ICD-10-PCS: Let it evolve

Sept. 28, 2015 / By Rhonda Butler

Ten years ago I had the chance to make my job portable and work from home, so I moved to a small town called Florence that I “discovered” on the Oregon coast—a perfect jewel set down between forest and river and ocean.

It soon became apparent that my definition of “perfect jewel” had strings attached. I loved Florence as it was when I moved there, and I didn’t want it to change. The changes that occurred after I arrived—the new blocky condos right by the riverbank, the new housing developments chewing up more of the forest, the old fish market replaced by a cheap chain restaurant—were all changes for the worse, I thought. How dare they mess up my town! Florence was supposed to stay the way it looked in the snapshots in my head.

I’m happy to say, I got over it. I had help. Just about any conversation I had with an old-timer would contain glimpses of an older Florence—a wilder and more picturesque place than any of the snapshots in my head. And I realized, wait a minute, this fixed Florence you cling to, it is all about you, what you saw when you first arrived, as if Florence and the universe were waiting for you to show up so it could commence existing. Not exactly the real world, honey.

I still live in Florence, and I still love Florence, as it was and as it is, and hope to be able to continue to watch it evolve for many more decades. I feel lucky it turned out that way—I could just as easily have become one of those grumpy reminiscers.

So where on earth am I going with all this? Believe it or not, there are people who love ICD-10-PCS. They have “discovered” PCS, in the sense that they have learned it in enough depth to appreciate its qualities, and I believe the correct phrase here is that they are passionate about it.

I get that. As a model for divvying up the things that can be done to the human body in surgery and elsewhere, PCS is pretty elegant.

But some of these people are falling into the same trap I fell into when I discovered Florence. They are opposed to changes to PCS that they think will compromise the beauty of the system.

I get that too. But beauty is in the eye of the beholder—and I know everybody has heard that corny saying, but when it is your own eye that is doing the beholding and you see something beautiful you wish you could preserve, you can suddenly develop a blind spot and lose perspective. So I am going to play old-timer here, and tell you a few old-timey things about the early days of PCS.

  • PCS used to have radiation oncology qualifiers that named the site at risk for any radiation procedure.
  • There used to be a whole separate section for lab codes in PCS that was cross-referenced with LOINC.
  • Root op Revision used to have a broader definition, and it also had a whole mess of qualifiers that specified the original root operation being revised.
  • Root op Supplement was not in the original version of PCS, it was added years later.

My point? PCS has changed dramatically since it was first introduced, and it will continue to change. This means that any particular snapshot of PCS we carry around in our heads is not something we can impose on the real world. (Being a hopeless PCS old-timer, the snapshots in my head have become a sort of weird composite, so I don’t even have the option of being fond of any particular version of PCS).

PCS has been evolving all along, and needs to be allowed to continue to evolve. Yes, it will be less elegant. By purist standards it is already messy, and we haven’t even started using it yet. But that is what happens to stuff over time—it changes.

Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems.

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