Introduction to ICD 10 PCS Root Operations-Group 1

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Introduction to ICD 10 PCS Root Operations-Group
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• Presented by
• THIMA ICD 10 Committee

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WHAT IS A ROOT OPERATION????

• THE OBJECTIVE
• OR
• ACTION OF THE PROCEDURE

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SURGICAL MEDICAL ROOT OPERATIONS (31)
Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
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31 ROOTS 9 GROUPS

• Take out some/all of a body part
• Take out solids/fluids/gases from a body part
• Involving cutting or separation only
• Put in/put back or move some/all of a body part
• Alter the diameter/route of a tubular body part
• Always involve a device
• Involving examination only
• Involve other repairs
• Involve other objectives

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Characters in the Medical and Surgical Section
Character 1 Section Character 2 Body System Character 3 Root Operation Character 4 Body Part Character 5 Approach Character 6 Device Character 7 Qualifier
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GROUP 1 PROCEDURES THAT TAKE OUT OR ELIMINATE
ALL OR A PORTION OF A BODY PART
Excision
Resection
Extraction
Destruction
Detachment
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EXCISION CUTTING OUT OR OFF

• A Portion of a body part
• Without replacing the body part
• EXAMPLE Sigmoid polypectomy

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Excision

• Excision is used when a portion of a body part is
  cut out or off using a sharp instrument
• Scalpel
• Wire
• Scissors
• Bone Saw
• Example Percutaneous needle core biopsy
  (diagnostic) of the left kidney pelvis
• 0TB43ZX Excision, Urinary System, Kidney Pelvis
  (0TB)

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Excision

• The qualifier Diagnostic (X) is used to identify
  excision procedures that are biopsies. This
  would be assigned as the seventh character.
• Exception Bone Marrow and Endometrial Biopsies
• These are not coded as Excision but rather as
  Extraction, with the qualifier Diagnostic
• Excision for Graft
• If the autograft is obtained from a different
  body part to complete the procedure, a separate
  procedure is coded
• Example CABG with excision of saphenous vein
  graft. Excision of the saphenous vein graft would
  be assigned a separate code

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Coding Guideline B3.4

• If a diagnostic biopsy is followed by a more
  definitive procedure, such as Excision,
  Resection, Destruction at the same procedure
  site, both the biopsy and the more definitive
  treatment are coded.
• Example Percutaneous needle biopsy of right
  breast followed by right total mastectomy, open

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RESECTION- CUTTING OUT OR OFF

• All of a body part
• Without replacing a body part
• EXAMPLE Total nephrectomy

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Resection

• Example Open right axillary lymphadenectomy of
  the complete chain
• 07T50ZZ Resection, by Body System, Lymphatic
  and Hemic Systems(07T) by Body Part, Lymphatic,
  Right Axillary (07T5)
• Logic When an entire lymph node chain is cut
  out, the appropriate root operation is resection.
  When a lymph node(s) is cut out, the root
  operation is Excision

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Documentation

• There is an opportunity to provide physician
  education on the need for more complete
  documentation on the following
• Lymph node(s) versus the complete chain
• The complete body part removal versus a portion

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Resection

• Be careful of documentation. It is important to
  convert common terminology to the appropriate
  root operation according to the intent of the
  procedure.
• Resection is similar to Excision except Resection
  includes all of a body part, or any subdivision
  of a body part that has its own body part value
  in ICD-10-PCS, while Excision includes only a
  portion of a body part.
• Example Left upper lung lobectomy coded to
  Resection of Upper Lung Lobe, left rather than
  excison because upper lobe of lung has its own
  body part value.

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EXTRACTION PULLING OUT OR OFF BY PHYSICAL FORCE

• All or a portion of a body part
• Without replacing a body part
• EXAMPLE Toenail extraction
• Non Excisional Debridement

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Extraction

• Extraction is coded when the method employed to
  take out the body part is pulling or stripping.
  Minor cutting, such as that used in vein
  stripping procedures is included in extraction if
  the objective of the procedure is met by pulling
  or stripping.
• The qualifier Diagnostic is used to identify
  extraction procedures that are biopsies.
• Example Nonexcisional debridement of skin of
  back
• 0HD6XZZ Extraction, by Body System, Skin and
  Breast (0HD), by Body part, Skin, Back (0HD6)

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DESTRUCTION Physical Eradication

• All or a portion of a body part
• by the direct use of energy, force, or a
  destructive agent
• EXAMPLE Rectal polyp fulguration

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Destruction

• Destruction takes out a body part in the sense
  that it obliterates the body part so it is no
  longer there. None of the body part is
  physically taken out. This root operation defines
  a broad range of common procedures, since it can
  be used anywhere in the body to treat various
  conditions such as
• Skin and genital warts
• Nasal and colon polyps
• Esophageal varices
• Endometrial implants

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Destruction

• Cryotherapy of 2 warts on left hand and one wart
  on the right hand
• 0H5GXZZ- Destruction, Skin and Breast (0H5), Skin
  Left Hand (0H5G)
• 0H5GXZZ Destruction, Skin and Breast (0H5),
  Skin Left Hand (0H5G)
• 0H5FXZZ- Destruction, Skin and Breast (0H5), Skin
  Right Hand (0H5F)

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Destruction

• Additional examples of Destruction procedures
• Cautery of nosebleed
• Laparoscopy with destruction of endometriosis of
  ovary
• Talc injection pleurodesis, left side
• Fulguration of endometrium
• Percutaneous radiofrequency ablation of right
  vocal cord lesion

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DETACHMENT CUTTING OFF

• All or a portion of an extremity
• Without replacing extremity
• EXAMPLE Below knee amputation

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Detachment

• Detachment represents a narrow range of
  procedures it is exclusively used for amputation
  procedures. Detachment procedure codes are found
  only in body systems X and Y because amputations
  are performed on extremities, across overlapping
  body layers.
• X Anatomical Regions, Upper Extremities
• Y Anatomical Regions, Lower Extremities
• Example Amputation at left elbow level
• 0X6C0ZZ detachment by Body System anatomical
  regions, upper extremities (0X6) by Body Part
  Elbow Region

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Documentation

• There is an opportunity to provide physician
  education on more complete documentation on the
  actual location of the amputation.
• According to the definition, the coder needs to
  know if the amputation is at the proximal, middle
  or distal portion of the shaft of the humerus,
  femur, radius/ulna, or tibia/fibula

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PCS Tables Group 1Procedures that take out or
eliminate all or a portion of a body part
OPERATION ACTION TARGET CLARIFICATION EXAMPLE
Excision Cutting out or off Portion of a body part Without replacing a body part Sigmoid polypectomy
Resection Cutting out or off All of a body part Without replacing a body part Total nephrectomy
Extraction Pulling out or off by physical force All or a portion of the body part Without replacing a body part Toenail extraction
Destruction Eradicating All or a portion of the body part Without replacing a body part Rectal polyp fulguration
Detachment Cutting off All or a portion of an extremity Without replacing extremity Below knee amputation
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DEBRIDEMENT REMAINS AN ISSUE

• ICD-10-PCS Index (Root Operations)
• Debridement -
• Excisional See Excision
• Non-Excisional See Extraction
• Root Operation Definitions
• Excision Cutting out or off, without
  replacement, a portion of a body part
• Extraction Pulling or stripping out or off all
  or a portion of a body part by the use of force

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Definition and Terminology Changes

• ICD-9 Procedure Term ICD-10 Procedure Term
• Amputation Detachment
• Amniocentesis Drainage
• Arthroscopy, Cystoscopy Inspection Endoscopic
  Approach
• Closed Reduction Reposition
• Debridement Excision, Extraction, Irrigation,
  Extirpation
• Radical Mastectomy Resection (right, left or
  bilateral)
• Subtotal Mastectomy Excision
• Tracheostomy, Bypass
• Cesarean section Extraction of Products of
  Conception
• Incision No ICD-10 term

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LETS SUM UP WHAT WE HAVE LEARNED

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What Have You Learned

• Excision Cutting out or off, without
  replacement, a portion of a body part
• Resection Cutting out or off, without
  replacement, all of a body part
• Detachment Cutting off all or part of the upper
  and lower extremities
• Destruction Physical eradication of all or a
  portion of a body part by the direct use of
  energy, force, or a destructive agent
• Extraction Pulling or stripping out or off all
  or a portion of a body part by the use of force