HIT 203 -- Chapter 34 - Osteopathi Other Procedures and Chiropractic Sections
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HIT203
Chapter 34
Osteopathic, Other Procedures, and Chiropractic Sections
Osteopathic Sections
Osteopathic services are sometimes referred to as osteopathic manipulation
therapy (OMT). OMT is manually guided therapy that is performed by a
Doctor of Osteopathic Medicine (DO) to improve physiological function.
The Osteopathic Section of ICD-10-PCS is made up of one table. Osteopathic
procedures are valued with the number 7 as the first character, the section
identifier, for this group of codes. To locate the correct code the coder needs
to reference the main term “Osteopathic Treatment” in the ICD-10-PCS Index.
Anatomical Region and Root Operation
The second position is identified as an anatomical region and has a value of
W. The third position is the root operation, of which there is only one:
Treatment. Treatment is defined by ICD-10-PCS in the Osteopathic Table as
manual treatment to eliminate or alleviate somatic dysfunction and related
disorders. The treatment has a value of 0.
Body Region
For osteopathic manipulation, the body region or body area needs to be
identified in the fourth-character position.
The following notes the body regions and their values for this section:
Head (value of 0)
Cervical (value of 1)
Thoracic (value of 2)
Lumbar (value of 3)
Sacrum (value of 4)
Pelvis (value of 5)
Lower extremities (value of 6)
Upper extremities (value of 7)
Rib cage (value of 8)
HIT203
Chapter 34
Osteopathic, Other Procedures, and Chiropractic Sections
Abdomen (value of 9
Approach, Method, and Qualifier
For the fifth-character position, the approach is always external
because osteopathic services are noninvasive. The value is X in the
fifth-character position.
The sixth character denotes the method. The method varies depending
on the service rendered and appears in the table as follows:
Articulatory
—raising (value of 0)—This is a direct approach technique
that articulates the rib heads by lifting and rotating them.
Fascial release
(value of 1)—This method treats fascial restrictions to
restore soft tissue mobility.
General mobilization
(value of 2)—This type of mobilization is a
method used to relieve tension in joints and tissue.
High velocity
—low amplitude (value of 3)—This method is also known
as popping or thrusting. A rapid therapeutic force is applied to an area
to release a restriction.
Indirect
(value of 4)—This is a manipulative technique that targets
tender points. The body is positioned and held in a specific position
until there is relief of the tenderness.
Low velocity
—high amplitude (value of 5)—This method is used to
relieve tension by using large gentle mobilization movements.
Lymphatic pump
(value of 6)—This method is used to optimize the
functioning of the lymphatic system.
Muscle energy
—isometric (value of 7)—This method uses the
patient’s voluntary muscle energy contractions for treatment by
applying an equal force to the body.
Muscle energy
—isotonic (value of 8)—This method uses the patient’s
voluntary muscle energy contractions for treatment by applying
resistance to the body.
Other method
(value of 9)—The value of 9 is used to denote other
treatment methods and techniques that are used for osteopathic
HIT203
Chapter 34
Osteopathic, Other Procedures, and Chiropractic Sections
treatment that are not identified by the other methods specified in ICD-
10-PCS.
Examples of such methods include balanced tension, cranial techniques
such as compression of the fourth ventricle, and the application of
mechanical vibratory force.
Any DO perform OMT services should clearly document the method used.
Query the physician before assigning a character from the table if you
have any doubt about which method was used. The seventh-character
position is not specified in the Osteopathic Section of ICD-10-PCS, so the
value for this. position is Z, None.
Other Procedures
In the section titled “Other Procedures,” there are two tables. The first
character, identifying the section, is 8. The second characters have a
value of C for indwelling device or E for physiological systems and
anatomical regions.
Root Operation
In the tables for other procedures, the third-character position value is 0.
The definition given in ICD-10-PCS for Other Procedures is methodologies
which attempt to remediate or cure a disorder or disease.
Body Region
In the tables for other procedures, the body region character is in the
fourth position. Tables 8C0 and 8E0 include values that are unique to each
table.
Approach
The fifth-character value represents the approach. For Table 8C0, there is
only one option for the fifth character, value X for external. For Table 8E0,
the following approach values are used:
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HIT203
Chapter 34
Osteopathic, Other Procedures, and Chiropractic Sections
X, External
0, Open
3, Percutaneous
4, Percutaneous endoscopic
7, Via natural or artificial opening
Method
The tables for other procedures contain various methods not seen in other
sections. For Table 8C0, in the sixth-character position, there is only one
value used: 6, meaning collection. For Table 8E0, the following values are
used in the sixth position:
0
, Acupuncture. Acupuncture is completed by inserting fine needles
into the skin to produce an analgesic effort to relieve pain or to alter
the function of a body system. Note in table 8E0 the seventh character
identifies the purpose of the acupuncture procedure completed.
1
, Therapeutic massage. The goal of therapeutic massage is to prevent
or relieve pain, increase circulation, reduce stress, improve muscle
tone and to create balance of the soft tissues within the body.
6
, Collection. Reference table 8C0 and note that this table is for
indwelling devices. Also note character 6 is entitled method and is
used to denote collection. Here the collection denotes that fluid was
taken from an indwelling device. Reference table 8E0, in this table in
the sixth character position the value of 6 denotes collection of breast
milk and sperm. In these two cases drainage of an organ is not
required.
B
, Computer assisted procedure. Coders need to select the value of B
for the sixth character position in table 8E0 when computer technology
is used during the preoperative or operative procedure to assist with
the performance and navigation of the procedure.
HIT203
Chapter 34
Osteopathic, Other Procedures, and Chiropractic Sections
C
, Robotic assisted procedure. During robotic assisted procedures the
surgeon uses a robotic device that allows for increased magnification
of the operative field and precision.
D
, Near infrared spectroscopy. NIRS is a noninvasive procedure that is
performed by use of a spectroscope to monitor the oxygen availability
in the body and to analyze the use of oxygen.
E
, Fluorescence Guided Procedure. A fluorescence guided procedure is
an imaging procedure in which a substance is ingested by a patient
that helps to detect fluorescently identified structures, such as tumors
when they are viewed under blue light.
Y
, Other method. In table
8E0
, the sixth character value of Y denotes
other methods as they relate to the seventh character values of
examination, in vitro fertilization, isolation, meditation, piercing, suture
removal, and yoga therapy. Reference table 8E0 and note the use of Y
in the sixth character position as they relate to the seventh character
position values.
The use of these values is dependent on the procedure completed, and
applicable values vary according to body region.
Qualifier
Character position 7 is the qualifier position. These alphanumeric
character values identify additional information that clarifies the service
rendered. For Table 8C0, the following values are used:
J, Cerebrospinal fluid
K, Blood
L, Other fluid
HIT203
Chapter 34
Osteopathic, Other Procedures, and Chiropractic Sections
Chiropractic Section
A chiropractor, a Doctor of Chiropractic Medicine, believes that all body
functions are connected. For this reason, healing involves the entire body.
Like the Osteopathic and Other Procedure Tables, the Chiropractic Table is
very small. Chiropractic services are recognized by the first-character value
of 9. The second-character position is identified by a W, Anatomical region.
To locate the chiropractic table the coder should reference the main term of
“Chiropractic Manipulation” in the ICD-10-PCS Index.
Root Operation
There is only one root operation in the Chiropractic Table: Manipulation. This
is identified in the third-character position with a value of B. Manipulation is a
manual procedure that involves a directed thrust to move a joint past the
physiological range of motion, without exceeding the anatomical limit.
Body Region
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HIT203
Chapter 34
Osteopathic, Other Procedures, and Chiropractic Sections
The fourth character indicates the body region on which the chiropractic
manipulation is performed. The following body regions are noted in the
Chiropractic Table:
Head (value of 0)
Cervical (value of 1)
Thoracic (value of 2)
Lumbar (value of 3)
Sacrum (value of 4)
Pelvis (value of 5)
Lower extremities (value of 6)
Upper extremities (value of 7)
Rib cage (value of 8)
Abdomen (value of 9
Approach, Method, Qualifier
The approach in the Chiropractic Table in ICD-10-PCS always has a value of X
because the approach is always external. The approach is in the fifth
position.
The method of manipulation is identified in the sixth-character position.
Several methods are coded from this table are categorized as nonmanual,
indirect visceral, extra-articular, direct visceral, long lever specific contact,
short lever specific contact, long and short lever specific contact,
mechanically assisted, and other method. The documentation should clearly
state the method of manipulation.
The qualifier for the seventh position is always represented by Z, denoting no
qualifier.
HIT203
Chapter 34
Osteopathic, Other Procedures, and Chiropractic Sections
Summary
Osteopathic services are sometimes referred to as osteopathic
manipulation therapy (OMT).
Osteopathic and chiropractic treatment services are defined differently
in ICD-10-PCS.
For osteopathic manipulation, the body region needs to be identified in
the fourth-character position.
The Other Procedures Section is identified by the first-character value
of 8.
Suture removal, piercings, and therapeutic massage are coded from
the Other Procedures Tables.
The method of chiropractic manipulation is identified in the sixth-
character position.
Key Terms Chapter 34
Chiropractor
a doctor who practices chiropractic medicine.
Osteopathic manipulation therapy (OMT)
manually guided therapy that is performed to improve physiological
function.
Other Procedures
a methodology that attempts to remediate or cure a disorder or
disease.
HIT203
Chapter 34
Osteopathic, Other Procedures, and Chiropractic Sections
Treatment
manual treatment to eliminate or alleviate somatic dysfunction and
related disorders.
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