by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Jul 13th, 2016
There are some PCS codes that have a GEMS mapping and is available on Find-A-Code, such as ICD-9-CM Vol 3. 02.11, the GEMS mapping can be found in out Map-a-code tool.
See this code mapping to the following PCS codes
| Code | Description |
|---|---|
| 00Q20ZZ | Repair Dura Mater, Open Approach |
| 00Q23ZZ | Repair Dura Mater, Percutaneous Approach |
| 00Q24ZZ | Repair Dura Mater, Percutaneous Endoscopic Approach |
One would not expect a PCS code to be linked to more than one I-9 code, since PCS is so much larger and more specific. However, since I-9 can be inconsistent, there are inevitable cases where it contains more detail than PCS. Characteristics of some I-9 procedure codes, such as subdividing body parts or approaches for a single procedure code category, or including diagnosis information in the description, were intentionally not incorporated in the PCS design. The ramification for mapping is that a PCS code may be linked to more than one I-9 code option, and choosing a closest match depends on the purpose of the mapping and whether the specific documentation in the chart is available.
There are examples where a distinction made in I-9 is not made in PCS. The result is that the PCS code may be linked to more than one I-9 code, because a particular area of the I-9 code set is more detailed than the norm.
More commonly you will also see PCS combination codes - the combination type is one code in the source system linked to a multiple-code alternative in the target system. If the source system is PCS, for example, the user must include I-9 codes A and B and C in order to cover all aspects of the procedure identified in the PCS code.
Take for example VOL 3. 83.64
The following ICD-10 codes have a mapping* to this code (83.64):
Note: the following codes are broken up by section for easier browsing. It is NOT necessary to have one code from each section.
Root Operation Q - Repair
Body Part 0 - Head and Neck Tendon
Body Part 3 - Upper Arm Tendon, Right
Body Part 4 - Upper Arm Tendon, Left
Body Part 5 - Lower Arm and Wrist Tendon, Right
Body Part 6 - Lower Arm and Wrist Tendon, Left
Body Part 9 - Trunk Tendon, Right
Body Part B - Trunk Tendon, Left
Body Part C - Thorax Tendon, Right
Body Part D - Thorax Tendon, Left
Body Part F - Abdomen Tendon, Right
Body Part G - Abdomen Tendon, Left
Body Part H - Perineum Tendon
Body Part J - Hip Tendon, Right
Body Part K - Hip Tendon, Left
Body Part L - Upper Leg Tendon, Right
Body Part M - Upper Leg Tendon, Left
Body Part N - Lower Leg Tendon, Right
Body Part P - Lower Leg Tendon, Left
Body Part V - Foot Tendon, Right
Body Part W - Foot Tendon, Left
Medicare has information to assist with PCS, visit CMS-User's guide for mapping for guidance, help on PCS FAQ's claims and billing guidance and much more.
For CMS information on other PCS topics visit CMS here
References/Resources
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.
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