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March 20, 2012

Medical and Surgical Root Operations – Procedures that Always Involve Devices

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

As usual, let’s review what we have 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.

So far we have touched on 18 of them, so we are more than halfway there. We have discovered that a fraction reduction is assigned the root operation “reposition,” and that there is no appendectomy designation in ICD-10-PCS. Coders 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 involves the total removal of the appendix, “resection” is the correct root operation. This is the type of translation the coder must make to ensure accurate code assignment.

Coders will find this topic covered in the ICD-10-PCS book, Appendix A and B. The PCS appendices are rich with helpful information meant to assist coders in the translation of medicine to PCS. That is for future discussion, as today we are focusing on the procedures that alter the diameter or route of a tubular body part. As in 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 represents the third character in the PCS code.

There are six root operations that have been grouped into procedures that always involve devices. They include:

 

Insertion (H)

Definition: Implanting a non-biological device that monitors, assists, performs or prevents a physiological function, but does not physically take the place of a body part.
Explanation: None
Examples: Insertion of radioactive implant, insertion of central venous catheter.
Coding Guideline: Reposition for fracture treatment (B3.15)
Reduction of a displaced fracture is coded to the root operation “reposition” and the application of a cast or splint in conjunction with the reposition procedure is not coded separately. Treatment of a non-displaced fracture is coded to the procedure performed.
Example: Putting a pin in a non-displaced fracture is coded to the root operation “insertion.” Casting of a non-displaced fracture is coded to the root operation “immobilization” in the Placement section.
Replacement (R)
Definition: Implanting or applying a biological or synthetic material that physically takes the place and/or function of all or a portion of a body part.
Explanation: The body part may be taken out, replaced, physically eradicated or rendered nonfunctional during the replacement procedure. A removal procedure is coded for taking out a device used in a previous replacement procedure.
Examples: Total hip replacement, bone graft, free skin graft, mastectomy with free TRAM flap reconstruction.
Coding Guideline: General guidelines (B3.1b)
Components of a procedure specified in the root operation definition and explanation are not coded separately. Procedural steps necessary to reach the operative site and close the operative site also are not coded separately.
Example: Resection of a joint as part of a joint replacement procedure is included in the root operation definition of “replacement” and is not coded separately. Laparotomy performed to reach the site of an open liver biopsy also is not coded separately.

 


 

Supplement (U)
Definition: Implanting or applying a biologic or synthetic material that physically reinforces and/or augments the function of a portion of a body part.
Explanation: The biological material is nonliving, or is living and from the same individual. The body part may have been replaced previously, and the supplement procedure is performed to physically reinforce and/or augment the function of the replaced body part.
Examples: Herniorrhaphy using mesh, free nerve graft, mitral valve ring annuloplasty, implantation of a new acetabular liner in a previous hip replacement.
Coding Guidelines: There are no guidelines addressing the supplement procedure.
Change (2)
Definition: Removing a device from a body part and putting back an identical or similar device in or on the same body part without cutting or puncturing the skin or a mucous membrane.
Explanation: All change procedures are coded using the approach “external.”
Examples: Urinary catheter change, gastrostomy tube change, replacement of chest tube.
Coding Guideline: General guidelines (B6.1c)
Procedures performed on a device only and not on a body part are specified in the root operations change, irrigation, removal and revision, and are coded to the procedure performed.
Example: Irrigation of percutaneous nephrostomy tube is coded to the root operation “irrigation” of indwelling device in the Administration section.
Removal (P)
Definition: Removing a device from a body part.
Explanation: If a device is taken out and a similar device is put in without cutting or puncturing the skin or mucous membrane, the procedure is coded to the root operation “change.” Otherwise, the procedure for taking out a device is coded to the root operation “removal.”
Examples: Drainage tube removal, cardiac pacemaker removal.
Coding Guidelines: There are no guidelines addressing removal.
Revision (W)
Definition: Correcting, to the extent possible, a malfunctioning or displaced device.
Explanation: Revision can encompass correcting a malfunctioning device by taking out and/or putting in part of the device.
Examples: Adjustment of pacemaker lead, adjustment of hip prosthesis, reposition of Swan-Ganz catheter.
Coding Guidelines: There are no guidelines addressing revision.

 

Our last groups of ICD-10-PCS Medical and Surgical Root Operations to explore are procedures involving cutting or separation only, procedures involving other repairs and procedures with other objectives.

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 696 times Updated 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.

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