Introducing ICD-10-PCS Approaches

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Introducing ICD-10-PCS Approaches

• Presented by
• THIMA ICD 10 Committee

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APPROACHES

• The fifth character of ICD-10-PCS codes
  represents the approach or technique that is used
  to reach the procedure site.
• 7 different approaches in the Medical and
  Surgical Section

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7 Approaches

• Open
• Percutaneous
• Percutaneous Endoscopic
• Via Natural or Artificial Opening
• Via Natural or Artificial Opening, Endoscopic
• Via Natural or Artificial Opening with
  Percutaneous Endoscopic Assistance
• External

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Approaches Table
VALUE APPROACH DEFINITION APPLICABLE GUIDELINES EXAMPLES
0 Open Cutting Through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure B5.1 Open CABG Open Endarterectomy Open resection cecum Abdominal hysterectomy
3 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 B5.4a Percu. needle core biopsy of kidney Liposuction Percu. Drainage of ascites Needle biopsy of liver
4 Percutaneous Endoscopic Entry, by puncture or minor incision, of instrumentation through the skin or mucouos membrane and any other body layers necessary to reach and visualize the site of the procedure Lap. Cholecystectomy Laparoscopy with destruction of endometriosis Endoscopic drainage of sinus Arthroscopy
7 Via Natural or Artificial Opening Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure Foley Catheter placement Transvaginal intraluminal cervical cerclage Endotracheal intubation
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Approaches Table, cont.
VALUE APPROACH DEFINITION APPLICABLE GUIDELINES EXAMPLES
8 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. Transurethral cystoscopy with removal bladder stones Endoscopic ERCP Hysteroscopy Colonoscopy/ EGD/ Sigmoidoscopy
F Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance Entry of instrumentation through a natural or artificial external opening and entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure. B5.1 Laparoscopic-assisted vaginal hysterectomy (LAVH)
X 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. B5.3a B5.3b Resection of tonsils Closed reduction of fracture Excision of skin lesion Cautery nosebleed Manual rupture joint adhesions Reattachment severed ear
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Approach - Open

• Cutting through the skin or mucous membrane and
  any other body layers necessary to expose the
  site of the procedure.

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Approach Guidelines

• B5.2 Procedures performed using the open approach
  with percutaneous endoscopic assistance are coded
  to approach value 0, open.

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Approach - Open

• The access location would be skin or mucous
  membranes
• No instrumentation used
• Example Abdominal Hysterectomy

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Approach - 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.

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Approach guideline

• B5.4 Procedures performed percutaneously via a
  device placed for the procedure are coded to the
  approach Percutaneous
• Example Fragmentation of kidney stone performed
  via percutaneous nephrostomy is coded to the
  approach Percutaneous

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Approach - Percutaneous

• The access location would be skin or mucous
  membrane
• Instrumentation without visualization
• EXAMPLE Needle biopsy of liver

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Approach 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.

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Approach - Percutaneous Endoscopic

• Access location is skin or mucous membran
• Instrumentation with visualization

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Approach Via Natural or Artificial Opening

• Entry of instrumentation through a natural or
  artificial external opening to reach the site of
  the procedure.

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Approach Via Natural or Artificial Opening

• Access location is Orifice
• Instrumentation without visualization
• Example Insertion of Endotracheal Tube

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Approach 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.

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Approach Via Natural or Artificial Opening,
Endoscopic

• Instrumentation is with visualization
• Access location is Orifice
• Example Sigmoidoscopy

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Approach Via Natural or Artificial Opening with
Percutaneous Endoscopic Assistance

• Entry of instrumentation through a natural or
  artificial external opening and entry, by
  puncture or minor incision, of instrumentation
  through the skin or mucous membrane and any other
  body layers necessary to aid in the performance
  of the procedure.

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Approach Via Natural or Artificial Opening with
Percutaneous Endoscopic Assistance

• Access location is skin or mucous membrane.
• Instrumentation is with visualization.
• Example Laparoscopic-assisted vaginal
  hysterectomy

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Approach - 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.

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Approaches - External

• Access location is skin or mucous membranes
• No specified instrumentation
• Example Closed reduction of fracture

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Approach - Guidelines

• B5.3a Procedures performed within an orifice on
  structures that are visible without the aid of
  any instrumentation are coded to approach
  External.
• Example Resection of tonsils

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Approach Guidelines, cont.

• B5.3b Procedures performed indirectly by the
  application of external force through the
  intervening body layers are coded to the approach
  External.
• Example Closed reduction of fracture

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Lets practice what weve just learned.
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Resection of Tonsils Approach?

• External

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Endoscopic Drainage of Sinuses Approach?

• Percutaneous Endoscopic

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Cautery of Nosebleed Approach?

• External

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Transurethral Cystoscopy with Removal of Bladder
Stone Approach?

• Via Natural or Artificial Opening, Endoscopic

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Open Cholecystectomy Approach?

• Open

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Laparoscopic Cholecystectomy Approach?

• Percutaneous Endoscopic

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CABG Approach?

• Open

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Colonoscopy Approach?

• Via Natural or Artificial Opening, Endoscopic

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Open Endarterectomy Approach?

• Open

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Endotracheal Intubation Approach?

• Via Natural or Artificial Opening

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Excision Of Skin Lesion Approach?

• External

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Percutaneous Drainage of Ascites Approach?

• Percutaneous

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Low Anterior Resection, Colon Approach?

• Open

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Bronchoscopy Approach?

• Via Natural or Artificial Opening, Endoscopic

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ERCP Approach?

• Via Natural or Artificial Opening, Endoscopic

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Youve got it!!!!

• Hooray!!!