Knowledge Center

Putting Together the Pieces of What We Know

ICD-10 Knowledge Center is a growing body of knowledge - a place to access our collective understanding of ICD-10 coding. The Knowledge Center, with assistance from our ICD-10 experts, facilitates to bring the benefit of collective experience of our team. The questions featured in this Knowledge Center are those submitted by our Members and uses our ICD-10 experts' input, comments, and feedback to create a contually evolving body of ICD-10 knowledge.

1) How do I code acute streptococcal tonsillitis with peritonsillar abscess in ICD-10-CM?

ICD-10-CM code for acute streptococcal tonsillitis is J03.00. But the excludes 1 at category J03 do not permit code for peritonsillar abscess J36 to be coded along with any code from J03. In our view, treatment management will have to do here some help for deciding the code. If the treatment is simply an antibiotic therapy as in tonsillitis, code it as J03.00. Instead if there is surgical drainage done for the abscess, code J36. In cases above like this, it would be prudent to consult the rendering physician also especially when reporting J03.00.

2) What is the code for retained products of conception (parts of placenta) after delivery without      hemorrhage in ICD-10-CM?

ICD-10-CM provides different codes for retention of products of conception. In my sense O73.1 is the most appropriate. Since only some parts of the placenta is retained so code O73.1, Retained portions of placenta and membranes, without hemorrhage.

3) I am confused here about a code for vomiting with colonic content in the vomitus to be selected      in ICD-10-CM.

Colonic content in vomitus means fecal matter. Do select code R11.3, other vomiting without nausea for this condition.

4) What code will replace 250.00 of ICD-9-CM, the most common diagnosis of my physician when      ICD-10-CM codes will become effective?

E11.9, type 2 diabetes mellitus without complication is the most appropriate replacement as per my understanding.

5) Cradle cap dermatitis in infants is coded in ICD-10-CM with code?

Code L21.0, seborrhea capitis is the code for cradle cap dermatitis or crusta lactea as per ICD-10-CM.

6) How should I code the diagnosis of primary carcinoma of left ovary with abnormally high      secretion of estrogens in ICD- 10-CM system?

One of the most important features that make ICD-10-CM different from ICD-9-CM is laterality. Codes are different for the same conditions on the organs of right & left side of the body. ICD-10-CM code for primary carcinoma of left ovary is C56.1, and E28.0 is for hyperestrogenism.

7) My physician has documented a diagnosis statement as fever associated with sickle-disease.      Please help me in coding as per ICD-10-CM.

You can code D57.1, sickle-cell disease for sickle-cell disease and code R50.8, other specified fever for the associated fever. Code D57.1 should be first listed and R50.81 should be the additional diagnosis.

8) How shall I code for an encounter of a patient for removal of internal fixations placed to treat a      displaced oblique fracture of right humerus shaft?

As per ICD-10-CM coding guidelines the codes for aftercare should not be used for aftercare for injuries. Instead the injury code with 7th character D should be selected to indicate the encounter as subsequent encounter for fracture with routine healing. So the correct code for this encounter should be S42.331D.

9) Can you please provide the ICD-10-CM code for idiopathic respiratory distress syndrome in a      newborn?

The most appropriate code for this condition would be P22.0

10) Suggest a suitable code for the diagnosis ruptured abdominal aortic aneurysm in a patient with        syphilis with cardiovascular complication.

ICD-10-CM provides combination codes for syphilis in different stages of the disease along with different complications of the disease. Code A52.01, syphilitic aneurysm of aorta is the most appropriate code for this condition.

11) How do I code an initial encounter visit of a patient with prosthetic valve endocarditis due to        Staphylococcus aureus as per ICD-10-CM?

You should code T82.6xxA, infection and inflammatory reaction due to cardiac valve prosthesis as first listed diagnosis and B95.6, Staphylococcus aureus as the cause of diseases classified elsewhere as additional diagnosis for this diagnostic statement. Since code T82.6xxA states that the complication is due to prosthetic valve, so no additional code is required to put a status Z code to indicate the prosthetic heart valve status of the patient.

12) ICD-10-CM provides codes for under-dosage effect of different drugs. My patient developed        non-ketotic hyperglycemic hyperosmolar coma due to under dosage of insulin lente because of        noncompliance due to financial constraints, initial encounter. How can I code this?

Yes, ICD-10-CM has provisions of coding for the effects of underdosing of drugs. You can code the said condition as T38.3x6A Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs as the first listed code, followed by E09.01, drug or chemical induced diabetes mellitus with hyperosmolarity with coma as additional code and also code Z91.120, patientÂ's intentional underdosing of medication regimen due to financial hardship to indicate the intent. ICD-9-CM lacks such codes for underdosing effects of drugs.

13) How do I code secondary malignancy of parietal pleura with malignant pleural effusion in         ICD-10-CM?

Code the said condition with code C78.2, secondary malignant neoplasm of pleura as first listed diagnosis, followed by code J91.0, malignant pleural effusion as additional diagnosis.

14) How can I code for metronidazole-resistant intestinal giardiasis as per ICD-10-CM?

ICD-10-CM has provisions for coding of resistance of the organisms to antimicrobial drugs along with code for the infection. So for the above said condition report code A07.1, Giardiasis [lambliasis] as first listed diagnosis and code Z16, infection with drug-resistant organisms as additional diagnosis. Remember that Z16 should always be additional diagnosis, not be the first listed diagnosis.

15) How different is the coding for late effects of burn injuries in ICD-10-CM compared to ICD-9-CM?

In ICD-10-CM coding of late effects or burn injuries require generally two codes. The first code should be for the condition or nature of the late effect followed by the late effect code for burn. Whereas in ICD-10-CM, such encounters should be coded with a burn injury code with 7th character extension S to indicate the sequelae or late effect.

16) I am a bit confused here with ICD-10-CM codes. My physician documents on most of his     patients records coronary artery disease or ASHD. I was coding this condition with code        414.00 in ICD-9-CM. I am trying to find the code for the same in ICD-10, please suggest.

Since ICD-10-CM is more specific about the documentation requirements, it is better to get more details about the diagnosis. You may code the same condition in ICD-10-CM as I25.10, atherosclerotic heart disease of native coronary artery without angina pectoris.

17) How is hypertension coded in ICD-10-CM?

Coding guidelines for ICD-10-CM are more or less similar to that of ICD-9-CM. But ICD-10-CM does not provide any table for hypertension. One has to select the codes with the help of alphabetic index and tabular list. Also there is no differentiation of hypertension - benign or malignant. So the diagnosis hypertension can be coded with code I10, essential (primary) hypertension.

18) How do I code diabetic retinopathy in type II diabetes in ICD-10-CM? In ICD-9-CM, the same        condition I was coding with two codes 250.50 [362.01] but I am not finding any slanted brackets        in alphabetic index, and there is no [use additional code] instructional notes also in ICD-10-CM         with the code for diabetes.

There are no slanted brackets used in the alphabetic index of ICD-10-CM. Moreover, ICD-10-CM codes for diabetes with complications are combination codes. Diabetes retinopathy may be coded with a single code only in ICD-10-CM. You can code this condition in ICD-10 with code E11.319, type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema.

19) How do I code for the encounter for cardiac clearance for electroconvulsive therapy (ECT) in        ICD-10-CM? I was coding the same condition in ICD-9-CM with a V code. But what surprises me        there is I found in ICD-10-CM V codes are external cause of injury codes?

Yes. V codes in ICD-10-CM are not for the conditions of V codes from ICD-9. This is also one of the major changes in ICD-10-CM. Z codes of ICD-10-CM are the codes for factors influencing health status and contact with health services. You can select code Z01.810, encounter for preprocedural cardiovascular examination for this encounter.

20) Where do I find a code in ICD-10-CM for a follow-up visit for forearm burn injury of second        degree treated by surgical debridement in the first encounter? Can I code it with code Z09?

ICD-10-CM codes for burn injuries are coded with 7 digits, with a 7th character extension for episode of care. You can report the said condition with the injury code T22.219 as it is coded for active injury with the 7th character extension D for subsequent encounter. The 7th character extension D is used to indicate the encounter as for follow up visit. So the complete code will be T22.219D, burn of second degree of unspecified forearm, subsequent encounter.

21) It's frustrating; I am unable to find a solution about coding of intestinal obstruction          postoperatively due to paralytic ileus in ICD-10-CM.

There is bit confusion here between codes K56.0, Paralytic ileus, K56.69, Other intestinal obstruction and K91.3, Postprocedural intestinal obstruction. But if you look here carefully code K91.3 can't be reported with any code from category K56. So the most appropriate code for this condition is K91.3, Postprocedural intestinal obstruction.

22) Alzheimer's disease with senile dementia and amyloid deposits in brain confirmed by brain         biopsy. How do you code this using ICD-10-CM?

Code G30.9, Alzheimer's disease, unspecified is the most appropriate diagnosis code for this condition. The category G30 includes senile dementia so no additional code for senile dementia is required. No separate code for amyloidosis from category E85 is also applicable here.

23) My physician has not documented the diagnosis diabetes on the medical record of a patient        whose fasting blood sugar came out from lab to be elevated. When I queried about it that can I         code diabetes mellitus he replied not sure? How do I code this encounter in ICD10?

ICD-10-CM is more specific compare to ICD-9-CM. There are specific codes for abnormal laboratory findings or documentations like prediabetes, latent diabetes, elevated glucose tolerance, Hyperglycemia etc. in ICD10. You can simply put code R73.01, Impaired fasting glucose for this condition.

24) How can we code paralytic scoliosis of thoracic region as late effect of poliomyelitis?

Late effects are coded in ICD10 similar to ICD9 with some exceptions. Coding of late effects in ICD-10-CM generally requires two codes. The code for condition or nature of the late effect is sequenced first followed by the code for the late effect. You can code this condition with codes M41.44, Neuromuscular scoliosis, thoracic region and B91, Sequelae poliomyelitis.

25) One of my physician's patients is having symptoms of chronic liver disease. The FNA confirmed      it as amyloidosis of liver. There is no specific code for this condition in ICD-9-CM but I was      coding it with code 277.39, Other amyloidosis. I learnt that ICD-10-CM is more specific, so is         there any specific code for this in ICD10?

You may code this condition with E85.4 [K77]. ICD-10-CM alphabetic index guides for coding of amyloidosis of liver for these two codes. The first code E85.4, Organ-limited amyloidosis, should be listed as first listed diagnosis and followed by code K77, Liver disorders in diseases classified elsewhere. The second code K77 is written in square brackets in the alphabetic index. Mandatory multiple coding rule applies here. You must use both codes following the above said sequence.

26) My physician has documented a diagnosis hydronephrosis of right ureter due to kink. How do I        code it in ICD-10-CM?

You can code this condition with code N13.1, Hydronephrosis with ureteral stricture, not elsewhere classified. Since kink causes obstruction to urine flow this condition is coded here only. The alphabetic index doesn't specify the search under the main term hydronephrosis for the subterm "due to kink". But if you search hydronephrosis under the term "kink" in the alphabetic index you will come to this code only.

27) How do I code splenic rupture in infectious mononucleosis due to Epstein-Barr virus in

ICD-10-CM provides more combination codes than ICD-9. Moreover, there is more number of specific diagnosis codes also in it. You can code this condition with code B27.09, Gammmaherpesviral mononucleosis with other complications. As is evident from this code that no additional code for rupture spleen is required it singly exists as a combination code for infectious mononucleosis with splenic rupture.

28) My physician has written a diagnosis statement on a 22 year old female patient's medical        record clay eating. How do I code this as per ICD-10-CM?

As we discussed before that ICD-10-CM is having more number of codes than ICD-9. There is a specific code for pica (cravings for substances that are not foods) in adults in ICD-10-CM. You can code here F50.8, Other eating disorders.

29) How should I code a pressure ulcer of the buttock and hip with skin loss in ICD-10-CM?

ICD-10-CM provides pressure ulcer codes with more specificity for different sites & stages & also for some sites with laterality. In this diagnosis statement you can take a code for pressure ulcer for contiguous sites of buttock & hip. Code L89.42, Pressure ulcer of back, buttock and hip, stage II is the most appropriate for this diagnosis.

30) How can we code polyarthritis, myalgia and rash associated with mosquito born Ross river        fever as per ICD-10-CM? I was coding the same in ICD-9 with code 066.3.

Since integral signs & symptoms of an established diagnosis is not coded along with the diagnosis code as per ICD-10-CM guidelines, so code this condition with B33.1, Ross River disease.

31) How shall we code encephalitis due to acute paralytic poliomyelitis in ICD-10-CM? Is there any        specific combination code existing for this condition in ICD-10-CM?

Mandatory multiple coding rules similar to ICD-9-CM also exist for some conditions in ICD-10-CM in spite of having more number of combination codes in it. You can code this condition with codes A80.30, Acute paralytic poliomyelitis, unspecified placed first followed by G05, Encephalitis and encephalomyelitis in diseases classified elsewhere.

32) One of my physician's patients had a below knee amputation 4 years before. He uses to visit my
   physician frequently for complaint of pain in the stump. My physician says that he has      developed Phantom limb syndrome. I am remembering the diagnosis code 353.6 on his visits.        How to code it in ICD-10-CM?

ICD-10-CM provides two codes for phantom limb syndrome based on its association with pain or without pain. In this case you may put G54.6, Phantom limb syndrome with pain for this condition. ICD-9 code for phantom limb syndrome was a non specific code for that it lacks separate codes for phantom limb syndrome associated with pain or without.

33) I am working for an optometrist. One of the common diagnoses on his claims is 367.1, Myopia.        How it is going to be affected in ICD-10-CM.

ICD-10-CM is more specific in the diagnosis coding compare to the outdated ICD-9 classification. It is providing more specific diagnosis codes for myopias of right & left eye as well as that of both eyes along with a code for unspecified eye myopia. See the expansion of ICD-9 code 367.1 into the given four codes here; H52.10, Myopia, unspecified eye; H52.11, Myopia, right eye; H52.12, Myopia, left eye; H52.13, Myopia, bilateral.

34) My physician is having some West African origin patients with HIV disease and they are also       confirmed for HIV-2 infection. I was using codes 042 and 079.53 from ICD-9. But I don't see any        instructions for additional coding for HIV 2 infection along with code B20 in ICD-10. What to do?

ICD-10-CM does not provide any instruction with B20, Human immuno deficiency virus [HIV] disease, for additional coding of HIV 2 infection. HIV-2 infection actually can be coded otherwise with code B97.35, Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere. But the "excludes 1" note at B97.35 indicates that this code should not be coded with B20. So you can report B20 only for the above condition.

35) I learnt from one of my friends that there are no codes ICD-10-CM for certain encounters such    as removal of internal fixations after the healing of fractures. How should we code such       encounters without the codes for aftercare?

There are aftercare codes for different conditions in ICD-10-CM but no such codes are available in it for aftercare encounters following healing of fractures such as removal of external fixation devices or internal fixation devices etc. Such encounters are coded with the injury code for the fracture with the 7th character extension D.

36) My physician has documented a diagnosis as adenoma prostate on a patient's health record.        When I am going through the ICD-10-CM neoplasm table I am not getting to it. Please help.

Neoplasm table is arranged according to the type of malignancy such as benign or malignant, carcinoma in situ etc. But in this case a histological term "adenoma" is used in the diagnostic statement. So in such situations first search the term adenoma in the alphabetic index, then follow the entry prostate under it. The index will guide you to search a code in the neoplasm table in the benign column for the organ prostate.

37) I am working for an orthopedcian as a coder. I am trying to acquaint myself with ICD-10-CM in        my leisure times. How can I code closed fracture of surgical neck of humerus initial treatment        with ICD-10-CM?

ICD-10-CM codes for fracture are expanded to a great extent than its predecessor system. Your physician needs to be more precise in diagnosis statement about the laterality of injury whether right or left humerus fractured. In addition you may discuss with your physician about the part of the surgical neck of humerus fractured. Even information about the fracture like displaced or non displaced may also be sought. Also attention must be given to the closed or open nature of fracture along with the episode of encounter such as initial or subsequent encounter or aftercare etc. In case of non availability of the above details you may code the above diagnosis with code S42.213A, Unspecified displaced fracture of surgical neck of unspecified humerus, initial encounter for closed fracture.

Note: A fracture not indicated as displaced or non displaced should be coded to displaced as per coding guidelines. Review the fracture extensions carefully before assigning an extension to a fracture code.

38) I work for an urgent care center. I am frequently encountering situations to assign codes for      alcohol abuse and dependence. How do I code alcohol dependence with intoxication delirium      after a heavy alcoholic binge? The blood alcohol level was documented as 205mg/100ml. Do I        need to code this as alcohol abuse only?

Codes for alcohol & drug abuse from chapter 5 may be used with poisoning & toxic effects codes of chapter 19 if a patient has an acute alcohol or drug poisoning or overdose, even if the patient is dependent on alcohol or drugs. The correct code assignments for this encounter should be T51.0x1A, Toxic effect of ethanol, accidental (unintentional), F10.221, Alcohol dependence with intoxication delirium, Y90.7, Blood alcohol level of 200-239mg/100ml, in the above sequence.

39) I found a surprising change in the drug & chemical table of ICD-10-CM when compare to ICD-9.        There are four columns of poisoning codes each with a different mean of intent as against only        one in the ICD-9 without intent component. What this change is & how does it works?

Yes, the drugs & chemicals table is organized in different order in ICD-10-CM. There are four columns of poisoning codes each with different intent component. Poisoning code selection is solely based upon the nature of intent. There is no separate external cause code to be assigned in addition to the poisoning code as per guidelines to show the intent. There is no place of occurrence code to be assigned with codes for poisonings, toxic effects, adverse effects or underdosing codes. The sequencing of codes for poisoning, toxic effect or adverse effect should be, a code from T36-T65 is sequenced first, followed by the code(s) that specifies the nature of the poisoning, toxic effect or adverse effect.

40) I am surprised to see two different types of codes for the same malignancy in the ICD-10-CM    manual. For example when I search malignant melanoma in the alphabetic index I found       (M8720/3) C43.9. How is it?

Neoplasms are classified according to site (topography) with broad groupings for behavior, malignant, benign, carcinoma in situ etc. In the above example the topography code is C43.9. On healthcare claims for disease coding topography codes are used for reporting. They can be searched in the neoplasm table of ICD-10. The other code which is in the brackets in the above example that begins with letter M is morphology code. These codes indicate the histologic type of the tumor. These codes are derived from the second edition of the International Classification of Diseases for Oncology (ICD-O). The correct morphology code can be found in the Alphabetic Index to Diseases under the main and subterm for the type of neoplasm, such as adenocarcinoma, melanoma, sarcoma etc.

The morphology codes should not be reported as diagnosis codes on a claim, but they can help you figure out the proper diagnosis code to use. The morphology codes are used by pathologists to collect further data on the types of neoplasms that they are analyzing. The morphology code numbers consist of five digits. The first four numeric digits (M8720/3 in your example) identify the histological type of neoplasm that was found. The fifth digit (/3 in your example) indicates its behavior.

41) I learnt about ICD-10-PCS as new coding system to be implemented from October 1st 2014 for         procedures. How does it going to affect physician office coding?

Physician office services will not be affected by ICD-10-PCS. For reporting of procedures physicians still be using CPT-4 codes. For physician's offices physicians and coders need not learn ICD-10-PCS. However, physicians should be aware that documentation requirements under ICD-CM-PCS are a lot different, so their impatient medical record documentation will be affected by this change. So, if your physician is works for inpatient side also then he will have to customize his documentation for different procedures as per the requirements of ICD-10-PCS.

42) It is learnt that there will be no definitely built codes in ICD-10-PCS. One has to prepare the         codes by themselves following the procedure coding guidelines?

Yes, there are no complete codes in ICD-10-PCS. Codes are selected from complex grids developed in the form of tables, based on the type of procedure performed, approach, body part, and other characteristics. ICD-10-PCS has completely abandoned the use of medical terminology based on Latin terms, eponyms etc. ICD-10-PCS uses a standard terminology of its own. While the meaning of the specific words can vary in common usage, the coding scheme does not include multiple meanings for the same term. Each term is assigned a specific meaning. ICD-10-PCS codes are very different from ICD-9-CM procedure codes. Coding in ICD-10-PCS requires a great understanding of the procedure performed, as the main index term is the root operation (eg. Excision, Resection etc.) rather than the eponym or name of the procedure. For example, there is no term in the ICD-10-PCS index for "Wilson operation" The coder must know which of the major root operations this falls under and code appropriately. Once the procedure is located in the index, the coder will find only the first 3-4 of the total 7 character code listed. Those first characters will lead the coder to tables, not a tabular list, that allows for building the rest of the code. All the codes in ICD-10-PCS must have 7 characters. No code of less than 7 characters exists in the entire system.

43) How different is ICD-10-PCS in terms of volume of codes than ICD-9-CM volume 3?

ICD-10-PCS lists approximately 87,000 procedure codes, which is an enormous expansion compare to only about 4,000 codes in ICD-9-CM.

44) How difficult will be the learning of ICD-10-PCS?

ICD-10-PCS is definitely going to be more difficult as far as learning & expertise is concern since it is based on a completely a new concept of constructing codes instead searching the codes as in vol. 3 of ICD-9. In addition, the clinical knowledge as well as knowledge of surgical procedure required to assign an ICD-10-PCS code is much broader than that is required for assigning a procedure code from ICD-9-CM.

45) How different are the codes of ICD-10-PCS than that of ICD-9-CM Vol. 3?

ICD-9-CM is having codes made of 3 or 4 digits all numeric, whereas, ICD-10-PCS codes are 7 characters alphanumeric codes. Each character may have up to 34 values. They are the 10 digits 0-9 and the 24 letters A-H, j-N and P-Z. The letters I and O are not used to avoid confusion with the numbers 1 and 0.

46) How is the ICD-10-PCS book organized?

As in ICD-9-CM volume 3 the ICD-10-PCS text also contains first the alphabetic index organized according to root operations as main terms, body parts or procedure names as main terms. Following the alphabetic index is list of tables for constructing codes organized into different sections. Procedures are divided into sections that identify the general type of procedure (e.g., medical and surgical, obstetrics, imaging etc.). The first character of each code in ICD-10-PCS always specifies the section. The complete code set is divided into 16 sections. The first section medical & surgical section constitutes the vast majority of procedures reported in an inpatient setting.

47) What is meant by the term root operation in ICD-10-PCS?

Every procedure in the ICD-10-PCS is identified with a unique and standard procedure definition with its name. These procedure names are referred as root operations. One has to be very familiar with these root operation definitions while assigning codes from the ICD-10-PCS. Coders are also required to have adequate knowledge about the clinical/surgical/investigative procedure performed to select the correct root operation while assigning the code. Root operation is specified in the third character position of ICD-10-PCS code structure.

48) How is the tables section of ICD-10-PCS organized?

Tables section consists of tables containing rows that specify the valid combination of code values. In most sections of the system, each table contains a description of first three characters i.e., for the name of the section, the body system, and the root operation at the top of the table. The rows in the table are filled with character values for each character of the 7 character code of ICD-10-PCS with their description for character four through seven separated by vertical rows in between them. A code may be constructed by adding required 4th, 5th, 6th and 7th character to the first three characters of the table as per the documentation details. While constructing a code from the table, the 4th to 7th characters are selected strictly from the same row in a table. Example in the following table 01P code 01PYX0Z using the 2nd row for 4th to 7th character is a valid code. Where as a code with combination of characters from both row of table such as 01PYX7Z is a wrong code.

0 Medical and Surgical
1 Peripheral Nervous System
P Removal: Taking out off a device from a body part
Body Part Character 4 Approach Character 5 Device character 6 Qualifier Character 7
Y Peripheral Nerve 0 Open
3 Percutaneous
4 Percutaneous Endoscopic
0 Drainage Device
2 Monitoring Device
7 Autologous Tissue Substitute
M Electrode
Z No Qualifier
Y Peripheral Nerve X External 0 Drainage Device
2 Monitoring Device
M Electrode
Z No Qualifier

49) Can procedures like esophagoscopy, cholecystectomy, gastrectomy etc. be considered as root         operations?

No. Composite terms such as esophagoscopy, cholecystectomy, gastrectomy etc. are not root operations in ICD-10-PCS, but they may specify different components of a specific root operation. You may find the words esophagoscopy, cholecystectomy, gastrectomy etc. in the alphabetic index but they are not considered as root operation in the tables section. The index guide you to the appropriate root operations with cross reference up on searching with composite terms as above.

50) How can we accept that ICD-10-PCS is more specific than ICD-9-CM volume 3?

In volume 3 of ICD-9-CM procedures performed on different body parts, by different approaches or procedures of different types are often coded with same code. Where as a unique code is available for variations of a procedure, that can be performed in ICD-10-PCS.


ICD-9-CM volume 3 code 98.51, Extracorporeal shockwave lithotripsy [ESWL] of the kidney, ureter and/or bladder, is used for ESWL of kidney, ureter and bladder.
ICD-10-PCS may help coding of the same procedure with different codes with more specificity than that in ICD-9 as follows:
0TF3XZZ Fragmentation in Right Kidney Pelvis, External Approach
0TF4XZZ Fragmentation in Left Kidney Pelvis, External Approach
0TF6XZZ Fragmentation in Right Ureter, External Approach
0TF7XZZ Fragmentation in Left Ureter, External Approach
0TFBXZZ Fragmentation in Bladder, External Approach
0TFCXZZ Fragmentation in Bladder Neck, External Approach
0WFRXZZ Fragmentation in Genitourinary Tract, External Approach

51) How do I code laparoscopic appendectomy as per ICD-10-PCS?

Appendectomy in ICD-10-PCS may be coded as root operation resection using table 0DT of Gastrointestinal System in section Medical & Surgical. Laparoscopic procedures are selected as percutaneous endoscopic approach in ICD-10-PCS system. So, laparoscopic appendectomy should be coded as 0DTJ4ZZ, Resection of Appendix, Percutaneous Endoscopic Approach.

52) How do I code endoscopy procedures in ICD-10-PCS system?

Endoscopic procedures are coded differently in ICD-10-PCS in comparison to that in ICD-9-CM volume 3. The diagnostic endoscopies are coded under root operation inspection and biopsies by endoscopy are coded as excision. Where as surgical endoscopy procedures are coded using different root operations, depending upon the technique utilized for the treatment or type of procedure done. Example: Endoscopic ablations are coded with root operation destruction, and endoscopic removal of a calculus from a hollow organ is coded with root operation extirpation etc.

53) How can fracture reductions be coded in ICD-10-PCS? It's really difficult here there is no root         operation reduction in the Medical & Surgical Section?

You are correct. There is no root operation by name reduction in ICD-10-PCS. Displaced fractures are coded in it with root operation reposition and nondisplaced fractures are coded differently according to actual procedure performed. Example: Application of internal fixation such as screws, nails etc to treat nondisplaced fractures are coded with root operation insertion and closed treatment of nondisplaced fractures by application of cast is coded with root operation immobilization in the placement section.

54) How do I code incision and drainage of an abscess in ICD-10-PCS? I am confused to select the        appropriate root operation whether I should go for root operation incision or drainage or both.

Incision and drainage of abscesses are coded under root operation drainage. Since the purpose of the procedure is letting out fluid from the abscess cavity so it is coded to root operation drainage. The incision made for the procedure is not coded separately.

55) How do we code the different hemorrhoidectomy procedures of ICD-9CM volume 3? I even don't    find the word hemorrhoidectomy in the alphabetic index of ICD-10-PCS. Its looking like the       transition is going to happen with great difficulty.

In many ways the transition looks difficult if not prepared well in advance. It is assumed that more training & practice is required to have command over the code search in ICD-10-PCS than that in ICD10-CM. Hemorrhoidectomy procedures by different methods are coded to different root operations in ICD-10-PCS. Examples: Hemorrhoidectomy by excision is coded to excision of anus procedures based on the approach applicable; Hemorrhoidectomy by crushing is coded to occlusion of hemorrhoid plexus based on the approach applicable.

56) How should I code different hernia operations like herniotomy, herniorraphy or hernioplasty in        ICD-10-PCS? I should choose what root operations?

The surgical correction of a hernia by cutting through a band of tissue that constricts it is termed as herniotomy. During this procedure no repair of the inguinal canal is performed. When herniotomy is combined with a reinforced repair of the weak posterior inguinal canal wall with autologous (patient's own tissue) or non autologous (other person's tissue) or synthetic (like steel or prolene mesh) material it is termed Hernioplasty. In contrast to this herniorraphy is a procedure in which no autogenous or heterogeneous material is used for reinforcement. ICD-10-PCS do not differentiate the hernia repair procedures based on these definitions. Herniotomy and herniorraphy procedures may be coded to root operation repair where as hernioplasty procedures are coded to root operation supplement.

57) Oh no! How ICD-10-PCS is going to affect the coding professionals I can understand by this that       I have wasted one hour for searching a code for tracheoesophageal fistula repair. Could you        suggest me how to do this?

You are correct there is no term fistula in the PCS index, not also under the main term repair. You should code such repair of such procedures to root operation repair for the organs trachea as well as esophagus based on the approach.

58) I am confused about how to code percutaneous transluminal coronary angioplasty. Shall I code        it to root operation repair?

The suffix "plasty" here should not be confused with repair. PTCA procedure is basically involves increasing the caliber of the coronary artery, so it is coded under root operation dilation.

59) How do I code amputations as per ICD-10-PCS? I learnt that the terminology amputation is not        having any place in the ICD-10-PCS system.

Yes you got correct information. The term amputation is abandoned in the PCS since PCS has its own standard terminology. All amputation procedure codes are coded to root operation detachment in ICD-10-PCS.

60) How do I code for a phototherapy procedure performed to treat a newborn with physiological        jaundice in ICD10-PCS?

Phototherapy may be coded in ICD-10-PCS to root operation phototherapy of section extracorporeal therapies. Depending upon the duration of the procedure (single or multiple) the procedure can be coded.

61) Hey suggest me how do I code hemorrhoidopexy for rectal prolapse in ICD-10-PCS? Shall we        code it to root operation replacement?

No! Coding hemorrhoidopexy procedure to root operation replacement doesn't make sense. It should be coded to root operationreposition since the definition of the root operation reposition "Moving to its normal location or other suitable location all or a portion of a body part" justifies hemorrhoidopexy to be coded to root operation reposition.

62) I am in search of a code in ICD-10-PCS for control of epistaxis by anterior nasal packing. The       PCS index is not guiding by any means here. I tried to search with root operation control. But I        doubt.

As discussed earlier diagnostic terms are excluded in the code descriptions of ICD-10-PCS codes. Root operation control is meant for coding of post procedural bleeding not for control of bleeding of diseased states or injuries. The actual root operation for this procedure is packing in placement section of PCS even though the purpose of packing is to control of bleeding. So code this procedure with code 2Y41X5Z, Packing of Nasal Region using Packing Material.