Knowledge Base Article

In the last I-10 Corner article we covered Part One of Musculoskeletal System in ICD-10-CM. For this week, Part Two will address the procedures for the Musculoskeletal System. For the PCS portion, we will cover some key points and guidelines that are necessary for you to assign the correct ICD-10-PCS codes.

For those of you who attended AHIMA’s ICD-10-CM/PCS training classes you already know the underlying meaning of the title. In ICD-10-PCS, this sentence helps us to identify the names of the seven characters and what they represent for a code in PCS. Notice below the sharp contrast between ICD-9 and ICD-10-PCS for a left total knee replacement:

ICD-9-CM: Total Knee Replacement, 81.54

ICD-10-PCS: Left Total Knee Replacement, with insertion of total knee prosthesis 0SRD0JZ

‍ICD-10-PCS for the Musculoskeletal System – Part 2

11 of the 31 Body Systems pertain to the MS System                  

• Muscles
• Tendons
• Bursae and Ligaments
• Head and facial bones
• Upper bones
• Lower bones
• Upper joints
• Lower joints
• Anatomical regions general
• Anatomical regions upper extremities
• Anatomical regions lower extremities Example of Root Operation Groups typically seen with Chapter 13
• Excision – Biopsy of muscle
• Detachment – Below knee amputation
• Division - Osteotomy
• Release – Carpal tunnel release
• Reattachment – Reattachment of hand
• Reposition – Fracture reduction
• Transfer – Tendon transfer
• Replacement – Total hip replacement
• Supplement – Placing a new acetabular liner in a previous hip replacement
• Revision – Re-cementing hip prosthesis
• Fusion – Spinal fusion
• Inspection – Diagnostic Arthroscopy
• laterality
• type and material the device is made of, i.e., synthetic substitute or autologous tissue substitute
• specific surface replaced in partial hip and knee replacements
• cemented vs. un-cemented

Arthroplasty of Hip and Knee

Often, the hip bearing surface was not known and was not reported. In ICD-10-PCS, you must know the type of surface for arthroplasty of the hips and knees in order to assign the correct procedure code.

You need to know:

• laterality
• type and material the device is made of, i.e., synthetic substitute or autologous tissue substitute
• specific surface replaced in partial hip and knee replacements
• cemented vs. un-cemented

ICD-10-PCS Coding Guideline

Conventions

A11

Many of the terms used to construct PCS codes are defined within the system. It is the coder’s responsibility to determine what the documentation in the medical record equates to in the PCS definitions. The physician is not expected to use the terms used in PCS code descriptions, nor is the coder required to query the physician when the correlation between the documentation and the defined PCS terms is clear.

Example: When the physician documents “partial resection” the coder can independently correlate “partial resection” to the root operation Excision without querying the physician for clarification.

B3. Root Operation

Overlapping Body Layers

B3.5

If the root operations Excision, Repair or Inspection are performed on overlapping layers of the musculoskeletal system, the body part specifying the deepest layer is coded.

Example: Excisional debridement that includes skin and subcutaneous tissue and       muscle is coded to the muscle body part.

Fusion Procedures of the Spine

B3.10a

The body part coded for a spinal vertebral joint(s) rendered immobile by a spinal fusion procedure is classified by the level of the spine (e.g. thoracic). There are distinct body part values for a single vertebral joint and for multiple vertebral joints at each spinal level.

Example: Body part values specify Lumbar Vertebral Joint, Lumbar Vertebral Joints, 2 or More and Lumbosacral Vertebral Joint.

B3.10b

If multiple vertebral joints are fused, a separate procedure is coded for each vertebral joint that uses a different device and/or qualifier.

Example: Fusion of lumbar vertebral joint, posterior approach, anterior column and fusion of lumbar vertebral joint, posterior approach, posterior column are coded separately.

B3.10c

Combinations of devices and materials are often used on a vertebral joint to render the joint immobile. When combinations of devices are used on the same vertebral joint, the device value coded for the procedure is as follows:

• If an interbody fusion device is used to render the joint immobile (alone or containing other material like bone graft), the procedure is coded with the device value Interbody Fusion Device
• If bone graft is the only device used to render the joint immobile, the procedure is coded with the device value Nonautologous Tissue Substitute or Autologous Tissue Substitute
• If a mixture of autologous and nonautologous bone graft (with or without biological or synthetic extenders or binders) is used to render the joint immobile, code the procedure with the device value Autologous Tissue Substitute

Examples: Fusion of a vertebral joint using a cage style interbody fusion device containing morsellized bone graft is coded to the device Interbody Fusion Device.

Fusion of a vertebral joint using a bone dowel interbody fusion device made of cadaver bone and packed with a mixture of local morsellized bone and demineralized bone matrix is coded to the device Interbody Fusion Device.

Fusion of a vertebral joint using both autologous bone graft and bone bank bone graft is coded to the device Autologous Tissue Substitute.

Release procedures

B3.13

In the root operation Release, the body part value coded is the body part being freed and not the tissue being manipulated or cut to free the body part.

Example:         Lysis of intestinal adhesions is coded to the specific intestine body part value.

Release vs. Division

B3.14

If the sole objective of the procedure is freeing a body part without cutting the body part, the root operation is Release. If the sole objective of the procedure is separating or transecting a body part, the root operation is Division.

Examples: Freeing a nerve root from surrounding scar tissue to relieve pain is coded to the root operation Release. Severing a nerve root to relieve pain is coded to the root operation Division.

B4. Body Part

Branches of body parts

B4.2

Where a specific branch of a body part does not have its own body part value in PCS, the body part is coded to the closest proximal branch that has a specific body part value.

Example: A procedure performed on the popliteus tendon is coded to the lower leg tendon body part.

Tendons, ligaments, bursae and fascia near a joint

B4.5

Procedures performed on tendons, ligaments, bursae and fascia supporting a joint are coded to the body part in the respective body system that is the focus of the procedure. Procedures performed on joint structures themselves are coded to the body part in the joint body systems.

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

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

Skin, subcutaneous tissue and fascia overlying a joint

B4.6

If a procedure is performed 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

Fingers and toes

B4.7

If a body system does not contain a separate body part value for fingers, procedures performed on the fingers are coded to the body part value for the hand. If a body system does not contain a separate body part value for toes, procedures performed on the toes are coded to the body part value for the foot.

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