Q&A: Getting surgeons on board with PCS

Q: What information do you have about physician response to ICD-10-PCS? I am getting some push-back from surgeons. The response I received from a surgeon was, “I want to choose my own words for the surgery that I performed” and “I don’t want a coder picking the words, ‘removal or extraction or insertion.’ I want them to code my words.”

He went on to state that he wasn’t going to change his language, which I reassured him that he didn’t have to do, according to the directive from CMS. Have you heard any complaints about the coders translating what the surgeon writes into the appropriate ICD-10-PCS code?

A: I think it is too soon to ascertain the overall reaction to ICD-10-PCS by surgeons. They may be unaware of how their documentation codes out in the inpatient setting under PCS, since their reimbursement works differently. You are right that the provider doesn’t have to use the root operation terms—the coder must interpret the surgeon’s documentation into one of the root operations. I guess it may become an issue for the surgeon if it affects a quality measure. Until then, who knows?

I think PCS is going to be a big challenge for most organizations, but they may not realize it, yet. Also, remember that, traditionally, CDI has been able to work around surgeons, because we often query about diagnoses, which can be based on the documentation of other providers as long as the surgeon is silent. So it might be helpful to go back to basics with the surgeon to let them know what CDI does, why it can and does affect them, what a query is, etc.

Further, in the Physician Advisor’s Guide to Clinical Documentation Improvement, Trey LaCharite, MD, writes (pp. 193-194):

“Surgeries/surgeons represent the largest financial drivers at most facilities and yet these individuals are notorious for providing limited documentation regarding their efforts and for non-compliance with CDI initiatives. Any increase in documentation from this physician group represents a total paradigm shift since a once universally perceived benefit of a career in surgery was less note writing. As the old joke goes, “where do you hide $100 from a surgeon? In the medical record!”…

“To win them over, focus on their nature. Surgeons are data driven, competitive, and worried about their public quality report cards. Show them, both individually and as a group how the facility down the street seems to have better performance scores (higher SOI/ROM, higher expected-to-observed mortality ratios, lower LOS, etc.) for a given procedure than your facility does. Additionally, if you have multiple surgeons or groups of physicians within your own facility performing the same procedure, show how one of them seems to be doing a better job than his or her colleague. The surgeons will do the rest since they are not used to being anything but ‘top of the class.’”

Editor’s Note: Cheryl Ericson, MS, RN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, Associate Director for Education at ACDIS and CDI Education Director at HCPro in Danvers, Mass responded to this question.