Structure of ICD-10-PCS
Experts agree that the structure of ICD-10-PCS is difficult to follow and practice coding under ICD-10-PCS is essential for understanding. Also there are other barriers aside from finding the time to practice. Coders need to be given immediate feedback on their work or have access to a consultant who can provide guidance. One of the challenges of the system is that there aren’t any foolproof methods of knowing whether the code assigned is right or not, unless the logic is followed, which makes it difficult to monitor the quality of data. Due to this coders might spend too much time second-guessing whether they’ve identified the correct PCS code.
The root operation may be the most difficult aspect of ICD-10-PCS simply because physician documentation often won’t correlate directly to the PCS definition. However, it is also difficult for the coders to decipher what’s considered a body part in PCS. There are many instances in which a physician will document a specific anatomical detail on which he or she performs a procedure. Although Appendix C in the ICD-10-PCS manual includes a body part key, many coders may need a refresher on anatomy and physiology.
Even facilities using actual medical records to train coders may find that documentation is insufficient to assign the entire PCS code. Incorporating laterality and anatomical specificity into query templates and prompts may help.
The ICD-10-PCS Reference Manual subdivides the 31 medical and surgical root operations into the following groups:
- Procedures that take out some or all of a body part;
- Procedures that put in/back or move some or all of a body part;
- Procedures that take out or eliminate solid matter, fluids, or gases from a body part;
- Procedures that involve only examination of body parts and regions;
- Procedures that alter the diameter/route of a tubular body part;
- Procedures that always involve devices;
- Procedures involving cutting or separation only;
- Procedures that define other repairs; and
- Procedures that define other objectives.
Rather than choose one of 31, you choose one of nine individual groups based on their characteristics and then you narrow it down within the group, picking the root operation that describes the intent of the procedure.
To help with the transition to ICD-10-PCS, some organizations have turned to computer-assisted coding (CAC). However, as with ICD-9-CM, Computer Assisted Coding is only as accurate as the documentation on which it’s based. There are ways for solutions that allow clinicians to select relevant procedure terms at the point of care that are subsequently mapped to CPT, HCPCS, ICD-9-CM, ICD-10-PCS, and SNOMED.
Coders should spend the time between now and October 1 practicing. Even if the organizations have not implemented a formal dual coding program, coders can continue to review documentation with ICD-10 in mind to determine how they would have coded the record under the new system.
Other suggestions include the following:
- Review root operations and PCS guidelines regularly.
- Ask questions about how to apply PCS guidelines.
- Make a note of clinical websites to research diagnoses, procedures, and anatomy/physiology.
- Create specialty-specific crosswalks that map the most frequently used procedure codes from ICD-9-CM to ICD-10-PCS.
- Ask physicians to educate coders about procedure types. What equipment is typically used? What surgical approach is most common? What are the standard types of grafts or implants for certain procedures?