Inpatient Facility Coding & Compliance Alert

Identify the procedure site  to ace PCS coding.

Every ICD-10-PCS code has seven characters, each character defining one aspect of the procedure performed.  Not correctly identifying your physician’s approach — the fifth digit — can throw off your claims accuracy. Keep the following list and accompanying chart handy to clarify your fifth-digit questions.

Definition: “Approach” refers to the technique a physician uses to reach the site of the procedure. ICD-10-PCS offers the following options for identifying the approach. Here is how you should define each of these approaches:

Open: The physician cuts through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure.

Percutaneous: The physician gains entry, by puncture or minor incision, with instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure.

Percutaneous endoscopic: The physician gains entry, by puncture or minor incision, with endoscopic instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure.

Via natural or artificial opening: The physician will use a natural or artificial opening to access the site of the procedure.

Via natural or artificial opening endoscopic: Instrumentation enters through a natural or artificial external opening to reach and visualize the site of the procedure.

Via natural or artificial opening with percutaneous endoscopic assistance: Like above, this involves instrumentation entering through a natural or artificial external opening, but it also involves puncture or minor incisions through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure.

External: The physician will perform a procedure directly on the skin or mucous membrane or indirectly by application of external force through the skin or mucous membrane.

Take a look at the summary chart below for fifth digit characters you’ll assign for each approach.