Official Coding Guidelines

ICD-10-PCS Dictionary

Search the complete ICD-10-PCS database. Access official guidelines, notes, modifiers, and documentation requirements instantly.

ICD-10-PCS Code Reference Directory

Browse the official clinical code repository for active ICD-10-PCS inpatient procedure classifications. Up to 50 codes are displayed per page.

Code Category / Specialty Description
XW033H5
Procedures
General
Introduction of Tocilizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
XW033H6
Procedures
General
Introduction of Other New Technology Monoclonal Antibody into Peripheral Vein, Percutaneous Approach, New Technology Group 6
XW033H7
Procedures
General
Introduction of Axicabtagene Ciloleucel Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 7
XW033J7
Procedures
General
Introduction of Tisagenlecleucel Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 7
XW033K7
Procedures
General
Introduction of Idecabtagene Vicleucel Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 7
XW033K9
Procedures
General
Introduction of Sulbactam-Durlobactam into Peripheral Vein, Percutaneous Approach, New Technology Group 9
XW033L6
Procedures
General
Introduction of CD24Fc Immunomodulator into Peripheral Vein, Percutaneous Approach, New Technology Group 6
XW033L7
Procedures
General
Introduction of Lifileucel Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 7
XW033M7
Procedures
General
Introduction of Brexucabtagene Autoleucel Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 7
XW033MA
Procedures
General
Introduction of Emapalumab-lzsg Anti-IFNy Monoclonal Antibody into Peripheral Vein, Percutaneous Approach, New Technology Group 10
XW033N7
Procedures
General
Introduction of Lisocabtagene Maraleucel Immunotherapy into Peripheral Vein, Percutaneous Approach, New Technology Group 7
XW033NA
Procedures
General
Introduction of Tarlatamab-dlle Antineoplastic into Peripheral Vein, Percutaneous Approach, New Technology Group 10
XW033P9
Procedures
General
Introduction of Glofitamab Antineoplastic into Peripheral Vein, Percutaneous Approach, New Technology Group 9
XW033PB
Procedures
General
Introduction of Aztreonam-avibactam Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 11
XW033Q5
Procedures
General
Introduction of Tagraxofusp-erzs Antineoplastic into Peripheral Vein, Percutaneous Approach, New Technology Group 5
XW033Q9
Procedures
General
Introduction of Posoleucel into Peripheral Vein, Percutaneous Approach, New Technology Group 9
XW033QB
Procedures
General
Introduction of Iloprost into Peripheral Vein, Percutaneous Approach, New Technology Group 11
XW033R9
Procedures
General
Introduction of Rezafungin into Peripheral Vein, Percutaneous Approach, New Technology Group 9
XW033RB
Procedures
General
Introduction of Letetresgene Autoleucel into Peripheral Vein, Percutaneous Approach, New Technology Group 11
XW033S5
Procedures
General
Introduction of Iobenguane I-131 Antineoplastic into Peripheral Vein, Percutaneous Approach, New Technology Group 5
XW033W5
Procedures
General
Introduction of Caplacizumab into Peripheral Vein, Percutaneous Approach, New Technology Group 5
XW033WB
Procedures
General
Introduction of Fosfomycin Anti-infective into Peripheral Vein, Percutaneous Approach, New Technology Group 11
XW04308
Procedures
General
Introduction of Spesolimab Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 8
XW0433A
Procedures
General
Introduction of Bentracimab, Ticagrelor Reversal Agent into Central Vein, Percutaneous Approach, New Technology Group 10
XW0434A
Procedures
General
Introduction of Cefepime-taniborbactam Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 10
XW04357
Procedures
General
Introduction of Narsoplimab Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 7
XW04358
Procedures
General
Introduction of Mosunetuzumab Antineoplastic into Central Vein, Percutaneous Approach, New Technology Group 8
XW0435A
Procedures
General
Introduction of Ceftobiprole Medocaril Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 10
XW04367
Procedures
General
Introduction of Terlipressin into Central Vein, Percutaneous Approach, New Technology Group 7
XW04368
Procedures
General
Introduction of Afamitresgene Autoleucel Immunotherapy into Central Vein, Percutaneous Approach, New Technology Group 8
XW04372
Procedures
General
Introduction of Inactivated Coagulation Factor Xa into Central Vein, Percutaneous Approach, New Technology Group 2
XW04377
Procedures
General
Introduction of Trilaciclib into Central Vein, Percutaneous Approach, New Technology Group 7
XW04378
Procedures
General
Introduction of Tabelecleucel Immunotherapy into Central Vein, Percutaneous Approach, New Technology Group 8
XW04387
Procedures
General
Introduction of Lurbinectedin into Central Vein, Percutaneous Approach, New Technology Group 7
XW04388
Procedures
General
Introduction of Treosulfan into Central Vein, Percutaneous Approach, New Technology Group 8
XW0438A
Procedures
General
Introduction of Obecabtagene Autoleucel into Central Vein, Percutaneous Approach, New Technology Group 10
XW04396
Procedures
General
Introduction of Ceftolozane/Tazobactam Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 6
XW04398
Procedures
General
Introduction of Inebilizumab-cdon into Central Vein, Percutaneous Approach, New Technology Group 8
XW0439A
Procedures
General
Introduction of Odronextamab Antineoplastic into Central Vein, Percutaneous Approach, New Technology Group 10
XW043A7
Procedures
General
Introduction of Ciltacabtagene Autoleucel into Central Vein, Percutaneous Approach, New Technology Group 7
XW043B3
Procedures
General
Introduction of Cytarabine and Daunorubicin Liposome Antineoplastic into Central Vein, Percutaneous Approach, New Technology Group 3
XW043B7
Procedures
General
Introduction of Amivantamab Monoclonal Antibody into Central Vein, Percutaneous Approach, New Technology Group 7
XW043BA
Procedures
General
Introduction of Orca-T Allogeneic T-cell Immunotherapy into Central Vein, Percutaneous Approach, New Technology Group 10
XW043C7
Procedures
General
Introduction of Autologous Engineered Chimeric Antigen Receptor T-cell Immunotherapy into Central Vein, Percutaneous Approach, New Technology Group 7
XW043CA
Procedures
General
Introduction of Zanidatamab Antineoplastic into Central Vein, Percutaneous Approach, New Technology Group 10
XW043E5
Procedures
General
Introduction of Remdesivir Anti-infective into Central Vein, Percutaneous Approach, New Technology Group 5
XW043F3
Procedures
General
Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 3
XW043F5
Procedures
General
Introduction of Other New Technology Therapeutic Substance into Central Vein, Percutaneous Approach, New Technology Group 5
XW043FA
Procedures
General
Introduction of Non-Chimeric Antigen Receptor T-cell Immune Effector Cell Therapy into Central Vein, Percutaneous Approach, New Technology Group 10
XW043FB
Procedures
General
Introduction of Valoctocogene Roxaparvovec-rvox into Central Vein, Percutaneous Approach, New Technology Group 11
Showing page 1598 of 1601 (Total: 80029 codes)

Mastering ICD-10-PCS: The Inpatient Procedural Coding Guide for Professionals

The International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) is unlike any other medical coding taxonomy utilized in the United States. Developed by 3M Health Information Systems under contract with the Centers for Medicare and Medicaid Services (CMS), ICD-10-PCS completely replaced the severely outdated ICD-9-CM Volume 3 for hospital inpatient procedural reporting on October 1, 2015.

While CPT codes dominate the outpatient and professional fee (ProFee) landscape, ICD-10-PCS is the exclusive domain of the hospital inpatient facility. For the Inpatient Coder, DRG Validator, and Clinical Documentation Improvement (CDI) specialist, mastering the complex, multi-axial structure of ICD-10-PCS is non-negotiable. The precision of these codes dictates the surgical MS-DRG (Medicare Severity Diagnosis-Related Group) assignment, which drives millions of dollars in hospital reimbursement.

Inpatient Coder's Note: The Semantic Taxonomy

ICD-10-PCS was not built as an expansion of ICD-9; it was built from scratch using a logical, multi-axial framework. There are no diagnostic codes here, and there are no ambiguous "Not Elsewhere Classified" dump buckets. Every single character in an ICD-10-PCS code holds a specific, immutable semantic meaning. If a procedure is performed, an exact code can be built to describe it.

The 7-Character Alphanumeric Structure

Every ICD-10-PCS code consists of exactly seven characters. Each character can be a number from 0 to 9 or a letter from A to Z (excluding the letters I and O to avoid confusion with the numbers 1 and 0). Because each character position represents a specific attribute of the procedure, coders do not merely "look up" an ICD-10-PCS code; they "build" it utilizing the PCS tables.

The definitions of the seven characters vary slightly depending on the Section, but in the Medical and Surgical Section (where the vast majority of coding occurs), the characters are defined as follows:

  • Character 1: Section. Defines the general type of procedure (e.g., 0 = Medical and Surgical, B = Imaging, F = Physical Rehabilitation).
  • Character 2: Body System. Identifies the physiological system on which the procedure is performed (e.g., 2 = Heart and Great Vessels, Q = Lower Bones).
  • Character 3: Root Operation. The most critical character. It defines the strict objective of the procedure (e.g., Excision, Resection, Bypass, Drainage).
  • Character 4: Body Part. Specifies the precise anatomical site (e.g., Right Atrium, Left Femoral Artery).
  • Character 5: Approach. Details the technique used to reach the operative site (e.g., Open, Percutaneous Endoscopic).
  • Character 6: Device. Identifies any material or appliance left in place at the end of the procedure (e.g., Intraluminal Device, Autologous Tissue Substitute).
  • Character 7: Qualifier. Provides unique additional information specific to the procedure (e.g., Diagnostic vs. Therapeutic).

The 31 Medical and Surgical Root Operations

The most challenging aspect of ICD-10-PCS for both coders and physicians is character 3: the Root Operation. Physicians are trained to use clinical jargon, which does not always align with PCS definitions. It is the coder's responsibility to translate the physician's documented objective into one of the 31 strict PCS Root Operations.

The Root Operations are logically grouped into categories based on what the procedure achieves:

Procedures that take out some or all of a body part

  • Excision (B): Cutting out or off, without replacement, a PORTION of a body part. (e.g., Partial nephrectomy, lumpectomy).
  • Resection (T): Cutting out or off, without replacement, ALL of a body part. (e.g., Total mastectomy, total nephrectomy). Note: "Resection" in clinical terms is often used loosely by surgeons to mean a partial removal. The coder must verify if the entire organ was removed.
  • Detachment (6): Cutting off all or part of the upper or lower extremities (Amputations).
  • Destruction (5): Physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent (e.g., Fulguration of a rectal polyp, radiofrequency ablation of a liver tumor).
  • Extraction (D): Pulling or stripping out or off all or a portion of a body part by the use of force (e.g., Dilation and curettage, vein stripping).

Procedures that alter the diameter or route of a tubular body part

  • Restriction (V): Partially closing an orifice or the lumen of a tubular body part (e.g., Cervical cerclage, gastroesophageal fundoplication).
  • Occlusion (L): Completely closing an orifice or the lumen of a tubular body part (e.g., Fallopian tube ligation).
  • Dilation (7): Expanding an orifice or the lumen of a tubular body part (e.g., Percutaneous transluminal coronary angioplasty - PTCA).
  • Bypass (1): Altering the route of passage of the contents of a tubular body part (e.g., Coronary artery bypass graft - CABG, gastric bypass).

Procedures that involve putting in or on, putting back, or moving living body parts

  • Transplantation (Y): Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part (e.g., Kidney transplant).
  • Reattachment (M): Putting back in or on all or a portion of a separated body part to its normal location (e.g., Reattachment of a severed finger).
  • Reposition (S): Moving to its normal location, or other suitable location, all or a portion of a body part (e.g., Reduction of a displaced fracture, orchiopexy).
  • Transfer (X): Moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part (e.g., Tendon transfer).

Understanding the 7 Approaches (Character 5)

In the ICD-9 era, the approach was often implied by the code or ignored entirely. In ICD-10-PCS, the surgical approach is mandatory and significantly impacts MS-DRG grouping.

  • Open (0): Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure.
  • Percutaneous (3): Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure.
  • Percutaneous Endoscopic (4): Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure.
  • Via Natural or Artificial Opening (7): Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure.
  • Via Natural or Artificial Opening Endoscopic (8): Entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure.

The Critical Role of Clinical Documentation Improvement (CDI)

ICD-10-PCS requires a level of anatomical and surgical specificity that physicians are historically not accustomed to documenting. For example, if a physician documents a "spinal fusion," the coder cannot complete the 7-character code. The coder must know: Which precise vertebrae were fused? Was the approach anterior or posterior? Was the device an interbody fusion device, a synthetic substitute, or non-autologous tissue? Was a 360-degree spinal fusion performed requiring multiple codes?

This is where Clinical Documentation Improvement (CDI) specialists become invaluable. CDI professionals bridge the gap between clinical intent and coding requirements. They review operative reports concurrently and issue queries to surgeons while the patient is still in-house, ensuring that the documentation contains the exact terminology required to construct a compliant and accurate PCS code.

MS-DRG Impact and Compliance Auditing

The accuracy of ICD-10-PCS coding directly dictates hospital revenue. The presence of a specific PCS code can shift an admission from a Medical DRG to a Surgical DRG, vastly increasing the relative weight and subsequent reimbursement.

However, aggressive coding triggers compliance audits. Recovery Audit Contractors (RACs) aggressively target inpatient claims for procedure unbundling. A strict rule in ICD-10-PCS is that the coder should not code a procedure that is inherent to the Root Operation. For example, an exploratory laparotomy (Open Approach) performed to reach the appendix is inherent to the Open Appendectomy. Coding the laparotomy separately is considered fraudulent unbundling.

Conversely, if a physician attempts a procedure via a percutaneous endoscopic approach but must convert to an open approach to finish the surgery, ICD-10-PCS guidelines require the coder to code both the percutaneous endoscopic inspection and the open definitive procedure. Knowing these nuanced guidelines separates average coders from elite compliance experts.

Conclusion

ICD-10-PCS is a triumph of health informatics. By abandoning ambiguous classifications in favor of a strict, logical, multi-axial framework, it allows data scientists, epidemiologists, and hospital administrators to track surgical outcomes, device efficacy, and healthcare utilization with unprecedented precision.

For the inpatient coder, mastering the 31 Root Operations, understanding the nuanced differences between approaches, and navigating the device characters is a continuous journey of clinical education. It requires a deep understanding of anatomy, physiology, and modern surgical techniques. Ultimately, accurate ICD-10-PCS coding ensures that hospitals are fairly compensated for the high-acuity care they provide while maintaining ironclad compliance against federal and commercial audits.

Free ICD-10-PCS Code Lookup & Search Tool

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