Updated on: September 23, 2013

Root Operations: Critical Factor for Correct Code Assignment

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Original story posted on: September 14, 2011

Much attention has been given to the need for coders to increase their knowledge of anatomy in preparation for the conversion to ICD-10-CM/PCS. While I acknowledge that there is more detail in these new classifications, I also maintain that the majority of today’s coders, and especially those who are credentialed and serious about their profession, already have the knowledge they need. It is applied every day – we just haven’t had the specificity in the codes to apply it so thoroughly.

Many of us have been frustrated in the past because we had great documentation but nowhere to differentiate either the diagnosis or the procedure adequately. With ICD-10 that frustration will be relieved by the detail in the codes.

Where the coder will need some additional education, outside of learning the new rules and the classifications themselves, is in the language, terms and definitions of ICD-10-PCS.  Specifically, these articles will focus on the root operation (the third character in the seven-character PCS codes). The root operation is the critical factor to making the correct code assignment. We cannot expect the medical staff to change the language of medicine, so it is the role of the coder to translate it to the language of coding. As coders, we always have done this to some extent, but now it is more critical than ever.

In the ICD-10 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 an entire body part is a “resection.” Since an appendectomy typically involves the removal of the entire appendix, resection is the correct root operation. This is the type of translation the coder must make to ensure accurate code assignment.

The medical and surgical root operations have been grouped into the following:

  • Procedures that take out or eliminate some or all of a body part:
    • Excision (B);
    • Resection (T);
    • Extraction (D);
    • Destruction (5); and
    • Detachment (6).
    • Procedures that put in/put back or move some or all of a body part:
      • Transplantation (Y);
      • Reattachment (M);
      • Reposition (S); and
      • Transfer (X).
      • Procedures that take out or eliminate solid matter, fluids or gases from a body part:
        • Drainage (9);
        • Extirpation (C); and
        • Fragmentation (F).
        • Procedures that involve only examination of body parts and regions:
          • Inspection (J); and
          • Map (K).


          • Procedures that alter the diameter or route of a tubular body part:
            • Bypass (1);
            • Dilation (7);
            • Occlusion (L); and
            • Restriction (V).
            • Procedures that always involve devices:
              • Insertion (H);
              • Replacement (R);
              • Supplement (U);
              • Removal (P);
              • Change (2); and
              • Revision (W).
              • Procedures involving cutting or separation only:
                • Division (8); and
                • Release (N).
                • Procedures involving other repairs:
                  • Control (3); and
                  • Repair (Q).
                  • Procedures with other objectives:
                    • Alteration (0);
                    • Creation (4); and
                    • Fusion (G).

Today’s article will focus on the five root operations that take out some or all of a body part.  As in the ICD-10-PCS book, we will review the definition, explanation and some examples of each.

Excision (B) Definition:  Cutting out or off, without replacement, a portion of a body part.

Explanation:       The qualifier “diagnostic” is used to identify excision procedures that are biopsies.

Examples: Partial nephrectomy, liver biopsy, excision of sebaceous cyst at any site, laparoscopy with excision of endometrial implant from left ovary, sigmoidoscopy with polypectomy, etc.

Resection (T) Definition:  Cutting out or off, without replacement, all of a body part.

Explanation:       N/A.

Examples: Total nephrectomy, total lobectomy of lung, right hemicolectomy, laparoscopic cholecystectomy, radical open retropubic prostatectomy, etc.

NOTE:       It is important to note that the difference between the excision and the resection is that the resection removes the total body part. The prostatectomy is a perfect example: when a transurethral resection of the prostate is performed, only the obstructing portions of the prostate are removed, so the correct root operation would be excision. When an open procedure is performed, the entire prostate is removed. The coder must be aware of the difference in order to code appropriately.

 


 

Detachment (6) Definition:  Cutting off all or part of the upper or lower extremities.

Explanation:       The body part value is the site of detachment, with a qualifier, if applicable, to specify further the level where the extremity was detached.

Examples: Below-knee amputation, disarticulation of shoulder, etc. (all amputations are classified as detachments).

Destruction (5) Definition:  Physical eradication of all or a portion of a body part by the direct use of energy, force or a destructive agent.

Explanation:       No part of the body is physically taken out.

Examples: Fulguration of rectal polyp, cautery of skin lesion, ablation, fulguration, cryotherapy, etc.

Extraction (D) Definition:  Pulling or stripping out of all or a portion of a body part by the use of force.

Explanation:       The qualifier “diagnostic” is used to identify extraction procedures that are biopsies.

Examples: Dilation and curettage, vein stripping a leg, bone marrow biopsy, extraction of teeth, etc.

NOTE:       A phacoemulsification of a cataract without replacement is an extraction, but if an intra-ocular lens is implanted the procedure is classified to the root operation of replacement. Extraction is done without replacement.

Our next article will focus on the next group of root operations: procedures that put in/put back or move some or all of a body part.

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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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.