Introduction to ICD 10 PCS Root Operations-Group 1

1. Introduction to ICD 10 PCS Root Operations-Group 1 Presented by: THIMA ICD 10 Committee

2. WHAT IS A ROOT OPERATION???? THE OBJECTIVE OR ACTION OF THE PROCEDURE

3. SURGICAL & MEDICAL ROOT OPERATIONS (31)

4. 31 ROOTS – 9 GROUPS Take out some/all of a body part Take out solids/fluids/gases from a body part Involving cutting or separation only Put in/put back or move some/all of a body part Alter the diameter/route of a tubular body part Always involve a device Involving examination only Involve other repairs Involve other objectives

5. Characters in the Medical and Surgical Section

6. GROUP 1 …PROCEDURES THAT TAKE OUT OR ELIMINATE ALL OR A PORTION OF A BODY PART

7. EXCISION –CUTTING OUT OR OFF • A Portion of a body part • Without replacing the body part EXAMPLE: Sigmoid polypectomy

8. Excision • Excision is used when a portion of a body part is cut out or off using a sharp instrument: • Scalpel • Wire • Scissors • Bone Saw • Example: Percutaneous needle core biopsy (diagnostic) of the left kidney pelvis • 0TB43ZX – Excision, Urinary System, Kidney Pelvis (0TB)

9. Excision • The qualifier Diagnostic (X) is used to identify excision procedures that are biopsies. This would be assigned as the seventh character. • Exception: Bone Marrow and Endometrial Biopsies • These are not coded as Excision but rather as Extraction, with the qualifier Diagnostic • Excision for Graft • If the autograft is obtained from a different body part to complete the procedure, a separate procedure is coded • Example: CABG with excision of saphenous vein graft. Excision of the saphenous vein graft would be assigned a separate code

10. Coding Guideline B3.4 If a diagnostic biopsy is followed by a more definitive procedure, such as Excision, Resection, Destruction at the same procedure site, both the biopsy and the more definitive treatment are coded. Example: Percutaneous needle biopsy of right breast followed by right total mastectomy, open

11. RESECTION- CUTTING OUT OR OFF • All of a body part Without replacing a body part EXAMPLE: Total nephrectomy

12. Resection Example: Open right axillary lymphadenectomy of the complete chain 07T50ZZ – Resection, by Body System, Lymphatic and Hemic Systems(07T); by Body Part, Lymphatic, Right Axillary (07T5) Logic: When an entire lymph node chain is cut out, the appropriate root operation is resection. When a lymph node(s) is cut out, the root operation is Excision

13. Documentation • There is an opportunity to provide physician education on the need for more complete documentation on the following: • Lymph node(s) versus the complete chain • The complete body part removal versus a portion

14. Resection • Be careful of documentation. It is important to convert common terminology to the appropriate root operation according to the intent of the procedure. • Resection is similar to Excision except Resection includes all of a body part, or any subdivision of a body part that has its own body part value in ICD-10-PCS, while Excision includes only a portion of a body part. • Example: Left upper lung lobectomy – coded to Resection of Upper Lung Lobe, left rather than excison because upper lobe of lung has its own body part value.

15. EXTRACTION – PULLING OUT OR OFF BY PHYSICAL FORCE • All or a portion of a body part Without replacing a body part EXAMPLE: Toenail extraction Non Excisional Debridement

16. Extraction • Extraction is coded when the method employed to take out the body part is pulling or stripping. Minor cutting, such as that used in vein stripping procedures is included in extraction if the objective of the procedure is met by pulling or stripping. • The qualifier Diagnostic is used to identify extraction procedures that are biopsies. • Example: Nonexcisional debridement of skin of back • 0HD6XZZ Extraction, by Body System, Skin and Breast (0HD), by Body part, Skin, Back (0HD6)

17. DESTRUCTION – Physical Eradication • All or a portion of a body part by the direct use of energy, force, or a destructive agent EXAMPLE: Rectal polyp fulguration

18. Destruction • Destruction “takes out” a body part in the sense that it obliterates the body part so it is no longer there. None of the body part is physically taken out. This root operation defines a broad range of common procedures, since it can be used anywhere in the body to treat various conditions such as: • Skin and genital warts • Nasal and colon polyps • Esophageal varices • Endometrial implants

19. Destruction Cryotherapy of 2 warts on left hand and one wart on the right hand 0H5GXZZ- Destruction, Skin and Breast (0H5), Skin Left Hand (0H5G) 0H5GXZZ – Destruction, Skin and Breast (0H5), Skin Left Hand (0H5G) 0H5FXZZ- Destruction, Skin and Breast (0H5), Skin Right Hand (0H5F)

20. Destruction • Additional examples of Destruction procedures: • Cautery of nosebleed • Laparoscopy with destruction of endometriosis of ovary • Talc injection pleurodesis, left side • Fulguration of endometrium • Percutaneous radiofrequency ablation of right vocal cord lesion

21. DETACHMENT – CUTTING OFF • All or a portion of an extremity Without replacing extremity EXAMPLE: Below knee amputation

22. Detachment • Detachment represents a narrow range of procedures; it is exclusively used for amputation procedures. Detachment procedure codes are found only in body systems X and Y because amputations are performed on extremities, across overlapping body layers. • X – Anatomical Regions, Upper Extremities • Y – Anatomical Regions, Lower Extremities • Example: Amputation at left elbow level • 0X6C0ZZ – detachment by Body System = anatomical regions, upper extremities (0X6); by Body Part = Elbow Region

23. Documentation There is an opportunity to provide physician education on more complete documentation on the actual location of the amputation. According to the definition, the coder needs to know if the amputation is at the proximal, middle or distal portion of the shaft of the humerus, femur, radius/ulna, or tibia/fibula

24. PCS Tables – Group 1Procedures that take out or eliminate all or a portion of a body part

25. DEBRIDEMENT REMAINS AN ISSUE • ICD-10-PCS Index (Root Operations) • Debridement - • Excisional – See Excision • Non-Excisional – See Extraction • Root Operation Definitions • Excision – Cutting out or off, without replacement, a portion of a body part • Extraction – Pulling or stripping out or off all or a portion of a body part by the use of force

26. Definition and Terminology Changes • ICD-9 Procedure TermICD-10 Procedure Term • Amputation Detachment • Amniocentesis Drainage • Arthroscopy, Cystoscopy… Inspection… Endoscopic Approach • Closed Reduction Reposition • Debridement Excision, Extraction, Irrigation, Extirpation • Radical Mastectomy Resection (right, left or bilateral) • Subtotal Mastectomy Excision • Tracheostomy, Bypass • Cesarean section Extraction of Products of Conception • Incision No ICD-10 term

27. LET’S SUM UP WHAT WE HAVE LEARNED

28. What Have You Learned • Excision – Cutting out or off, without replacement, a portion of a body part • Resection – Cutting out or off, without replacement, all of a body part • Detachment – Cutting off all or part of the upper and lower extremities • Destruction – Physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent • Extraction – Pulling or stripping out or off all or a portion of a body part by the use of force