B4.5 – Tendons, ligaments, bursae and fascia near a joint:

Procedures performed on tendons, ligaments, bursae, and fascia that support a joint are coded to the body part in the respective body system that is the focus of the procedure.  Procedures performed on joint structures themselves are coded to the body part in the joint body systems. 

Examples:  repair of the anterior cruciate ligament of the knee is coded to the knee bursa and ligament body part in the bursae and ligaments body systems.  Shaving of the articular cartilage of the knee is coded to the knee joint body part in the lower joints body system.  Note PCS classifies the body parts as follows:

  • 0J  Subcutaneous Tissue and Facia
  • 0K  Muscles
  • 0L Tendons
  • 0M Bursae and Ligaments

B4.6 – Skin and Subcutaneous Tissue Overlying a Joint:

If a procedure is performed on the skin, subcutaneous tissue or fascia overlying a joint, the procedure is coded to the following body part:

  • Shoulder is coded to Upper Arm
  • Elbow is coded to Lower Arm
  • Wrist is coded to Lower Arm
  • Hip is coded to Upper Leg
  • Knee is coded to Lower Leg
  • Ankle is coded to Foot

B3.5 – Overlapping Body Layers:

If root operations such as Excision, Extraction, Repair or Inspection are performed on overlapping layers of the musculoskeletal system, the body part specifying the deepest layer is coded. 

Example:  Excision debridement that includes skin and subcutaneous tissue and muscle is coded to the muscle body part.

B3.17 – Transfer Procedures Using Multiple Tissue Layers:

The root operation Transfer contains qualifiers that can be used to specify when a transfer flap is composed of more than one tissue layer, such as a musculocutaneous flap.  For procedures involving transfer of multiple tissue layers including skin, subcutaneous tissue, fascia or muscle, the procedure is code to the body part value that describes the deepest tissue layer in the flap, and the qualifier can be used to describe the other tissue layer(s) in the transfer flap.

Example: A musculocutaneous flap transfer is coded to the appropriate body part value in the body system Muscles, and the qualifier is used to describe the additional issue layer(s) in the transfer flap.