ICD-10-PCS Medical and Surgical Related Sections: Beyond the 31 Most Common Root Operations

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When providing education in the assignment of codes from the ICD-10-PCS code classification, it seems that much of the focus is on the learning the 31 root operations used in the Medical and Surgical Section of the ICD-10-PCS code set.

The Medical and Surgical Section of PCS is the largest section of the classification. It provides the tables used by medical coders to build codes to report the vast majority of procedures performed in the inpatient setting. This section is divided by body system and then further sub-divided, within the body system, by root operation.

However, what if we needed a code to report a blood transfusion for a patient with postoperative acute blood loss anemia or bililite therapy for a newborn with jaundice? Root operations that report these procedures are not found in the Medical and Surgical Section of PCS. Luckily, there are additional sections of PCS that contain root operations that report these and many other procedures.

Beyond the Medical and Surgical Section and its standard 31 root operations, there are 9 sections of tables in the Medical and Surgical Related Section of PCS, such as the Obstetrics and Administration sections, and 6 sections of tables in the Ancillary Section of PCS that cover procedures such as Radiological Imaging and Physical Rehabilitation. Some of these sections may have tables for procedures performed by employing one of the root operations from the Medical and Surgical section, such as the table for extraction in the Obstetrics section, but each of these sections also has their own root operations that are unique to that section.

Procedures in the Medical and Surgical Related Section of ICD-10-PCS and their unique root operations
Obstetrics – Section 1: Abortion, Delivery,
Placement – Section 2: Compression, Dressing, Immobilization, Packing, Traction,
Administration – Section 3: Transfusion, Irrigation, Introduction,
Measurement and Monitoring – Section 4: Measurement, Monitoring
Extracorporeal Assistance and Performance – Section 5: Assistance, Performance, Restoration
Extracorporeal Therapies – Section 6: Atmospheric Control, Decompression, Electromagnetic Therapy, Hyperthermia, Hypothermia, Pheresis, Phototherapy, Ultrasound Therapy, Ultraviolet Light Therapy, Shock Wave Therapy
Osteopathic – Section 7: Treatment
Other Procedures – Section 8: Other Procedures
Chiropractic – Section 9: Manipulation

Procedures in the Ancillary Section of ICD-10-PCS
Imaging – Section B: Plain Radiography, Fluoroscopy, Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasonography,
Nuclear Medicine – Section C: Planar Nuclear Medicine Imaging, Tomographic Nuclear Medicine Imaging, Positron Emission Tomographic (PET) Imaging, Nonimaging nuclear probe,
Radiation Therapy – Section D: Beam Radiation, Brachytherapy, Sterotactic Radiosurgery, Other Radiation
Physical Rehabilitation and Diagnostic Audiology – Section F
Mental Health – Section G
Substance Abuse Treatment – Section H

Of additional note is the fact that while the codes from these sections are still all composed of 7 characters and the first to third characters still report the section, body system and root operation, though the fourth to seventh characters do not always represent the same information in these sections as in the Medical and Surgical Section. For instance, in the Extracorporeal Assistance and Performance Section the fifth character reports the duration of the procedure as opposed to the method of approach and in the Mental Health and Substance Abuse Sections the fourth character reports the type of treatment being provided versus the body site as seen in the Medical and Surgical Related Section.

To read a full description of and get more information about the assignment of the root operations in the Medical and Surgical Related and Ancillary Sections of PCS, visit http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html and select the option to download the 2014 ICD-10-PCS Reference Manual provided by the Center for Medicare and Medicaid Services.

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