June 2012

Twenty First Edition

As the deadline for ICD-10 implementation is proposed to be delayed, there are some people started again to talk about shifting directly to ICD-11. There is absolutely no sense in advocating for ICD-11 implementation without adopting ICD-10. ICD-11 will have its own structure and needs special training for its usage.
According to ICD Revision, the most important difference between ICD-10 and ICD-11 will be the "Content Model".
The Content Model is designed to support detailed descriptions of the clinical characteristics of each category and clear relationships to other terminologies and classifications. It identifies the basic characteristics needed to define any ICD category through use of multiple parameters (eg Body Systems, Body Parts, Signs and Symptoms, Diagnostic Findings, Causal Agents, Mechanisms, Temporal Patterns, Severity, Functional Impact, Treatment interventions, Diagnostic Rules).
So there is the potential for considerably more content to be included for diseases, disorders and syndromes for any given entity in ICD-11 than currently appears in ICD-10. Do not all these will make ICD-11 more difficult to learn if we do a "leap frog"?
When we haven't got ourselves ready to implement ICD-10 for the last 17 years, how can we expect the readiness to use ICD-11 in the near future.
Since ICD-11 is not yet out, there is time for it to be, then the time for user comments, final version ICD-11,then the development of ICD-11-CM, followed by public comment period, CMS GEMS, Reimbursement Mappings, implementation date, then again delays and what more…?
We may ask for delay in implementation but the delay should not become a reason for postponing the learning. The more we learn the more we achieve perfection, and develop the required confidence to achieve the goal of successful transition. The time now demands an aggressive approach to learn and be ready a step ahead towards deadline.
The administration section of ICD-10-PCS provides tables to construct codes for injection administration, intravenous infusions and also transfusion procedures. Development of such a separate section for coding of administration of different substances for diagnostic and therapeutic use has made the task of coding for these services easier, precise and a lot specific than ICD-9-Procedures. Use of NEC procedure codes is reduced to minimum in ICD-10-PCS since the tables provide specific administration procedure codes for most of the significant and other procedures.
The section provides tables for three root operations only but four tables. The root
operations are
  • Transfusion, for coding of different blood products transfusion and also bone marrow transplantation. (Surprisingly bone marrow transplantation procedures are included in the administration section not in medical and surgical. Bone marrow transplantation is coded to root operation transfusion).
  • Introduction, to code different diagnostic or therapeutic injections via different routes
  • Irrigation, to code cleansing procedures using antiseptics in different parts of the body. Root operation irrigation is spread into two tables (table 3C1 is provided for coding of irrigation of indwelling devices, and the other table 3E1 is provided for coding of irrigation of different body parts or organs). Interestingly peritoneal dialysis procedure is coded to root operation irrigation.
Coding of administration procedures in ICD-10-PCS has the following advantages:
  • Sixth and seventh character identifies the substance administered, or its type (eg. class, source etc.)hence more specific
  • Separate code for each type of substance administered
  • Same substance when administered by different routes is coded with different codes
  • In most of the codes body tissue or organ in which the drug is administered is also identified
Coding examples:
  • Transplantation of donor match bone marrow through central vein via percutaneous route is coded as
    30243G1 - Transfusion of Nonautologous Bone Marrow into Central Vein, Percutaneous Approach
  • Percutaneous donor matched fresh plasma transfusion through peripheral vein is coded as
    30233L1 - Transfusion of Nonautologous Fresh Plasma into Peripheral Vein, Percutaneous Approach
  • Percutaneous intrauterine whole blood transfusion is coded as
    30273H1 - Transfusion of Nonautologous Whole Blood into Products of Conception, Circulatory, Percutaneous Approach
  • Intravenous infusion of normal saline by percutaneous approach is coed as
    3E0337Z - Introduction of Electrolytic and Water Balance Substance into Peripheral Vein, Percutaneous Approach
  • Alllotransplantation of pancreatic islet cells through peripheral vein by open approach is coded as
    3E030U1 - Introduction of Nonautologous Pancreatic Islet Cells into Peripheral Vein, Open Approach
  • Percutaneous intracoronary thrombolysis by Drotrecogin alfais coded as
    3E07316 - Introduction of Recombinant Human-activated Protein C into Coronary Artery, Percutaneous
  • Transvaginal transplantationof embryo developed from self egg is coded as
    3E0P7Q0 - Introduction of Autologous Fertilized Ovum into Female Reproductive, Via Natural or Artificial Opening
  • Tattooing of vitiligo patches on the face should be coded as
    3E00X3Z - Introduction of Pigment into Skin and Mucous Membranes, External Approach
  • Intravenous administration of dopamine into a central vein, by percutaneous route should be coded as
    3E043XZ - Introduction of Vasopressor into Central Vein, Percutaneous Approach
  • Peritoneal dialysis should be coded as
    3E1M39Z – Irrigation of Peritoneal Cavity using Dialysate, Percutaneous Approach
Note: Table 3C1 with root operation irrigation is provided for cleaning of the devices such as shunt tubes and catheters using cleansing substance representing a single code 3C1ZX8Z.
Interesting fact: Even though ICD-10-PCS is more specific and detail than ICD-9-CM Vol. 3 Procedures but code 3C1ZX8Z is an example where ICD-9-Volume 3 Procedures is more specific than ICD-10-PCS. On backward mapping the code 3C1ZX8Z maps to 11 ICD-9-Volume 3 Procedure codes as shown in the table below.
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