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by Michael Alan Meyer, DO, CCS, CPC, CPCI, AHIMA ICD-10-CM/PCS Trainer and Ambassador

In week ten of this article series, we will look at ICD-10-PCS (facility procedure coding). But, first, let’s look at the ANSWER for last week’s ICD-10-CM challenge question.

PCS; Not for Everyone

The ICD-10-PCS (procedure) coding system was developed by CMS for inpatient hospital settings only. However, it is also used by some insurance companies that require the Universal Billing 2004 (UB 04) (CMS 1450) facility form for outpatient surgery center procedures. So, the PCS codes are used in selective outpatient procedure facility billing, but they are not used for Medicare and Medicaid outpatient billing, which is done on the CMS 1500 form.

The new ICD-10-PCS uses 7 alpha or numeric digits. ICD-9-CM/PCS Volume III coding system uses 3 or 4 numeric digits. All ICD-10-PCS procedure codes are coded using the full seven (7) alphanumeric characters. Each character can be any of 34 possible values of the ten digits 0-9 and the 24 letters A-H, J-N and P-Z and may be used in each character location. This allows for a lot of expandability in coding procedures. Therefore, where in ICD-9-CM there are a little over 4,000 procedures, in ICD-10-CM there are over 72,000 procedures. It is important to note that the letters O and I are not used to avoid confusion with the numbers 0 and 1. There are no decimals in ICD-10-PCS, which can make the seven digit codes confusing. Much attention to detail is required. This is where your medical billing software system can really be a blessing by pre-loading the code combinations for your specific facility or departments’ most common procedures.

The ICD-10-PCS index allows codes to be located based on an alphabetic lookup, just like in ICD-9, Volume III. Codes may be found in the index based on the general type of the procedure e.g., resection, transfusion, fluoroscopy, or a more commonly used terms e.g., Cholecystectomy, Appendectomy, Tonsillectomy. The code for percutaneous intraluminal dilation of the coronary arteries with an intraluminal device can be found in the index under dilation, or a synonym of dilation (e.g., angioplasty).

Once the desired “main term” is located in the index, the index specifies the first three or four values of the code, followed by three or four periods (example: 027....), or directs the user to see another term. Each table also identifies the first three values of the code. Based on the first three values of the code obtained from the index, the corresponding table can be located. The table is then used to obtain the complete code by specifying the last four values of the procedure code.

Attached is an introduction to ICD-10-PCS: See: ICD-10-PCS Presentation. Download the primary source files for PCS that are in the presentation and code some cases! See: ICD-10-PCS Practice Cases.

WARNING: ICD-10-PCS is more complex than ICD-9-CM Volume III coding. Therefore, we have prepared a coding tool for you to use in your coding of procedures! See: ICD-10-PCS coding tool.

CMS. (2012) Centers for Medicare & Medicaid Services (CMS) ICD-10 Website. https://www.cms.gov/Medicare/Coding/ICD10/index.html

CMS. (2012) ICD-10-PCS Coding System, Mappings, and Related Training Manual

CMS. (2012) ICD-10-CM Coding System, Mappings, and Guidelines. http://www.cms.gov/ICD10/12_2010_ICD_10_CM.asp

CMS. (2012) Report on Use of Health Information Technology to Enhance and Expand Health Care Anti-Fraud Activities. http://www.hhs.gov/healthit/documents/ReportOnTheUse.pdf

CMS. (2012) CMS-0013-P—HIPAA Administrative Simplification: Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS. http://edocket.access.gpo.gov/2008/pdf/E8-19298.pdf


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