welcome i am terry tropin and today i'm discussing the qualifier character 7 used to build a pcs code for the medical and surgical session section see the videos already posted on youtube for an introduction of pcs digits one and two and others just discussing root operations body parts approaches and device first let me introduce myself i have a master's in healthcare administration and informatics from the university of maryland global campus i have an rhia and ccsp certification also i'm an ahima approved icd-10 trainer i've taught health information technology at montgomery college for over 20 years i've also written books on coding these books are study guides that summarize the coding guidelines and translate them into regular english my books include one on e m coding one in icd-10-cm coding icd-10-pcs and external classes these are available on amazon character 7 in an icd-10-pcs code indicates the qualifier used qualifiers are different from the other characters in a pcs code because there are no specific guidelines for qualifiers it's kind of a other stuff category qualifiers provide additional information related to the other characters in a code remember not all procedures will use a qualifier remember that all pcs codes require a seventh digit if there's no qualifier you're going to use a value x value z no qualifier it's used with the other values listed here all of these to build a valid pcs code qualifier values include provide additional information or modify the meaning of the other characters used in a code here's kind of a summary of the different types of qualifiers there are qualifiers that provide information on route operations some that qualif that qualify the approach the device and body parts including how many body parts are involved in the timing each of these will be discussed in this video first let's look at qualifiers used for specific route operations these are when the procedure was a biopsy and when there's a specific method for the operation so first let's talk at biopsies i think this is probably the most important most often used qualifier the qualifier is x and it's defined as diagnostic which means it's a biopsy so if you're going to do a biopsy you do excision drainage extraction whichever is appropriate and then the qualifier value says this was a biopsy this was diagnostic here's an example fine needle aspiration biopsy of fluid in the lung so the root operation drainage removing fluid and the qualifier value is diagnostic so this is not for treatment to take the fluid out to treat a condition is to take fluid out to send to analysis to figure out what the problem is there are also root operations that provide information about how the brew procedure was performed so for example the qualifier irreversible electroporation uses low energy electrical impulses to destroy tissue so under destruction in the hepatobiliary system in pancreas in the liver you're going to have irreversible electroporation that gives more infra it was destroyed how is it destroyed this tells you how what methodology was used another one is cell suspension technique this is used in skin and breast as can be various areas of the skin and skin replacement this is when cells are taken and placed in the taken from the patient placed in a culture medium to multiply and create a tissue substitute notice that the device value is autologous tissue so what happens is that the cell suspension the cells created are used in a spray or sheets of tissue to treat conditions such as burn to replace the skin so it's a replacement procedure another method message method is the qualifier value vertical this is in the gastrointestinal system and used for a gastrectomy procedure it's a call this is a specific gastrectomy called a vertical sleeve gastrectomy you can see it's called a sleeve because what's left is kind of a long tube and all of this is taken out so it's to remove part of the stomach for weight loss so it's gastrointestinal system excision stomach and the qualifier vertical tells you what kind of excision was done here's yet another method so this is for fragmentation procedures in the blood vessels heart heart and great vessels upper arteries upper veins so it's fragmentation it's percutaneous the qualifier value is ultrasonic so what happens is that something is a instrument is put percutaneously to insert it um device in to get it to a vessel and an ultrasound probe is used to fragment a clot for example percutaneous ultra segmentation of a clot in the pulmonary trunk okay so this is heart and grade vessels fragmentation body part is pulmonary trunk that's where it's being done the approach is always percutaneous the qualifier is ultrasonic so it gives a little bit more information about what exactly happened here the next group of qualifiers i'm going to discuss are those that provide additional material about information about body parts these qualifiers are used with body part values in these root operations bypass transfer transportation transplantation creation replacement detachment and resection so first is bypass a bypass procedurally remember is altering the root of passage of fluids contents of a tubular part so in the gastrointestinal system the body part value is the area bypassed from the qualifier area is the area bypass two so the body part works with the qualifier to give a picture of exactly what was going on for example open bypass from stomach to jejunum the bypass is from the stomach so that's a value six and it's to the jejunum which is a qualifier value a here's another example of a bypass procedure in the gastrointestinal system in this case the qualifier value indicates the type of anastrom anastomosis used such as cutaneous meaning to the skin level gastrointestinal system open bypass from stomach to skin level cutaneous is a so body part is bypassed from the qualifier is bypass two and it's to the skin's cutaneous so it bypass is also used in the heart and great vessels category the body part value is the area bypassed from the qualifier areas area bypass two much like what we just talked about so bypass from has two coronary arteries and we're saying it's the left anterior and the right marginal which i don't see on there so we use two coronary arteries bypass two the aorta so open bypass with autologous arterial tissue 0 2 1 0 0 2 1 1 0 9 w and the w is for the aorta also qualifiers used for transfer procedures in the body systems cutaneous tissue and fascia and systems related to the muscular skeletal system this is for transfer and the rule is when multiple layers are involved the body part values for the deepest level the qualifier value is for other layers and here's an example uh musculocutaneous flap transfer of the shoulder muscle it's in muscles transfer the body part value is the shoulder muscle it's the deepest layer and then the qualifier is skin because it says cutaneous so we have musculo and cutaneous transplantation is another brute operation that uses qualifiers in the heart and great vessels system the qualifier describes the type of tissue allergenic syngenic zooplastic here's a definition of those so it gives additional information open heart transplantation no device through plastic and what kind of tissue was used to plastic so animal heart the root operation creation also uses qualifiers to fully explain what happened creation is used in making a new genital structure that does not that does not take over the function of a body part this is a sex change so for the sex change operations you're going to go to general anatomical region the body part value is the um sex the patient was born with the qualifier value is the new sex so for example sex change from female to male using nomatologist tissue we have from female to male the tissue being created so together that gives you the information that you need root operation is also used in the heart and grade vessels body system this is for creation of a new heart valve the qualifier value is the tissue used to create the valve the body part value value is the valve being created so this is what's being created this is what tissue is being used to create the valve so for example creation of a new mutual valve from the patient's common atrioventricular valve which is a birth defect you can see that it's all open between all the chambers and the blood flows freely between all of them which is not what you want because you want to separate the oxygenated of the non-oxygenated so what they do is make a new mutual valve from the from this common tissue in the common area zero two four g zero seven two so autologous tissue because it's using the patient's tissue the new body part value is the g the qualifier values the tissue used to make the new part is two qualifiers are also used in body systems upper and lower extremities with the root operation detachment this is really complicated in the body system upper extremities root operation detachment has values for body values for arm hand fingers and thumbs and then the qualifiers give you which part of the arm the hand are the fingers and thumb in the lower extremities the body part is leg foot toes and then they give you these qualifiers high mid low complete partial and the raise and complete high mid so let's look at each one of those separately so let's start with hand so the body part values are just hand right or left the qualifier values are both raised and whether it's complete or partial complete is through the metacarpal the carpal metacarpal here bones partial is along the shaft or head of the metacarpal so that would only be partial the rays are which finger it is you start in the thumb side which is one and then you have two three four and five end with the pinky finger so which which side of the hand you have that's for hand for finger it's a little different the body part value is for specific finger the qualifier value is complete or partial detachment so you have complete metacarpal phalangeal joints and that's here in green you have mid through the proximal or middle joints you have low the distal like the tip of the finger so also in the body system is for upper and lower arm the body parts are upper arm lower arm right and left the qualifier values are for upper arm which is the humerus it's here you have high mid and low in the lower arm the radius and our alma you have again high mid low so this is giving you more information well they did a detachment of the arm which part of the arm lots of very specific information about that so let's move on to the foot the lower extremities the body part values are foot right or left the qualifier values give a lot more information about that complete is defined as through the tarsal metatarsal joint partial issue just the metatarsal the complete would be here partial would be here and then again it uses rays ray 1 is on the big toe side ray 5 is on the baby toe side so finally let's look at toe detachment the body part gives the specific toe right left whatever and the qualifier and you have one two three four five complete is metatarsal phalangeal high is pr is up to the proximal phalanx mid is proximal or middle phalangeal joint low is down here so finally we'll look at leg detachments the body part value is for the leg which leg leg right or left the qualifiers are for upper leg lower leg so for upper leg you have high mid low then where it is on the shaft of the femur and the lower leg you have high mid low where it is on the tibia fibula okay pretty confusing but get these definitions down in your book and that should help a lot now let's move on to replacement procedures also in the upper extremities the body part is the tissue being replaced the qualifier value is the tissue the tissue that was moved to replace this so for example for replacement of the thumb different values for right or left they're using the toe you can see the difference this is a toe that's used now as a finger and this is a regular finger over here so the tissue used to replace the body part is the toe that's the qualifier replacement of patient's right thumb with his left toe zero xrl07p so the value being replaced tissue being replaces the thumb and replaced by the toe that's the qualifier so more replacement values in the upper joints the qualifiers are also used to identify more information for replacement so for example for body part value shoulder the qualifier values indicate the area being replaced humeral or glenoid surface so for body parts removal similarly in the lower joints body system the body part value is um the knee joint the qualifier value is what part of the knee in this case the patellar surface the synthetic patellar surface so which part of the knee joint is being removed of a previous um previously done surgery so replacement is also used in the female reproductive system so for hysterectomy procedures the qualifier value indicates this was super cervical only in the area above the cervix so super cervical we have here this is the cervix this is the vagina and so sometimes hysterectomies here sometimes it goes a little more but in this case the the qualifier value says no only the uterus was removed only above the cervix now body part values qualifier values sometimes include the number of body parts for example in the body system mouth and throat for all of these root operations you have body part values for teeth you have upper tooth lower tooth the qualifier values give you more information was this one tooth this is several teeth or is this all of them all the upper or all the lower so in the skin and breast there's a also qualifiers for destruction of lesions on the skin so for this is for numbers again so skin and breast you have destruction and then you have specific uh the body part is a specific area of the skin the approach value is external no device and then you have multiple lesions and no qualifier which will only be if there's just one lesion so finally now let's move on to qualifiers that provide additional information for approaches these approaches have qualifiers that deal with these bottoms have qualifiers that deal with the approach upper joints heart and grade vessels lower arteries upper arteries lower veins upper veins so let's look at fusion infusion procedures the qualifier provides information about the approach used so the approach may vary and that but you have anterior approach interior column anterior approach posterior column posterior approach anterior column so here's the anterior column towards the front here's the posterior column so what's the approach and where are they going for the anterior column or the posterior column which column or it is going to be treated there's also interesting qualifier value for insertion procedures in the lower veins body system this also includes qualifier approach um values in the qualifier so sometimes a newborn who still has an umbilical cord or a stump will need administration of fluids medications or possibly blood so you go to the lower veins use insertion inferior vena cava approaches either open or percutaneous but the important part is the qualifier says through the umbilical cord so that gives a lot more information about the approach being used also approach values by replacement this is how it's um the the um procedure is being done the approach says percutaneous but the qualifier says transapical so you see that's from here as opposed to the other possible approaches so that gives you a lot more information it's percutaneous and spar the device is the type of valve replacement that's being used but the qualifier gives you more information replaced replaced using what approach this one so qualifiers may also include additional information about devices so we've talked about uh qualifiers dealing with approaches and body parts and um other other areas but also it includes devices so qualifiers may provide additional information about devices and here are some body systems where that occurs upper lower arteries skin and breasts lower joints and heart and grade vessels so in skin and breast system a replacement option may include a specific type of flap using autologous tissue so you know that it's autologous tissue that's the device but the qualifier says full thickness or partial thickness so that gives you additional information what kind of device what kind of tissue you also have a type of flap which is all of these gluteal superficial transverse rectus abdominus cutaneous so the type of flap so you have autologous tissue substitute what kind and then it gives you a specific type of flap used and this is a replacement for breast so let's look at compare the device and qualifier values it's interesting the different terms are used in this you have device value ontologist tissue substitute qualifier value doesn't have any because it uses more specific so you have autologous tissue substitute non-autologous qualifier value has allergenic syngenic suplastic and none so non-autologous is used in these two for device value and these three but the qualifier value gets more information what kind of non-otologist tissue what kind of autologous tissue so it gives more information when you use those two together it gives more information for dilation procedures in the upper and lower arteries body systems the device interluminal is further defined as a drug coated balloon it may not be a drug coated balloon but if it is then you're going to use qualifier value one it gives more information about the type of device being used sometimes qualifiers indicate that a device is used only for a short period of time for example device value short term external heart assist system intraoperative is the qualifier value this is in the heart grade vessels insertion so you insert temporarily an external heart assist system so there's that there's no way you can remember all the guidelines in this pcs book as the qualifiers don't have any guidelines but they're kind of hidden within some of the other guidelines so here's some suggestions of things to write in your book that help jog your memory for creation procedures make note that for sex change operations the body part value is the original sex the qualifier value is the new sex for heart valve procedures the heart body part value is the valve being created qualifier value is the tissue being used and don't forget for bypass procedures note that the body part is bypassed from the qualifier is bypass two and together they give a whole picture of what happened now for detachment and replacement procedures there's a lot of information there hot you know which ray is it high low mid um so partial complete and those are all defined in this video so you might write in the definition of raise what's partial what's complete and what's low mid and high that completes this video if you have questions or comments please feel free to call to contact me and here's where you can contact me i'd love to hear from you and again i've written books on coding these are available on amazon the piece you can use this link or you can just go to amazon books and type in my last name tropin t-r-o-p-i-n thank you so much for listening i hope to have more lessons up soon thank you