ICD-10-PCS – How and When Should Coders Start the Transition Process?

I know that coders are feeling a little overwhelmed by the prospects of having to learn not one, but two completely new coding systems: ICD-10-CM for diagnoses and ICD-10-PCS for procedures. In this article I want to discuss some ways that we as individual coders can make the transition to ICD-10-PCS a little bit easier.

I don’t know how familiar you are with this new inpatient procedure coding system, but it is very different than ICD-9. It is organized into 14 sections based on the general type of procedure, with the largest being Section 0 for medical and surgical procedures.

This is the section where you will find the majority of procedures you will be coding on a day-to-day basis. Some examples include:

  • Percutaneous transluminal coronary angioplasty;
  • Coronary artery bypass;
  • Total splenectomy;
  • Thrombectomy;
  • Colon resection;
  • Breast reconstruction; and
  • Fracture reduction.

We are all familiar with these terms and probably have the most frequently reported procedure codes memorized. While we are familiar with the terms and physicians will continue to document these procedures using these terms, however, we as coders will need to translate them into the 31 root operations designated in the Medical and Surgical section. For example, in ICD-10-PCS, these procedures translate as follows:

Percutaneous transluminal coronary angioplasty = Dilation (expanding an orifice or the lumen of a tubular body part)

Coronary artery bypass = Bypass

Total splenectomy = Resection

Thrombectomy = Extirpation

Colon resection = Resection (if the entire body part is removed) or Excision (if just a portion of the body part is removed)

Breast reconstruction = Replacement (if biological, living tissue or synthetic tissue takes the place of the breast) or Transfer (if living tissue remains connected to its blood supply and takes the place of the breast tissue)

Fracture reduction = Reposition

These examples are just a few the many types of procedures each of us code on a regular basis, and translating all of the more commonly reported procedures into the correct root operations may seem like a daunting task. But it is possible to break this process into manageable pieces. Here is the process I suggest.

  1. Download the ICD-10-PCS files available on the CMS website, or purchase a copy of the 2012 ICD-10-PCS Draft.
  2. Review the Medical and Surgical Root Operations table. This table lists the 31 root operations alphabetically and provides definitions. It can be found in the downloadable file in the “definitions” section of the 2012 Tables and Index, or in an appendix in most ICD-10-PCS drafts.
  3. Memorize the names of the 31 root operations – not the definitions, just the names.
  4. Review the Medical and Surgical Root Operations Comparison table. This table groups the 31 root operations into nine procedure types, which are defined as procedures that have the same purpose. For example, if the purpose of a procedure is to take out or eliminate all or a portion of a body part, there are five root operation choices (excision, resection, extraction, destruction, detachment). This table provides information on similarities and differences between procedures with the purpose of helping the coder identify the correct root operation.
  5. Memorize the nine procedure types and identify which root operations are included in each procedure type category.
  6. Memorize the definitions of the 31 root operations.
  7. As you continue to code using ICD-9, begin identifying which of the 31 ICD-10-PCS medical and surgical root operations the ICD-9 codes represent. For example, if an open reduction internal fixation of a distal tibia and fibula fracture has been performed, identify the ICD-10-PCS root operation as reposition.