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Beta Procedure Classes for ICD-10-PCS
Procedure Classes for ICD-10-PCS is one of the HCUP tools that can be applied to HCUP and other similar databases. These tools are created by AHRQ through a Federal-State-Industry partnership.
 
Caution: These ICD-10-CM/PCS tools were created prior to the availability of ICD-10-CM/PCS-coded data. AHRQ is conducting analyses of ICD-10-CM/PCS data; preliminary findings suggest some unexpected discontinuities between the tools based on ICD-9-CM and those based on ICD-10-CM/PCS. See this page www.hcup-us.ahrq.gov/datainnovations/icd10_resources.jsp for details. The tools will undergo periodic updates and corrections as data using ICD-10-CM/PCS codes come into greater use. You are advised to visit this page regularly to download and apply the most recent version of the HCUP tools for your data throughout your research process.


Procedure Classes for ICD-10-PCS

The Beta Procedure Classes for the ICD-10-PCS is one in a family of databases and software tools developed as part of the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases, tools, and software inform decision making at the national, State, and community levels.

Contents:

The Procedure Classes provide users with an easy way to categorize procedure codes into one of four broad categories: Minor Diagnostic, Minor Therapeutic, Major Diagnostic, and Major Therapeutic.

Procedure codes for this tool are based on the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). The ICD-10-PCS has more than 71,900 procedure codes, a considerable expansion over the approximately 4,000 procedure codes under ICD-9-CM.

This documentation provides an overview of the following:

  • The categorization scheme used by the Procedure Classes
  • A description of downloadable, electronic files that contain the translation of ICD-10-PCS procedure codes into Procedure Classes
The Procedure Classes are updated each year. This version is based on the 2018 ICD-10-PCS procedure codes. ICD-10-PCS is valid as of October 1, 2017.
 
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The Procedure Classes are created to facilitate health services research on hospital procedures using administrative data. This classification system allows the researcher to readily determine (1) whether a procedure is diagnostic or therapeutic and (2) whether a procedure is minor or major in terms of invasiveness, resource use, or both.

The Procedure Classes assign all ICD-1O-PCS procedure codes to one of four categories:

  1. Minor Diagnostic—Nonoperating room procedures that are diagnostic (e.g. B244ZZZ, Ultrasonography of Right Heart)
  2. Minor Therapeutic—Nonoperating room procedures that are therapeutic (e.g. 02HQ33Z, Insertion of Infusion Device into Right Pulmonary Artery, Percutaneous Approach)
  3. Major Diagnostic—Procedures that are considered valid operating room procedures by the Medicare Severity Diagnosis Related Group (MS-DRG) grouper and that are performed for diagnostic reasons (e.g. 02BV0ZX, Excision of Superior Vena Cava, Open Approach, Diagnostic)
  4. Major Therapeutic—Procedures that are considered valid operating room procedures by the Medicare Severity Diagnosis Related Group (MS-DRG) grouper and that are performed for therapeutic reasons (e.g. 0210093, Bypass Coronary Artery, One Site from Coronary Artery with Autologous Venous Tissue, Open Approach).

The determination of major versus minor procedures is based on logic presented in the ICD-10 MS-DRG V31R logic, specifically, Appendix E, Operating Room Procedures and Procedure Code/MS-DRG Index, of the ICD-10 MS-DRG Definitions Manual. Appendix E identifies operating room (OR) and non-OR procedures that impact the MS-DRG assignment during the grouping process. Procedures that are included in the Medical & Surgical (PCS codes that begin with the number 0) and Obstetrics (PCS codes that begin with the number 1) sections of PCS are eligible to be assigned as Major procedures in the tool. Therefore, PCS procedures are categorized as Major procedures when:

  • they begin with number 0 or 1 and
  • are identified as OR procedures in ICD-10 MS-DRG Definitions Manual Appendix E.

All other PCS codes are assigned as Minor procedures in the tool. There is one exception; bone marrow transplants are included in the Introduction section of PCS (PCS codes that begin with the number 3) yet are identified as OR procedures by ICD-10 MS-DRG Definitions Manual Appendix E. Due to the major nature of these procedures they have been categorized as Major in the tool.

It is also important to note that the number of combination coding scenarios required for MS-DRG assignment has increased under ICD-10-PCS. Since each component of the surgery is coded more surgical procedures will require multiple codes to be reported in order for the correct MS-DRG to be assigned. Within these combination of codes that are reported together to reach the correct surgical MS-DRG there are PCS codes that are considered non-OR in Appendix E of the ICD-10 MS-DRG Definitions Manual. Therefore, these codes are assigned as a Minor procedure in our tool even though the code description appears to be surgical. For example, code 02H40JZ, Insertion of Pacemaker Lead into Coronary Vein, Open Approach, is part of combination code requirement and is identified as non-OR in Appendix E of the ICD-10 MS-DRG Definitions Manual. In order for an encounter with this procedure to be assigned to MS-DRGs 242-244, Permanent Cardiac Pacemaker Implant, code 02H40JZ must be reported with the following codes:

  • 02H60JZ, Insertion of Pacemaker Lead into Right Atrium, Open Approach, identified in Appendix E as non-OR
  • 02HK0JZ, Insertion of Pacemaker Lead into Right Ventricle, Open Approach, identified in Appendix E as non-OR
  • 0JH607Z, Insertion of Cardiac Resynchronization Pacemaker Pulse Generator into Chest Subcutaneous Tissue and Fascia, Open Approach, identified in Appendix E as OR

When all four of the PCS codes are reported together on the same date of service the encounter is assigned to MS-DRGs 242-244, Permanent Cardiac Pacemaker Implant. For more on required combination reporting please see Appendix E of the ICD-10 MS-DRG Definitions Manual.

The Procedure Classes consist of one ASCII (DOS text) file that can be applied to translate ICD-10-PCS procedure codes into four Procedure Classes. The file contains four elements: ICD-1O-PCS procedure codes, ICD-1O-PCS code labels, Procedure Class assignments, and Procedure Class names.
 
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System Requirements

In order to use the Procedure Classes for ICD-10-PCS file, you will need a program (such as WinZip™) that will allow you to decompress or "unzip" files. You will also need approximately six megabytes of disk space available on your hard drive to accommodate the Procedure Classes file.

Required Data Elements

The Procedure Classes for ICD-10-PCS require procedure codes (ICD-10-PCS) with no embedded periods.

File Layout

  • Field 1: Procedure Code
  • Field 2: Code Description (word label for the code)
  • Field 3: Procedure Class
  • Field 4: Procedure Class Name

"Unzipping" the File

There is one downloadable self-extracting zipped file called pc_icd10pcs_2018.zip. Users are advised to:

  1. Create a subdirectory (or folder) called PC on your hard drive (e.g., C:\PC)
  2. Download and save pc_icd10pcs_2018.zip to this subdirectory
  3. Using WinZip (or comparable program), double click on the zip file to expand the file

The zipped file will unzip (expand for normal use) the following file: pc_icd10pcs_2018.csv. Note that the original file (pc_icd10pcs_2018.zip) will remain intact.

Using the Translation File

The Procedure Classes translation file lists the ICD-1O-PCS procedure codes and their corresponding Procedure Classes. Your use of the file will depend on the software system being used. For example, if you are using SASĀ®, you can adapt these translations to create a SAS PROC FORMAT. If you are working with SPSSĀ®, you can adapt these translations into VALUE LABELS or into a series of recodes.

Representation of ICD-10-PCS Procedure Codes

In practice, ICD-10-PCS procedures are represented as 7-character codes. All 7 characters must be specified in order for the code to be valid. Each character in the 7-character code represents an aspect of the procedure. If a device or qualifier is not used in the procedure the character location is populated by the letter Z in order to ensure that all PCS codes are seven characters. ICD-10-PCS procedure codes do not contain implicit or explicit decimals. Letters O and I are not used to avoid confusion with numbers 0 and 1.
Procedure ICD-10-PCS Procedure code Alphanumeric code
Division of Brain, Open Approach 00800ZZ '00800ZZ'
Repair Right Thumb Phalanx, Open Approach 0PQR0ZZ '0PQR0ZZ'

For proper handling of procedure codes:

Leading zeroes must be preserved; they are significant.

Calculating ORPROC: If you wish to identify discharges that contain an operating room procedure, follow the basic guidelines below:

  1. Assign the Procedure Classes indicators to a dataset using the tool. This entails creating an array of Procedure Class flags on each record that is equal in size to the number of procedures on the record. If you have 15 procedures (PR1-PR15) on a given record, then create 15 Procedure Class flags (PCLASS1-PCLASS15). Each Procedure Class indicator would be created using the corresponding procedure code array element (e.g., PCLASS5 would be created by examining the fifth procedure—PR5).
  2. Once an array of Procedure Class flags is made for each record, loop through that array to find any instances in which a procedure takes place in the Operating Room (OR) (PCLASS is 3 or 4). When an OR procedure is found, set the ORPROC data to 1; otherwise set it to 0.

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Shift-click from this Web page: Click on the file name to automatically download the files for Procedure Classes for ICD-10-PCS. Alternately, click on the following links with the right mouse button and select "Save Link As" (Google Chrome) or "Save Target As" (Internet Explorer) to download the ZIP folder to your computer. After downloading the files, extract the ZIP file contents by double clicking on the ZIP folder. The ZIP folder includes the Tool, a load program, and instructions for applying the Tool to your data using the load program. Additionally, the HCUP Tools Loading Tutorial, part of the HCUP On-line Tutorials Series, provides step-by-step instructions for downloading, applying, and verifying HCUP Tools.

ASCII Procedure Classes for ICD-10-PCS file for use with user analytic software (i.e., SAS, Stata®, or SPSS)

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Copies of previous versions of the Procedure Classes for ICD-10-PCS are available for users who need to replace or access the old programs.

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There are currently no publications using the Procedure Classes for ICD-10-PCS Tool. The following are selected publications that use the ICD-9-CM version of the Procedure Classes Tool:

  • Leventhal JM, Gaither JR, Sege R. Hospitalizations due to firearm injuries in children and adolescents. Pediatrics. 2014;133(2):219-55.
  • Tsai J, Abe K, Boulet SL, Beckman MG, Hooper WC, Grant AM. Predictive accuracy of 29-comorbidity index for in-hospital deaths in US adult hospitalizations with a diagnosis of venous thromboembolism. PLoS One. 2013 July;8(7):e70061.
  • Tsai J, Grant AM, Soucie JM, Helwig A, Yusuf HR, Boulet SL, Reyes NL, Atrash HK. Clustering patterns of comorbidities associated with in-hospital death in hospitalizations of US adults with venous thromboembolism. Int J Med Sci. 2013 Aug;10(10):1352-60.
  • Spector WD, Mutter R, Owens P, Limcangco R. Thirty-day, all-cause readmissions for elderly patients who have an injury-related inpatient stay. Med Care. 2012 Oct;50(10):863-9.
  • Wachtel RE, Dexter F, Barry B, Applegeet C. Use of state discharge abstract data to identify hospitals performing similar types of operative procedures. Anesth Analg. 2010 Apr;110(4):1146-54.

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Questions regarding the Procedure Classes may be directed to HCUP User Support through the following channels:

 
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Internet Citation: Beta Procedure Classes for ICD-10-PCS. Healthcare Cost and Utilization Project (HCUP). March 2018. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/procedureicd10/procedure_icd10.jsp.
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Last modified 3/23/18