ICD-10-PCS, Root Operations – Part 7, Procedures: Answer Key & Rationale

ICD-10-PCS, Root Operations – Part 7, Procedures: Answer Key & Rationale

Answer Key

  1. 0JH63XZ
  2. 0SRB039
  3. 0WUF4JZ
  4. 0WUFX0Z
  5. 00PVX2Z
  6. 02WA4MZ

 

Answer Key Rationale

To Locate Codes:

Problem #1, VAD insertion:

Index > Insertion of device in > Subcutaneous Tissue and Fascia > Chest > 0JH6 > locate table 0JH6 and go across the row to finish building the code:

Insertion of vascular access device into chest subcutaneous tissue and fascia, percutaneous approach:

Root Ops 6

 

Problem #2, Total hip replacement:

Index > Replacement > Joint > Hip > Left > 0SRB > locate table 0SRB and go across the row to finish building the code:

Replacement of left hip joint with ceramic synthetic substitute, cemented, open approach

Root Ops 1

 

Problem #3, Abdominal wall herniorrhaphy using mesh:

Index > Supplement > Abdominal wall > 0WUF > locate table 0WUF and go across the row to finish building the code:

Supplement abdominal wall with synthetic substitute, percutaneous endoscopic approach

Root Ops 2

 

 

Problem #4, Drainage tube change:

Index > Change device in > Abdominal Wall > 0W2FX > Locate table 0W2FX and go across the row to assign the last two values to complete the code:

Change Drainage Device in Abdominal Wall, External Approach

Root Ops 3

 

Problem #5, Removal of spinal cord monitoring device:

Index > Removal of device from > Spinal Cord > 00PV > locate table 00PV and go across the row to finish building the code:                    

Removal of monitoring device from spinal cord, external approach 

Root Ops 4

 

Change versus Removal:  If a device is taken out and a similar device 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.

 

Problem #6, Revision cardiac pacemaker leads via thoracoscope:

Index > Revision of device in > Heart > 02WA > locate table 02WA and go across the row to finish building the code:

Root Ops 5

 

Coding of ‘Revision’

1)  Revision always involves a device (synthetic/biologic) and includes correcting a malfunctioning device by taking out and/or reinserting part of or same device, or repositioning the device.

2)  A complete re-do of a procedure is coded to the root operation performed and not to revision.

3)  Removing a device and replacing it with an entirely new device via incision is coded to root operations ‘Removal’ and ‘Insertion’.

4) A complete re-do of a procedure is coded to the root operation performed and not to revision.

Last week we reviewed root operations that always involve a device. You were given an exercise matching the root operation to the appropriate procedure. In this week’s exercise you may test your skill set by coding procedures that always include devices. Refer to these terms:

      • Insertion:   Putting in a non-biological device, in or on a body part.
      • Replacement:  Putting in devices that replace a body part.*
      • Supplement:  Putting in devices that reinforces or augments a body part.
      • Change:  Exchanging a device without cutting/puncturing.
      • Removal:  Taking out a device.
      • Revision:  Correcting a malfunctioning/displaced device.

Code the following:

  1. Insertion of a totally implantable vascular access device via the chest (VAD) to provide access for renal dialysis, percutaneous approach.
  2. Total hip replacement, left hip, ceramic-on-ceramic (cemented), open approach.
  3. Supplement:  Laparoscopic abdominal wall herniorrhaphy of incisional hernia using mesh.
  4. Change of drainage device in abdominal wall, external approach.
  5. Spinal cord monitoring device removal, external approach (w/o incision.)
  6. Revision of pacemaker insertion via repositioning the cardiac leads, achieved via thoracoscope.

The last discussion on root operations addressed cutting or separation only and root operations that alter the diameter/route of a tubular body part. This week we are going to focus on root operations that always involve a device. Devices are specified in the 6th character and are only used to specify devices that remain after the procedure is completed. A quick review first:

  • Insertion:   Putting in a non-biological device, in or on a body part.
  • Replacement:  Putting in devices that replace a body part.*
  • Supplement:  Putting in devices that reinforces or augments a body part.
  • Change:  Exchanging a device without cutting/puncturing.
  • Removal:  Taking out a device.
  • Revision:  Correcting a malfunctioning/displaced device.

*Replacement includes some or all of a body part, whereas the remaining devices include in or on a body part.

Match the root operation with the procedures:

  1. Change:  ___________                        A. Central line insertion
  2. Insertion:  __________                        B. Total hip replacement
  3. Revision:  __________                        C. Abdominal wall herniorrhaphy using mesh
  4. Replacement:  ______                        D. Drainage tube change
  5. Supplement:  ______                        E. Central line removal
  6. Removal:  _________                        F.  Revision of pacemaker insertion

 

 

 

 

 

Who We Are

 

 

 

 

 

 

Answer Key

  1. D
  2. A
  3. F
  4. B
  5. C
  6. E

Two-year old infant admitted with pneumonia due to respiratory syncytial virus. Patient’s history includes prematurity and HIV positive. Patient was treated with Ribavarin and bronchodilators. All blood work was normal; HIV test was negative.

What is the diagnosis?

 

 

 

Who We Are

 

 

 

Answer:

480.1 - Pneumonia due to respiratory syncytial virus

A 30-year-old female who has a history of multiple episodes of exacerbation of shingles, presents to her physician’s office with low-back pain and lower extremity weakness. AN MRI was ordered, which revealed no lesions outside or within the spinal cord. A presumptive diagnosis of herpes zoster myelitis was made.

What is the primary diagnosis?

 

 

 

 

Who We Are

 

Answer -
ICD-9: 053.14
ICD-10: B02.24

ICD-10 Code Rationale -

To locate B02.24: Index > Myelitis > Herpes zoster

This is a very straight forward code to assign. B02.24 is part of the B00-B09 group of codes that describe viral infection characterized by skin and mucous membrane lesions. B02 is the branch of all herpes zoster conditions, of which myelitis is part of B02.2, Zoster with other nervous system involvement.

Herpes zoster myelitis, commonly known as shingles, manifests as a rash similar to chicken pox, notably on the torso, often in stripes. Early symptoms include headache, fever, and malaise. Then followed by sensations of burning pain, itching, hyperesthesia (oversensitivity), or paresthesia (“pins and needles”: tingling, pricking, or numbness).

Pathophysiology: Basically this is the manifestation of the chickenpox virus that remains dormant and hidden from your immune system in the nerve ganglia next to the spinal cord and at the base of the skull. It is not known why the virus is triggered, but it does occur mostly in old people and those who are immunosuppressed. In healthy people the virus is suppressed, and more than half of occurrences were with people over the age of 50. A study in the 1960s showed 50% people living to 85 had one outbreak, and 1% had two or more. Drugs must be started within 3 days of the rash developing.

Hodgkin’s sarcoma, right axillary and right upper limb lymph nodes. This 62-year-old male patient was treated for this condition 3 years ago via a bone marrow transplant. However, a biopsy of the right axillary and right upper limb lymph nodes, percutaneous endoscopic approach, was positive for sarcoma, verifying that the patient is experiencing a reoccurrence of the disease.

What are the appropriate procedure codes?

 

Who We Are

 

 

Answer:

C81.94, Z94.81; 07B54ZX, 07B34ZX

Answer key:

1.    0F798DZ
2.    0UVC7ZZ
3.    0D840ZZ
4.    0VLQ0ZZ
5.    0T184CZ
6.    01N54ZZ

Answer Key Rationale:

Problem #1:  ERCP w/ dilation CBD via stent insertion:

     To Locate:  Index > ERCP > Dilation > Duct > Common Bile Duct > 0F79. Locate table 0F79 and go across the row to complete the code:

#1  Dilation of common bile duct with intraluminal device, via natural or artificial opening Endoscopic

PCS Part 5 - A


Comments:

  • Definition: Expanding an orifice or the lumen of a tubular body part.
  • Explanation: The orifice can be a natural orifice or an artificially created orifice. Accomplished by stretching a tubular body part using intraluminal pressure or by cutting part of the orifice or wall of the tubular body part.
  • Approach:  Entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure.
  • The logical place to start in the Index is ERCP (Endoscopic Retrograde Cholangiopancreatography.) However, if you can’t locate the table by the appropriate body system under ERCP, then refer to the root operation, in this instance Dilation.
  • Only those devices that remain in place postoperatively are assigned a device value.

 

Problem #2:  Cervical cerclage w/ strong sutures.

To Locate:  PCS Index > Cerclage > see Restriction > Cervix > 0UVC > locate table OUV and go across the row to complete the code:

#2  Restriction of Cervix, Via Natural or Artificial Opening

PCS Part 5 - B

Comments:

  • Definition: Partially closing an orifice or the lumen of a tubular body part
  • Explanation: The orifice can be a natural orifice or an arificially created orifice.
  • Approach:  Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure.
  • Device:  Because sutures are not considered devices, the device value is Z.

 

Problem #3:  Anal sphincterotomy

To Locate:  PCS Index > Sphincterotomy, anal > see Division, Anal Sphincter > 0D9R  > locate table 0D9 and go across the row to complete the code:

#3 Division of anal sphincter, open approach

PCS Part 5 - C

Comments:

  • 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
  • Anal fissures can be acute or chronic. An acute fissure is a superficial tear and a short-term condition. A chronic fissure is deeper and may expose underlying muscle.

 

Problem #4:  Vas deferens ligation

To Locate:  PCS Index > Ligation > see Occlusion > Vas deferens > Bilateral > 0VLQ > locate table OVL and go across the row to complete the code:

#4  Occlusion of vas deferens, open approach

PCS Part 5- D

Comments:

  • Definition: Completely closing an orifice or the lumen of a tubular body part.
  • Explanation: The orifice can be a natural orifice, or an artificially created orifice.

 

Problem #5:  Urinary diversion with ileal conduit

To Locate:  PCS Index > Diversion > see Bypass > Ureters, bilateral > 0T18 > locate table 0T1 and go across the row to complete the code:

#5  Bypass bilateral ureters to ileocutaneous, percutaneous endoscopic approach

PCS Part 5 - E, v2

Comments:

  • Definition: Altering the route of passage of the contents of a tubular body part.
  • Explanation:  Rerouting contents from one area of a body part to a downstream area in the normal route; rerouting the contents to a similar route and body part; or to an abnormal route and a dissimilar body part. Includes one or more anastomoses, with or without the use of a device.
  • Percutaneous Endoscopic Approach:  Entry, by puncture or minor incision, of instrumentation through the skin and any other body layers necessary to reach the site of the procedure.

 

Problem #6: Carpal tunnel release, right

To Locate:  PCS Index > Release > Nerve > Median > 01N5 > locate 01N and go across the row to complete the code:

#6  Release median nerve, percutaneous endoscopic approach

PCS Part 5 - F

Comments:

  • Definition Release: Freeing a body part from an abnormal physical constraint by cutting or by use of force.
  • Explanation: Some of the restraining tissue may be taken out, but none of the body part is taken out.
  • Approach:  See previous problem.

 

 

In the previous post, we discussed root operations that involve cutting or separation only and root operations that alter the diameter/route of a tubular body part. To test your skill set, you completed an exercise matching the root operation to the appropriate procedure. This week we are going to further test your skill set by giving you six procedures to code, focusing on the afore-mentioned root operations:

  1. ERCP with dilation of common bile duct via insertion of stent into duct.
  2. Cervical cerclage in this pregnant patient, 2nd trimester, with a history of cervical incompetence. Strong sutures are placed in and around the cervix to prevent miscarriage.
  3. Anal sphincterotomy to correct chronic internal fissure by cutting the spphincterotomy muscle, the muscle that restricts and relaxes when stool passes from the body.
  4. A 45-year-old man requests sterilization. This simple procedure, open approach, was accomplished by bilateral vas deferens ligation.
  5. The patient underwent resection of the bladder due to malignant adenocarcinoma . She is in surgery today to create a urinary diversion with an ileal conduit. The bypass was from the ureters. The approach was percutaneous endoscopic.
  6. Carpal tunnel release, right, endoscopic approach.

 

We will post the answers on Thursday with detailed rationales.

#1. Lithotripsy for fragmentation and removal of urinary stones from bladder neck
To locate:  PCS Index > Lithotripsy > With removal of fragments see Extirpation > Bladder Neck > 0TCC > locate table OTCC and go across the row to finish building the code:

Extirpation of material from bladder neck via natural or artificial opening endoscopic

PCS Part 4 - A

Via Natural or Artificial Opening, Endoscopic:  Entry of instrumentation  through a natural or artificial external opening to reach and visualize the site of the procedure.


#2. Phacoemulsification of cataract, left lens
To locate:  PCS Index > Phacoemulsification, lens > Without IOL implant see Extraction, Eye 08D > locate table 08D and go across the row to finish building the code:

Extraction of left lens, percutaneous approach

PCS Part 4 - B

Percutaneous Approach:  Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure.


#3. Thoracentesis of left pleural cavity to relieve patient of 
accumulation of excess fluid, percutaneous approach
To locate:  PCS Index > Thoracentesis > see Drainage > Pleural Cavity > Left > 0W9B > locate table 0W9 and go across the row to complete the code:

PCS Part 4 - C

The PCS Index instructs us to see Anatomical Regions, General. However, there is no listing for Anatomical Regions. When the Index gives incorrect advice, go to the body part; in this instance, the pleural cavity. General Anatomical Regions include the major body cavities. Procedures performed on the pleural cavity, rather than the pleura itself, are classified in the Anatomical Regions, General body system.


#4. Arthrocentesis for biopsy of right knee joint in order to determine cause 
of abnormal buildup of fluid, percutaneous approach
To locate:  PCS Index > see Drainage, Lower Joints > NOTE:  The Index does not list Lower Joints, so go to Joints, Knee > Left > 0S9 > locate table 0S9 and go across the row to complete the code:

Drainage of right knee joint, percutaneous approach, diagnostic

PCS Part - D

Lower Joints:  Upper bones and upper joints in ICD-10-PCS are defined as bones and joints above the level of the lumbar vertebrae,  plus the upper extremities. Lower bones and lower joints in ICD-10-PCS are defined as bones and joints below the level of the lumbar vertebrae, plus the lower extremities.

 

#5. Crushing (fragmentation) of fallopian tubes, bilateral, for sterilization, laparoscopic approach
To locate:  PCS Index > Fragmentation > Fallopian Tubes, Bilateral > 0UF7 > locate table 0UF and go across the row to complete the code:

Fragmentation in bilateral fallopian tubes, percutaneous endoscopic approach

PCS Part 4 - E

Laparoscopic approach is considered Percutaneous Endoscopic:  Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure.


#6. Declotting of arteriovenous renal dialysis graft, left basilic vein, open 
approach
To locate:  PCS Index > Extirpation > Vein > Basilic > Left > 05CC > locate table 05CC and go across the row to complete the code:

PCS Part 4 - G

Where the general body system values “Upper” and “Lower” are provided as an option in the Upper Veins, Lower Veins sections, “Upper” and “Lower” specifies the body parts located above or below the diaphragm.

The last coding tidbit focused on root operations that take out solids / fluids / gases from a body part. During this week’s tidbit we will focus on coding procedures utilizing this particular root operation. A quick review first:

  • Drainage:  Taking / letting out fluids / gases
  • Extirpation:  Taking / cutting out solid matter
  • Fragmentation:  Breaking solid matter into pieces

Code the following procedures:

  1. Lithotripsy for fragmentation and removal of urinary stones from bladder neck.
  2. Phacoemulsification of cataract, left lens.
  3. Thoracentesis of left pleural cavity to relieve patient of buildup of excess fluid, perutaneous approach.
  4. Arthrocentesis to biopsy right knee joint in order to determine cause of  abnormal buildup of fluid, percutaneous approach.
  5. Crushing (fragmentation) of fallopian tubes, bilateral, for sterilization, laparoscopic approach.
  6. Declotting of arteriovenous renal dialysis graft, left basilic vein.

 

From the Blog

ICD-10-PCS, Root Operations – Part 7, Procedures: Answer Key & Rationale

Answer Key 0JH63XZ 0SRB039 0WUF4JZ 0WUFX0Z 00PVX2Z 02WA4MZ   Answer Key Rread more