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Introducing ICD-10-PCS Approaches

Introducing ICD-10-PCS Approaches. Presented by: THIMA ICD 10 Committee . APPROACHES. The fifth character of ICD-10-PCS codes represents the approach or technique that is used to reach the procedure site. 7 different approaches in the Medical and Surgical Section. 7 Approaches. Open

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Introducing ICD-10-PCS Approaches

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  1. Introducing ICD-10-PCS Approaches Presented by: THIMA ICD 10 Committee

  2. APPROACHES The fifth character of ICD-10-PCS codes represents the approach or technique that is used to reach the procedure site. 7 different approaches in the Medical and Surgical Section

  3. 7 Approaches Open Percutaneous Percutaneous Endoscopic Via Natural or Artificial Opening Via Natural or Artificial Opening, Endoscopic Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance External

  4. Approaches Table d 4

  5. Approaches Table, cont. d 5

  6. Approach - Open Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure.

  7. Approach Guidelines B5.2 Procedures performed using the open approach with percutaneous endoscopic assistance are coded to approach value 0, open.

  8. Approach - Open The access location would be skin or mucous membranes No instrumentation used Example: Abdominal Hysterectomy

  9. Approach - Percutaneous Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure.

  10. Approach guideline • B5.4 Procedures performed percutaneously via a device placed for the procedure are coded to the approach Percutaneous • Example: Fragmentation of kidney stone performed via percutaneousnephrostomy is coded to the approach Percutaneous

  11. Approach - Percutaneous The access location would be skin or mucous membrane Instrumentation without visualization EXAMPLE: Needle biopsy of liver

  12. Approach – Percutaneous Endoscopic Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure.

  13. Approach - Percutaneous Endoscopic Access location is skin or mucous membran Instrumentation with visualization

  14. Approach – Via Natural or Artificial Opening Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure.

  15. Approach – Via Natural or Artificial Opening Access location is Orifice Instrumentation without visualization Example: Insertion of Endotracheal Tube

  16. Approach – Via Natural or Artificial Opening, Endoscopic Entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure.

  17. Approach – Via Natural or Artificial Opening, Endoscopic Instrumentation is withvisualization Access location is Orifice Example: Sigmoidoscopy

  18. Approach – Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance Entry of instrumentation through a natural or artificial external opening and entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure.

  19. Approach – Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance Access location is skin or mucous membrane. Instrumentation is with visualization. Example: Laparoscopic-assisted vaginal hysterectomy

  20. Approach - External Procedures performed directly on the skin or mucous membrane and procedures performed indirectly by the application of external force through the skin or mucous membrane.

  21. Approaches - External Access location is skin or mucous membranes No specified instrumentation Example: Closed reduction of fracture

  22. Approach - Guidelines B5.3a Procedures performed within an orifice on structures that are visible without the aid of any instrumentation are coded to approach External. Example: Resection of tonsils

  23. Approach Guidelines, cont. B5.3b Procedures performed indirectly by the application of external force through the intervening body layers are coded to the approach External. Example: Closed reduction of fracture

  24. Let’s practice what we’ve just learned.

  25. Resection of Tonsils – Approach? External

  26. Endoscopic Drainage of Sinuses –Approach? Percutaneous Endoscopic

  27. Cautery of Nosebleed – Approach? External

  28. Transurethral Cystoscopy with Removal of Bladder Stone – Approach? Via Natural or Artificial Opening, Endoscopic

  29. Open Cholecystectomy – Approach? • Open

  30. Laparoscopic Cholecystectomy – Approach? Percutaneous Endoscopic

  31. CABG – Approach? Open

  32. Colonoscopy – Approach? Via Natural or Artificial Opening, Endoscopic

  33. Open Endarterectomy – Approach? Open

  34. Endotracheal Intubation – Approach? Via Natural or Artificial Opening

  35. Excision Of Skin Lesion – Approach? External

  36. Percutaneous Drainage of Ascites – Approach? Percutaneous

  37. Low Anterior Resection, Colon – Approach? Open

  38. Bronchoscopy – Approach? Via Natural or Artificial Opening, Endoscopic

  39. ERCP – Approach? Via Natural or Artificial Opening, Endoscopic

  40. You’ve got it!!!! Hooray!!!

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