Procedure code set for Procedures ICD-10-PCS to ICD-9-CM

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
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

CodeDescription
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

References:

Procedure code set for Procedures ICD-10-PCS to ICD-9-CM. (2016, July 13). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/procedure-code-set-for-procedures-icd-10-pcs-to-icd-9-cm-29640.html

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