ICD 10 Coding Alert

Bonus: Tackle this combination of materials special case.

To complete your seven character ICD-10-PCS code , you're sixth character relies on the device. Not only do you have to decide if the physician had to use a device, but you have to know the type of device. That sometimes involves untangling tricky terminology.

Follow through these steps to understanding what device character you should apply.

Step 1: Break Down Device Types and Values

When you choose your device digit or letter (the sixth character), you may have to decipher whether the procedure involved four types of devices:

• Grafts or prostheses
• Implants
• Simple or mechanical appliances
• Electronic appliances

The general types of devices are:

• Biological or synthetic material that takes the place of all or a portion of a body part (i.e., skin graft, joint prosthesis)
• Biological or synthetic material that assists or prevents a physiological function (i.e., IUD)
• Therapeutic material that is not absorbed by, eliminated by, or incorporated into a body part (i.e., radioactive implant)
• Mechanical or electronic appliances used to assist, monitor, take the place of or prevent a physiological function (i.e., cardiac pacemaker, orthopedic pin).

If the procedure does not involve a device, then you will use the no device character value of "Z."

Also, the devices must remain after the procedure. Materials that incidental to the procedure, such as clips and sutures, are not considered devices.

Step 2: Make the Extraluminal, Transluminal Distinction

To understand "extraluminal" versus "intraluminal," you need to know what lumen means. The lumen is the inside space of a tubular structure, such as an artery or intestine.

Extraluminal: This device works on the outside of the lumen, such as the clipping of a cerebral aneurysm.

Intraluminal: An intraluminal device means that the device is within the lumen, such as within a blood vessel.

Here is an example of an extraluminal or intraluminal procedure. Examine the "Device" column:

Step 3: Define Autologous, Nonautologous

"Autologous" means that the cell source comes from the patient. For instance, a patient scheduled for a non-emergency surgery may donate blood for herself that will be stored for the surgery. In that way, she is both the donor and the recipient. Another example is that the patient may have an autologous skin graft, which means the skin is taken from the patient's body and used as the graft. You would use the ICD-10-PCS value of "7."

On the other hand, "nonautologous" means the cell source is not from the patient. The donor and the recipient are not the same person. For instance, if the patient has an emergency surgery and requires a blood from a blood bank, then this blood is "nonautologous." You would use the ICD-10-PCS value of "K."

Check out the following example of a PCS chart featuring autologous and nonautologus devices. In particular, examine the "Device" column for your sixth character:

Step 4: Tackle This Combination Scenario

Physicians sometimes use combinations of devices and materials on a vertebral joint to render the joint immobile. When the physician uses combinations of devices on the same vertebral joint, you would code the device value as follows:

• If the physician uses an interbody fusion device to render the joint immobile (alone or containing other material like bone graft), you would code the procedure with the device value "Interbody Fusion Device" (A).
• If the physician uses the bone graft as the only device to render the joint immobile, you should code the procedure with the device value "Nonautologous Tissue Substitute" (K) or "Autologous Tissue Substitute" (7).
• If the physician uses a mixture of autologous and nonautologous bone graft (with or without biological or synthetic extenders or binders) to render the joint immobile, you should code the procedure with the device value "Autologous Tissue Substitute" (7).

Examples: Suppose a physician performs a fusion of a vertebral joint using a cage style interbody fusion device containing morsellized bone graft. You would select the "Interbody Fusion Device" character (A). On the other hand, suppose the physician performs a 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. In this circumstance, you would still select the "Interbody Fusion Device" character (A).

Editor's Note: Refer to ICD-10-PCS 2012 Code Book Appendix D (pages 509==516). Appendix D provides a Device Key and Aggregation Table.

CMS released the 2013 ICD-10-PCS and GEMs files, so you can refer to them here: http://www.cms.gov/Medicare/Coding/ICD10/2013-ICD-10-PCS-GEMs.html.