Inpatient Facility Coding & Compliance Alert

Key: Boil down what physician performed to match root operation definitions.

How confident are you when it comes to facing the dual challenge of handling ICD-10- PCS codes, apart from the ICD-10-CM codes? How well the hospitals are faring in terms of success in ICD-10 implementation, still remains to be seen.

Good news: “I really haven’t heard much of anything, at least from hospitals,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA. “Hospitals generally were well prepared. If there are problems it is probably with smaller operations such as smaller physician offices.”

Nurture your PCS skills: When you build a PCS code from the “0” section (the largest one), you must first identify the body system — but your second step is to choose the root operation. This will be the third character of your PCS code, but be aware: your selection can be tricky, because you need to distinguish between similar root operations attributes.

Take a Broad Look at the Third Character

When reporting ICD-10-PCS, you have to really break down what the physician performed into one of 31 root operations, which you will find in the medical and surgical section. They are arranged into these nine categories:

1. Root operations that take out some/all of a body part
2. Root operations that take out solids/fluids/gases from a body part
3. Root operations involving cutting or separation only
4. Root operations that put in/put back or move some/all of a body part
5. Root operations that alter the diameter/route of a tubular body part
6. Root operations that always involve a device
7. Root operations involving examination only
8. Root operations that include other repairs
9. Root operations that include other objectives.

Example: Suppose your physician performs an open cholecystectomy. This means that the physician surgically removes the gallbladder. You would thus categorize this as a “root operation that takes out some/all of a body part.”

Underneath that section, you’ll find five of the root operations grouped here:

1. Excision
   
2. Resection
   
3. Detachment
   
4. Destruction
   
5. Extraction

Because the root operation of “resection” is defined as “cutting off, without replacement, all of a body part,” you would classify the cholecystectomy as a resection. Therefore, you would use “T” as your root operation, which represents resection.

Here’s how: Go to the PCS Index > Cholecystectomy > see Resection > Gall bladder > 0FT4 > Locate table 0FT4 and then go across the row to finish building the code:

Your code will be 0FT40ZZ.

Challenge: What if your physician performed multiple procedures with distinct objectives (such as a procedure that removes some/all of a body part as well as a procedure that involved a device)? Then you should report multiple codes. We shall continue to explore these scenarios in issues to come.