Learning How to Use the Keys to the PCS Kingdom

One positive result of the ICD-10 delay is that coders have this extra time to brush up on the newest coding classification system—ICD-10-PCS. In their Sunday pre-convention session “The Keys to the PCS Kingdom,” Lynn Kuehn, RHIA, CCS-P, FAHIMA, and Gail Smith, MA, RHIA, CCS-P, provided helpful hints for coding in PCS.

Going with the Group

There is power in differentiating between groups of root operations, according to Smith and Kuehn. Rather than remembering the long description of the groups of root operations, Kuehn and Smith offered up some shorter, more succinct descriptions, such as “Take Out Group,” “Cutting Group” and “Gunk Group.”

Another trick they suggested was using the Index and Tables to help differentiate between the Excision and Resection sections of ICD-10-PCS. The index can help coders determine if the body part is subdivided. For example, the stomach has a subdivision of pylorus.

Coders should consider the body part key to be their friend, according to the presenters. As Smith explained, “With any good classification system, within the system they make sure everyone’s on the same page.”

When considering the Achilles tendon, is the body part the ankle or the lower leg? Using the body part key will guide the coder to which body part to use, the presenters said.

The Alphabetic Index, on the other hand, isn’t always the coder’s friend, warned Smith and Kuehn. For example, when looking up fasciotomy in the Alphabetic Index, the only root operations listed are Division and Drainage. Going back to the Achilles tendon, if the coder thinks about what the intent of the procedure is for a tight Achilles tendon, the surgeon is releasing the fascia from the muscle. That makes the procedure a Release, not a Division or Drainage.

Coding software is a tool, not an answer, the presenters reminded. As Smith noted, the brain is smarter than any software tool, and coders must not code the words but the actual procedure performed.

Technical Tricks for PCS

Smith and Kuehn stressed the importance of the relationship between Repair and Supplement.

“Repair with a device equals supplement,” said Kuehn, noting that there are no devices listed in any of the Repair tables, so repairs done with mesh, a patch, a ring, etc., would be considered Supplement.

What’s more, revision is about devices, not about body parts. Kuehn pointed out that a coder’s definition of Revision is not necessarily the same as the provider’s definition. “Revision, for us, is fixing a device,” she said.

Kuehn noted that it’s helpful to compare the human body to a tube. Using this metaphor, coders should start in the “Tubular Group” of root operations such as bypass or dilation. If the body part was not completely separated, it can’t be a device.

“If the body part is still connected to me, we may want to look at options like Transfer or Reposition. If it’s a device, we may want to look at options like Placement,” Kuehn said.

Catch up on the news and get insights from AHIMA’s 86th annual Convention and Exhibit held September 27-October 2 in San Diego, CA. For a complete list of event coverage on the Journal of AHIMA website, click here.

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