by Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
July 13th, 2016
There are some PCS codes that have a GEMS mapping and is available on Find-A-Code, such as ICD-9-CM Vol 3. 02.11, the GEMS mapping can be found in out Map-a-code tool.
See this code mapping to the following PCS codes
|00Q20ZZ||Repair Dura Mater, Open Approach|
|00Q23ZZ||Repair Dura Mater, Percutaneous Approach|
|00Q24ZZ||Repair Dura Mater, Percutaneous Endoscopic Approach|
One would not expect a PCS code to be linked to more than one I-9 code, since PCS is so much larger and more specific. However, since I-9 can be inconsistent, there are inevitable cases where it contains more detail than PCS. Characteristics of some I-9 procedure codes, such as subdividing body parts or approaches for a single procedure code category, or including diagnosis information in the description, were intentionally not incorporated in the PCS design. The ramification for mapping is that a PCS code may be linked to more than one I-9 code option, and choosing a closest match depends on the purpose of the mapping and whether the specific documentation in the chart is available.
There are examples where a distinction made in I-9 is not made in PCS. The result is that the PCS code may be linked to more than one I-9 code, because a particular area of the I-9 code set is more detailed than the norm.
More commonly you will also see PCS combination codes - the combination type is one code in the source system linked to a multiple-code alternative in the target system. If the source system is PCS, for example, the user must include I-9 codes A and B and C in order to cover all aspects of the procedure identified in the PCS code.
Take for example VOL 3. 83.64
The following ICD-10 codes have a mapping* to this code (83.64):
Note: the following codes are broken up by section for easier browsing. It is NOT necessary to have one code from each section.
Root Operation Q - Repair
Body Part 0 - Head and Neck Tendon
Body Part 3 - Upper Arm Tendon, Right
Body Part 4 - Upper Arm Tendon, Left
Body Part 5 - Lower Arm and Wrist Tendon, Right
Body Part 6 - Lower Arm and Wrist Tendon, Left
Body Part 9 - Trunk Tendon, Right
Body Part B - Trunk Tendon, Left
Body Part C - Thorax Tendon, Right
Body Part D - Thorax Tendon, Left
Body Part F - Abdomen Tendon, Right
Body Part G - Abdomen Tendon, Left
Body Part H - Perineum Tendon
Body Part J - Hip Tendon, Right
Body Part K - Hip Tendon, Left
Body Part L - Upper Leg Tendon, Right
Body Part M - Upper Leg Tendon, Left
Body Part N - Lower Leg Tendon, Right
Body Part P - Lower Leg Tendon, Left
Body Part V - Foot Tendon, Right
Body Part W - Foot Tendon, Left
Medicare has information to assist with PCS, visit CMS-User's guide for mapping for guidance, help on PCS FAQ's claims and billing guidance and much more.
For CMS information on other PCS topics visit CMS here