Conventions

A1

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.

Example: The fifth axis of classification specifies the approach in sections 0 through 4 and 7 through 9 of the system.

A2

One of 34 possible values can be assigned to each axis of classification in the seven-character code: they are the numbers 0 through 9 and the alphabet (except I and O because they are easily confused with the numbers 1 and 0). The number of unique values used in an axis of classification differs as needed.

Example: Where the fifth axis of classification specifies the approach, seven different approach values are currently used to specify the approach.

A3

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

Example: If a significantly distinct type of device is used in a new procedure, a new device value can be added to the system.

A4

As with words in their context, the meaning of any single value is a combination of its axis of classification and any preceding values on which it may be dependent.

Example: The meaning of a body part value in the Medical and Surgical section is always dependent on the body system value. The body part value 0 in the Central Nervous body system specifies Brain and the body part value 0 in the Peripheral Nervous body system specifies Cervical Plexus.

A5

As the system is expanded to become increasingly detailed, over time more values will depend on preceding values for their meaning.

Example: In the Lower Joints body system, the device value 3 in the root operation Insertion specifies Infusion Device and the device value 3 in the root operation Replacement specifies Ceramic Synthetic Substitute.

A6

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.

A7

It is not required to consult the index first before proceeding to the tables to complete the code. A valid code may be chosen directly from the tables.

A8

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.

A9

Within a PCS table, valid codes include all combinations of choices in characters 4 through 7 contained in the same row of the table. In the example below, 0JHT3VZ is a valid code, and 0JHW3VZ is not a valid code.

Section: 0 Medical and Surgical

Body System: J Subcutaneous Tissue and Fascia

Operation: H Insertion: Putting in a nonbiological appliance that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part

Body Part Approach Device Qualifier
S Subcutaneous Tissue and Fascia, Head and Neck
V Subcutaneous Tissue and Fascia, Upper Extremity W Subcutaneous Tissue and Fascia, Lower Extremity
0 Open
3 Percutaneous
1 Radioactive Element
3 Infusion Device
Z No Qualifier
T Subcutaneous Tissue and Fascia, Trunk 0 Open
3 Percutaneous
1 Radioactive Element
3 Infusion Device
V Infusion Pump
Z No Qualifier

A10

"And," when used in a code description, means "and/or."

Example: Lower Arm and Wrist Muscle means lower arm and/or wrist muscle.

A11

Many of the terms used to construct PCS codes are defined within the system. It is the coder’s responsibility to determine what the documentation in the medical record equates to in the PCS definitions. 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.

Example: When the physician documents “partial resection” the coder can independently correlate “partial resection” to the root operation Excision without querying the physician for clarification.