ICD-10-PCS APPROACHES

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1. Name the sev- - Open

en different ap- - Percutaneous
proaches in - Percutaneous Endoscopic
ICD-10-PCS - Via Natural or Artificial Opening
- Via Natural or Artificial Opening Endoscopic
- Via Natural or Artificial Opening with Percutaneous En-
doscopic Assistance
- External

2. Open (0) Cutting through the skin or mucous membrane and any
other body LAYERS necessary to expose the site of the
procedure.

Examples of Open Procedures:

-Amputation at the right elbow level
-Open fracture reduction of right tibia
-Incision and removal of right lacrimal duct stone
-Abdominal hysterectomy (laparoscopic-assisted hys-
terectomy)
-Appendectomy via abdominal incision
-Wedge biopsy of right breast
-Surgical removal of entire sigmoid colon via abdominal
incision
-laparotomy with removal of the gallbladder 0FT40ZZ

method: cutting
Instruments; none?

Guideline B5.2
Procedures performed using the open approach with per-
cutaneous endoscopic assistance are coded to the ap-
proach Open.

Example: Laparoscopic-assisted sigmoidectomy is coded

to the approach Open.

3.
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Open Vs Percuta- open procedure there is cutting (which means there will be
neous suturing of the skin when they are done)

percutaneous procedure they either just nick the skin or

use a needle and a band aid to close up instead of sutures.

Another distinction is in an open procedure they cut

you open and in a percutaneous procedure they poke it
through.

4. ICD-10-PCS Open; Percutaneous; Percutaneous Endoscopic

Approaches
through the skin
or mucous
membrane

5. Percutaneous (3) 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.

Examples of Percutaneous Procedures:

-Percutaneous chest tube placement for right pneumoth-
orax
-needle biopsy of liver
-liposuction
-Microincisional phlebectomy of spite veins right lower leg.
-Insertion of intravenous pacemaker lead
-Percutaneous excisional biopsy of the liver
-diagnostic percutaneous paracentesis for ascites
0W9G3ZX
-fine needle aspiration

Instrumentation: without visualization

Method: puncture or minor incision

Guideline B5.4
Procedures performed percutaneously via a device placed
for the procedure are coded to the approach Percuta-

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neous.

Example: Fragmentation of kidney stone performed via

percutaneous nephrostomy is coded to the approach Per-
cutaneous.

6. Percutaneous Entry, by puncture of minor incision, of instrumentation

Endoscopic (4) through the skin or mucous membrane and any other body
layers necessary to REACH and VISUALIZE the site of the
procedure.

Examples of Percutaneous Endoscopic Procedures:

-Laparoscopic cholecystectomy
-Arthroscopy (i.e. arthroscopic knee chondroplasty)
-Left knee arthroscopy with reposition of ACL.
-endoscopic carpel tunnel release
-Laparoscopic total right oophorectomy
-Laparoscopic excision pf right ovarian cyst
-Arthroscopic subtalar arthrodesis with internal fixation
device
-laparoscopy with ablation of endometriosis of the en-
dometrium 0U5B4ZZ

Endoscopic means allows visualization

-Key Words: SCOPY/SCOPIC

Instrumentation: with visualization

Method: puncture or minor incision; nick the skin but then
they use a scope to finish the job

7. ICD-10-PCS - Via Natural or Artificial Opening

Approaches - Via Natural or Artificial Opening Endoscopic
through an - Via Natural or Artificial Opening with Percutaneous En-
orifice doscopic Assistance
- External

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8. Via Natural or Ar- Entry of instrumentation through a NATURAL or artificial
tificial Opening external opening to REACH the site the procedure.
(7)

Examples of Via Natural or Artificial Opening Procedures:

-Transvaginal intraluminal cervical cerclage,
-vaginal endometrial ablation
-Removal of tattered right each drum fragments with
tweezers,
-Routine Foley catheter placement
-dilation and curettage 0UDB7ZZ
-Insertion of endotracheal tube

Method: Direct entry

Instrumentation: without visualization

9. Via Natural or Ar- Entry of instrumentation through a NATURAL or artificial

tificial Opening external opening to REACH and VISUALIZE the site of
Endoscopic (8) procedure.

Examples of Via Natural or Artificial Opening Endoscopic

Procedures:
Like through your mouth, vaginal or a man made opening.
- sigmoidoscopy
-EGD with gastric biopsy
-ERCP
-hysteroscopy with balloon dilation of bilateral fallopian
tubes.
-bronchoscopy
-Endometrial ablation using hysteroscope
-endoscopic retrograde cholangiopancreatography with
lithotripsy of the common bile duct (0FF98ZZ)
-Colonoscopy

Method: Direct entry; they use a scope, but this time they
do not nick the skin, they just go in through the mouth,
nose, ear, or other natural (or artificial) orifice.

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Instrumentation: with visualization (Endoscopic means al-
lows visualization)

10. Via Natural or Entry of instrumentation through a NATURAL or artifi-

Artificial Open- cial external opening and entry, by PUNCTURE of minor
ing with Per- incision, of instrumentation through the skin or mucous
cutaneous En- membrane and any other body layers necessary to AIDE
doscopic Assis- in the performance of the procedure.
tance (F)
Examples of Via Natural or Artificial Opening with Percu-
taneous Endoscopic Assistance:

-laparoscopic assisted total vaginal hysterectomy

(0UT9FZZ)
-Laparoscopic assisted Sigmoidectomy

Procedures performed using the open approach with per-

cutaneous endoscopic assistance are coded to the....

OPEN APPROACH

Method: Direct entry with puncture or minor incision for

instrumentation only
Instrumentation: with visualization

Endoscopic means allows visualization

11. External (X) Procedures performed DIRECTLY on the skin or mucous

membrane and procedures performed indirectly by the
application of external force through skin or mucous mem-
brane.

Examples of External Procedures:

-Resection of tonsils,
-Closed reduction of fracture,

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-Excision of malignant melanoma,
-Removal of foreign body right cornea,
-Exchange of daring tube from right hop joint,
-Tracheostomy tube exchange.
-resection of tonsils
-adenoidectomy
-chest tube removal
-extracorporeal shock wave lithotripsy of a calculus of the
right kidney (0TF3XZZ)
-Reposition of closed fracture

Method: Direct or indirect

Instrumentation: none

External is a tricky one.

coding guideline that pertains to this external is B5.3a and

B5.3b
if you go into an orifice and do a procedure on structures
that you can see without having to use any other type of
aid, then you code the approach to external.

Example 1: resection of tonsils coded to external because

you entered through the mouth, but you did not need any
instrument to see the tonsils - the doctor just used his
eyes, not a scope.

Example 2: cauterizing a nose bleed or sewing back on a

severed ear would be external as well because the doctor
just uses his eyes.
If they cut a lesion off the skin then it would also be external
(even though they might have cut the skin - they did not
open up the skin and to get to the lesion - the skin just
happened to get cut because they were removing the
lesion.

B5.3a
Procedures performed within an orifice on structures that
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are visible without the aid of any instrumentation are cod-
ed to the approach External.

Example: Resection of tonsils is coded to the approach

External.

B5.3b
Procedures performed indirectly by the application of ex-
ternal force through the intervening body layers are coded
to the approach External.

Example: Closed reduction of fracture is coded to the

approach External.

12. The approach is Access location -

determined by
Method-

Type of instrumentation-

13. Access Location: Specifies the EXTERNAL SITE through which the site of
the proc reach either through skin mucous membrane or
external orifices.

14. Method: Specifies how the external access location is entered.

15. Type of Instru- Specifies the specialized equipment used to perform the
mentation: proc.

16. Procedures per- EXTERNAL

formed within an
orfice on struc- (Resection of Tonsils)
tures that are vis-
ible without the
aid of instrumen-
tation, they are
coded to the ap-
proach....

17.
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Procedures per- EXTERNAL
formed indirect-
ly by the appli- (Closed reduction of fracture)
cation of exter-
nal force through
intervening body
layers are coded
to the....

18. Procedures per- PERCUTANEOUS

formed percuta-
neously via a de- (Fragmentation of Kidney Stone performed via Percuta-
vice placed for neous Nephrostom)
the procedures
are coded to the
approach....

19. Multiple Ap- Some approaches have multiple techniques - for example
proaches for percutaneous endoscopic they may nick the skin but
then they use a scope to finish the job

- or via natural or artificial opening endoscopic, they again

use a scope, but this time they do not nick the skin - they
just go in through the mouth, nose, ear, or other natural
(or artificial) orifice.

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