Each ICD-10-PCS code is comprised of seven characters with a specific meaning. In the Medical and Surgical section, the fourth character denotes the body part involved in the procedure.
Each table within ICD-10-PCS includes specific body part choices based on the anatomy and the possible procedures a physician can perform. Coders need to remember that a body part in anatomical terms is not always equal to a body part as defined by ICD-10-PCS, says Jennifer Avery, CCS, CPC-H, CPC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, senior coding instructor for HCPro, a division of BLR, in Danvers, Massachusetts.
For example, most people think of the right lung as a single body part. ICD-10-PCS offers four options for the right lung body part:
- C, upper lung lobe, right
- D, middle lung lobe, right
- F, lower lung lobe, right
- K, lung, right
Coders should brush up on their anatomy and physiology knowledge in the run up to ICD-10 implementation, says Nena Scott, MSEd, RHIA, CCS, CCS-P, AHIMA-approved ICD-10-CM/PCS trainer, director of education at TrustHCS in Springfield, Missouri.
ICD-10-PCS does include body part tables that coders can use as well. “Sometimes you may have to refer to that body part table to actually get the exact body part that you would need to use when building that code,” Scott says.
For example, a physician may document lateral epicondyle of the humerus. The ICD-10-PCS tables do not contain a body part value for the lateral epicondyle of the humerus. However, the ICD-10-PCS Body Part Key, found in the ICD-10-PCS Manual, does. The entry for lateral epicondyle of the humerus directs coders to use the body part humeral shaft, right or humeral shaft, left.
Body parts and root operation
How the physician documents the body part can affect root operation selection. The most obvious example involves root operations Excision and Resection.
Excision involves cutting out or off, without replacement, a portion of the body part.
Resection is cutting out or off, without replacement, all of the body part.
Coders will need to pay attention to how ICD-10-PCS defines a body part to choose between these two root operations, Avery says.
If a physician documents removing the upper lobe of the right lung using an open approach, coders would use root operation Resection, not Excision, because the upper lobe has its own body part, Avery says.
Similarly, ICD-10-PCS includes separate body part values for the two lobes of the liver as well as the liver as a whole. If the surgeon removes the entire left lobe of the liver, use root operation Resection. If the physician only removes part of the left lobe, use Excision.
However, if the physician removes the anterior lobe of a male patient’s prostate, coders would report Excision. ICD-10-PCS does not include separate body part values for the lobes of the prostate.
In some cases, a physician will remove part of a body part, then years later remove the remaining part. For example, a physician may remove part of the right large intestine and two years later need to remove the remaining portion.
In these cases, coders should still use root operation Resection, says Gretchen Young-Charles, RHIA, senior coding consultant for the American Hospital Association in Chicago. The intent of the procedure is to remove the complete remaining section of the right large intestine. For purposes of the root operation selection, it doesn’t matter that part of the right large intestine was already removed.
ICD-10-PCS also includes separate body part characters for right and left structures. For example, table 089 (drainage of the eye) includes separate characters for:
- Right eye (0)
- Left eye (1)
- Right sclera (6)
- Left sclera (7)
- Right cornea (8)
- Left cornea (9)
- Right conjunctiva (S)
- Left conjunctiva (T)
ICD-10-PCS includes limited bilateral body part characters. If the physician performs the identical procedure on contralateral body parts that have a bilateral body part value, coders will report a single procedure using the bilateral body part value. If no bilateral body part value exists, coders must report each procedure separately using the appropriate body part value, Avery says.
For example, if the physician performs bilateral drainage of the lungs using a percutaneous approach and a drainage device, coders would only report a single code (0B9M30Z) because the table includes a bilateral body part character.
Body parts near or over a joint
When a physician performs a procedure on tendons, ligaments, bursae, and fascia supporting a joint, coders will report the body part in the respective body system that is the focus of the procedure. If the physician performs a procedure on the actual joint structures, use the body part in the joint body systems.
If the physician performs a Repair of the anterior cruciate ligament of the knee, coders will use the knee bursae and ligament body part in the Bursae and Ligaments body system. If the physician shaves the articular cartilage of a knee, coders will use the knee joint body part in the Lower Joints body system.
If a physician performs a procedure 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
- Elbow is coded to Lower Arm
- Wrist is coded to Lower Arm
- Hip is coded to Upper Leg
- Knee is coded to Lower Leg
- Ankle is coded to Foot
Additional body part guidelines
ICD-10-PCS includes specific guidelines to help coders choose the correct body part.
When the prefix “peri” is combined with a body part to identify the site of the procedure, coders would report the body part named. A perirenal procedure would be coded using the body part kidney.
Where a specific branch of a body part does not have its own body part value in ICD-10-PCS, coders will report the body part for the closest proximal branch that has a specific body part value.
For example, if the physician performs a release on the mandibular branch of the trigeminal nerve, coders would use the body part for the trigeminal nerve.
Email your questions to Senior Managing Editor Michelle A. Leppert, CPC, at mleppert@hcpro.com.