Coding Procedures for Inpatient Accounts

When coding inpatient procedures, it is very possible that a coder will have to report multiple procedures for one encounter. It is important for coders to remember the directive about how to properly capture multiple procedures. Per the ICD-10-PCS Official Guidelines for Coding and Reporting FY 2021 Section B3.2, multiple procedures are reported if:

• The same root operation is performed on different body parts as defined by distinct values of the body part character (i.e. excision of
• The same root operation is repeated in multiple body parts, and those body parts are separate and distinct body parts classified as a single ICD-10-PCS body part value
• Multiple root operations with distinct objectives are performed on the same body part
• The intended root operation is attempted using one approach but is converted to a different approach