Principal or Primary ICD-10-PCS Procedure Selection


In this course, participants will delve into the intricacies of selecting the principal or primary ICD-10-PCS procedure with a comprehensive focus on guidelines from UHDDS, Official Guidelines for Coding and Reporting, and Coding Clinic references. Coders will gain the knowledge and skills necessary to accurately determine the principal or primary procedure, especially in scenarios involving multiple procedures where no definitive procedure has been performed for the principal diagnosis. This course covers key topics, including the definition of a principal or primary procedure, sequencing procedures for definitive treatment, and real-world examples of multiple procedures and their sequencing. Participants will also explore essential coding information and Coding Clinic references related to the selection of the principal or primary procedure.

Included Lessons:

  • What is a Principal or Primary Procedure?
  • What To Do When More Than One Procedure is Performed
  • Common Example of Multiple Procedures and Sequencing
  • Coding Information and Coding Clinics Pertaining to Sequencing the Principal/Primary Procedure
CEUs available for the following credentials:




Key Takeaways

Completing this course empowers medical coders with the expertise needed to navigate complex coding scenarios, prioritize procedures, and accurately assign codes that reflect the intricacies of a patient's medical condition and treatment. Some key takeaways of this course include:

  • Understanding of Principal vs. Primary Procedure: Participants will gain a clear understanding of the difference between the principal procedure (performed for definitive treatment related to the principal diagnosis) and the primary procedure (the main procedure consuming the most resources and affecting the DRG).
  • Guidelines and References: Coders will become proficient in using guidelines from UHDDS, Official Guidelines for Coding and Reporting, and Coding Clinic references to make informed decisions when selecting the principal or primary procedure.
  • Sequencing Procedures: Participants will learn how to sequence procedures in cases where both definitive treatment and diagnostic procedures are performed for the principal and secondary diagnoses. This includes scenarios with multiple procedures and how to prioritize them.
  • Resource Intensity Considerations: Coders will understand the importance of considering resource intensity when designating the principal procedure, even when it may not be the same as the primary procedure.
  • Impact on DRG Assignment: Participants will recognize the significance of their coding decisions in relation to Diagnosis-Related Group (DRG) assignment and how these decisions can impact healthcare reimbursement and patient care.
  • Querying for Clarification: When documentation is unclear regarding the most significant procedure, coders will learn the importance of querying physicians for clarification to ensure accurate coding.

Benefits of Taking this Course

  • Enhanced Coding Accuracy
  • Increased Proficiency
  • Improved Understanding of Principal or Primary Procedures
  • Ability to Make Informed Coding Decisions in Complex Cases
  • Career Advancement
  • Greater Confidence


What is the difference between a principal procedure and a primary procedure?
The principal procedure is performed for definitive treatment related to the principal diagnosis and is chosen based on its relation to the principal diagnosis. In contrast, the primary procedure is technically the main procedure that consumes the most resources and care during a patient's stay and impacts the DRG. While these terms are often used interchangeably, they may not always be the same. For example, in cases of multiple procedures, the principal procedure is selected based on its relevance to the principal diagnosis, while the primary procedure is the one consuming the most resources.
What is the significance of accurate principal procedure selection?

Accurate selection of the principal procedure is crucial because it directly impacts Diagnosis-Related Group (DRG) assignment, which in turn affects healthcare reimbursement. Inaccurate coding can lead to financial losses for healthcare facilities and may result in incorrect patient care planning. Therefore, precise principal procedure selection is essential for both financial and clinical reasons.

About our Medical Coding Courses

HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a comprehensive online education platform for medical coders. With a catalog of over 200 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection approved by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPTE/M, ICD-10-CMICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatientoutpatientprofee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CMICD-10-PCSCPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams. 

Disclaimer: If you're currently subscribed to HIAlearn on a monthly or annual basis, you automatically have access to this course and DO NOT need to fill out the form below.

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