Q&A: How should we prepare for PCS?

Q: How can our CDI team prepare for potential productivity losses post-ICD-10 implementation, specifically regarding procedure codes (PCS)? Should we consider hiring additional staff, or staff with a surgical background?

A: The shift to ICD-10 will affect coding and CDI productivity, primarily due to the technical features of PCS.  Using surgical templates for high-volume procedures can make the transition to PCS easier. These templates could ask the surgeon to identify devices, grafts, and other qualifying information [that CDI and coders need to document to the highest specificity]. For example, was the stent bare metal or drug-eluting? Or was cement used for the arthroplasty?

I do not think we need surgical experience to help us with the PCS coding, as knowledge of anatomy and physiology should suffice. I have found that the extremely granular requirements of PCS coding can make proper MS-DRG assignment challenging in certain situations. This factor will impact CDI and coding DRG match efforts.

I think the most pertinent value and mission for CDI professionals is accurate documentation of diagnoses, but we can selectively query for some PCS procedures.

Editor’s Note: Paul Evans, RHIA, CCS, CCS-P, CCDS, Manager of Regional Clinical Documentation & Coding Integrity at Sutter West Bay in San Francisco, answered this question. Contact him at evanspx@sutterhealth.org, or connect with him and other CDI professionals on CDI Talk.