Guest post: Determining which procedures to report

Editor’s note: This is part one of a series reviewing rules for ICD-10-PCS code assignment. To gain the most from this series, have an ICD-10-PCS manual in front of you and flip to the various sections for each step to see how the process works.

by Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO

According to the Uniform Hospital Discharge Data Set (UHDDS), all significant procedures are to be reported.

A significant procedure is one that is surgical in nature, carries an anesthetic risk, carries a procedural risk, or requires specialized training. A surgery encompasses techniques such as an

• Incision
• Excision
• Destruction
• Amputation
• Introduction
• Insertion
• Endoscopy
• Repair
• Manipulation

An anesthesia risk includes any procedure performed under anesthesia that is not inclusive of topical anesthesia, and a procedural risk is commonly recognized as one which could impact functional impairment, possible trauma during surgery, or a physiological disturbance.

“Specialized training” is when procedures are performed by specialized professionals; these include clinical teams or qualified technicians specifically trained to carry out certain procedures.

Further, Medicare requires that all procedures to be reported that affect payment whether or not the procedure is considered “significant” as called out by the UHDDS. So, what would not be reported? Typically, ancillary procedures or diagnostic procedures in an inpatient setting would not be reported using ICD-10-PCS codes.

The principal procedure is the procedure that is performed for definitive treatment or a procedure which is required for the necessary care of a complication.

When two or more procedures are performed, the procedure which is most related to the principal diagnosis would be considered the principal procedure. When both procedures are equally related to the principal procedure, the procedure that is more resource intensive or complex should be reported as the principal procedure.

Selecting the principal procedure is important, particularly for the reporting of surgical quality indicators.

Editor’s note: Rivet is a partner with the American Regulatory Compliance Society in Grand Haven, Michigan. His experience includes conducting fraud, waste, and abuse audits across a wide variety of services and provider settings. He is a national speaker and has published two books along with numerous articles. Opinions expressed are that of the author and do not necessarily represent HCPro, ACDIS, or any of its subsidiaries. Want to write for the ACDIS Blog? Contact ACDIS Associate Editor Carolyn Riel today!