Procedure Classes for ICD-10-PCS The 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.
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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:
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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:
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:
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:
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
"Unzipping" the File There is one downloadable self-extracting zipped file called pc_icd10pcs_2017.zip. Users are advised to:
The zipped file will unzip (expand for normal use) the following file: pc_icd10pcs_2017.csv. Note that the original file (pc_icd10pcs_2017.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 SAS®, you can adapt these translations to create a SAS PROC FORMAT. If you are working with SPSS®, 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 |
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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:
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Shift-click from this Web page: Your browser may support loading the file for the ICD-10-PCS Procedure Classes from this Web page. To download the file from this Web page, click on the following link with the right mouse button and select Save Link As (Firefox®) or Save Target As (Internet Explorer®). After saving the file, find the file by using Windows® Explorer (Windows 98/95/NT/Vista/7/8/10) or File Manager (Windows 3.x), and then open it by double clicking on it.
ASCII Procedure Classes for ICD-10-PCS file for use with user analytic software (i.e., SAS, Stata®, or SPSS) pc2017.csv. |
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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:
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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: Procedure Classes for ICD-10-PCS. Healthcare Cost and Utilization Project (HCUP). October 2016. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/procedureicd10/procedure_icd10.jsp. |
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Last modified 10/3/16 |