Question

Read and answer the following case studies. Once complete, upload and explain your answers in to your discussion post for this week. Please review your classmates’ post and give them feedback on their answers. Case Study #2 This 9-year-old patient presents with an inflamed left eye. His mother states that he has gotten “some- thing” in this eye and it has become irritated. His left eye is red and the conjunctiva is inflamed. I felt it best to irrigate the eye with ophthalmic irrigating solution. I also gave the patient a prescription for oph- thalmic antibiotics. He is to follow up with me in 10 days or call if the eye becomes worse. ICD-10-PCS Code Assignment: ______

Answer 1

The U.S. developed a Clinical Modification (ICD-10-CM) for medical diagnoses based on WHO's ICD-10 and CMS developed a new Procedure Coding System (ICD-10-PCS) for inpatient procedures. ICD-10-CMreplaces ICD-9-CM, volumes 1 and 2, and ICD-10-PCS replaces ICD-9-CM, volume 3.

The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States.

ICD-10_PCS codes are composed of seven characters:

Each character is an axis of classification that specifies information about the procedure performed. Within a defined code range, a character specifies the same type of information in that axis of classification.

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 procedure performed in the United state

The World Health Organization (WHO):

has maintained the International Classification of Disease (ICD) for recording cause of death since 1893. it update the ICD periodically.

National Center for Health Statistic (NCHS):

the WHO authorized NCHS to develop a clinical modification of ICD-10for use in the United State.

Center for Medicare and Medicate Services maintaining the inpatient procedure:

Contracted with 3M Health Information System 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 that initially released in 1998 and updated annually.

ICD-9-CM Volume:

1. follows ICD structure (designed for diagnosis coding )
2. codes available as a fixed/finite see in list volume
3. codes are numeric
4. codes are 3 through 4 digits long

ICD-10-PCS

1. designed/developed to meet healthcare needs for a procedure code system.
2. codes constructed from flexible code components (values) using tables
3. codes are alphanumeric
4. All codes are seven characters long.

Characters of a PCS code:

1. Section
2. Body System
3. Root Operation
4. Body Part
5. Approach
6. Device
7. Qualifier

character (6) Device:

Values fall into 4 categories :
1. Graft and Prostheses
2. Implant
3. Simple or Mechanical Appliance
4. Electronic Appliance

Z value in 6ht character

used to represent NO Device.

Z value in 7th character:

used to represent NO Qualifier

ICD-10-PCS system is organized in three parts:

The tables, The index, and The List of Codes

Sections:

composed of 16 sections and the number from 0 to 9 and letter B through D and F through H.

The 16 sections are divided into three groups:

1. Medical and Surgical Section
2. Medical/Surgical Related Section
3. Ancillary Section

Medical and surgical section:

contains the great majority of procedure typically reported in an inpatient setting.

Several structure attributes were recommended for a new procedure coding system:

1. Multiaxial structure
2. completeness
3. expandability

Multiaxial:

the key attribute that provides the framework for all other structural attribute. make it passible for the ICD-10-PCS to be complete, expandable, and to provide a high degree of flexibility and functionality for multiple uses.

Completeness:

is considered a key structural attribute for a new procedure coding system. include, A unique code is available for each significant different procedure. Each code retain its unique definition. code are not reuse.

In Volume 3 of ICD-9-CM different from ICD-10-PCS:

ICD-9-CM procedures performed on many different body parts using different approach or device may be assign to same procedure code. in ICD-10-PCS, a unique code can be constructed for every significantly different procedure.

ICD-10-PCS codes are constructed for individual values rather than lists of fixed codes and text descriptions:

The unique stable definition of a code in the system is retained. New values may be added to the system to represent a specific new approach or device or qualifier, but whole codes by design cannot to given new meaning and reused.

Expandability:

key structural attributes. include 1. accommodate new procedures and technology. 2. Add new codes without disrupting the existing structure.

ICD-10-PCS No Eponyms or common Procedure Name:

Do not include eponyms or common procedure names. physician's names are not included in a code description, nor are procedures identified by common terms or acronyms such as appendectomy or CABG.

No combination codes:

ICD-10-PCS does not define multiple with one code. provides a standardized level of specificity for each code, so that each represents a single procedure variation.

A procedure that meet the reporting criteria for a separate procedure is coded separately in ICD-10-PCS:

This allows the system to respond to change in technology and medical practice with the maximum degree of stability and flexibility.

NOS code options restriction:

ICD-10-PCS restricts the use of broadly applicable NOS "Not otherwise Specified" or unspecified code option in the system. a minimum level of specificity is required to contrast a valid code.

Limited "NEC" Code option:

"not elsewhere classified" provided in ICD-10-PCS but only specific limited use.

One of the 34 possible values can be assigned to each axis of classification in the seven-character code:

they are numbers 0 through 9 and the alphabet (except I and O because they are easily confused with numbers 1 and 0). The number of unique values used in an axis of classification differs as needed.

valid values

The --- for an axis of classification can be added to as needed.

combination of its axis of classification and any preceding values

As with words in their context, the meaning of any single value is a --- on which it may dependent.

more values will depend on preceding values for their meaning.

As the system is expanded to become increasingly detailed, over time ---

The purpose of the alphabetic index:

is to locate the appropriate table that contains all information necessary to construct a procedure code. The PCS Tables should always be consulted to find the most appropriate valid code.

A valid code may be chosen directly from the table.

It is not required to consult the index first before proceeding to the tables to complete the code---

All seven characters must be specified to be a valid code.

If the documentation is incomplete for coding purposes, the physician should be queried for the necessary information.

Within a PCS table, valid codes include all combinations of choices

---in characters 4 through 7 contained in the same row of the table.

"And,"

when used is a code description, means "and/or"

It is the coder's responsibility to determine what the documentation in the medical record equated to in the PCS definitions

Many of the terms used to construct PCS codes are defined within the system. ---. The physician is not expected to use the terms used in PCS code descriptions, nor is the coder required to query the physician when the correlation between the documentation and the defined PCS terms is clear.

The procedure codes in the general anatomical regions body systems should

ONLY be used when the procedure is performed on an anatomical region rather than a specific body part (e.g., root operations Control and Detachment, drainage of a body cavity) or on the rare occasion when no information is available to support assignment of a code to a specific body part.

Where the general body part values "upper" and "lower"

are provided as an option in the Upper Arteries, Lower Arteries, Upper Veins, Lower Veins, Muscles and Tendons body systems, "upper" or "lower" specifies body parts located above or below the diaphragm respectively.

Character

an axis of classification that specifies information about the procedure performed

Value

one of the 34 letters or numbers that can be selected to represent one of the characters in an ICD-10-PCS code

Approach

the fifth character in the code in the Medical and Surgical Section; the way the procedure site is reached (for example: open or percutaneous)

Qualifier

the seventh character in the code in the Medical and Surgical Section; it carries additional information for that particular procedure

Root Operation

the third character in the code in Medical and Surgical Section corresponding to the objective of the procedure; in this section alone there are 31 possible objectives.

Character 1: Section

refers to a broad procedure category or section where the code is found. ICD-10-PCS is divided into 16 sections relating to the general type of procedure.

Character 2: Body Systems

indicates the general physiological system or anatomical region involved (e.g., gastrointertinal). Within the Medical and Surgical Section, these characters will retain the same value.

Character 3: Root Operation

is one of the most important concepts that the user needs to understand in order to identify and select the correct ICD-10-PCS code.

Character 4: Body Part

indicates the specific part of the body system or anatomical site where the procedure was performed.

Character 5: Approach

refers to the technique or approach used to reach the procedure site.

If the intended procedure is discontinued

code the procedure to the root operation performed.

If procedure is discontinued before any other root operation is performed

code the root operation "Inspected" of the body part or anatomical region inspected.

Medical and Surgical Section Approaches: External

Procedures performed directly on the skin or mucous membrane and procedures performed indirectly by the application of external force through the skin.