ICD-10-PCS, designed for use in U.S. inpatient hospital settings, seems to have many of us scratching our heads as we try and understand how it will affect our current business practices, once implemented. Some providers are hopeful to avoid it altogether! However, ICD-10 will be here before we know it, and we need to understand the impact. Specifically, ICD-10 PCS presents a challenge to providers because it is an alphanumeric, seven-character system that does not include decimals. PCS is very different from our current numeric, three- to four-character system, which does include decimals. This notion in and of itself can have a provider’s head spinning.
With ICD-10-PCS, all seven characters must be specified for the code to be valid. If a facility’s documentation is incomplete as it pertains to coding purposes, the provider must be queried for the necessary additional information. Understand that the road to successful ICD-10-PCS implementation can be smooth or bumpy. No one said it would be easy, but choosing the right path is your choice to make. A roadmap to PCS success includes two major steps that can be summarized in two words: “prepare and share”.
Step 1 – Prepare
Preparation is the first key step. This involves determining which common and surgical procedures are performed with the greatest frequency at your facility. Knowing these details can help you concentrate your efforts on the most common procedures. To identify potential problem areas in the documentation, locate samples of the common procedures and organize them by specialty. Coders trained in ICD-10-PCS code assignment should assign codes to the samples and take note of any documentation deficiencies.
Step 2 – Share
Sharing what you’ve learned in the first step comes next. If you fail to do this, you could have a significant increase in queries once the implementation date arrives, and no one wants that to happen! Share the information by holding meetings with each surgical specialty to discuss their documentation in ICD-10-PCS. Invite representatives from coding, data management and surgical support, as well as all of the surgeons. Seek advice from physician leadership about how best to organize the meetings among various specialties. As an example, large medical staffs may want separate meetings for cardiac and vascular surgery. In other facilities, cardiac and vascular specialties easily may be grouped together for one meeting.
Appoint a leader with good communication skills as well as strong clinical and ICD-10-PCS coding knowledge. Start the meeting by explaining the basics of the ICD-10-PCS system, even if this already has been done in a general training session. Share the fact that maintaining hospital surgical revenue will be dependent upon successful assignment of these new codes, and that assignment is based on the documentation of root operations and specific body-part values. Leaders should stress that the surgeons and coders need to work as a team.
The same roadmap should be followed for each specialty meeting. Review the available body-part values in the various tables that likely will be used for coding procedures performed by each specialty. Provide details on problem areas for every individual specialty, such as classification of coronary artery sites treated for cardiovascular surgery, details required for coding spinal fusions for orthopedic surgery, and applying separate body-part values for the uterus and cervix for gynecology. Also highlight common problem areas for all specialties, such as:
- Biopsies versus therapeutic excisions;
- Exact location and number of biopsies performed;
- Partial versus total lymph node chain removal; and
- Need for detailed documentation of body-part locations.
An additional challenge that cannot be forgotten involves the device values found in the PCS tables. The challenge is that the device names in the tables don’t always match the device names commonly used in the industry. During the meetings held for specialties, it will be imperative to do the following:
- Review the common devices used by each specialty;
- Ask surgeons to identify common brand names and features of the devices they use;
- Bring device samples to the meeting; and
- Invite surgical technicians or central supply representatives to the meetings.
Once the devices have been reviewed in detail, explain any coding issues related to assigning device values. Review any unique qualifier values found in the tables for each specialty, noting that qualifiers may be related to the root operation value, the body-part value or device value.
Using current procedure documentation to highlight applications of the root operations, body parts, devices and qualifiers can assist everyone in understanding where improvements are needed to speed the coding process.
There’s still time to use the above roadmap to guide you toward ICD-10-PCS implementation. To ensure that you understand the components of the roadmap, we have provided a sample for review. Take a leap of faith and use the two key steps outlined – “prepare and share,” and you too can implement ICD-10-PCS successfully!
Sample Roadmap – Cardiovascular Surgery Meeting for a Small to Mid-sized Hospital
Step 1 – Prepare
Limited cardiac surgery performed at this location, with these common procedures:
- Cardiac catheterization
- Pacemaker insertion
- Defibrillator insertion
- PTA of other vessels
- Vascular bypass procedures on lower extremities
- Central venous access device, port, reservoir and/or pump placement
(no open-heart work performed)
Problems determined during documentation review:
- Drug-eluting versus non-drug-eluting stents
- Identification of number of coronary artery sites treated
- Exact location of cardiac lead placement
- Destination of bypass in vascular procedures
Step 2 – Share
The cardiovascular meeting:
Leader: coding manager
Attendees: cardiac surgeon, vascular surgeon, lead coder, decision support manager, surgical technician, central supply supervisor
- Introduction to ICD-10-PCS
- How procedure codes affect MS-DRG assignment and revenue
- Root operations commonly used
- Tubular body part group (Restriction, Occlusion, Dilation, Bypass)
- Device group (Insertion, Replacement, Supplement, Change, Removal and Revision)
- Excision, Resection
- Body systems and body parts in ICD-10-PCS tables
- Heart and great vessels, including coronary artery sites treated
- Upper and lower arteries
- Upper and lower veins
- Pacemaker, single or dual chamber
- Cardiac leads
- Cardiac rhythm related device
- Contractility modulation device
- Extraluminal device
- Intraluminal device, plain, drug-eluting or radioactive
- Vascular access device, port, reservoir or pump
- Infusion device
- Destination body part for vascular bypass procedures
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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