There are many surgical and non-surgical procedures performed using different approach. If you know about the approach of a procedure, it can help in finding the correct CPT or ICD-10 PCS codes. This way it will be a great help for both outpatient and inpatient coders.

Being an outpatient coder, I generally come across the non-surgery procedures like MRI, CT, ultrasound etc. But, for coding some diagnostic and interventional radiology procedures we come across the percutaneous (minimal invasive surgery) procedures as well like angioplasty, stent placement, nephrostogram, cholangiogram etc.

So, today we will learn about the different techniques or approaches used for performing a surgery in medical coding and how it can help in coding a medical report.

List of Different APPROACH used for performing surgeries

Most of different approach are used for coding Obstetrics procedures. The approach plays an important role in finding the 5th character of ICD-10 PCS code in inpatient coding. Let us checkout the definition of different approaches used in surgery.

Open (0) : Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. “0” is the 5th character used for coding Open approach surgery procedures.
Percutaneous (3) :Entry (through the skin), 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. These procedures are very common in coding Interventional Radiology (IR). “3” is the 5th character used for coding Percutaneous approach surgery procedures.
Percutaneous Endoscopic (4) : Entry(through the skin), 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. “4” is the 5th character used for coding Percutaneous endoscopic approach surgery procedures.
Via natural or artificial opening (7) : Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure. “7” is the 5th character used for coding via natural or artificial opening surgery procedures.
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. “8” is the 5th character used for coding via natural or artificial opening endoscopic surgery procedures.
External (X) : Procedures performed directly on the skin or mucous membrane and procedures performed indirectly by the application of external force through the skin or mucous membrane. “7” is the 5th character used for coding External surgery procedures.
Via natural or artificial opening with percutaneous endoscopic assistance (F) : Entry of instrumentation through a natural or artificial external opening, and entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to aid in the performance of the procedure
Guidelines related to the selection of the approach, as follows:
Open approach with percutaneous endoscopic assistance: code to “open” approach. Example: laparoscopic-assisted sigmoidectomy is coded to “open.”
Percutaneous endoscopic approach with extension of incision. Procedures performed using the percutaneous endoscopic approach, with incision or extension of an incision to assist in the removal of all or a portion of a body part or to anastomose a tubular body part to complete the procedure, are coded to “percutaneous endoscopic.” Example: laparoscopic sigmoid colectomy with extension of stapling port for removal of specimen and direct anastomosis is coded to “percutaneous endoscopic.”
External approach. The following procedures should be coded to “external”:
Procedures performed within an orifice on structures that are visible without the aid of any instrumentation. Example: resection of tonsils.
Procedures performed indirectly by the application of external force through the intervening body layers. Example: closed reduction of fracture.
Percutaneous procedure via device: Code to “percutaneous.” Example: fragmentation of kidney stone via percutaneous nephrostomy is coded to “percutaneous.”