Lori
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ICD-10-PCS describes seven different approaches: open, percutaneous, percutaneous endoscopic, via natural or artificial opening, via natural or artificial opening endoscopic, via natural or artificial opening with percutaneous endoscopic assistance, and external.
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Open Approach 0
An open approach is defined as cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. Procedures performed via an open approach have a fifth character value of 0. The access location for this approach is through either the skin or a mucous membrane; the type of instrumentation used is not applicable.
Percutaneous Approach 3
A procedure performed via a percutaneous approach (character value 3) is one in which there is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure. The access location for this approach is the skin or mucous membrane with nonvisualization instrumentation such as needles or catheters being used to reach the operative site.
Percutaneous Endoscopic Approach 4
Percutaneous endoscopic approach (character value 4) is defined as entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure. The access location for this approach is the skin or mucous membrane with visualization instrumentation being used to reach the operative site.
Via Natural or Artificial Opening Approach 7
An approach made via either a natural or artificial opening (character value 7) is defined as the entry of instrumentation through a natural or artificial external opening to reach the site of the procedure. The access location for this approach is an orifice with nonvisualization instrumentation being used to reach the operative site.
Via Natural or Artificial Opening Endoscopic Approach 8
A via natural or artificial opening endoscopic approach (character value 8) is defined as the entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure. The access location for this approach is an orifice with visualization instrumentation being used to reach the procedure site.
Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance Approach F
An approach made via natural or artificial opening with percutaneous endoscopic assistance (character value F) is defined as the entry of instrumentation through a natural or artificial external opening 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.
External Approach X
The external approach (character value X) is one in which the procedure is either performed directly on the skin or mucous membrane or indirectly by application of external force through the skin or mucous membrane.


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Open Approach 0
An open approach is defined as cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure. Procedures performed via an open approach have a fifth character value of 0. The access location for this approach is through either the skin or a mucous membrane; the type of instrumentation used is not applicable.
Percutaneous Approach 3
A procedure performed via a percutaneous approach (character value 3) is one in which there is entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure. The access location for this approach is the skin or mucous membrane with nonvisualization instrumentation such as needles or catheters being used to reach the operative site.
Percutaneous Endoscopic Approach 4
Percutaneous endoscopic approach (character value 4) is defined as entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure. The access location for this approach is the skin or mucous membrane with visualization instrumentation being used to reach the operative site.
Via Natural or Artificial Opening Approach 7
An approach made via either a natural or artificial opening (character value 7) is defined as the entry of instrumentation through a natural or artificial external opening to reach the site of the procedure. The access location for this approach is an orifice with nonvisualization instrumentation being used to reach the operative site.
Via Natural or Artificial Opening Endoscopic Approach 8
A via natural or artificial opening endoscopic approach (character value 8) is defined as the entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure. The access location for this approach is an orifice with visualization instrumentation being used to reach the procedure site.
Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance Approach F
An approach made via natural or artificial opening with percutaneous endoscopic assistance (character value F) is defined as the entry of instrumentation through a natural or artificial external opening 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.
External Approach X
The external approach (character value X) is one in which the procedure is either performed directly on the skin or mucous membrane or indirectly by application of external force through the skin or mucous membrane.