coded to the specific
body systems (Muscles or Subcutaneous Tissue and Fascia). In
these body systems, qualifiers delineate the body layers
involved.
B2.3. Body systems designated as upper or lower contain body
parts located above or below the diaphragm respectively.
Example: Upper Veins body parts are above the diaphragm;
Lower Veins body parts are below the diaphragm.
Root operation guidelines B3.1. In order to determine the appropriate root operation, the
full definition of the root operation as contained in the Tables
must be applied.
B3.2. Components of a procedure necessary to complete the
objective of the procedure specified in the root operation are
considered integral to the procedure and are not coded
separately.
Example: Resection of a joint is integral to joint replacement.
ICD-10-PCS draft coding guidelines B.5
Preliminary
12/10/07
Multiple procedures
B3.3. During the same operative episode, multiple procedures
are coded if:
a. The same root operation is performed on different body
parts as defined by distinct values of the body part
character.
Example: Diagnostic excision of liver and pancreas are
coded separately.
b. The same root operation is repeated at different body sites
that are included in the same body part value.
Example: Excision of the sartorius muscle and excision of
the gracilis muscle are both included in the upper leg mus-
cle body part value, and multiple procedures are coded.
Destruction of separate skin body sites on the face are all
included in the body part value Skin, Face, and multiple
procedures are coded.
c. Multiple root operations with distinct objectives are per-
formed on the same body part.
Example: Destruction of sigmoid lesion and bypass of sig-
moid colon are coded separately.
d. The intended root operation is attempted using one
approach, but is converted to a different approach.
Example: Laparoscopic cholecystectomy converted to an
open cholecystectomy is coded as endoscopic Inspection
and open Resection.
Discontinued procedures
B3.4. If the intended procedure is discontinued, code the
procedure to the root operation performed. If a procedure is
discontinued before any other root operation is performed,
code the root operation Inspection of the body part or anatomi-
cal region inspected.
Example: Ureteroscopy with unsuccessful extirpation of ure-
teral stone is coded to Inspection of ureter.
Bypass
B3.5. Bypass procedures are coded according to the direction
of flow of the contents of a tubular body part: the body part
value identifies the origin of the bypass and the qualifier identi-
fies the destination of the bypass.
Example: Bypass from stomach to jejunum, stomach (origin) is
the body part and jejunum (destination) is the qualifier.
Note: Coronary arteries are coded differently. The body part
value identifies the number of coronary artery sites bypassed.
The qualifier identifies the origin of the bypass.
B.6 ICD-10-PCS Reference Manual
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Preliminary
B3.6. If multiple coronary artery sites are bypassed, a separate
procedure is coded for each coronary artery site that uses a dif-
ferent device and/or qualifier.
Example: Aortocoronary artery bypass and internal mammary
coronary artery bypass are coded separately.
Control
B3.7. If an attempt to stop postprocedural bleeding is unsuc-
cessful and requires performing Bypass, Detachment, Excision,
Extraction, Reposition, Replacement, or Resection to stop the
bleeding, then that root operation is coded instead of Control.
Example: Resection of spleen to stop postprocedural bleeding is
coded to Resection instead of Control.
Diagnostic excision
B3.8. If a diagnostic excision (biopsy) is followed by a thera-
peutic excision at the same procedure site, or by resection of
the body part during the same operative episode, code only the
therapeutic excision or resection.
Example: Biopsy of breast followed by partial mastectomy at the
same procedure site, only the partial mastectomy procedure is
coded.
Inspection
B3.9. Inspection of a body part(s) integral to the performance
of the procedure is not coded separately.
Example: Fiberoptic bronchoscopy with irrigation of bronchus,
only the irrigation procedure is coded.
B3.10. If multiple body parts are inspected, the body part char-
acter is defined as the general body part value that identifies the
entire area inspected. If no general body part value is pro-
vided, the body part character is defined as the most distal body
part inspected.
Example: Laparoscopy of pelvic organs is coded to the pelvic
region body part value. Cystoureteroscopy with inspection of
bladder and ureters is coded to the ureter body part value.
Division and Release
B3.11. If the sole objective of the procedure is separating a
nontubular body part, the root operation is Division. If the sole
objective of the procedure is freeing a body part without cutting
the body part, the root operation is Release.
B3.12. In the root operation Release, the body part value coded
is the body part being freed and not the tissue being manipu-
lated or cut to free the body part.
Example: Lysis of intestinal adhesions is coded to one of the
intestine body part values.
ICD-10-PCS draft coding guidelines B.7
Preliminary
12/10/07
Fusion of vertebral joints
B3.13. If multiple vertebral joints included in the same body
part value are fused, a separate procedure is coded for each
joint that uses a different device and/or qualifier. Joints between
two areas of the spine (e.g., cervicothoracic vertebral joint) have
their own body part values and are coded separately.
Example: Fusion of C-4/5 with fixation device and C-5/6 with
bone graft are coded separately. Fusion of the C-5/6 joint and
the C7-T1 joint are coded separately.
Fracture treatment
B3.14. Reduction of a displaced fracture is coded to the root
operation Reposition. Treatment of a nondisplaced fracture is
coded to the procedure performed.
Example: Putting a pin in a nondisplaced fracture is coded to
the root operation Insertion. Casting of a nondisplaced fracture
is coded to the root operation Immobilization in the Placement
section.
Transplantation
B3.15. Putting in a mature and functioning living body part
taken from another individual or animal is coded to the root
operation Transplantation. Putting in autologous or nonautolo-
gous cells is coded to the Administration section.
Example: Putting in autologous or nonautologous bone marrow,
pancreatic islet cells or stem cells is coded to the Administra-
tion section.
Body part guidelines B4.1. If a procedure is performed on a portion of a body part
that does not have a separate body part value, code the body
part value corresponding to the whole body part.
Example: A procedure performed on the alveolar process of the
mandible is coded to the mandible body part.
B4.2. If the prefix “peri” is used with a body part to identify the
site of the procedure, the body part value is defined as the body
part named.
Example: A procedure site identified as perirenal is coded to the
kidney body part.
B4.3. If the procedure documentation uses a body part to fur-
ther specify the site of the procedure, the body part value is
defined as the body part on which the procedure is performed.
Example: A procedure site identified as the prostatic urethra is
coded to the urethra body part.
B.8 ICD-10-PCS Reference Manual
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Preliminary
Coronary arteries
B4.4. The coronary arteries are classified as a single body part.
They are further specified by number of sites treated, not by
name or number of arteries. Separate body part values are pro-
vided to indicate the number of sites treated, when the same
procedure is performed on multiple sites in the coronary
arteries.
Example: Two dilations with stents of a coronary artery are
coded as dilation of Coronary Artery, Two Sites, with intralumi-
nal device. Two dilations, one with stent and one without, are
coded separately as dilation of Coronary Artery, One Site, with
intraluminal device, and dilation of Coronary Artery, One Site,
with no device.
Bilateral body part values
B4.5. Bilateral body part values are available for a limited num-
ber of body parts. They are included in the system on the basis
of frequency and common practice. If the identical procedure is
performed on contralateral body parts, and a bilateral body part
value exists for that body part, a single procedure is coded
using the bilateral body part value. If no bilateral body part
value exists, code each procedure separately using the appro-
priate body part value.
Example: The identical procedure performed on both fallopian
tubes is coded once using the body part value Fallopian Tube,
Bilateral. The identical procedure performed on both knee
joints is coded twice using the body part values Knee Joint,
Right and Knee Joint, Left.
Body parts near a joint
B4.6. Procedures performed on tendons, ligaments, bursae and
fascia supporting a joint are coded to the body part that is the
focus of the procedure, in the respective body system. Proce-
dures performed on joint structures are coded to the body part
in the joint body systems.
Example: Repair of the anterior cruciate ligament of the knee is
coded to the knee body part in the bursae and ligaments body
system. Shoulder arthroscopy with shaving of articular cartilage
is coded to the shoulder joint body part.
B4.7. In body systems containing skin, subcutaneous tissue,
muscle, and tendon body part values, where a specific body
part value does not exist for the area surrounding a joint, the
corresponding body part is coded as follows:
◆ Shoulder is coded to Upper Arm
◆ Elbow is coded to Lower Arm
◆ Wrist is coded to Lower Arm
◆ Hip is coded to Upper Leg
◆ Knee is coded to Lower Leg
ICD-10-PCS draft coding guidelines B.9
Preliminary
12/10/07
◆ Ankle is coded to Foot
Fingers and toes
B4.8. If a body system does not contain a separate body part
value for fingers, procedures performed on the fingers are
coded to the body part value for the hand. If a body system
does not contain a separate body part value for toes, proce-
dures performed on the toes are coded to the body part value
for the foot.
Example: Excision of finger muscle is coded to the hand mus-
cle body part value.
Humerus
B4.9. Procedures performed on the distal (elbow) end of the
humerus are coded to the humeral shaft body part value.
Skin glands and ducts
B4.10. Procedures performed on skin and breast glands and
ducts are coded to body part values in the body system Skin
and Breast.
Forequarter and hindquarter
B4.11. In the anatomical regions body system containing lower
extremities body parts, the body part value Forequarter
describes the entire upper limb plus the scapula and clavicle,
and the body part value Hindquarter describes the entire lower
limb including all of the hip and the buttock.
Nerves and vessels
B4.12. Nerves and vessels that are not identified by a separate
body part value are coded to the closest proximal branch identi-
fied by a body part value.
Example: A procedure performed on the mandibular branch of
the trigeminal nerve is coded to the trigeminal nerve body part
value.
Approach guidelines B5.1. Procedures performed using the open approach with per-
cutaneous endoscopic assistance are coded to approach value
0, Open.
Endoscopic assistance
Example: Laparoscopic-assisted sigmoidectomy is coded to
approach value 0, Open.
B5.2. Procedures performed via natural or artificial opening
with percutaneous endoscopic assistance are coded to approach
value F, Via Natural or Artificial Opening with Percutaneous
Endoscopic Assistance.
Example: Laparoscopic-assisted vaginal hysterectomy (LAVH) is
coded to approach value F, Via Natural or Artificial Opening
with Percutaneous Endoscopic Assistance.
B.10 ICD-10-PCS Reference Manual
12/10/07
Preliminary
External approach
B5.3a. Procedures performed within an orifice on structures
that are visible without the aid of any instrumentation are coded
to approach value X, External.
Example: Resection of tonsils is coded to approach value X,
External.
B5.3b. Procedures performed indirectly by the application of
external force through the intervening body layers are coded to
approach value X, External.
Example: Closed reduction of fracture is coded to approach
value X, External.
Indwelling device
B5.4a. Procedures performed via indwelling device are coded
to approach value 3, Percutaneous.
Example: Fragmentation of kidney stone performed via percuta-
neous nephrostomy is coded to approach value 3,
Percutaneous.
B5.4b. Procedures performed on a device, as defined in the
root operations Change, Irrigation, Removal and Revision, are
coded to the procedure performed.
Example: Irrigation of percutaneous nephrostomy tube is coded
to the root operation Irrigation of indwelling device in the
Administration section.
Device guidelines B6.1. A device is coded only if a device remains after the proce-
dure is completed. If no device remains, the device value No
Device is coded.
B6.2. Materials such as sutures, ligatures, radiological markers
and temporary post-operative wound drains are considered
integral to the performance of a procedure and are not coded as
devices.
B6.3. A separate procedure to put in a drainage device is coded
to the root operation Drainage with the device value Drainage
Device.
B6.4. If, as part of a procedure, an autograft is obtained from a
different body part, a separate procedure is coded.
Example: Coronary bypass with excision of saphenous vein
graft, excision of saphenous vein is coded separately.
ICD-10-PCS draft coding guidelines B.11
Preliminary
12/10/07
C. Other medical and surgical-related sections (sections 1–9)
—————————
C.1. The Obstetrics section includes only the procedures per-
formed on the products of conception. Procedures performed
on the pregnant female other than the products of conception
are coded to a root operation in the Medical and Surgical
section.
Example: Episiotomy is coded to a root operation in the Medical
and Surgical section.
B.12 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Glossary G.1
Preliminary
12/10/07
Glossary
Character One of the seven components that comprise an ICD-10-PCS
procedure code
Value Individual units defined for each character and represented by a
number or letter
Procedure The complete specification of the seven characters
Section (1st character) Defines the general type of procedure
Body System (2nd character) Defines the general physiological system on which the proce-
dure is performed or anatomical region where the procedure is
performed
Root Operation (3rd
character)
Defines the objective of the procedure
Body Part or Region (4th
character)
Defines the specific anatomical site where the procedure is
performed
Approach (5th character) Defines the technique used to reach the site of the procedure
G.2 ICD-10-PCS Reference Manual
12/10/07
Preliminary
Device (6th character) Defines the material or appliance that remains in or on the body
at the end of the procedure
Qualifier (7th character) Defines an additional attribute of the procedure performed, if
applicable
Index I.1
Index
A
Abortion, 3.6
Abortion coding note
, 3.5
Administration
, 3.10
root operation
, 3.10
introduction
, 3.10
irrigation
, 3.11
transfusion
, 3.11
Alter a tubular body part
, 2.40
Alteration coding note
, 2.68
Ancillary sections
, 1.12
Ancillary sections of ICD-10-PCS, list of
, 4.4
Approach character
, 1.8
Approach values coding note
, 2.17, 2.28
Approaches
definitions
, A.8
Assessment coding note
, 4.14
Assistance
, 3.14
Assistance coding note
, 3.14
Autograph tissue coding note
, 2.70
B
Body part character, 1.8
Body part values coding note
, 2.23, 2.30
Body system character
, 1.7
Bone marrow coding note
, 2.9
Bypass
, 2.47
C
Caregiver training coding note, 4.15
Change
, 2.54, 3.8
Character 1
, 1.7
Character 2
, 1.7
Character 3
, 1.8
Character 4
, 1.8
Character 5
, 1.8
Character 6
, 1.9
Character 7
, 1.9
Character values
, 1.6
Characters used in ICD-10-PCS
, 1.6
Code list
, 1.17
Code structure
, 1.6
Code tables
, 1.13
Coded data
, 1.26
Coding note
abortion (obstetrics)
, 3.5
alteration
, 2.68
approach values
, 2.17, 2.28
assessment
, 4.14
assistance (extracorporeal assistance and
performance)
, 3.14
body part values
, 2.23, 2.30
bone marrow
, 2.9
caregiver training
, 4.15
control
, 2.62
delivery (obstetrics)
, 3.6
endometrial biopsies
, 2.9
fitting
, 4.15
harvest autograph tissue
, 2.70
I.2 ICD-10-PCS Reference Manual
hyperthermia (extracorporeal therapies), 3.17
immobilization (placement)
, 3.8
lymph nodes
, 2.11
performance (extracorporeal assistance and
performance)
, 3.15
pheresis (extracorporeal therapies)
, 3.17
phototherapy (extracorporeal therapies)
, 3.18
qualifier values
, 2.15
restoration (extracorporeal assistance and
performance), 3.15
traction (placement)
, 3.9
treatment
, 4.14
Comparing ICD-9-CM to ICD-10-PCS
, 1.4
Complete ray amputation
, 2.13
Completeness
, 1.19
Compression
, 3.8
Control
, 2.62
Control coding note
, 2.62
Cutting or separation only
, 2.27
D
Data in healthcare, 1.26
Definition of ICD-10-PCS
, 1.4
Delivery
, 3.6
Delivery coding note
, 3.6
Destruction
, 2.16
Detachment
, 2.13
qualifiers
, 2.13
Device
root operations always involving
, 2.49
Device character
, 1.9
Dilation
, 2.45
Division
, 2.28
Drainage
, 2.21
E
Endometrial biopsies coding note, 2.9
Examination only
, 2.58
Excision
, 2.9
Expandable system
, 1.21
Extirpation
, 2.23
Extracorporeal assistance and performance
, 3.14
root operation
, 3.14
assistance
, 3.14
performance
, 3.15
restoration
, 3.15
Extracorporeal therapies
, 3.16
root operation
, 3.16
Extraction
, 2.18
F
Fifth character, 1.8
First character
, 1.7
Fitting coding note
, 4.15
Fourth character
, 1.8
Fragmentation
, 2.25
Function, measurement and monitoring
, 3.12
Fusion
, 2.66
G
Glossary, G.1
H
Harvest autograph tissue coding note, 2.70
History of ICD-10-PCS
, 1.4
Hyperthermia coding note
, 3.17
I
ICD-10-PCS code list, 1.17
ICD-10-PCS defined
, 1.4
ICD-10-PCS design
, 1.18
ICD-10-PCS index
, 1.15
ICD-10-PCS tables
, 1.13
Imaging
, 4.5
Immobilization
, 3.8
Immobilization coding note
, 3.8
Index
, 1.15
Insertion
, 2.50
Inspection
, 2.59
Introduction
, 3.10
Introduction to ICD10-PCS
, 1.4
Irrigation
, 3.11
L
List of ancillary sections in ICD-10-PCS, 4.4
List of codes
, 1.17
Lymph nodes coding note
, 2.11
M
Map, 2.60
Measurement
, 3.12
Measurement and monitoring
, 3.12
definitions of
, 3.12
functions
, 3.12
Index I.3
root operation, 3.12
measurement
, 3.12
monitoring
, 3.12
Medical and surgical
list of related sections
, 1.11, 3.4
root operations
bypass, 2.47
change
, 2.54
control
, 2.62
destruction
, 2.16
detachment
, 2.13
dilation
, 2.45
division
, 2.28
drainage
, 2.21
excision
, 2.9
extirpation
, 2.23
extraction
, 2.18
fragmentation
, 2.25
fusion
, 2.66
insertion
, 2.50
inspection
, 2.59
map
, 2.60
occlusion
, 2.43
reattachment
, 2.34
release
, 2.29
removal
, 2.55
repair
, 2.63
replacement
, 2.52
reposition
, 2.38
resection
, 2.11
restriction
, 2.41
revision
, 2.57
transfer
, 2.36
transplantation
, 2.32
Medical and surgical section
described, 1.11
Medical and surgical subgroups
, 2.6
Mental health
, 4.17
Monitoring
, 3.12
Move a body part
, 2.31
Multiaxial design
, 1.18
N
New procedure codes, 1.21
Non-medically necessary procedures
, 2.65
Not elsewhere classified (NEC) codes
, 1.25
Not otherwise specified (NOS) codes
, 1.25
Nuclear medicine
, 4.8
O
Obstetrics, 3.5
root operation
, 3.5
abortion
, 3.6
delivery
, 3.6
Occlusion
, 2.43
Osteopathic
, 3.19
root operation
, 3.19
treatment
, 3.19
Other repairs
, 2.61
P
Packing, 3.8
Partial ray amputation
, 2.13
Performance
, 3.15
Performance coding note
, 3.15
Pheresis coding note
, 3.17
Phototherapy coding note
, 3.18
Physical rehabilitation and diagnostic audiology
, 4.13
Placement
, 3.7
root operation
, 3.7
change
, 3.8
compression
, 3.8
immobilization
, 3.8
packing
, 3.8
removal
, 3.9
traction
, 3.9
Procedure
non-medically necessary
, 2.65
substance abuse treatment
, 4.19
Put in/back a body part
, 2.31
Q
Qualifier
defined
, 1.9
detachment
, 2.13
Qualifier character
, 1.9
Qualifier values coding note
, 2.15
R
Radiation oncology, 4.11
treatment modality
, 4.11
Reading codes
, 1.28
Reattachment
, 2.34
Related sections
, 1.11
Release
, 2.29
Removal
, 2.55, 3.9
Remove
, 2.8
Remove solid, fluids, gases from body part
, 2.20
Repair
, 2.63
Replacement
, 2.52
I.4 ICD-10-PCS Reference Manual
Reposition, 2.38
Resection
, 2.11
Restoration
, 3.15
Restoration coding note
, 3.15
Restriction
, 2.41
Revision
, 2.57
Root operation
administration
, 3.10
introduction
, 3.10
irrigation
, 3.11
transfusion
, 3.11
character
, 1.8
defined
, 1.8
extracorporeal assistance and performance
, 3.14
assistance
, 3.14
performance
, 3.15
restoration
, 3.15
extracorporeal therapies
, 3.16
measurement and monitoring
, 3.12
measurement
, 3.12
monitoring
, 3.12
medical and surgical
alter diameter or route of tubular body part
, 2.40
always involve device
, 2.49
bypass
, 2.47
change
, 2.54
control
, 2.62
cutting or separation only
, 2.27
destruction
, 2.16
detachment
, 2.13
dilation
, 2.45
division
, 2.28
drainage
, 2.21
examination only
, 2.58
excision
, 2.9
extirpation
, 2.23
extraction
, 2.18
fragmentation
, 2.25
fusion
, 2.66
insertion
, 2.50
inspection
, 2.59
map
, 2.60
non-medically necessary procedures
, 2.65
occlusion
, 2.43
other repairs
, 2.61
put in, put back, move some or all of a body part
,
2.31
reattachment
, 2.34
release
, 2.29
removal
, 2.55
remove solid, fluids, gases from body part
, 2.20
remove some or all of a body party
, 2.8
repair
, 2.63
replacement
, 2.52
reposition
, 2.38
resection
, 2.11
restriction
, 2.41
revision
, 2.57
subgroups
, 2.6
transfer
, 2.36
transplantation
, 2.32
obstetrics
, 3.5
abortion
, 3.6
delivery
, 3.6
osteopathic
, 3.19
treatment
, 3.19
placement
, 3.7
change
, 3.8
compression
, 3.8
immobilization
, 3.8
packing
, 3.8
removal
, 3.9
traction
, 3.9
Root operations
definitions
, A.4
S
Search capability, 1.26
Second character
, 1.7
Section
administration, 3.10
ancillary
, 1.12
extracorporeal assistance and performance
, 3.14
extracorporeal therapies
, 3.16
imaging
, 4.5
list of medical and surgical sections
, 3.4
measurement and monitoring
, 3.12
medical and surgical-related
, 1.11
mental health
, 4.17
nuclear medicine
, 4.8
obstetrics
, 3.5
osteopathic
, 3.19
physical rehabilitation and diagnostic audiology
, 4.13
placement
, 3.7
radiation oncology
, 4.11
substance abuse treatment
, 4.19
Section code
, 1.7
Sections in ICD-10-PCS
, 1.11
Seventh character
, 1.9
Sixth character
, 1.9
Standard character meanings
, 1.27
Standard terminology
, 1.23
Structure of codes
, 1.6
Subgroups
medical and surgical
, 2.6
Substance abuse treatment
, 4.19
procedures
, 4.19
Index I.5
T
Tables
understanding
, 1.15
Terminology used in ICD-10-PCS
, 1.23
Terms
, G.1
complete ray amputation
, 2.13
partial ray amputation
, 2.13
Third character
, 1.8
Traction
, 3.9
Traction coding note
, 3.9
Transfer
, 2.36
Transfusion
, 3.11
Transplantation
, 2.32
Treatment
, 3.19
Treatment coding note
, 4.14
Treatment modality in radiation oncology
, 4.11
Tubular body part
, 2.40
U
Understanding ICD-10-PCS tables, 1.15
Unique codes
, 1.19
Using the ICD-10-PCS index
, 1.15
V
Values of each character in a code, 1.6
W
World Health Organization, 1.4
I.6 ICD-10-PCS Reference Manual
