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January 2014 marked one of the coldest months on record for many states. Below-zero temperatures, mountains of snow, and blustering winds shut down airports and closed classroom doors. Similarly, ICD-10 is predicted to be healthcare’s “storm of the century.” And lost surgical service revenue may pack the nastiest punch.

Major MS-DRG Shifts Ahead

The biggest differences between ICD-9 and ICD-10 coding lie within the Procedural Coding System (PCS); hence the high probability of significant MS-DRG shifts for surgical cases.

The majority of ICD-9-CM procedure codes map to multiple ICD-10-PCS codes. Coders must determine the correct root operation for each and every step within each operative procedure versus assigning a single code for the entire surgery (as is commonly the case in ICD-9-PCS). ICD-10-PCS also requires a deeper review of each operative report. Detailed documentation is a must. One-paragraph operative reports won’t suffice under ICD-10.

Finally, there are new terms to describe many surgical procedures in ICD-10-PCS. Coders must be trained, encouraged, and empowered to assign the correct ICD-10-PCS root operation based on the clinical documentation provided — even if the surgeon uses traditional, ICD-9-CM procedural terminology. The first step is to master root operations.


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