Procedure code set for Procedures ICD-10-PCS to ICD-9-CM

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

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