ICD-10-PCS Coding Refresher
The International Classification of Diseases Tenth Revision Procedure Coding System (ICD-10-PCS) is the procedure coding system and classification of operations and procedures developed for use in the United States. It’s used to collect data, determine payment, and support the electronic health record for all inpatient procedures performed in the United States. It was officially implemented on October 1, 2015, and is used by hospitals to report inpatient procedures. It was created to accompany the World Health Organization’s (WHO) ICD-10-CM diagnosis classification.
ICD-10-PCS Code Structure and Sections
All ICD-10-PCS codes are alphanumeric and made up of seven characters with no decimal points. Each character represents a specific value:
- Character 1: Section
- Character 2: Body system
- Character 3: Root Operation
- Character 4: Body Part
- Character 5: Approach
- Character 6: Device
- Character 7: Qualifier
There are 17 sections in ICD-10-PCS that represent 78,948 codes available for discharges occurring from October 1, 2024, through September 30, 2025:
- 0 = Medical and Surgical
- 1 = Obstetrics
- 2 = Placement
- 3 = Administration
- 4 = Measurement and Monitoring
- 5 = Extracorporeal or Systemic Assistance and Performance
- 6 = Extracorporeal or Systemic Therapies
- 7 = Osteopathic
- 8 = Other Procedures
- 9 = Chiropractic
- B = Imaging
- C = Nuclear Medicine
- D = Radiation Oncology
- F = Physical Rehabilitation and Diagnostic Audiology
- G = Mental Health
- H = Substance Abuse Treatment
- X = New Technology
ICD-10-PCS Root Operation Groups
The objective of the procedure performed is reflected in the root operation. The Medical and Surgical section of ICD-10-PCS has a total of 31 root operations:
- 0 = Alteration
- 1 = Bypass
- 2 = Change
- 3 = Control
- 4 = Creation
- 5 = Destruction
- 6 = Detachment
- 7 = Dilation
- 8 = Division
- 9 = Drainage
- B = Excision
- C = Extirpation
- D = Extraction
- F = Fragmentation
- G = Fusion
- H = Insertion
- J = Inspection
- K = Map
- L = Occlusion
- M = Reattachment
- N = Release
- P = Removal
- Q = Repair
- R = Replacement
- S = Reposition
- T = Resection
- V = Restriction
- W = Revision
- U = Supplement
- X = Transfer
- Y = Transplantation
ICD-10-PCS Approach
The approach is the technique used to reach the procedure site. There are 7 different approach values used in the Medical and Surgical Section:
- External
- Open
- Percutaneous
- Percutaneous Endoscopic
- Via Natural or Artificial Opening
- Via Natural or Artificial Opening Endoscopic
- Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance
Device
The 6th character is in reference to the device used that remains after the procedure is completed. There are 4 basic categories for the device value:
- Grafts and prostheses
- Implants
- Simple or mechanical appliances
- Electronic appliances
Example devices:
- Drainage Device
- Monitoring Device
- Infusion Device
- Autologous Tissue Substitute
- Extraluminal Device
- Intraluminal Device
- Endobronchial Device
- Synthetic Substitute
- Nonautologous Tissue Substitute
- Feeding Device
- Other Device
- No Device
Qualifier
The qualifier specifies an additional attribute of the procedure. Example qualifiers:
- T = Stereotactic
- V = Diagnostic Stereotactic
- X = Diagnostic
- Z = No Qualifier
ICD-10-PCS was designed to meet healthcare needs for a procedure code system. There are specific coding guidelines applicable to ICD-10-PCS, and there were 41 new procedure codes effective April 1, 2024. It’s very important for all hospital coding professionals to understand the basic principles of using ICD-10-PCS in an effective and compliant manner.
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