The approach is defined as the technique used to reach the site of the procedure. So basically - how did they enter the body to get to the site that needed to be operated on. The approach is the fifth character in our ICD-10-PCS code in the Medical and Surgical related sections. There are seven different approaches.




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You can see in the table above I also put some pictures to help you to remember these a bit better.

You need to understand how procedures are done in order to be able to assign the approach correctly. When you are coding for real of course you will have an operative note.

Open Vs Percutaneous

The biggest difference between open and percutaneous is that in an open procedure there is cutting (which means there will be suturing of the skin when they are done) while in a percutaneous procedure they either just nick the skin or use a needle - a band aid to close up instead of sutures. Another way to think of it is that in an open procedure they cut you open and in a percutaneous procedure they poke it through.


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External is a tricky one. The coding guideline that pertains to this one is B5.3a and it specifies that if you go into an orifice and do a procedure on structures that you can see without having to use any other type of aid, then you code the approach to external. This is why resection of tonsils codes to external - yes you entered through the mouth, but you did not need any instrument to see the tonsils - the doctor just used his eyes, not a scope. Other things like cauterizing a nose bleed or sewing back on a severed ear would be external as well because the doctor just uses his eyes.

If they cut a lesion off the skin then it would also be external (even though they might have cut the skin - they did not open up the skin and to get to the lesion - the skin just happened to get cut because they were removing the lesion.

Multiple Approaches

Some of the approaches have multiple techniques - for example for percutaneous endoscopic they may nick the skin but then they use a scope to finish the job - or via natural or artificial opening endoscopic, they again use a scope, but this time they do not nick the skin - they just go in through the mouth, nose, ear, or other natural (or artificial) orifice.


Ann Barta wrote a great article differentiating Approaches in ICD-10-PCS ("Differentiating Procedure Approach in ICD-10-PCS) I have pulled the grid below from that article as I think it does a good job highlighting the approach.

The Seven ICD-10-PCS Medical and Surgical Approaches Characters and Examples


Fifth Character




0FT40ZZ, laparotomy with removal of the gallbladder



0W9G3ZX, diagnostic percutaneous paracentesis for ascites

Percutaneous endoscopic


0U5B4ZZ, laparoscopy with ablation of endometriosis of the endometrium

Via natural or artificial opening


0UDB7ZZ, dilation and curettage

Via natural or artificial opening endoscopic


0FF98ZZ, endoscopic retrograde cholangiopancreatography with lithotripsy of the common bile duct

Via natural or artificial opening with percutaneous endoscopic assistance


0UT9FZZ, laparoscopic-assisted total vaginal hysterectomy



0TF3XZZ, extracorporeal shock wave lithotripsy of a calculus of the right kidney




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