Inpatient Facility Coding & Compliance Alert

Question: In ICD-10-CM we use “X” as a way to show that codes need an additional digit. However, I learned that “X” has a different meaning in ICD-10- PCS. Can you explain?

Georgia Subscriber

Answer: You are right: “X” can be a placeholder under ICD-10 but won’t have that role under ICD-10-PCS. The ICD-10-PCS codes are so detailed that the concept of place­holders doesn’t exist. Because of that, an “X” in an ICD-10-PCS code carries particular mean­ing instead of simply filling a spot.

Explanation: Each ICD-10-PCS code is a seven-digit combination of letters and numbers, with each alphanumeric character telling you something about the procedure (body system, root operation, body part, surgical approach, etc.).

You’ll use categories and cross-reference charts to determine the appropriate letter or number for each digit in the code. An “X” can be one of those characters, and its meaning will depend on its position in the code and section involved.

For example, “X” can represent anatomical regions/upper extremities when placed as the second character in the code. But “X” can also represent an external approach when listed as the code’s fifth character, or a diagnostic test when listed as the seventh character. It all depends on knowing what each character in the code signifies.

For example, look at 0G9G4ZX. The “X” in this case shows that the fine-needle aspiration biopsy of the left lobe of the thyroid was done for diagnostic purposes.