Coding with PCS When There is No Code

August 5th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS

Categories: Coding

ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as there are ICD-10-CM guidelines.

When searching ICD-10-PCS codes, the purpose of the index is to locate the table that contains the table needed for a procedure. Remember, with PCS seven characters are REQUIRED to be considered a valid code, unlike ICD-10-CM where three characters could be a complete code such as I10.

The Prefix “peri”

The Prefix "peri" may be combined with a body part to identify the site of the procedure, such as: perirenal, this is coded to the kidney body part when the site of the procedure is not further specified.

NOTE: This use of this guideline and others will apply only when there is not a specific body part available!

General Guidelines

The general guidelines, when coding for a body part that does not have a code pertaining to it, state to code the body part value corresponding to the whole body part. Confused yet? Take a look at some examples and instructions PCS offers.

Example: A procedure performed on the alveolar process of the mandible is coded to the mandible body part.

Skin Repairs on a Joint

What about coding repairs on skin, subcutaneous tissue, and fascia overlying a joint? There are no codes for shoulder, so how is this coded? The following is according to the ICD-10-PCS Guidelines B4.6. If a repair is performed on the skin, subcutaneous tissue, or fascia overlying a joint, the procedure is coded to the following body part.

Shoulder is coded to Upper Arm

Body Part B - Skin, Right Upper Arm

Elbow is coded to Lower Arm

Body Part D - Skin, Right Lower Arm

Wrist is coded to Lower Arm

Body Part D - Skin, Right Lower Arm

Hip is coded to Upper Leg

Body Part H - Skin, Right Upper Leg

Knee is coded to Lower Leg

Body Part K - Skin, Right Lower Leg

Ankle is coded to Foot

Body Part M - Skin, Right Foot

Branches of Body Parts

In addition to location, the guidelines tell us how to code branches of body parts. These are different and have more to do with the root operation. For example, the body part is typically coded to the closest proximal branch that has a specific body part value.

B4.2 states, "In the cardiovascular body systems, if a general body part is available in the correct root operation table, and coding to a proximal branch would require assigning a code in a different body system, the procedure is coded using the general body part value.

Examples: A procedure performed on the mandibular branch of the trigeminal nerve is coded to the trigeminal nerve body part value.

Occlusion of the bronchial artery is coded to the body part value Upper Artery in the body system Upper Arteries, and not to the body part value Thoracic Aorta, Descending in the body system Heart and Great Vessels."

Bilateral Body Part Values

Certain codes will identify bilateral body part values, if a specific code does not exist, the instructions are to code once using the body part that includes bilateral.

Example: Fallopian Tube, Bilateral.

Most major body parts have right and left built into the codes. such as knee joint, right and knee joint, left, in this case. If the procedure was performed on both, you would use two codes: one for the right knee and one for the left knee.

Coronary arteries

Coronary arteries are specified by the number of arteries treated but classified as a single body part, therefore only one code is used when doing a procedure on multiple arteries. More information on coding coronary arteries can be found under section B4.4 of the coding guidelines.

Tendons, Ligaments, Bursae, and Fascia near a Joint

The determining factor when coding PCS for tendons, ligaments, bursae, and fascia near a joint is in respect to the body system that is the focus of the procedure. For example, joint structures are coded to the joint body system.

Examples: Knee arthroscopy with shaving of articular cartilage is coded to the knee joint body part in the Lower Joints body system.

Repair of the anterior cruciate ligament of the knee is coded to the knee bursa and ligament body part in the bursae and ligaments body system.

Fingers and Toes

When doing procedures on fingers or toes if there is not a code specific to that exact body part, then code to the body part value. Therefore if the procedure is on a toe, code it to the foot; if it is a muscle and there is a code for a muscle in the foot then use the code that is more specific pertaining to the muscle in the foot.

Example: Excision of finger muscle is coded to one of the hand muscle body part values in the muscles body system.

Upper and Lower Intestinal Tract

There are several root operations for the upper and lower intestinal tract, such as change, inspection, removal, and revision.

Upper Intestinal Tract includes the portion of the gastrointestinal tract from the esophagus down to and including the duodenum.

Lower Intestinal Tract includes the portion of the gastrointestinal tract from the jejunum down to and including the rectum and anus.

Example: In the root operation Change table, change of a device in the jejunum is coded using the body part lower intestinal tract.

###

Questions, comments?

If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.

Latest articles: (any category)

COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli

COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.

Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli

2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....

Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?
October 10th, 2023 - Aimee Wilcox

When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.

Accurately Reporting Signs and Symptoms with ICD-10-CM Codes
October 5th, 2023 - Aimee Wilcox

Coders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.

The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin Resistance
September 19th, 2023 - Aimee Wilcox

Diabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.

Documenting and Reporting Postoperative Visits
September 12th, 2023 - Aimee Wilcox

Sometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period?

Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding
August 22nd, 2023 - Aimee Wilcox

Gastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.