What Lies Beyond the 31 Most Common

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 or root types that are unique to that section.

Procedures in the Medical and Surgical Related Section of ICD-10-PCS and their root operations that are not shared with the Medical and Surgical Section.

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, Perfusion

Osteopathic – Section 7: Treatment

Other Procedures – Section 8: Other Procedures

– Section 9: Manipulation

Procedures in the Ancillary Section of ICD-10-PCS and their root operations/root types that are not shared with the Medical and Surgical Section.

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 Medicine Probe

Radiation Therapy
– Section D: Beam Radiation, Brachytherapy, Stereotactic Radiosurgery, Other Radiation

Physical Rehabilitation and Diagnostic Audiology – Section F: Speech Assessment, Motor and/or Nerve Function Assessment, Speech Treatment, Motor Treatment, Activities of Daily Living Treatment, Hearing Treatment, Cochlear Implant Treatment, Vestibular Treatment, Device Fitting, Caregiver Training, Hearing Assessment, Hearing Aid Assessment, Vestibular Assessment

Mental Health – Section G: Psychological Tests, Crisis Intervention, Medication Management, Individual Psychotherapy, Counseling, Family Psychotherapy, Electroconvulsive Therapy, Biofeedback, Hypnosis, Narcosynthesis, Group Psychotherapy, Light Therapy

Substance Abuse Treatment – Section H: Detoxification Services, Individual Counseling, Group Counseling, Individual Psychotherapy, Family Counseling, Medication Management, Pharmacotherapy

New Technology
– Section X: Assistance, Monitoring

Of additional note is the fact that while the codes from these sections are still all composed of 7 characters and the 1st -3rd characters still report the section, body system and root operation or root type, the 4th – 7th 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 5th character reports the duration of the procedure as opposed to the method of approach and in the Mental Health and Substance Abuse Sections the 4th character reports the type of treatment being provided versus the body site as seen in the Medical and Surgical Related Section.

For additional resources related to the Medical and Surgical Related and Ancillary Sections of PCS, visit the link below for the Center for Medicare and Medicaid Services.


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