“In the kNOW” addresses the new ICD-10-PCS guideline on “detachment” which is effective October 1, 2022. In ICD-10-PCS detachment is a root operation which means “cutting off all or a portion of the upper or lower extremities”. Others synonymous terms are disarticulation and amputation. With the PCS updates for FY2023, there is a new guideline, B3.19, which provides detail for the qualifiers when coding for detachment procedures of the extremities.
In the official explanation of the root operation of detachment, the following is provided: “The body part value is the site of the detachment, with a qualifier if applicable to further specify the level where the extremity was detached”. This new guideline provides the definitions for the qualifiers.
Upper arm and upper leg have qualifiers of high, mid, and low.
High=proximal part of shaft of humerus or femur
Mid=middle part of shaft of humerus or femur
Low=distal part of shaft of humerus or femur
Lower arm and lower leg have qualifiers of high, mid, and low.
High=proximal part of shaft of radius/ulna or tibia/fibula
Mid=middle part of shaft of radius/ulna or tibia/fibula
Low=distal part of shaft of radius/ulna or tibia/fibula
Hand and foot have qualifiers for complete, complete ray, and partial ray
Further clarification was provided on complete vs. partial
Complete=detachment
through the carpometacarpal joint of the hand, or tarsal-
metatarsal
joint of the foot
Partial=detachment
anywhere along the shaft or head of the metacarpal bone of the
hand
or the metatarsal bone of the foot
Amputations of the thumb, finger or toe have qualifiers of complete, high, mid, and low.
Complete=amputation at the metacarpophalangeal/metatarsal-phalangeal joint
High=amputation anywhere along the proximal phalanx
Mid=amputation
through the proximal interphalangeal joint or anywhere along the
middle
phalanx
Low=amputation
through the distal interphalangeal joint or anywhere along the
distal phalanx
For example, if the patient had a right index finger amputation at the proximal interphalangeal joint, the appropriate ICD-10-PCS code assignment would be 0X6N0Z2.
Now you are In the kNOW!!
About the Author
Dianna Foley, RHIA, CCS, CHPS, CDIP is
OHIMA's Education Coordinator. Dianna has been an HIM
professional for over 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati and holds RHIA, CHPS, CDIP and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and is a presenter on coding topics at the national, state, and regional levels. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
