January 27, 2014

ICD-10-PCS says “Adios” to the Surgical Eponym

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An eponym is defined as the person for whom something is named. In the world of Western science and medicine, eponyms are commonly used to name everything from conditions, drugs, and devices to procedures and techniques.

This is a relic from the past, when medicine lacked tools to investigate underlying causes of various conditions and syndromes. The eponym simply offered a convenient way to label a disease to promote further discussion and research. Eponymous surgical procedures typically are named after the surgeon or surgeons who performed or reported them first, popularized them, or refined the technique. On rare occasion, surgical eponyms have been used to reflect the patient who first underwent the procedure.

The ICD-9-CM Alphabetical Index for both diagnoses and procedures contains numerous examples of eponyms, and this is still true for ICD-10-CM, but not for ICD-10-PCS. In fact, all traces of surgical eponyms have been removed from ICD-10-PCS. In their place are root terms that describe the objective of each procedure performed. So in other words, you now will need to know the actual objective of the procedure, as well as the extent and technique being used to accomplish it, in order to assign procedure code(s). If you are still not convinced that the end of the surgical eponym is newsworthy, maybe an example will help in making the point.

One of the best examples to compare coding with and without surgical eponyms is the Whipple procedure. A Whipple procedure is technically known as a pancreaticoduodenectomy. In ICD-9-CM this procedure is coded to 52.7, Radical pancreaticoduodenectomy. This one code includes all inherent components of the procedure: the pancreaticojejunal anastomosis, choledochojejunal anastomosis, and gastrojejunostomy. Now contrast this to ICD-10-PCS and the absence of the surgical eponym “Whipple” procedure. In ICD-10-PCS, the same procedure will require the assignment of five procedure codes: 0FBG0ZZ for the excision of the pancreas, open approach; 0DBA0ZZ for the excision of the jejunum, open approach; 0DB90ZZ for the excision of the duodenum, open approach; 0F1G0ZB for the bypass of the pancreas to the small intestine, open approach; and lastly, 0D160ZA for the bypass of the stomach to jejunum, open approach. The rationale for the need to replace one code in ICD-9-CM with five codes in ICD-10-PCS is that in PCS, it is necessary to assign individual codes when the same procedure is performed on separate body parts. This necessitates three codes to report the excision of the pancreas, duodenum, and jejunum, plus two codes to report the bypasses performed from the pancreas to the small intestine and the stomach to the jejunum.

After seeing the impact of the removal of surgical eponyms from ICD-10-PCS, you may be wondering “What were they thinking?” To be fair, there are both pros and cons to continuing the use of eponyms in medicine, but the unwavering trend is to replace them with medical names that provide a more descriptive definition. In the case of ICD-10-PCS, one only can surmise that surgical eponyms were excluded from the Alphabetical Index for the following reasons:

  • The same eponym may apply to more than one procedure, and different countries may have different eponyms for the same thing. The need to collect, analyze, share, and compare healthcare data globally supports the need for a more concise nomenclature.
  • The proper name provides no relative information other than an historical reference. It provides no indication of the objective of the procedure, its approach, technique, or possible device use.
  • Let’s face it: there can be a Western bias to the eponyms selected. Of course ICD-10-PCS was developed for use in the United States, but it inevitably will be adopted for use in other countries as well.
  • Historically, we know that on more than one occasion, the wrong individual was credited with a discovery, so a move to eliminate eponyms in some instances would be a step towards rectifying a wrong.

The pros for their removal aside, I know I speak for more than just one coder when I argue in support of maintaining surgical eponyms. The eponyms are shorter, and certainly more memorable, than the surgical descriptions that will replace them. For those who have the propensity to be a little nostalgic, the use of the surgical eponym also would continue to respect a person who may otherwise be forgotten in modern medicine.

For physicians, the elimination of surgical eponyms will have no impact. Physicians are not required to adopt the terminology used in ICD-10-PCS to describe the objective of the procedures referred to as “root operations.” They can continue to utilize terms such as “Whipple,” “Bankart” repair, or “Billroth I” or “Billroth II.” The onus is on the coder to decipher what procedure was performed and to code it accurately, completely, and consistently.

So, what is a coder to do? Keep track of the types of surgical eponyms that physicians are currently using. Review the operative record to determine if the description of the procedure being performed will allow them to discern the objective of the procedure, anatomical sites involved, and whether there is any device left in after the procedure. If any of the key details are missing from the description of the procedure, the coder should work with the clinical documentation specialists to educate the physician(s) and obtain this information concurrently. This will permit the coder to sail through the coding of these procedures, which historically were known only to coders by their eponym.

About the Author

Angela Carmichael is a registered health information administrator, a clinical documentation improvement practitioner and a certified coding specialist for both hospital and physician services. She is an MBA with extensive experience in the health information management field, specializing in various payment methodologies, coding education, compliance, and management. Her experience includes services provided in the hospital, physician office, consulting, and insurance settings. She has expertise in technical writing, public speaking, testing, and training development.  In addition, Angela is an American Health Information Management Association (AHIMA)-approved ICD-10-CM/PCS instructor and ambassador.

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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.
Angela Carmichael