Are You Ready for ICD-10-PCS?

ICD-10-PCS, ICD-10 training, icd-10 provider documentation, ICD-10 eLearning, ICD-10-CM implementation, ICD-10 implementation date

We hear a lot about ICD-10-CM implementation, but what about ICD-10-PCS? Well, the good news is that if you’re a physician coder, you won’t be using ICD-10-PCS — you’ll submit claims using CPT® like always, with ICD-10-CM for diagnosis coding. But if you are an inpatient coder or clinical documentation improvement professional, you will want to be intimately acquainted with PCS after the ICD-10 implementation date of October 1, 2015.

The new ICD-10-PCS codes will be used to collect data, determine payment, and support the electronic health record for all inpatient procedures performed in the US. Significantly different from ICD-9-CM’s Volume 3 for procedure coding, every ICD-10-PCS code has seven characters, each defining an aspect of the procedure performed. Here, good clinical documentation concepts and coder understanding of procedures is vital, because if you incorrectly identify your physician’s approach in the PCS code’s fifth character, and if you can’t distinguish among similar root operations, the claim will be rejected as inaccurate.

In a SuperCoder webinar, Amy Pritchett, CCS, CPC, CASCC, CEDC, CMRS explained the basic differences between the current procedure reporting system, ICD-9-CM Volume 3, and ICD-10-PCS. The old I-9 Volume 3 was designed for diagnosis coding, using a 3 to 4 digit-long code set in list form. The biggest problem with ICD-9’s Volume 3, she said, is that it is fixed, finite, and full – that is, it has no room for new procedures. However, ICD-10-PCS was designed from the ground up to meet the needs of the U.S. healthcare system for procedure coding, using flexible values to construct code components using tables.

Good Provider Documentation Is Key in Accurate ICD-10-PCS Coding

The seven-character alphanumeric code structure of the ICD-10-PCS system makes detailed provider documentation the key to accurate procedure coding. Each of the code’s seven digits represents an aspect of the procedure, specifically the its applicable section, body system, root operation, body part, approach, device, and qualifier. For this reason, Pritchett said, providers must be sure to describe each procedure in detail so that coders can select the appropriate codes.

First Character for Section; Second Character Describes Body System

The first character determines the Section, which is the broad area where the code is found. For example, the Medical and Surgical Section uses a 0, Pritchett explained, while Obstetrics uses a 1, and Imaging, a B. Medical-Surgical is the largest section grouping in ICD-10-PCS. In a code from the Medical Surgical Section, the second character, Body System, refers to the general physiologic or anatomic region involved. For example, the Gastrointestinal System is represented with a D.

Root Operation Described by Third Character

The third character represents the root operation, Pritchett said, describing the procedure’s objective. For example, within the Gastrointestinal System, the digit 1 represents “Bypass: Altering the route of passage of the contents of a tubular body part” in ICD-10-PCS. The fourth digit describes the body part or specific anatomical site where the procedure was performed, and the fifth character defines the approach for the technique used to reach the procedure site. The sixth character indicates a type of device – that is, one that stays in the body – that was used, if any, and the seventh character defines qualifiers or additional attributes of the procedure.

Approaching the Fifth Character Can Be Tricky

As hospital staff and coders prepare for ICD-10-PCS, learning what each character represents can be tricky, especially for character 5. This means that coders must fully understand the differences among surgical approaches. An approach, of course, is the way the surgeon reaches the procedure site, and ICD-10-PCS offers seven choices of approach, each comprised of three components: the access location, method used to access the site, and the type of instrumentation used, such as endoscopy. The approaches are open, percutaneous, percutaneous endoscopic, via natural or artificial opening such as the mouth or a stoma, via natural or artificial opening endoscopically, via natural or artificial opening with percutaneous endoscopic assistance, and external, which is used for procedures performed directly on the skin or mucous membrane.

Stay tuned — we’ll dig deeper into determining surgical approaches when we continue with more ICD-10-PCS tips and examples from Amy Pritchett tomorrow.

Get Help with ICD-10-PCS the Easy Way!

Ease your transition to ICD-10-PCS with SuperCoder’s DRG Coder, now with ICD-10-PCS Search! Get complete code details tied to GEMS, reimbursement maps, and more with an index with complete code links that instantly takes you to the right table. Each includes information from official conventions and section guidelines shown at the code level, so you don’t have to waste time flipping around in code books or hunting through online PDFs. Developed by AHIMA ICD-10-PCS Certified Instructor Trainers, DRG Coder speeds your PCS code lookup and understanding. Try it today!

About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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