ICD-10-PCS: The Potential Financial Impact of Root Operation Decisions

by Lynn Kuehn, MS, RHIA, CSS-P, FAHIMA

It is not always obvious that doing something the same way we have always done it can actually be to our detriment. In coding, this can occur when we fail to investigate a procedure we thought we knew all about or when we accept a code that the encoder or computer assisted coding software assigned, without even questioning the assignment.

On February 24, 2020, I wrote my blog about “Tackling Those Tendons.” Since then, our profession has rightly been focused on COVID-19 and the coding issues related to the virus. With some states relaxing their restrictions and some hospitals preparing to allow elective surgeries to slowly resume, it is time for us to get back to our business of getting the coding right.

So, let’s go back to those tendons. That blog was a great example of the problems that occur when we don’t know what we don’t know.

The procedure involved cutting tendons. I asked the question, “When is cutting not Division?” I explained that in my example “Cutting is an operate step but it is not about the cutting; it is about the objective of releasing the joint.”

Root operation decisions make a difference, not just for accurate coding but also for your organization’s revenue stream. Getting it wrong has serious impacts. Coding the root operation of Division (of the Achilles tendon) instead of the correct root operation of Release (of the ankle joint), can be costly. Each time your root operation decision making is incorrect on this one, it costs your facility 0.1299 of MS-DRG relative weight. That is the difference between MS-DRG 505 for a soft tissue procedure and the correct MS-DRG of 494 for a lower extremity procedure.

Colleagues: Don’t be caught not being in the “know.” I put all my best decision-making techniques into my ICD-10-PCS Root Operation Decision Making course to help keep you in the “know.” Join me in the search for accurate coding and proper reimbursement. — Lynn


ICD-10 Root Operations Flash CardsICD-10-PCS: Root Operation Decision Making
Root Operations are unique to ICD-10-PCS and careful selection of the root operation is an essential step to accurate and complete coding of inpatient procedures! ICD-10-PCS: Root Operation Decision Making will teach you how with the insight and guidance of nationally recognized ICD-10-PCS coding expert Lynn Kuehn! Learn more here.

About the Author

Lynn Kuehn is president of Kuehn Consulting, LLC, in Waukesha, Wisconsin, a consulting firm specializing in ICD-10-PCS coding for the inpatient setting. Lynn is a nationally recognized trainer on ICD-10-PCS and other HIM-related topics. Lynn served on the AHIMA Board of Directors and authored several of AHIMA’s most popular books including ICD-10-PCS: An Applied Approach and Procedural Coding and Reimbursement for Physician Services. Together with her co-Author Theresa Jorwic, Lynn received the Triumph Literary Legacy Award from AHIMA for ICD-10-PCS: An Applied Approach. Called the “go-to” resource for learning and mastering ICD-10-PCS, ICD-10-PCS: An Applied Approach provides step-by-step instructions and exercises at all levels, and is used throughout Kuehn’s ICD-10-PCS courses authored for Libman Education.

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