February 20, 2012

Medical and Surgical Root Operations – Procedures that Alter the Diameter/Route of a Tubular Body Part

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EDITOR’S NOTE: This is the fourth in a series of articles addressing the definitions and differences between the Medical and Surgical Root Operations of ICD-10.

This is the fourth in a series of articles addressing the definitions of, and differences between, the Medical and Surgical Root Operations of ICD-10-PCS. Let’s review what we covered so far: in the Medical and Surgical section (first character 0) there are 31 root operations using standardized terminology with no procedure names, no diagnostic information and no eponyms. You won’t find an appendectomy in ICD-10-PCS, but you will need to know that the cutting out or off, without replacement, of all of a body part is a “resection.” Since an appendectomy typically means the total removal of the appendix, resection is the correct root operation in this case. This is the type of translation coders must make to ensure accurate code assignment.

Coders will find this information in Appendices A and B of the ICD-10-PCS book. The PCS appendices are rich with helpful information meant to assist the coder in the translation of medicine to PCS. That is for future discussion, however, as today we are focused on procedures that alter the diameter or route of a tubular body part. Per the ICD-10-PCS book, we will review the definition, explanation and some examples of each. We also will introduce the applicable coding guidelines. The character listed after each root operation below represents the third character in the PCS code.

 

Restriction (V) Definition: Partially closing an orifice or the lumen of a tubular body part.
Explanation: The orifice can be a natural or an artificially created orifice.
Examples: Esophagogastric fundoplication; cervical cerclage; craniotomy with clipping of cerebral aneurysm.

Coding Guideline Occlusion vs. Restriction for vessel embolization procedures (B3.12)

If the objective of an embolization procedure is to close a vessel completely, the root operation "occlusion" is coded. If the objective of an embolization procedure is to narrow the lumen vessel, the root operation "restriction" is coded.

Examples: Tumor embolization is coded to the root operation of occlusion because the objective of the procedure is to cut off blood supply to the vessel.

Embolization of a cerebral aneurysm is coded to the root operation of restriction because the objective of the procedure is not to close off the vessel entirely, but to narrow the lumen of the vessel at the site of the aneurysm where it is abnormally wide.

Occlusion (L) Definition: Completely closing an orifice or the lumen of a tubular body part.
Explanation: The orifice can be a natural or anartificially created orifice.
Examples: Fallopian tube ligation; ligation of inferior vena cava.
Coding Guideline (see above, B3.12)

 


 

Dilation (7) Definition: Expanding an orifice or the lumen of a tubular body part.
Explanation: The orifice can be a natural or an artificially created orifice. This procedure is accomplished by stretching a tubular body part using intraluminal pressure or by cutting part of the orifice or wall of the tubular body part.
Examples: Percutaneous transluminal angioplasty (PTA); percutaneous transluminal coronary angioplasty (PTCA); esophageal dilation.

Coding Guideline Coronary arteries (B4.4)

The coronary arteries are classified as a single body part, further specified by number of sites treated and not by any name or number of arteries. Separate body-part values are used to specify the number of sites treated when the same procedure is performed on multiple sites in the coronary arteries.

Examples: Angioplasty of two distinct sites in the left anterior descending coronary artery with placement of two stents is coded as Dilation of Coronary Arteries, Two Sites, with Intraluminal Device.

Angioplasty of two distinct sites in the left anterior descending coronary artery, one with a stent placed and one without, is coded separately as Dilation of Coronary Artery, One Site with Intraluminal Device, and Dilation of Coronary Artery, One Site with No Device.

Coding Guideline Procedures following delivery or abortion (C2)

Procedures performed following a delivery or abortion for curettage of the endometrium or evacuation of retained products of conception are all coded in the obstetrics section, to the root operation of “extraction” and the body part “products of conception, retained.” Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period are all coded in the Medical and Surgical section, to the root operation of “extraction” and the body part “endometrium.”

Bypass (1) Definition: Altering the route of passage of the contents of a tubular body
Explanation: Rerouting contents of a body part to a more distant area of the normal route, either to a similar route and body part or to an abnormal route and dissimilar body part. Includes one or more anastomoses, with or without the use of a device.
Examples: Coronary artery bypass; colostomy formation; urinary diversion: ureter: using ileal conduit to skin.
Coding Guideline Bypass procedures
(B3.6a)
Bypass procedures are coded by identifying the body part bypassed “from” and the body part bypassed “to.” The fourth character, denoting body part, specifies the body part bypassed from, while the qualifier specifies the body part to which the bypass leads.
Example: For bypass from stomach to jejunum, stomach is the body part and jejunum is the qualifier.
(B3.6b)
Coronary arteries are classified by the number of distinct sites treated rather than the number of coronary arteries or any anatomic name of a coronary artery (i.e. left anterior descending). Coronary artery bypass procedures are coded differently than other bypass procedures, as described in the previous guideline. Rather than identifying the body part bypassed from, the body part identifies the number of coronary artery sites bypassed to, and the qualifier specifies the vessel from which the bypass leads.
Example: Aortocoronary artery bypass of one site on the left anterior descending coronary artery and one site on the obtuse marginal coronary artery is classified in the body-part axis of classification as two coronary artery sites. The qualifier specifies the aorta as the body part from which the bypass leads.
(B3.6c)
If multiple coronary artery sites are bypassed, a separate procedure is coded for each coronary artery site that uses a different device and/or qualifier.
Example: Aortocoronary artery bypass and internal mammary coronary artery bypass are coded separately.

 

Our next group of ICD-10-PCS root operations to explore includes procedures that always involve devices.

About the Author

Becky DeGrosky, RHIT, is the Product Manager for TruCode. She brings over 35 years experience in health information management.  She worked for 11 years in HIM software development for QuadraMed and MedAssets, including product management, content maintenance, implementation and training, and client support.  She is an active member of the Pennsylvania Health Information Management Association, where she has served on multiple committees including Chairman of the Education Committee and the Coding Roundtable.

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Read 173 times Last modified on September 23, 2013
Rebecca DeGrosky, RHIT

Becky DeGrosky, RHIT, is the Product Manager for TruCode. She brings over 35 years experience in health information management.  She worked for 11 years in HIM software development for QuadraMed and MedAssets, including product management, content maintenance, implementation and training, and client support.  She is an active member of the Pennsylvania Health Information Management Association, where she has served on multiple committees including Chairman of the Education Committee and the Coding Roundtable.