ICD-10-PCS Coding the Approach

January 9th, 2018 - Find-A-Code

Categories: Diagnosis Coding

When coding surgical procedures, the approach is the technique you use to reach the site of the procedure, or how you get in to do the operation. The fifth character of PCS code is used to indicate the approach when using.

There are seven approaches. They are listed below with their definitions, brief descriptions, and their corresponding code.

Open: Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. With an open approach is used the code doesn't change depending on the instrumentation used with percutaneous or via natural or artificial opening approaches. This approach is indicated by the fifth character of 0.
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. This code is for use with non-visualization instruments only, such as a needle or catheter. This approach is indicated by the fifth character of 3.
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. Use this code when there's the use of visualization instrumentation, but not through a natural or artificial opening. For example with ablation of endometriosis of the endometrium, use of a laparoscope would qualify for this code, a hysteroscope would not. This approach is indicated by the fifth character of 4.
Via natural or artificial opening: Entry of instrumentation through a natural or artificial opening to reach the site of the procedure. With this code non visual instrumentation is granted entry through an orifice. This approach is indicated by the fifth character of 7.
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. Use this code when you use an orifice to reach the procedure site with visualization instrumentation, such as a scope, without puncturing the skin or mucous membrane. A hysteroscope would qualify for this code. This approach is indicated by the fifth character of 8.
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. This approach is indicated by the fifth character of F.
External (indicated by the fifth character of X): 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.

Looking at these approaches you may be asking "Both open and percutaneous approaches seem to be so similar, what's the difference?" The biggest difference is that in an open procedure sutures will be required for the entry point to heal, and a percutaneous procedure will only need a band-aid. The rest of them can be guided by the following official guidelines under section B5.

Open approach with percutaneous endoscopic assistance
B5.2
Procedures performed using the open approach with percutaneous endoscopic assistance are coded to the approach Open.
Example: Laparoscopic-assisted sigmoidectomy is coded to the approach Open.

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

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 is coded to the approach External.

Percutaneous procedure via device
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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