Inpatient Facility Coding & Compliance Alert

Grab these must know facts on inpatient coding

October is here, and so is ICD-10, finally. As the new system takes roots, hospitals face the added challenge of handling ICD-10- PCS codes. “With the implementation of ICD-10 CM diagnosis coding, learning the ICD-10-PCS is considered as just a part,” explains Duane C. Abbey, PhD, president of Abbey and Abbey Consultants, Inc., in Ames, IA.

First things first: ICD-10-PCS (Procedural Coding System) is for providers to report procedures performed only in U.S. hospital inpatient health care settings. As we know, ICD-10-PCS coding is different from the ICD-10-CM codes. ICD-10-PCS talks of various procedures that the provider performs, and it may also include devices and technologies, unlike ICD-10-CM, that classifies the diagnosis of various kinds of diseases.

“For most part, coding staff will be using computer software to assist in the ICD-10-PCS coding,” contemplates Abbey.

Effect on MS-DRGs: Inpatient providers will report ICD-10-CM diagnosis and ICD-10-PCS procedure codes on claims, which the MAC will use to assign discharges to the appropriate MS-DRG.

“MS-DRGs will simply use ICD-10-CM and ICD-10-PCS,”clarifies Abbey. “One of the questions with the implementation of ICD-10 is whether there will be any aberrations in MS-DRG groupings. The MS-DRG grouper has been reprogrammed with the new code sets, but there may be some aberrations that will have to be identified and corrected.”

Caveat: Physicians, suppliers, outpatient facilities, and hospital outpatient departments will continue to report and receive payments for furnished services, including physician visits to inpatients, based on CPT^® and HCPCS codes. These entities also will use only ICD-10-CM (diagnosis) codes, not ICD-10-PCS (procedure) codes, on claims. Further, physicians will not use the code set to report their services, including ambulatory services and inpatient visits.

Remember the Structure of a Typical ICD-10-PCS Code

In a major feat, ICD-10-PCS has a unique code for all the procedures that are currently performed. It has a seven character alphanumeric code structure. Each character can acquire up to 34 different values, ranging from digits zero to nine and all alphabets except “O” and “I,” lest one may confuse those with numerals one or zero.

The first character in the code denotes a section. Sections are the general broad categories in which procedures are organized. There are 16 in total, such as Medical and Surgical, Imaging, or Physical Medicine. The second character denotes the specific body system that the provider will work on.

The third character specifies the procedure, and the rest of the characters give additional information as needed.

Codes may be found in the index based on the general type of the procedure and the root operation (such as resection, transfusion, and fluoroscopy). For example, the code for percutaneous intraluminal dilation of coronary arteries with an intraluminal device can be found in the index under dilation or a synonym of dilation (angioplasty). The index then specifies the first 3 or 4 values of the code or directs the user to see another term. The coder must use the tables to construct valid codes.

Here are a few examples of pcs codes for procedures to zap through yourself.

1) Breast lumpectomy, open approach

To locate: PCS Index > Lumpectomy > see Excision > Breast > Right > 0HB > Locate table 0HB and then go across the row to finish building the code:

2) Total mastectomy, left breast, open approach

To locate: PCS Index > Mastectomy > see Resection, Skin and Breast >0HT > Resection > Breast > Left > 0HTU0ZZ. Even though the Index gave you the entire code, you should still locate the table to verify whether or not it is correct. Also, you should never code from the Index:

3) Detachment of left upper arm (mid)/amputation above elbow, open approach

To locate: PCS Index > Amputation > see Detachment > Arm > Upper > Left > 0X690Z > Locate table 0X6 and then go across the row to 1) assign upto the 7^th character, and 2) verify that the Index is correct:

Editor’s note: In upcoming issues, we shall continue to discuss more examples to help you get better acclimatized to ICD-10-PCS codes.