ICD-10-PCS: Think Big Before You Think Small

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

I will bet that you know there are 31 individual root operations in ICD-10-PCS. But some people may be surprised to learn that there are nine groups of these root operations, based on common features within each group. Understanding these nine groups is critical to quickly and confidently identifying the root operation for any inpatient procedure.

I challenge you to think differently about ICD-10-PCS, especially now when we have been forced to think differently about a lot of things in our lives. If you struggle with determining the root operation in ICD-10-PCS, my recommendation is that you Think Big before you Think Small. Think first about the group before focusing on the specific root operation.

Here are the four steps that I recommend for the Think Big first process:

1. Pick the group based on the rules and the guidelines.
Determine the objective and pick the matching group. The objective may be taking out a body part, working with a tubular body part, or doing a procedure with a device.

2. Pick the root operation from that group.
Within the group, identify the key differentiating factor such as taking out a portion of a body part versus taking out all of a body part.

3. Pick the body part based on the tables and the body part key guidance.
Do not jump to another group if the table is not available. After double checking your choice, use the NEC procedures of Supplement when using a device and Repair when not using a device.

4. Identify the correct code.
Use all the guidelines and definitions to be sure you have the correct code.

Unsure how all of this works? I have a short tutorial available on Libman Education that shows how to use the nine root operation group flashcards. See the video on this page.


ICD-10-PCS: Respiratory Procedure Coding
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About the Author

Lynn Kuehn is president of Kuehn Consulting, LLC, and a nationally recognized authority on ICD-10-PCS coding. Lynn was elected to the AHIMA Board of Directors, served as faculty for the original ICD-10 “Train-the-Trainers” program, and authored or co-authored several of AHIMA’s most popular books including ICD-10-PCS: An Applied Approach, recognized as the “go-to” resource for learning and mastering ICD-10-PCS. As a Subject Matter Expert with Libman Education, Lynn’s unique and engaging teaching methods as well as her leadership on the importance of accuracy and efficiency in coding is recognized by clients and students throughout the country.

One thought on “ICD-10-PCS: Think Big Before You Think Small

  1. Janice Noller RHIA, CCS, CDIP, CICA - May 8, 2020 at 7:38 pm

    Thanks, Lynn – I try to stress when educating our coders to determine the intent of the procedure – what is the goal? I guess that’s the “think big” part, but sometimes the technology of CAC gets in the way and coders may have a tendency to only code the key words in CAC. I always stress reading the entire Operative Report to really figure out what is being performed, then choose the root operation and fill in the rest. I learned to fine-tune my PCS knowledge from you – hopefully I am applying correctly!