What happens in ICD-10-PCS stays in ICD-10-PCS: Understanding the device value

A device value and a device are not the same thing

The heading for each axis in the seven axis PCS table is self-referential. What does that mean? It means that PCS defines its own terms for use inside the system. In the case of headings, they give an indication of what type of thing is classified to that axis of the code. For example, the heading over the fourth axis is body part, the heading over the fifth is called approach. PCS doesn’t worry about what “body part” or “approach” means in some kind of absolute sense in the real world. It is simply telling you what kind of thing an axis is going to contain. Everyone seems cool with that and it doesn’t cause any confusion, except in the case of the column heading over the sixth character, the one usually labeled “device”.

In the PCS model of reality, the sixth axis “Defines the material or appliance used to accomplish the objective of the procedure that remains in or on the procedure site at the end of the procedure.” The function of the sixth axis, then, is to capture the fact that something (material or appliance is pretty broad) that is essential to accomplishing the objective of the procedure (meaning it is central to the root operation definition) has been left in the body at the end of the procedure.

People get themselves in trouble over the device value, because they get all metaphysical about what it really means. Either they say that PCS is “wrong,” thinking that somehow PCS is telling them whether or not something is considered a device outside of PCS—at the FDA, in a manufacturer’s marketing materials, or anywhere else in the real world. (Is the FDA the real world, or is it a parallel Matrix?)

PCS definitions: Every value in the sixth axis of a Medical and Surgical section code is called a device value, including the value Z No Device. (Is No Device a device in the real world? I don’t think so.) When a PCS code has a device value of Z, it means it would NOT be useful to add more information to the code using a non-Z value in the sixth axis. Bookmark this sentence in your head, because I will be coming back to it later.

It’s later now, so go get that sentence you bookmarked—never mind, I’ll get it—when a device value other than Z No Device is used, it is only telling you that it would NOT be useful to add more information to the procedure code using one of the non-Z values. It is not making any highfalutin claims about whether a device is to be or not to be.

Unpacking device value Z

First we are going to unpack the device value No Device, and then we’ll deal with the other values. Use of the device value Z comes in two flavors: 1) Plain Vanilla—meaning “there really is no device or tissue substitute used to accomplish the central objective of the procedure”, or 2) Rocky Road—meaning “it is so freaking obvious that a tissue substitute was used and also what kind it was, because it is inherent in   the root operation definition, that adding the device value tissue substitute for every single row in the PCS table would just make the code title longer to read, and give the impression that this was real information being added to the code, and not a long winded way of saying “duhhh.”

Another way to say it in PCS lingo: Some root operations always use a device that has only one non-specific device value in in the sixth axis, for example 7 Autologous Tissue Substitute or K Nonautologous Tissue Substitute.

See the table below for examples of both flavors of device value Z.

Oops, I’m over my length limit. This continues in part 2.

Rhonda Butler is a clinical research manager with 3M Health Information Systems.