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The U.S. healthcare industry has had a sharp focus on ICD-10-CM, in turn publishing a great amount of guidance on the upgraded coding set and its projected impacts.

However, the real game-changer is ICD-10-PCS. ICD-10-PCS is a new classification system that replaces the third volume of ICD-9-CM, which is used for coding inpatient procedures. By design, it is a completely different classification system. Each portion of the seven-character code represents a characteristic of the operative procedure:

  1. Section
  2. Body System
  3. Root Operation
  4. Body Part
  5. Approach
  6. Device
  7. Qualifier

Many coders have asked the question: What is the best way to tackle learning ICD-10-PCS? Since the classification system is based on 31 root operations, mastering the definitions and applying them to case studies is the answer. Remember, it is the coder’s responsibility to translate the physician’s documentation into ICD-10-PCS codes. Definitions for the root operations allow for that translation. For example, if the surgeon states that an entire gallbladder was removed, how does this translate into root operations? The root operation for removal of the complete gallbladder is “resection” because the definition of that term is “cutting out or off, without replacement, all of a body part.” The operative term “removal” is one of the 31 root operations, but the definition for that term is “taking out or off a device from a body part.” If the physician states “removal,” the coder then can translate the procedure into “resection” because it meets the root-operation definition.

Learning root operations will be the key to your success! Now, let’s take a look at a step-by-step approach to get you there.

Step 1- Focus on the Groupings

The 31 root operations are classified into nine general categories. For example, five root operations (excision, resection, extraction, destruction, detachment) fall into the category that describes “procedures that take out some or all of a body part.” If the intent of the procedure is to remove the uterus (a hysterectomy), there is no reason to review all 31 root operations; shift your focus to just these five root operations.

Step 2 – Ask the Question: What is the difference?

Each aforementioned grouping has common characteristics, but the individual root operations within the groupings have distinct meanings. For example, there are three root operations under the classification of “procedures that take out or eliminate solid matter, fluids or gases from a body part.” What are the differences between the three root operations (drainage, extirpation and fragmentation)? If you are reading the operative report for a patient who had a thoracentesis for pleural effusion, the definition of “drainage” applies, since the intent of the procedure was to remove fluid. If the surgeon excised a piece of a chicken bone lodged in the throat, the root operation “extirpation” applies for taking or cutting out solid matter from a body part. Why wouldn’t the root operation “excision” apply? Comparing the two root operations (excision and extirpation) will reveal that “excision” is reserved for cutting out a portion of a body part. A piece of chicken bone is not a body part; therefore, the root operation goes to the grouping that “eliminates solid matter.”

Step 3 – Use the Alphabetic Index

Although coding guidelines state that final code selection must be accomplished using the PCS table, use the Alphabetic Index to discover how the classification system works. Remember that ICD-10-PCS is a classification system; therefore, part of the learning process will include discovering how procedures are grouped. For example, the

operative term thrombectomy leads you to “extirpation.” For the operative procedure meatotomy, the Alphabetic Index states to see “drainage” of the urinary system. The procedure epididymoplasty in the Alphabetic Index reveals the following:

See repair, male reproductive system
See supplement, male reproductive system

This entry begs the question, “What is the difference between the root operations “repair” and “supplement”? The answer lies in the definitions for these two root operations. If the patient required a device to repair the epididymis, then the root operation “supplement” applies. If not, the procedure would be classified as “repair.”

Keep in mind that the Alphabetic Index provides guidance, but again, the final coding decisions are based on the PCS table that matches the documentation in the health record.


Step 4 – Practice Exercises

At first, practice sessions may include assigning root operations to one-line operative statements, but eventually, sessions will have to involve real case studies. Consider obtaining a list of your facility’s 20 most common inpatient procedures and practice assigning root operations for those procedures.

Next Steps

After mastering the root operation definitions, the next step involves coding case studies and applying official coding guidelines. This will allow coders to leverage their knowledge about the classification system, guidelines and anatomy in order to capture the codes that tell the complete story about every operative episode. Mastering the root operations will allow you to feel more confident about taking the next steps, delving into case studies and official coding guideline application. As you can see, ICD-10-PCS is much different than ICD-10-CM – and it is a game-changer for coders as they learn ICD-10.

About the Author

Maria T. Bounos, RN, MPM, CPC-H, is the Business Development Manager for Regulatory and Reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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