All Entries Tagged With: "ICD-10-PCS"

My experience at an AHIMA trainer session Part 2

In a recent post, I talked about my experience attending an American Health Information Management Association (AHIMA) Academy for ICD-10 trainer session. While I am excited about certain aspects of ICD-10-CM, I’m not as quick to warm up to ICD-10-PCS, which is very different from what we currently use in ICD-9-CM Volume 3.

The use of the many tables and definitions of certain procedures make this system much more applicable in a clinical sense. However, I did find myself having to continually reference definitions of the various root operations in the front of the PCS manual.

I would read a question and have to really think about whether the question was about a “change,” “replacement,” “extraction,” “extirpation,” etc.

Extirpation was my word of the day. I looked this word up in the Merriam-Webster Dictionary only to find the definition includes the following:

• To pull up by the roots
• To destroy completely
• To remove by surgery

Well, that didn’t help me much considering some of my choices for root operations include destruction, resection, transplantation, and excision, which all seem similar, don’t they?

Luckily, the introduction to the ICD-10-PCS manual provides a specific definition for extirpation, which is “taking or cutting out solid matter from a body part” (e.g., removal of a calculus). I’m glad this definition was in the manual otherwise I would have had a hard time using the official definition.

One of the comments people made at the AHIMA session was, “Will all my physicians have to document ‘extirpation’?”  Rest assured, physicians do not need to use this exact verbiage for coders to assign the appropriate ICD-10-PCS codes.

However, because of the way the ICD-10-PCS system is set up, you do need to understand what the root operations are so you can reference the correct part of the procedure tables, identify the procedures the physicians document, and assign the correct codes.

Knowledge of anatomy vital for ICD-10-PCS

I have always thought that ICD-9 procedure codes were very non-specific and that it is no wonder that inpatient coders don’t like CPT coding. However after looking at what is going to happen with ICD-10-PCS, I have to say that as inpatient coders, we are in for quite a challenge. Coders who work in both inpatient and outpatient coding areas are probably going to be at an advantage to those who code only inpatient records.

Over the years, I had heard that the ICD-10-PCS system was going to be more specific. After all, we are going from approximately 3,000 ICD-9 procedure codes to 72,589 ICD-10-PCS codes. However, I have never actually gone out and looked to see what does this mean when we talk about code specificity?

I took time this week to sit down and actually look at the ICD-10-PCS coding system. The ICD-10-PCS system deals with tables to give us all of the characters necessary to code the procedure.  Consider the following examples of code characters and what they indicate:

• 0 (zero): Surgical/medical
• K: Muscles
• Q: Repair
• Fourth character represents the body part (e.g., left shoulder muscle is a “6”)
• Fifth character represents approach (e.g., arthroscopic is a “4”, percutaneous endoscopic approach)
• Sixth character represents an implant (“z” is no device)
• Seventh digit represents a qualifier (“z” for no qualifier)

The tables alone require you to understand each of the digit placements and what they represent. For example, what does the field “qualifier” mean? According to ICD-10-PCS, a qualifier is used with rehabilitation and speech assessment procedures.

There are several references that are available to assist us with each of the fields necessary to code the procedure correctly, including definitions for the various surgical approaches. I found it interesting that ICD-10 refers to arthroscopic as percutaneous endoscopic. ICD-10 also defines for you the body parts because it will be necessary to know the PCS definition in order to choose the appropriate character for the body part (e.g., biceps brachii tendon is considered an upper arm tendon). You will also need to select the appropriate code to indicate the left or right side of the body. As an orthopedic coder, the biceps tendon is often a part of a rotator cuff repair and so it is easy for one to think of the biceps as a part of the shoulder when it is actually part of the upper arm.

Because inpatient coders generally are not “speciality” coders, I find myself wondering whether we are going to need more knowledge of anatomy and physiology than ever before? If so, should I be proactive in obtaining the continuing education now?