ICD-10-PCS has a 7 character alpha-numeric code structure that provides a unique code for all substantially different procedures, and allows new procedures to be incorporated as new codes. All procedures currently performed can be specified in ICD-10-PCS.
The first character always specifies the section. The 2nd - 7th characters mean the same thing within each section, but may mean different things in other sections. In all sections, the third character specifies the general type of procedure performed, while the other characters give additional information.
The Medical and Surgical section codes represent the vast majority of procedures reported in an inpatient setting. Medical and surgical procedure codes have a first character value of "0". The 2nd character indicates the general body system (e.g., gastrointestinal).
The first through fifth characters are always assigned a specific value, but the device (6th character) and the qualifier (7th character) are not applicable to all procedures.
00Central Nervous System and Cranial Nerves
01Peripheral Nervous System
02Heart and Great Vessels
07Lymphatic and Hemic Systems
09Ear, Nose, Sinus
0CMouth and Throat
0FHepatobiliary System and Pancreas
0HSkin and Breast
0JSubcutaneous Tissue and Fascia
0MBursae and Ligaments
0NHead and Facial Bones
0UFemale Reproductive System
0VMale Reproductive System
0WAnatomical Regions, General
0XAnatomical Regions, Upper Extremities
0YAnatomical Regions, Lower Extremities
Obstetrics procedure codes have a first character value of “1”. The second character value for body system is Pregnancy. The root operations Change, Drainage, Extraction, Insertion, Inspection, Removal, Repair, Reposition, Resection and Transplantation are used in the obstetrics section, and have the same meaning as in the medical and surgical section.
The obstetrics section includes procedures performed on the products of conception only; procedures on the pregnant female are coded in the medical and surgical section (e.g., episiotomy). The term “products of conception” refers to all physical components of a pregnancy, including the fetus, amnion, umbilical cord and placenta. There is no differentiation of the products of conception based on gestational age. Thus, the specification of the products of conception as a zygote, embryo or fetus, or the trimester of the pregnancy, is not part of the procedure code but can be found in the diagnosis code.
Placement section codes represent procedures for putting an externally placed device in or on a body region for the purpose of protection, immobilization, stretching, compression or packing. Placement procedure codes have a first character value of “2”. The second character value for body system is either anatomical regions or anatomical orifices.
Administration section codes represent procedures for putting in or on a therapeutic, prophylactic, protective, diagnostic, nutritional or physiological substance. Administration procedure codes have a first character value of “3”. The body system character contains three values: circulatory system, indwelling device, and physiological systems and anatomical regions. The circulatory body system is used for transfusion procedures.
Measurement and monitoring section codes represent procedures for determining the level of a physiological or physical function. Measurement and monitoring procedure codes have a first character value of “4”. The second character value for body system is either physiological systems or physiological devices.
In extracorporeal assistance and performance procedures, equipment outside the body is used to assist or perform a physiological function. Extracorporeal assistance and performance procedure codes have a first character value of “5”. The second character value for body system is physiological systems.
In extracorporeal therapy, equipment outside the body is used for a therapeutic purpose that does not involve the assistance or performance of a physiological function. Extracorporeal therapy procedure codes have a first character value of “6”. The second character value for body system is physiological systems.
Osteopathic procedure codes have a first character value of “7”. The body system character contains the value anatomical regions. There is only one root operation in the osteopathic section.
The other procedures section includes acupuncture, suture removal and in vitro fertilization. Codes in this section have a first character value of “8”. The second character value for body system is physiological systems and anatomical regions.
Chiropractic section procedure codes have a first character value of “9”. The second character value for body system is anatomical regions. There is only one root operation in the chiropractic section.
Imaging procedure codes have a first character value of “B”. Imaging section codes represent procedures including plain radiography, fluoroscopy, CT, MRI, and ultrasound. Nuclear medicine procedure codes, including PET, uptakes, and scans, are in the nuclear medicine section. Therapeutic radiation procedure codes are in a separate radiation oncology section.
B0Central Nervous System
B9Ear, Nose, Mouth and Throat
BFHepatobiliary System and Pancreas
BHSkin, Subcutaneous Tissue and Breast
BNSkull and Facial Bones
BPNon-Axial Upper Bones
BQNon-Axial Lower Bones
BRAxial Skeleton, Except Skull and Facial Bones
BUFemale Reproductive System
BVMale Reproductive System
BYFetus and Obstetrical
Nuclear medicine section codes represent procedures that introduce radioactive material into the body in order to create an image, to diagnose and treat pathologic conditions, or to assess metabolic functions. The nuclear medicine section does not include the introduction of encapsulated radioactive material for the treatment of cancer. These procedures are included in the radiation oncology section. Nuclear medicine procedure codes have a first character value of “C”. The second character specifies the body system on which the nuclear medicine procedure is performed. The third character root type indicates the type of nuclear medicine procedure (e.g., planar imaging or non-imaging uptake).
C0Central Nervous System
C7Lymphatic and Hematologic System
C9Ear, Nose, Mouth and Throat
CFHepatobiliary System and Pancreas
CHSkin, Subcutaneous Tissue and Breast
CVMale Reproductive System
Radiation oncology procedure codes have a first character value of “D”. The second character specifies the body system (e.g., central nervous, musculoskeletal) irradiated. The third character root type specifies the general modality used (e.g., beam radiation) and the fifth character further specifies the radiation modality used (e.g., photons, electrons). The fourth character specifies the body part that is the focus of the radiation therapy. The sixth character specifies the isotopes introduced into the body, if applicable, or whether the beam used is a gamma beam or other photon. The seventh character is not specified in the radiation oncology section, and always has the value None.
D0Central and Peripheral Nervous System
D7Lymphatic and Hematologic System
D9Ear, Nose, Mouth and Throat
DFHepatobiliary System and Pancreas
DUFemale Reproductive System
DVMale Reproductive System
Physical rehabilitation section codes represent procedures including physical therapy, occupational therapy and speech-language pathology. Osteopathic procedures and chiropractic procedures are in sections 7 and 9 respectively. Physical rehabilitation and diagnostic audiology procedure codes have a first character value of “F”. The second character specifies the section qualifier Rehabilitation or Diagnostic Audiology. The third character specifies the root type.
Mental Health procedure codes have a first character value of “G”. The second character is used to identify the body system elsewhere in ICD-10-PCS. Because body system does not apply in this section, the second character always has the value None. The third character specifies the root type, such as crisis intervention or counseling. The fourth character is a type qualifier (e.g., to indicate that counseling was educational or vocational). The fifth, sixth and seventh characters are not specified and always have the value None.
Substance abuse treatment codes have a first character value of “H”. The second character is used to identify the body system elsewhere in ICD-10-PCS. Because body system does not apply in this section, the second character always has the value None. The third character specifies the root type. Examples include detoxification services and individual counseling. The fourth character is a type qualifier that further specifies the procedure type. The individual counseling procedure further specified in the fourth character includes the values Cognitive Behavioral, 12-step, and Interpersonal. The fifth, sixth and seventh characters are not specified and always have the value None.
Section X was created in response to public comments received regarding New Technology proposals presented at ICD-10 Coordination and Maintenance Committee Meetings, and general issues facing classification of new technology procedures.