Updated on: September 23, 2013

Drainage vs. Extirpation: Overview of Two ICD-10 Root Operations

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Original story posted on: July 29, 2013

As most of us have learned by now, the root-operation character in ICD-10-PCS defines the objective of the procedure. There are 31 root operations in the Medical and Surgical Section of ICD-10-PCS, and two of these are discussed below.

Fluids and Gases vs. Solid Material

Drainage is the process of taking out, or letting out, fluids and/or gases from a body part. This root operation is coded for both diagnostic and therapeutic drainage procedures. Examples of this type of procedure include 1) thoracentesis and 2) the incision and drainage of an abdominal wall abscess.

Extirpation is the process of taking out, or cutting out, solid matter from a body part. This root operation includes a wide range of procedures with the objective of removing solid material such as a foreign body from the body part. The solid matter may be an abnormal byproduct of a biological function or a foreign body that is imbedded in a body part or in the lumen of a tubular body part. The solid matter may or may not have been previously broken into pieces. Examples include 1) mechanical thrombectomy and 2) an excision of a retained foreign body from subcutaneous tissue.

ICD-10-PCS Guidelines

As with ICD-9-CM guidelines, the same four cooperating parties approve the guidelines for ICD-10-PCS: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Centers for Medicare & Medicaid Services (CMS), and the National Center for Health Statistics (NCHS).

The first general guideline under the section Root Operation (B3.1a) states the following: “In order to determine the appropriate root operation, the full definition of the root operation as contained in the PCS Tables must be applied.”

Guideline A6 under the Conventions section states: “The purpose of the alphabetic index is to locate the appropriate table that contains all information necessary to construct a procedure code. The PCS Tables should always be consulted to find the most appropriate valid code.”

The guidelines tell us that we are not required to consult the index first when looking for the appropriate procedure code. However, it is beneficial to do so since most of us are still learning how to assign ICD-10-PCS codes.

The PCS guidelines (A11) also state that physicians are not required to use the same terminology as is found in the PCS code descriptions. It is the coder’s responsibility to determine what the medical record documentation means in relation to the PCS definitions.

Examples of Procedures

The physician documents an evacuation of a hematoma by incision from the right breast, post-excisional biopsy. Even though the term “evacuation” is not a root operation, it can be found in the alphabetical index as a main term. The sub-term “Hematoma” is listed under Evacuation followed by “see Extirpation.”

At that point, we see the following entries:

Extirpation

Breast

Right 0HCT

The letters OHCT following the last entry of the index indicate that the coder must find the appropriate PCS table labeled 0HC and the fourth character of T. (Note that only a portion of the actual table is provided below.)

0 Medical and Surgical

H Skin and Breast

C Extirpation Taking or cutting out solid matter from a body part

Body Part

Character 4

Approach

Character 5

Device

Character 6

Qualifier

Character 7

T Breast, Right

U Breast, Left

V Breast, Bilateral

W Nipple, Right

X Nipple, Left

0 Open

3 Percutaneous

7 Via Natural or Artificial Opening

8 Via Natural or Artificial Opening Endoscopic

X External

Z No Device

Z No Qualifier

If the physician’s documentation had included the statement “incision and drainage of hematoma of right breast, post-excisional biopsy,” the coder would focus on the word drainage, which, as we know, is a root operation. Like the term “evacuation” mentioned above, the term “incision” is not a root operation but can be found in the alphabetic index, although the only index option is for the incision of an abscess, which does not fit this example.

Drainage

Breast

Right 0H9T

From the index, find the appropriate PCS table labeled 0H9 and the fourth character of T. (Note that only a portion of the actual table is provided below.)

0 Medical and Surgical

H Skin and Breast

9 Drainage Taking or letting out fluids and/or gases from a body part

Body Part

Character 4

Approach

Character 5

Device

Character 6

Qualifier

Character 7

T Breast, Right

U Breast, Left

V Breast, Bilateral

W Nipple, Right

X Nipple, Left

0 Open

3 Percutaneous

7 Via Natural or Artificial Opening

8 Via Natural or Artificial Opening Endoscopic

X External

Z No Device

X Diagnostic

Z No Qualifier

Coding professionals have raised questions about the validity of considering a hematoma as solid material instead of a fluid since it may be only partially clotted and, therefore, could be identified as a fluid. The question then becomes whether “Extirpation” is an appropriate root operation to use for the evacuation by incision of a hematoma even though the alphabetic index leads to the root operation of Extirpation for evacuation of a hematoma?

Since we are still working with a draft copy of ICD-10-CM/PCS, time remains for CMS to consider resolving these types of issues before the final version goes into effect on October 1, 2014.

About the Author

Susan Howe is a senior healthcare consultant, clinical consulting services, with Panacea Healthcare Solutions, Inc..

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.