Show Your Work! Decision-making Skills Essential to ICD-10-PCS

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

If you were a coding professional in 2015, you lived through ICD-10 implementation that year. Much anxiety ahead of time led to intensive training and preparation which resulted in an implementation that was not perfect but nothing we as profession could not handle.

Four years in and any coder working with ICD-10-CM for diagnosis coding has it well in hand. There is always more to learn but “CM” is under control.

On the inpatient procedure side, the ICD-10-PCS side, challenges remain. ICD-10-PCS is such a unique coding system, unlike any other we use and the decision-making process necessary to code accurately and completely is different. In particular, the selection of the root operation, an attribute unknown in any other coding system, has proved particularly difficult and the errors potentially costly.

Questions that find their way to my desk continue to show the struggle that coding professionals are having with PCS. Coding managers and educators that I work with confirm that decision-making skills are a big part of this problem. Yet, these skills are some of the most difficult to teach.

I’ve been advising educators to use the “show your work” method that was used by my 4th grade math teacher. By submitting my homework with all the steps I took, she could check my thought process and decision-making skills. I ask coders who I am training to do that same thing. I ask them to code a problematic case and explain their thought process before I’ll address their questions.

Understanding where the coder went wrong in their decision-making allows a coding leader to correct misconceptions or provide targeted training on specific subjects. Give it a try!


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, 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 “Show Your Work! Decision-making Skills Essential to ICD-10-PCS

  1. Tonya Demyon - February 5, 2020 at 5:04 pm

    Excellent idea!! Knowing where the coder took a wrong turn would help one correct the error. I love reading your emails, short, sweet and basic enough for all. Thank you