Introduction to ICD 10 PCS Root Operations-Group 1

Presented by:THIMA ICD 10 Committee

THE OBJECTIVE

OR

ACTION OF THE PROCEDURE

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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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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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Character 1

Section

Character 2

Body

System

Character 3

Root Operation

Character 4

Body Part

Character 5

Approach

Character 6

Device

Character 7

Qualifier

5

6

Excision

Resection

Extraction

Destruction

Detachment

A Portion of a body part

Without replacing the body part

EXAMPLE: Sigmoid polypectomy

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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)

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

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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All of a body partWithout replacing a body part

EXAMPLE: Total nephrectomy

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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

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

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.

All or a portion of a body part

Without replacing a body part

EXAMPLE: Toenail extraction Non Excisional

Debridement

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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)

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 “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

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)

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

All or a portion of an extremity

Without replacing extremity

EXAMPLE: Below knee amputation

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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

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

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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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

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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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

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