ICD-10-PCS Coding the Approach

by  Find-A-Code
January 9th, 2018

When coding surgical procedures, the approach is the technique you use to reach the site of the procedure, or how you get in to do the operation. The fifth character of PCS code is used to indicate the approach when using. 

There are seven approaches. They are listed below with their definitions, brief descriptions, and their corresponding code.

Looking at these approaches you may be asking "Both open and percutaneous approaches seem to be so similar, what's the difference?" The biggest difference is that in an open procedure sutures will be required for the entry point to heal, and a percutaneous procedure will only need a band-aid. The rest of them can be guided by the following official guidelines under section B5.

Open approach with percutaneous endoscopic assistance
B5.2
Procedures performed using the open approach with percutaneous endoscopic assistance are coded to the approach Open.
Example: Laparoscopic-assisted sigmoidectomy is coded to the approach Open.

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

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 is coded to the approach External.

Percutaneous procedure via device
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 percutaneous nephrostomy is coded to the approach Percutaneous.

References:

ICD-10-PCS Coding the Approach. (2018, January 9). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/icd-10-pcs-approach-code-31832.html

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