Chapter 9: Basic ICD-10-PCS Coding Steps
arrangement of Tables in ICD-10-PCS
-begins with section (0,1,2,3,4,5,6,7,8,9,B,C,D,F,G,H) -for character positions 2 thru 7, same convention is used with numeric values first, followed by alphabetic values
locating an entry in the Alphabetic Index
-main terms may be a ... 1) common procedure (refers to root operation & body part) 2) root operation (subterms will be body parts) 3) body part (helpful reference to ICD-10-PCS body term) -subterms provide more specific information
UHDDS significant procedures
1) Is surgical in nature 2) Carries an anesthetic risk 3) Carries a procedural risk 4) Requires specialized training
basic coding steps
1) Locate the main term in the Alphabetic Index 2) Find the applicable Table 3) Continue building the code by selecting a value from each column for the remaining 4 characters
guidelines for designating principal procedures
1) if 2 procedures equally meet the definition, the principal procedure is the one most related to the principal diagnosis 2) if 2 procedures are equally related to the principal diagnosis, the most resource-intensive or complex procedure is usually designated as principal procedure 3) follow the UHDDS definition unless a payer has substantially different reporting requirements
rules for reporting procedures
UHDDS - must report all significant procedures CMS - must report all procedures affecting payment Hospitals - may report other procedures at their discretion
principal procedure
a procedure performed for definitive treatment or necessary to care for a complication
diagnostic procedure is performed for principal diagnosis & a procedure is performed for definitive treatment of a secondary diagnosis
sequence the diagnostic procedure as the principal procedure, since the procedure most related to the principal diagnosis takes precedence
procedure performed for definitive treatment & diagnostic procedures performed for principal & secondary diagnoses
sequence the procedure performed for definitive treatment most related to the principal diagnosis as the principal procedure
procedure performed for definitive treatment of both principal and secondary diagnoses
sequence the procedure performed for definitive treatment most related to the principal diagnosis as the principal procedure
when no procedures are performed for principal diagnosis, but definite treatment & diagnostic treatments performed for secondary diagnosis
sequence the procedure performed for definitive treatment of the secondary diagnosis as the principal procedure, since no procedures are related to the principal diagnosis
