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Descripción del ICD10-PCS para clasificación de procedimientos. JORNADA TÉCNICA SOBRE CIE-1015 y 16 de Septiembre 2009.Aula Pitaluga. Escuela Nacional de Sanidad
Marc Berlinguet, MD, MPH, CSPQ-International Medical Manager, 3M HIS
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Head Start to Implementation:Preparing Now for ICD-10
Reasons for changeBasic structure of ICD-10-CM and ICD-10-PCSDifferences between ICD-9 and ICD-10Preparing for implementation and change
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Reasons to Switch to ICD-10
ICD-9-CM …has been used in the U.S. since 1979cannot keep up with medical technology does not allow new codes to be added as needed
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ICD code set: 1001 uses
Set healthcare policyDetermine reimbursementConduct research and clinical trialsMeasure quality of health careEvaluate health care providersProvide treatment optionsTrack and manage health risk and disease process
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Development of ICD-10-PCS PCS – Procedure Coding System
Replacement for ICD-9-CM, procedures 1998 – first version released by CMS Annual updates since that time Not in use at this time
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The ICD-10-PCS is being developed with the support of the Centers forMedicare and Medicaid Services, under contract
Nos. 90-1138, 91-22300 500-95-0005 and HHSM-500-2004-00011C
to 3M Health Information Systems.
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I-10 PCS: Essential Characteristics
Seven Character Alphanumeric CodeDigits 0 - 9Letters A-H, J-N, P-Z
Source: 3M Health Information Systems
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I-10 PCS: Essential Characteristics
Completeness: unique code for every distinct procedureExpandability: easily adapts to changes in technology and clinical practiceStandardized terminology: terms have a single precise meaningMulti axial: fixed order, each character functions independently
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1st 2nd 3rd 4th 5th 6th 7th
Section
BodySystem
RootOperation
BodyPart
Approach
Device
Qualifier
PCS Character Assignment:Medical and Surgical Procedures
Source: 3M Health Information Systems
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0 0 9 0 0 0 Z
Med/Surg
CNS
Drainage
Brain
Open
Drainage Device
None
PCS Codes:Each Code Tells a Story
Source: 3M Health Information Systems
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Section (1st character)
1st 2nd 3rd 4th 5th 6th 7th
0 Medical and Surgical 9 Physical Rehabilitation and1 Obstetrics Diagnostic Audiology2 Placement B Extracorporeal 3 Administration Assistance and Performance4 Measurement and Monitoring C Extracorporeal Therapies5 Imaging D Laboratory6 Nuclear Medicine F Mental Health7 Radiation Oncology G Chiropractic8 Osteopathic H Miscellaneous
J Substance Abuse Treatment
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Body System (2nd character)
1st 2nd 3rd 4th 5th 6th 7th
Identifies general area of procedureExamples:1 Peripheral Nervous System2 Heart and Great VesselsB Respiratory SystemC Mouth and ThroatD Gastrointestinal System
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Root Operation (3rd character)
1st 2nd 3rd 4th 5th 6th 7th
Identifies essential surgical action performedExamples in Medical/Surgical:0 Alteration 4 Creation1 Bypass 5 Destruction2 Change 6 Detachment3 Control 7 Dilation
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Body Part (4th character)
1st 2nd 3rd 4th 5th 6th 7th
Describes specific body part on which the procedure was performedBody parts include lesions, polyps, etc. found in/on the body part
Example: body system D, Gastrointestinal0 Esophagus B Ileum1 Esophagus, Upper J Appendix 5 Upper Intestine W Peritoneum
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Approach (5th character)
1st 2nd 3rd 4th 5th 6th 7th
Indicates the method used to reach the body part13 different approaches made up of three basic types, plus the external approach:
Open => Open intraluminalPercutaneous=> Percutaneous intraluminalTransorifice=> Transorifice intraluminal
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Device (6th character)
1st 2nd 3rd 4th 5th 6th 7th
Describes a device placed during the procedureApplies only to devices that remain after the procedureis completed
Grafts and prostheses (skin graft, joint prosthesis)Implants (IUD, brachytherapy seeds)Simple/Mechanical Appliances (tracheostomy tube, VAD)Electronic Appliances (pacemakers, infusion pumps)
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Qualifier (7th character)
1st 2nd 3rd 4th 5th 6th 7th
Unique meaning for different root operations Examples:
Genetic compatibility of transplantBiopsy (diagnostic excision)Destination site for a bypassOriginal procedure being revised
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Number of PCS codes by section= 86,617Medical and Surgical 77,242Obstetrics 331Placement 864Administration 1,401Measurement and Monitoring 290Extracorporeal Assistance andPerformance 26Extracorporeal Therapies 34Osteopathic 100Other Procedures 21Chiropractic 90Imaging 2,466Nuclear Medicine 458Radiation Oncology 1,823Rehabilitation and DiagnosticAudiology 1,382Mental Health 30Substance Abuse Treatment 59
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I-10-PCS Book Format
Matrix and indexIndex provides first three or four charactersMatrix must be used to build valid codeNo eponyms are included
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3M Health Information Systems0: Medical and Surgical SectionD Gastrointestinal SystemB: EXCISION: Cutting out or off, without replacement, a portion of a body part.
1 Esophagus, upper2 Esophagus, middle3 Esophagus, lower4 Esophagogastric junction6 Stomach7 Stomach, pylorus9 DuodenumA JejunumB IleumC Ileocecal valveH CecumJ AppendixK Ascending ColonL Transverse ColonM Descending ColonN Sigmoid ColonP Rectum
0 Open1 Open Intraluminal2 Open Intraluminal Endoscopic3 Percutaneous4 Percutaneous Endoscopic5 Percutaneous Intraluminal6 Percutaneous Intraluminal Endoscopic7 Transorifice Intraluminal8 Transorifice Intraluminal Endoscopic
Z None X DiagnosticZ None
Q Anus 0 Open1 Open Intraluminal2 Open Intraluminal Endoscopic3 Percutaneous4 Percutaneous Endoscopic5 Percutaneous Intraluminal6 Percutaneous Intraluminal Endoscopic7 Transorifice Intraluminal8 Transorifice Intraluminal EndoscopicZ None
Z None X DiagnosticZ None
R Anal SphincterS Greater OmentumT Lesser OmentumV MesenteryW Peritoneum
0 Open3 Percutaneous4 Percutaneous Endoscopic
Z None X DiagnosticZ None
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0 D B 6 8 Z X
Med/Surg
Gastrointestinal
Excision
Stomach
TransorificeIntraluminalEndoscopic
None
Biopsy-Diagnostic
PCS Code Example:“EGD with biopsy of stomach”
Source: 3M Health Information Systems
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0 F 9 0 0 Z Z
Med/Surg
Hepatobiliary
Drainage
Liver
Open
None
None
PCS Code Example:“Drainage of liver, open”
Source: 3M Health Information Systems
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I-9-CM to I-10-PCS:“Excisional debridement of skin”
ICDICD--99--CMCM ICDICD--1010--PCSPCS DescriptionDescription
86.22 0HBJZZZ Excision, skin right upper leg
86.22 0HBLZZZ Excision, skin right lower leg
86.22 0HB9ZZZ Excision, skin buttock
86.2 0HBPZZ Excision, skin left foot
Source: 3M Health Information Systems
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ICD-9-CM Angioplasty 1 code (39.50)ICD-10-PCS Angioplasty codes854 codes , specifying body part, approach, and device, including:
047K04Z – Dilation of right femoral artery with drug-eluting intraluminal device, open approach047K0DZ – Dilation of right femoral artery with intraluminal device, open approach047K0ZZ – Dilation of right femoral artery, open approach047K34Z – Dilation of right femoral artery with drug-eluting intraluminal device, percutaneous approach047K3DZ – Dilation of right femoral artery with intraluminal
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3M Health Information SystemsICD-9-CM : Mechanical complication of other vascular device, implant and graft • 1 code (996.1)ICD-10-CM : Mechanical complication of other vascular grafts• 156 codes, including:
» T82.310 – Breakdown (mechanical) of aortic (bifurcation) graft (replacement)
» T82.311 – Breakdown (mechanical) of carotid arterial graft (bypass)
» T82.312 – Breakdown (mechanical) of femoral arterial graft (bypass)
» T82.318 – Breakdown (mechanical) of other vascular grafts» T82.319 – Breakdown (mechanical) of unspecified vascular
grafts» T82.320 – Displacement of aortic (bifurcation) graft
(replacement)» T82.321 – Displacement of carotid arterial graft (bypass)» T82.322 – Displacement of femoral arterial graft (bypass)» T82.328 – Displacement of other vascular graft
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HIM: Implementation Issues
Evaluate education needs:Expertise in medical terminologyDetailed knowledge of anatomyBetter comprehension of operative reportsIncreased collaboration with medical staffComprehension, interpretation and application of ICD-10-PCS definitions
Source: 3M Health Information Systems
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HIM: Implementation Issues
Clinical ImpactPhysician Documentation
• Is the key to appropriate coding• Has been a problem since 1900s• Will need to meet expanded requirements
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Single most important step to take in determining weakness:
Gap analysis of current documentation and coding practices
Audit for weaknesses in: Coder knowledge of anatomy and surgical proceduresPhysician documentation
Source: 3M Health Information Systems
HIM: Implementation Issues
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ICD-10-PCS resources
Access ICD-10-PCS on the CMS website:http://www.cms.gov/paymentsystems/icd9/icd10.asp
3M http://www.3m.com/us/healthcare/his/ICD-10.jhtml
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Thank you!
Questions/Comments?