Coding Tip: Surgical Approaches–Open vs. Percutaneous vs. External
This Coding Tip was updated on 12/10/2018
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
Open approach is cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. If procedures are performed using the open approach with percutaneous endoscopic assistance or hand-assisted laparoscopy they are coded as open. An example of this is laparoscopic-assisted bowel resection/excision and nephroureterectomy via hand-assisted laparoscopy. A different example of an open approach is repair of second-degree obstetrical laceration of the perineum. This would be coded as an open approach since the laceration has cut through the external body layers exposing the muscle.
A small nick in the skin or small incision made in the skin does not constitute an open approach. These are necessary for percutaneous procedures.
Percutaneous endoscopic approach is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach and visualize the site of the procedure. Examples include knee arthroscopy and laparoscopic cholecystectomy. This approach includes procedures whereby the procedure is performed entirely by percutaneous endoscopic approach. Percutaneous endoscopic-assisted procedures are coded to the open approach as stated above.
Percutaneous approach is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach the site of the procedure. Examples of percutaneous approach are arterial/venous catheter placement, coil embolization of artery, drainage of subdural hemorrhage via burr hole, laser trabeculoplasty, and PTCA of the coronary artery.
External approach is for 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. Examples of external approach procedures are closed fracture reduction, laceration repair of skin or mucous membranes, and excisional debridement of skin only.
Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance is for limited procedures only in the Female Reproductive System. Defined as “entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure, 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.” One example is an “LAVH” or laparoscopic assisted vaginal hysterectomy.
These are but a few examples of these selected approaches. There are also multiple examples in the ICD-10-PCS Reference Manual to help you better understand the procedure approaches.
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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Happy National Volunteer Week! This week we celebrate the impact volunteer work has on building stronger communities. We know that our staff have a positive impact while they’re on the job, and we are proud to share a few ways our #PeopleBehindTheNumbers are taking time to volunteer in their own local communities.
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Giving back is an important part of the HIA mission. Each year, HIA employees take a consensus and choose three National charities to support. Individuals can volunteer a portion of their wages to one of the three organizations. HIA Corporate will match each individual donation up to five dollars. We are proud to share with you our 2018 contribution totals combined with HIA matching funds.
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