December 5, 2011

ICD-10-PCS Says Extirpation – What Does the Physician’s Documentation Say?

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If you have not glanced at the ICD-10-PCS Operations Table and reviewed the 31 root operations listed there for the coding system's Medical and Surgical section, you might wonder what the word “extirpation” has to do with coding. The term is not one most of us see often in documentation of surgical procedures.

In fact, when I Googled "extirpation," the first definition I found, on the Wikipedia website, was “local extinction of a species or other taxon: the condition where a species ceases to exist in a geographic area in which it had previously existed but continues to exist elsewhere.” The next definition, found in Merriam-Webster online, was “complete excision or surgical destruction of a body part.” That definition brings us a little closer to the ICD-10-PCS definition, but it is still not exact for coding purposes. For those purposes, extirpation is defined and explained as follows:

Extirpation

Root Operation Value - C

 

Definition

Taking or cutting out solid matter from a body part

Explanation

The solid matter may be an abnormal product of a biological function or a foreign body; it may be imbedded in a body part or the lumen of a tubular body part. The solid matter may or may not have been previously broken into pieces.

Armed with this definition and explanation, it is our job as coders to determine what the current procedural terminology is for procedures that will be coded as extirpation. The Operations Table provides two examples: thrombectomy and choledocholithotomy. These are both examples of an abnormal product of a biological function (blood clot, calculus, etc.) contained within the lumen of a tubular body part (blood vessel, bile duct, etc.). Also included in the scope of extirpation are procedures involving the removal of a foreign body in the lumen of a tubular body part, such as removal of an aspirated peanut from the trachea or removal of a substance from other tissues or other sites (for example, removal of a metal fragment from the sclera or loose cartilage of a knee joint).

Related Procedures

There are a number of helpful tables in ICD-10-PCS that define terms (such as the Operations and Approaches table), and one that groups similar procedures together. Extirpation is grouped with two other procedures (drainage and fragmentation) that take out or eliminate solid matter, fluids or gases from a body part. The table below compares and contrasts the three procedures.

Table 1: Procedures That Take Out Or Eliminate Solid Matter, Fluids, Or Gases From A Body Part

Operation

Action

Target

Clarification

Example

Drainage

Taking or letting out

Fluids and/or gases from a body part

Without taking out any of the body part

Incision and drainage

Extirpation

Taking or cutting out

Solid matter in a body part

Without taking out any of the body part

Thrombectomy

Fragmentation

Breaking down

Solid matter in a body part

Without taking out any of the body part or any solid matter

Lithotripsy of gallstones

 


 

While drainage is easily distinguishable from extirpation, fragmentation and extirpation procedures have the potential to be confused with one another. The key difference between extirpation and fragmentation is that in extirpation the solid matter is removed, while in fragmentation it is not removed but rather eliminated or absorbed through normal biological functions. So, lithotripsy of a ureteral calculus without removal would be reported as fragmentation while lithotripsy of the calculus with removal would be reported as extirpation.

Coding Examples – Extirpation

Example 1: Open choledocholithotomy

0FC90ZZ

0

Section – Medical and Surgical

F

Body System – Hepatobiliary system and pancreas

C

Root Operation – Extirpation

9

Body Part – Common bile duct

0

Approach – Open

Z

Device – No Device

Z

Qualifier – No Qualifier

 

Example 2: Tracheoscopy with extraction of peanut lodged in and partially obstructing trachea

0BC18ZZ

0

Section – Medical and Surgical

B

Body System – Respiratory

C

Root Operation – Extirpation

1

Body Part – Trachea

8

Approach – Via Natural or Artificial Opening Endoscopic

Z

Device – No Device

Z

Qualifier – No Qualifier

 


 

Example 3: Exploration of right eye with removal of BB gun pellet from sclera.

08C6XZZ

0

Section – Medical and Surgical

8

Body System – Eye

C

Root Operation – Extirpation

6

Body Part – Right Sclera

X

Approach – External

Z

Device – No Device

Z

Qualifier – No Qualifier

 

About the Author

Lauri Gray, RHIT, CPC, is the clinical technical editor of coding and reimbursement print and electronic products for Contexo Media. She has worked in the health information management field for 30 years and began her career as a health records supervisor in a multi-specialty clinic. Following that she worked in the managed care industry as a contracting and coding specialist for a major HMO. Lauri has also taught medical coding at the College of Eastern Utah.  She is a member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA).

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