22 ICD-10-PCS Inpatient Procedures Practice Questions & Answers

1. 1. A coder is building an ICD-10-PCS code in the Medical and Surgical section. Which character position specifies the approach used to reach the operative site?

   • A.The fifth character, placed after body part and before device✓ Answer
   • B.The third character, placed after body system and before body part
   • C.The fourth character, placed after root operation and before approach
   • D.The sixth character, placed after approach and before the qualifier

   In the Medical and Surgical section the seven axes run Section, Body System, Root Operation, Body Part, Approach, Device, Qualifier, so approach is always the fifth character. Convention A1 states that the fifth axis of classification specifies the approach in sections 0 through 4 and 7 through 9.

   Source: ICD-10-PCS Official Guidelines for Coding and Reporting, Convention A1Report a problem with this question

2. 2. Convention A9 governs how values may be combined within one ICD-10-PCS table. Which statement describes a valid code built from that table?

   • A.Characters 4 through 7 must all come from the same row of the table✓ Answer
   • B.Characters 1 through 3 must come from the row that lists the chosen body part
   • C.Characters 5 through 7 may cross rows whenever the body part value is the same
   • D.Characters 4 through 7 may come from any row as long as the table is correct

   A9 provides that within a PCS table valid codes include all combinations of choices in characters 4 through 7 contained in the same row. The guideline's own illustration shows 0JHT3VZ as valid and 0JHW3VZ, which pulls a device value from a different row, as invalid.

   Source: ICD-10-PCS Official Guidelines, Convention A9Report a problem with this question

3. 3. An operative report lets the coder determine the section, body system, root operation, body part and device, but the approach cannot be established from the documentation. What does ICD-10-PCS require?

   • A.Report the six characters that are supported and add the approach when the record is amended
   • B.Query the provider, because a code is valid only when all seven characters are specified✓ Answer
   • C.Assign the value External, because no entry into the body was described in the report
   • D.Assign the value Open, because open is the accepted default when nothing else is stated

   Convention A8 requires that all seven characters be specified for a code to be valid and directs the coder to query the physician when the documentation is incomplete for coding purposes. There is no default approach value, and a partial code cannot be reported.

   Source: ICD-10-PCS Official Guidelines, Convention A8Report a problem with this question

4. 4. A coder new to ICD-10-PCS asks whether a procedure can be coded without first consulting the Alphabetic Index. Which statement reflects conventions A6 and A7?

   • A.The Index only locates a table, and a valid code may be built straight from the Tables✓ Answer
   • B.The Index must be checked first, and the code it lists may be reported as it stands there
   • C.The Index and the Tables are interchangeable, so either one alone yields a valid code
   • D.The Index supplies characters 1 through 3 and the Tables supply characters 4 through 7

   A6 states that the purpose of the Index is to locate the appropriate table, and that the Tables must always be consulted to find the most appropriate valid code; A7 adds that consulting the Index first is not required. This is why PCS codes are built rather than looked up.

   Source: ICD-10-PCS Official Guidelines, Conventions A6 and A7Report a problem with this question

5. 5. An operative note is headed 'excision of the left upper lung lobe,' and the body of the note states that the entire left upper lobe was removed. Which root operation is coded?

   • A.Excision, because the surgeon's own wording governs the root operation
   • B.Resection, because all of the left upper lobe body part was cut out✓ Answer
   • C.Excision, because only a portion of the left lung was actually removed
   • D.Detachment, because a whole anatomical subdivision was cut off entirely

   Guideline B3.8 says PCS carries specific body parts for anatomical subdivisions such as lung lobes, and Resection is coded whenever all of that body part is cut out. Convention A11 makes the point that the coder maps the documentation to the PCS definitions, so the surgeon's use of the word excision does not control.

   Source: ICD-10-PCS Official Guidelines, Guideline B3.8 and Convention A11Report a problem with this question

6. 6. A hematologist performs a bone marrow biopsy on an inpatient being worked up for pancytopenia. Which root operation and qualifier are correct?

   • A.Extraction with the qualifier Diagnostic✓ Answer
   • B.Resection with the qualifier Diagnostic
   • C.Excision with the qualifier Diagnostic
   • D.Drainage with the qualifier Diagnostic

   Guideline B3.4a limits biopsies to Excision, Extraction or Drainage with the qualifier Diagnostic, and names bone marrow biopsy specifically as Extraction because the marrow is pulled out by force rather than cut out. Lymph node sampling is the Excision example and fine needle aspiration of fluid is the Drainage example.

   Source: ICD-10-PCS Official Guidelines, Guideline B3.4aReport a problem with this question

7. 7. A laparoscopic cholecystectomy is begun, but dense adhesions force the surgeon to convert to an open cholecystectomy, which is then completed. How is this episode coded?

   • A.An open Excision code alone, since the gallbladder was reached by incision
   • B.A percutaneous endoscopic Resection code plus an open Inspection code
   • C.A percutaneous endoscopic Inspection code plus an open Resection code✓ Answer
   • D.An open Resection code alone, since the completed approach supersedes the first

   Guideline B3.2d directs that multiple procedures be coded when the intended root operation is attempted by one approach and converted to another, and it uses this exact scenario: laparoscopic cholecystectomy converted to open is coded as percutaneous endoscopic Inspection and open Resection. The abandoned approach is captured as an Inspection because no other root operation was completed through it.

   Source: ICD-10-PCS Official Guidelines, Guideline B3.2dReport a problem with this question

8. 8. What distinguishes the approach value Percutaneous Endoscopic from the approach value Percutaneous in ICD-10-PCS?

   • A.Percutaneous Endoscopic reaches and visualizes the site; Percutaneous only reaches it✓ Answer
   • B.Percutaneous Endoscopic uses several ports; Percutaneous uses a single puncture site
   • C.Percutaneous Endoscopic enters a natural opening; Percutaneous enters through the skin
   • D.Percutaneous Endoscopic requires an incision; Percutaneous requires a needle puncture

   Both values describe entry by puncture or minor incision of instrumentation through the skin or mucous membrane and any other body layers necessary. The single discriminator in the definitions is purpose: Percutaneous is defined as reaching the site, while Percutaneous Endoscopic is defined as reaching and visualizing the site.

   Source: ICD-10-PCS approach definitions, Medical and Surgical section (CMS ICD-10-PCS Reference Manual)Report a problem with this question

9. 9. An operative report is headed 'laparoscopic-assisted sigmoidectomy' and describes an abdominal incision that exposes the colon, with a laparoscope used to assist. Which approach value applies?

   • A.Percutaneous Endoscopic, because a laparoscope was used to assist throughout
   • B.Open, because the site was exposed by cutting through the body layers✓ Answer
   • C.Via Natural or Artificial Opening Endoscopic, because the colon lumen was entered
   • D.Percutaneous, because instrumentation passed through a puncture in the wall

   Guideline B5.2a states that procedures performed using the open approach with percutaneous endoscopic assistance are coded to the approach Open, and gives laparoscopic-assisted sigmoidectomy as the example. What controls is that an incision exposed the operative site, not that a scope was also used.

   Source: ICD-10-PCS Official Guidelines, Guideline B5.2aReport a problem with this question

10. 10. A robotic-assisted laparoscopic prostatectomy is performed, and the surgeon extends one port incision in order to remove the resected prostate. Which approach value applies?

    • A.Percutaneous, since the enlarged port is a minor incision without endoscopic entry
    • B.Percutaneous Endoscopic, since enlarging a port to remove the specimen does not change it✓ Answer
    • C.Via Natural or Artificial Opening, since the extended port acts as an artificial opening
    • D.Open, since the extended incision exposed the operative site directly to the surgeon

    Guideline B5.2b keeps the approach at Percutaneous Endoscopic when the endoscopic procedure uses hand assistance, or an incision or extension of an incision to help remove all or part of a body part or to anastomose a tubular body part. Robotic-assisted laparoscopic prostatectomy with extension of the incision is one of the guideline's own examples.

    Source: ICD-10-PCS Official Guidelines, Guideline B5.2bReport a problem with this question

11. 11. During a laparotomy for obstruction, the surgeon frees loops of small intestine from dense adhesive bands; the bowel wall itself is not cut. Which root operation and body part are coded?

    • A.Excision, with the peritoneum as the body part, since adhesive tissue was removed
    • B.Release, with the small intestine as the body part freed from the constraint✓ Answer
    • C.Division, with the small intestine as the body part separated by the surgeon
    • D.Release, with the peritoneum as the body part, since the bands were what was cut

    Guideline B3.14 assigns Release when the sole objective is freeing a body part without cutting the body part, and Division when the objective is separating or transecting it. Guideline B3.13 then fixes the body part as the one being freed rather than the tissue cut, so lysis of intestinal adhesions is coded to the specific intestine value.

    Source: ICD-10-PCS Official Guidelines, Guidelines B3.13 and B3.14Report a problem with this question

12. 12. An interventional radiologist coils a cerebral aneurysm so that the abnormally widened segment is narrowed while flow through the parent vessel continues. Which root operation is coded?

    • A.Dilation, because the objective is to restore the caliber of the vessel
    • B.Occlusion, because the objective is to close the aneurysm off from flow
    • C.Supplement, because the coils reinforce the weakened wall of the vessel
    • D.Restriction, because the objective is to narrow the lumen at the aneurysm✓ Answer

    Guideline B3.12 turns on the objective of the embolization: Occlusion when the vessel is to be completely closed, Restriction when the lumen is to be narrowed. The guideline names embolization of a cerebral aneurysm as Restriction precisely because the vessel is abnormally wide at that point and is not being closed off.

    Source: ICD-10-PCS Official Guidelines, Guideline B3.12Report a problem with this question

13. 13. A posterior lumbar fusion at a single vertebral joint is rendered immobile with a mixture of the patient's own morselized bone and bone bank graft; no cage is used. Which device value is coded?

    • A.Interbody Fusion Device, the cage or bone dowel value
    • B.Nonautologous Tissue Substitute, the allograft value
    • C.Autologous Tissue Substitute, the autograft value✓ Answer
    • D.Synthetic Substitute, the manufactured implant value

    Guideline B3.10c sets a three-step device hierarchy for spinal fusion. An interbody fusion device is coded when one renders the joint immobile; bone graft alone takes a tissue substitute value; and when a mixture of autologous and nonautologous graft is used, with or without extenders or binders, the device value coded is Autologous Tissue Substitute.

    Source: ICD-10-PCS Official Guidelines, Guideline B3.10cReport a problem with this question

14. 14. At the close of an open procedure the surgeon leaves sutures, a radiological marker clip and a temporary post-operative wound drain in the patient. How is the device character handled?

    • A.None of the three is coded, because all are integral to performing the procedure✓ Answer
    • B.Only the wound drain is coded, using the device value Drainage Device for that site
    • C.Only the marker clip is coded, because it is the item that stays in the body longest
    • D.All three are coded as devices, because each of them remains in place after closure

    Guideline B6.1a codes a device only when a device remains after the procedure is completed, and otherwise uses the value No Device. Guideline B6.1b then names sutures, ligatures, radiological markers and temporary post-operative wound drains as materials integral to performing a procedure that are never coded as devices.

    Source: ICD-10-PCS Official Guidelines, Guidelines B6.1a and B6.1bReport a problem with this question

15. 15. A surgeon lays synthetic mesh over a weakened area of the abdominal wall; the patient's own tissue stays in place and the mesh reinforces it. Which root operation is coded?

    • A.Supplement, because the material reinforces a body part that remains in place✓ Answer
    • B.Repair, because the objective was to restore the wall to its normal structure
    • C.Replacement, because the material takes over the function of the weakened wall
    • D.Insertion, because a nonbiological appliance was put in without removing tissue

    Supplement is defined as putting in or on biologic or synthetic material that physically reinforces or augments the function of a portion of a body part, which is exactly what mesh over intact tissue does. Replacement would apply only if the material physically took the place of all or a portion of the body part, and Insertion is limited to nonbiological appliances that monitor, assist, perform or prevent a physiological function.

    Source: ICD-10-PCS root operation definitions, Supplement (U) and Replacement (R)Report a problem with this question

16. 16. A patient undergoes extracorporeal shock wave lithotripsy; the ureteral calculus is broken into pieces that the patient later passes spontaneously. Which root operation is coded?

    • A.Extirpation, because the solid matter was taken out of the lumen of the ureter
    • B.Destruction, because energy was applied to eradicate the stone in the ureter
    • C.Extraction, because force was used to pull the stone material out of the body
    • D.Fragmentation, because the solid matter was broken into pieces in the body part✓ Answer

    Fragmentation is defined as breaking solid matter in a body part into pieces, and the pieces are not removed; Extirpation is defined as taking or cutting solid matter out of a body part. Destruction is ruled out because it eradicates a portion of the body part itself rather than a stone, and Extraction pulls or strips out a body part.

    Source: ICD-10-PCS root operation definitions, Fragmentation (F) and Extirpation (C)Report a problem with this question

17. 17. A displaced cardiac pacemaker lead is repositioned during an open procedure to correct its position, and the same lead is left in place. Which root operation is coded?

    • A.Removal, which takes a device out of a body part in an operative episode
    • B.Reposition, which moves a body part to its normal or another suitable location
    • C.Revision, which corrects the position of a displaced or malfunctioning device✓ Answer
    • D.Change, which exchanges a device for a similar one without cutting or puncturing

    Revision is defined as correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device, which is what repositioning a dislodged lead accomplishes. Change is restricted to taking out a device and putting back an identical or similar one without cutting or puncturing, and it always uses the approach External; Reposition applies to body parts, not devices.

    Source: ICD-10-PCS root operation definitions, Revision (W), Change (2) and Removal (P)Report a problem with this question

18. 18. In a non-coronary bypass such as a gastrojejunostomy, how do the fourth character and the seventh character of the code function?

    • A.The body part is the site of anastomosis and the qualifier names the graft material
    • B.The body part is the site bypassed to and the qualifier is the site bypassed from
    • C.The body part is the number of sites bypassed and the qualifier names the conduit
    • D.The body part is the site bypassed from and the qualifier is the site bypassed to✓ Answer

    Guideline B3.6a codes bypass procedures by identifying the body part bypassed from in the fourth character and the body part bypassed to in the qualifier, using bypass from stomach to jejunum as its example. Coronary artery bypass reverses this under B3.6b, where the body part gives the number of coronary arteries bypassed to and the qualifier names the vessel bypassed from.

    Source: ICD-10-PCS Official Guidelines, Guidelines B3.6a and B3.6bReport a problem with this question

19. 19. A fiberoptic bronchoscopy is performed in order to irrigate the bronchus, and the irrigation is completed through that same scope. What is reported?

    • A.Only the inspection, because visualization was the access route for the irrigation
    • B.Both procedures, because the bronchoscope was passed through a natural opening
    • C.Only the irrigation, because the inspection was done to achieve that objective✓ Answer
    • D.Both procedures, because inspection and irrigation are distinct root operations

    Guideline B3.11a provides that inspection of a body part performed in order to achieve the objective of a procedure is not coded separately, and it uses fiberoptic bronchoscopy for irrigation of the bronchus as its example. Inspection would be coded separately only under B3.11c, when it is performed on the same body part using a different approach than the other procedure.

    Source: ICD-10-PCS Official Guidelines, Guidelines B3.11a and B3.11cReport a problem with this question

20. 20. An excisional debridement is performed on skin and subcutaneous tissue overlying the ankle. Under guideline B4.6, which body part value is used?

    • A.Foot, the value assigned to skin and subcutaneous tissue over the ankle✓ Answer
    • B.Lower Leg, the value assigned to tissue over the ankle and the knee alike
    • C.Lower Extremity, the general value used when no joint-specific value exists
    • D.Ankle Joint, the value assigned when the tissue lies directly over that joint

    Guideline B4.6 lists fixed body part assignments for skin, subcutaneous tissue or fascia overlying a joint: shoulder to upper arm, elbow and wrist to lower arm, hip to upper leg, knee to lower leg, and ankle to foot. The ankle entry is the one that does not follow the pattern of moving proximally, which is why it is so often missed.

    Source: ICD-10-PCS Official Guidelines, Guideline B4.6Report a problem with this question

21. 21. The same laparoscopic appendectomy is performed on a hospital inpatient at one facility and in a hospital outpatient department at another. Which statement describes the procedure code sets reported?

    • A.Both settings report CPT codes, and ICD-10-PCS is reserved for research data sets
    • B.The inpatient stay reports ICD-10-PCS and the outpatient encounter reports CPT or HCPCS✓ Answer
    • C.Both settings report ICD-10-PCS, and CPT is added only for the physician's own claim
    • D.The inpatient stay reports CPT codes and the outpatient encounter reports ICD-10-PCS

    ICD-10-PCS is the procedure classification adopted under HIPAA for hospital inpatient health care settings, as the guidelines themselves state in their introduction. Hospital outpatient and physician professional reporting of the same surgery uses CPT and HCPCS Level II instead, so the identical operation carries different procedure code sets by setting.

    Source: ICD-10-PCS Official Guidelines, introduction (HIPAA adoption for hospital inpatient settings)Report a problem with this question

22. 22. An inpatient is admitted with a principal diagnosis of gastrointestinal bleeding, for which a diagnostic colonoscopy with biopsy is done. A cholecystectomy is also performed for a secondary diagnosis of cholelithiasis. Which is the principal procedure?

    • A.The diagnostic colonoscopy, since diagnostic work is always sequenced before therapy
    • B.The diagnostic colonoscopy, since it is the procedure related to the principal diagnosis✓ Answer
    • C.The cholecystectomy, since definitive treatment always outranks a diagnostic procedure
    • D.The cholecystectomy, since it is the more resource-intensive of the two procedures

    Section F scenario 3 covers exactly this pattern: when a diagnostic procedure is performed for the principal diagnosis and a definitive procedure treats a secondary diagnosis, the diagnostic procedure is sequenced as principal, since the procedure most related to the principal diagnosis takes precedence. Relation to the principal diagnosis, not definitiveness, drives the ranking.

    Source: ICD-10-PCS Official Guidelines, Section F, Selection of Principal Procedure, scenario 3Report a problem with this question

Practice questions based on the AHIMA Certified Coding Associate (CCA) Exam Content Outline, the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting, and the AHIMA Standards of Ethical Coding. This site is not affiliated with or endorsed by AHIMA. Code sets and their official guidelines are revised every year, so no question here keys a specific code value — always assign codes from the current code books, encoder and official guidelines in effect for the date of service, never from a practice test. Confirm current eligibility and exam requirements with AHIMA before you test. About the CCA credential →