ICD-10-PCS, Root Operations – Part 11, Procedures: Answer Key & Rationale

ICD-10-PCS, Root Operations – Part 11, Procedures: Answer Key & Rationale

Answer Key:

  1. 0FB13ZX
  2. 0BH17EZ
  3. 0SNDXZZ
  4. 0CTPXZZ
  5. 0HB4XZZ
  6. 09M0XZZ
  7. 095KXZZ

 

Problem #1, Needle Biopsy Right Lobe of Liver

To Locate:  PCS Index >Biopsy > see Excision with qualifier Diagnostic > Excision > Liver > Right lobe > 0FB1 > locate table 0FB and go across the row to finish building the code: Root Ops, Part 11 - A

  • Explanation: The qualifier DIAGNOSTIC is used to identify excision procedures that are biopsies.
  • Percutaneous Approach:  Entry by puncture or minor incision, or instrumentation through the skin or mucous membrane and/or any other body layers necessary to reach the site of the procedure. Some other examples include:  Percutaneous Drainage of Abscess, Thoracentesis, Transvenous Insertion of Pacemaker Lead AND Injection.

 

Problem #2, Endotracheal Intubation

To Locate:  Intubation > Airway > see insertion of device in, Trachea > 0BH1 > locate table 0BH and go across the row to finish building the code:

Insertion of endotracheal airway into trachea, via natural or artificial opening Root Ops, Part 11 – B

  • Definition: Putting in a nonbiological device that monitors, assists, performs or prevents a physiological function, but DOES NOT physically take the place of a body part.
  • Examples: Brachytherapy seed placement, Implantation of VAD, Insertion of a central venous catheter, Placement of cardiac pacemaker, Placement of an intrathecal infusion pump for pain management  

 

Problem #3, Manual rupture knee joint adhesions

To Locate:  PCS Index > Rupture > Adhesions > see Release > Joint > Knee > Left > 0SND > go to table 0SSN and go across the row to complete the code:

Release left knee joint, external approach Root Ops, Part 11 – C

  • Definition: 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.
  • Examples:  Adhesiolysis, Carpal tunnel release, Release of median nerve, Relaxation of scar contracture, Frenulotomy, Achilles tendon release

RELEASE GUIDELINE B3.13: In the root operation Release, the body part value coded is the body part being freed and not the tissue being manipulated or cut to free the body part.

CODING NOTE: The ‘body part value’ assigned is the structure released and NOT the structure cut to obtain the release.

  • Examples: – The transverse carpal ligament was cut to release the median nerve and not for its own sake – Lysis of intestinal adhesions is coded to the specific intestine body part value with root operation Release

 

Problem #4, Resection of tonsils, external approach

To Locate:  PCS Index > Tonsils > 0CTP > go to table 0CT to complete the code:  

Resection of tonsils, external approach

Root Ops, Part 11 – D

  • Definition: Procedures performed directly on the skin or mucuous membrane and procedures performed indirectly by the application of external force through the skin or mucous membrane.
  • Explanation: Includes procedures on structures that are visible without the aid of any instrumentation to reach the site.
  • Examples: Resection of tonsils, Closed reduction of fracture, Local skin excision, Debridement of skin, Extubation, endotracheal tube, Removal of nasogastric drainage tube  

Problem #5, Local excision of skin lesion of neck

To Locate:  PCS Index > Excision > Skin > Neck > 0HB4XZ > go to table 0HB to 1) verify characters 4-6 and 2) Assign 7th character:

Root Ops, Part 11 – E

  • Definition: Cutting out or off, without replacement, a portion of a body part
  • Examples: Partial nephrectomy, Liver biopsy by excision of tissue, Polypectomy, Wedge ostectomy, Pulmonary segmentectomy, Breast lumpectomy  

 

Problem #6 Reattachment severed right ear

To Locate:  PCS Index > Reattachment > Ear > Right > 09M0XZZ > locate table 09M and go across the row to verify the code:

Root Ops, Part 11 – F

 

  • Definition: Putting back in or on all or a portion of a separated body part to its normal location or other suitable location
  • Explanation: Vascular circulation and nervous pathways may or may not be reestablished
  • Examples: Reattach penis, Reattach finger, Reattachment of severed ear, Replantation of avulsed teeth

 

Problem #7, Cautery Nosebleed

Root Ops, Part 11 – G

  • Definition: Physical eradication of all or a portion of a body part by the direct use of energy, force or a destructive agent
  • Explanation: None of the body part is physically taken out
  • Examples: Cautery of varicose vein, Cryosurgery, Fulguration of a rectal polyp, Laser ablation of arrhythmogenic focus AV node, Pleurodesis, scarification (mechanical abrasion), Transurethral needle ablation of prostate (TUNA)

 

We have been discussing approaches for the past 3 weeks, with last week’s tidbit being a quiz  matching various root operations to their respective approaches. This week we are going to practice coding a variety of scenarios that incorporate the approaches. Just a reminder that the 7/28/14 post covered the Percutaneous Endoscopic approach and the 8/5/14 post covered the approach, Via Natural or Artificial Opening Endoscopic.

This week we will code the following approaches:  Percutaneous, Via Natural or Artificial Opening, External and Open. So, let’s get started:

  1. Needle biopsy of right lobe of liver
  2. Endotracheal Intubation
  3. Manual rupture left knee joint
  4. Resection of tonsils
  5. Local excision of skin lesion of neck
  6. Reattachment severed right ear
  7. Cautery Nosebleed

For the past few weeks have been focusing on approaches, Percutaneous Endoscopic and Via Natural or Artificial Opening Endoscopic. This week we will focus on the remaining approaches:

  • Open:  Cutting through the skin or mucous membrane (mm) and any other body layers necessary to expose the site of the procedure.
  • Percutaneous:  Entry, by puncture or minor incision, of instrumentation through the skin or mm and any other body layers necessary to reach and visualize the site of the procedure.
  • Via Natural or Artificial Opening:  Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure.
  • Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance:  Entry of instrumentation through a natural or artificial external opening and entry, by puncture or minor incision through the skin or mm and any other body layers necessary to aid in the performance of the procedure. An LAVH, Laparoscopic-assisted vagina hysterectomy, is an example of this approach, one not that frequently assigned.
  • External:  Procedures performed directly on the skin or mm and procedures performed indirectly by the application of external force through the skin or mucous membrane.

 

Before moving ahead, a quick review of the two approaches previously discussed:

  • Percutaneous Endoscopic:  Entry, by puncture or minor incision, of instrumentation through the skin or mm and any other body layers necessary to reach and visualize the site of the procedure.
  • Via Natural or Artificial Opening Endoscopic:  Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure.

 

Test yourself on how well you understand the various approaches by matching the root operation to the approach in the following exercise. Please note that the approach, Via Natural or Artificial Opening with Percutaneous Endoscopic Assistance, is not included in the following quiz.

 

Match the root operations with the approaches:

  1. Open:  ________________________
  2. Percutaneous:  __________________
  3. Endoscopic:  ___________________
  4. Via Natural or Artificial Opening: ______________
  5. Via Natural or Artificial Opening Endoscopic: __________________________________
  6. External:  ______________________

 

A. Resection of Tonsils

B. CABG

C. Percutaneous needle core biopsy kidney

D. Transurethral cysto w/ removal bladder stone

E. Excision skin lesion

F. Liposuction

G. Endoscopic ERCP

H. Abdominal hysterectomy

I. Colonoscopy

J. Closed reduction fracture

K. Percutaneous drainage ascites

L. Foley catheter placement

M. Digital rectal exam

N. Laparoscopic cholecystectomy

O. Needle biopsy liver

P. Cautery nosebleed

Q. Open endarterectomy

R. Manual rupture joint adhesions

S. Endotracheal intubation

T. Arthroscopy

U. Transvaginal intraluminal cervical cerclage

V. Endoscopic drainage sinus

W. EGD

X. Laparoscopy with destruction endometriosis

Y. Reattachment severed ear

Z. Hysteroscopy

 

 

 

 

 

Who We Are

 

 

 

 

 

Answer Key:

 

  1. Open:  B, H, Q
  2. Percu: C, F, K, O
  3. Endo:  N, T, V, X
  4. Nat/Art Open:  L, M, S, U
  5. Nat/Art Open Endo:  D, G, I, W, Z
  6. Ext:  A, E, J, P, R, Y

Answer key:

  1. 0TCB8ZZ
  2. 0UJD8ZZ
  3. 0DJD8ZZ
  4. 0DJ08ZZ

 

Problem #1, Transurethral cystoscopy with removal of bladder stone

To locate:  PCS Index >Extirpation >Bladder > 0TCB > locate table 0TC and then go across the row to finish building the code:

Extirpation of matter from bladder, via natural or artificial opening endoscopic

Part 9, A

  • If you go to the PCS Index and refer to the main term/the root operation, Cystoscopy, the code listed is 0TJB8ZZ, Inspection of Bladder. This is not the correct code, so what do you do now? The easiest and quickest method is to refer to the Root Operations glossary located in the front of the ICD-10-PCS coding book. “Removal” is out because it pertains only to the removal of devices. Removal of a bladder stone falls under the definition of Extirpation, “Taking or cutting out solid matter from a body part.”
  • Another method is to bypass the Index altogether and go directly to the tables. First go to the Med/Surg section and then determine the body system, Urinary. Then scan the root operations (character #3), an alpha list looking for Extirpation. You are now in the correct table, 0TC.

 

 

Problem #2, Hysteroscopy

To Locate:  PCS Index > 0UJD8ZZ > Since you should never code from the Index, we’re going to refer to the table 0UJ and go across the row to verify that the code is correct:

Inspection of uterus and cervix, via natural or artificial opening endoscopic

Part 9, B

 

 

Problem #3, Diagnostic Colonoscopy in a colostomy patient

To Locate:  PCS Index > Colonoscopy >0DJD8ZZ

This is such a commonly performed procedure the PCS Index gives the entire code. However, you should never code from the Index. That being said, let’s verify the code:

Inspection of lower intestinal tract, via natural or artificial opening endoscopic

Part 9, C

  • In ICD-10-PCS it makes no difference whether the scope is inserted through the colostomy stoma rather than through the anus, but in ICD-9-CM, it does impact code assignment.  In ICD-10-PCS the colostomy stoma is an artificial opening and since the definition of this approach includes artificial opening, we’re good to go.

 

 

Problem #4, EGD

To Locate:  PCS Index > 0DJ08ZZ > Since we never code from the index, locate table 0DJ and go across the row to verify that the code is correct:

Inspection of upper intestinal tract, via natural or artificial opening endoscopic

Part 9, D

 

SUMMARY

The common element shared by these four procedures is the approach, Via Natural or Artificial Opening Endoscopic. Regardless of the type of procedure carried out, 3 out of 4 procedures were accomplished by utilizing the body’s natural orifices. In problem #1, the urethra was used to access the bladder; in problem #2, the vagina was used to access the uterus; in problem #3, the colostomy site (artificial opening) was used to access the colon; in problem #4, the oral cavity was used to access upper GI tract.

 

Last week we started a discussion addressing the various approaches used in ICD-10-PCS, starting with the percutaneous endoscopic approach. This week’s discussion focuses on the natural or artificial opening endoscopic. It is defined as:

Entry of instrumentation through a natural or artificial external opening to reach and visualize the site of the procedure. 

So what’s the difference between the two approaches: 1) Percutaneous endoscopic and 2) Via natural or artificial opening endoscopic? Percutaneous endoscopic requires only a puncture or minor incision to access the targeted organ or site, whereas via natural or artificial opening endoscopic requires no puncture/incision because this approach relies on the body’s natural orifices to target the desired organ or site.

 

Some examples of this approach include:

  • Transurethral cystoscopy with removal of bladder stone
  • Endoscopic ERCP
  • Hysteroscopy
  • Colonoscopy
  • EGD
  • Sigmoidoscopy

 

For this week’s exercise,  code the following  using the approach “Via natural or artificial opening endoscopic”:

  1. Transurethral cystoscopy with removal of bladder stone.
  2. Hysteroscopy
  3. Colonoscopy in a colostomy patient
  4. EGD

Answer Key 

  1. 0FT44ZZ
  2. 0U5B4ZZ
  3. 099V4ZZ
  4. 0SJD4ZZ

 

Problem #1, Laparoscopic cholecystectomy

To locate:  PCS Index > Cholecystectomy > Resection > see Resection, Gallbladder > 0FT4 > locate table 0FT and go across the row to finish building the code:

Resection of gallbladder, percutaneous approach

Part 8, A

  • Resection versus excision:  The index lists these two choices. If a partial organ removal takes place and there is a portion left behind, such as in a biopsy, it is considered an excision; if the entire organ is removed and there are no remaining remnants left behind, it is considered a resection.
  • Approach:  The term “endoscopic” as used in approach values, refers to instrumentation into the body part to visualize and assist in the performance of a procedure. In our scenario, the instrumentation is the laparoscope.

 

Problem #2, Laparoscopy with destruction of endometriosis

To locate:  PCS Index > Destruction > Endometrium > 0U5B > locate table 0U5 and go across the row to finish building the code:

Destruction of endometrium, percutaneous endoscopic approach

Part 8, B

 

Problem #3, Endoscopic drainage of left ethmoid sinus

To locate:  PCS Index > Drainage > Sinus > Ethmoid > Left > 099V > locate table 099 and go across the row to finish building the code:

Drainage of left ethmoid sinus, percutaneous endoscopic approach

Part 8, C

 

Problem #4, Diagnostic arthroscopy left knee joint

To locate:  PCS Index > Arthroscopy > see Inspection, Lower Joints (refers to table, not PCS Index) > locate the Lower Joints section in the PCS coding book > locate root operation, Inspection, noting that the root operations for the various tables in the Lower Joint section are listed alphabetically > by now you should be in table 0SJ > go across the row to finish building the code:

Inspection of left knee joint, percutaneous endoscopic approach

Part 8, D

For the past several weeks we have focused on devices. Starting with this week’s discussion, we are shifting gears and will be focusing on approaches.

There are 7 approaches in ICD-10-CM:

  1. Open
  2. Percutaneous
  3. Percutaneous Endoscopic
  4. Via natural or artificial opening
  5. Via natural or artificial opening endoscopic
  6. Via natural or artificial opening endoscopic with percutaneous endoscopic assistance
  7. External

This week’s discussion centers on the percutaneous endoscopic approach, which is defined as:

Entry by puncture or minor incision, of instrumentation through the skin or mucous membranes and/or any other body layer necessary to reach and visualize the site of the procedure.

 

Some examples of the percutaneous endoscopic approach include:

  • Laparoscopic cholecystectomy
  • Laparoscopy with destruction of endometriosis
  • Endoscopic drainage of sinus
  • Arthroscopy

 

Code the following problems using the percutaneous endoscopic approach:

  1. Laparoscopic cholecystectomy.
  2. Laparoscopy with destruction of endometriosis.
  3. Endoscopic drainage of ethmoid sinuses, bilaterally.
  4. Knee arthroscopy with biopsy of left knee joint

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

From the Blog

ICD-10-PCS, Root Operations – Part 11, Procedures: Answer Key & Rationale

Answer Key: 0FB13ZX 0BH17EZ 0SNDXZZ 0CTPXZZ 0HB4XZZ 09M0XZZ 095KXZZ   Proread more