Coding with PCS When There is No Code

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Aug 5th, 2020

ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn?  To the guidelines, of course! There are ICD-10-PCS guidelines just as there are ICD-10-CM guidelines.  

When searching ICD-10-PCS codes, the purpose of the index is to locate the table that contains the table needed for a procedure. Remember, with PCS seven characters are REQUIRED to be considered a valid code, unlike ICD-10-CM where three characters could be a complete code such as I10. 

The Prefix “peri” 

The Prefix "peri" may be combined with a body part to identify the site of the procedure, such as: perirenal, this is coded to the kidney body part when the site of the procedure is not further specified.  

NOTE: This use of this guideline and others will apply only when there is not a specific body part available!

General Guidelines 

The general guidelines, when coding for a body part that does not have a code pertaining to it, state to code the body part value corresponding to the whole body part. Confused yet? Take a look at some examples and instructions PCS offers. 

Example: A procedure performed on the alveolar process of the mandible is coded to the mandible body part.

Skin Repairs on a Joint 

What about coding repairs on skin, subcutaneous tissue, and fascia overlying a joint? There are no codes for shoulder, so how is this coded? The following is according to the ICD-10-PCS Guidelines B4.6. If a repair is performed on the skin, subcutaneous tissue, or fascia overlying a joint, the procedure is coded to the following body part.

Branches of Body Parts

In addition to location, the guidelines tell us how to code branches of body parts. These are different and have more to do with the root operation. For example, the body part is typically coded to the closest proximal branch that has a specific body part value. 

B4.2 states, "In the cardiovascular body systems, if a general body part is available in the correct root operation table, and coding to a proximal branch would require assigning a code in a different body system, the procedure is coded using the general body part value.

Examples: A procedure performed on the mandibular branch of the trigeminal nerve is coded to the trigeminal nerve body part value.

Occlusion of the bronchial artery is coded to the body part value Upper Artery in the body system Upper Arteries, and not to the body part value Thoracic Aorta, Descending in the body system Heart and Great Vessels."

Bilateral Body Part Values 

Certain codes will identify bilateral body part values, if a specific code does not exist, the instructions are to code once using the body part that includes bilateral.

Example: Fallopian Tube, Bilateral.

Most major body parts have right and left built into the codes. such as knee joint, right and knee joint, left, in this case. If the procedure was performed on both, you would use two codes: one for the right knee and one for the left knee.     

Coronary arteries

Coronary arteries are specified by the number of arteries treated but classified as a single body part, therefore only one code is used when doing a procedure on multiple arteries. More information on coding coronary arteries can be found under section B4.4 of the coding guidelines.

Tendons, Ligaments, Bursae, and Fascia near a Joint

The determining factor when coding PCS for tendons, ligaments, bursae, and fascia near a joint is in respect to the body system that is the focus of the procedure. For example, joint structures are coded to the joint body system. 

Examples: Knee arthroscopy with shaving of articular cartilage is coded to the knee joint body part in the Lower Joints body system.

Repair of the anterior cruciate ligament of the knee is coded to the knee bursa and ligament body part in the bursae and ligaments body system.

Fingers and Toes 

When doing procedures on fingers or toes if there is not a code specific to that exact body part, then code to the body part value. Therefore if the procedure is on a toe, code it to the foot; if it is a muscle and there is a code for a muscle in the foot then use the code that is more specific pertaining to the muscle in the foot.    

Example: Excision of finger muscle is coded to one of the hand muscle body part values in the muscles body system.

Upper and Lower Intestinal Tract

There are several root operations for the upper and lower intestinal tract, such as change, inspection, removal, and revision. 

Upper Intestinal Tract includes the portion of the gastrointestinal tract from the esophagus down to and including the duodenum.

Lower Intestinal Tract includes the portion of the gastrointestinal tract from the jejunum down to and including the rectum and anus. 

Example: In the root operation Change table, change of a device in the jejunum is coded using the body part lower intestinal tract.