More on ICD-10-PCS: Coding Procedures by Dr. Helen Walker

A quick review: The procedure codes in ICD-10-PCS contain 7 characters. Each character has a specific meaning:

1 2 3 4 5 6 7
Section Body System Root Operation Body Part Approach Device Qualifier

The 3rd character is the “Root Operation”. This is the objective of the procedure. There are 31 root operations grouped according to 9 different attributes.

  • Operations that take out or eliminate all or a portion of a body part
  • Operations that take solids, fluids or gasses from a body part
  • Operations that involve only cutting or separation
  • Operations that put in, put back or move a body part
  • Operations that are performed only on tubular body parts
  • Operations that always involve devices
  • Operations that involve only an examination of body parts
  • Operations that include other repairs
  • Operations that include other objectives

 Let’s take a closer look at the 5 Root operations that take out or eliminate all or some of a body part

  • Excisions (Root Operation B) involve cutting out or off, without replacement, a portion of a body part. Examples include partial nephrectomy, liver biopsy, breast lumpectomy, sigmoid polypectomy. Note that bone marrow and endometrial biopsies are not excisions but “extractions”. The qualifier “diagnostic” is added to identify excision procedures that are biopsies
  • Resections (Root Operation T) involve cutting out or off all of a body part, without replacement. This includes total nephrectomy, total lobectomy of lung, total mastectomy, prostatectomy and cholecystectomy. When an entire lymph node chain is cut out, it is a resection; if it is just a lymph node it is an excision.
  • Detachments (Root Operation 6) refer to amputations of all or part of the upper or lower extremities. Use a qualifier to further specify the level where the extremity was detached.
  • Destruction (Root Operation 5) refers to eradication of a portion or all of a body part by the use of energy, force or a destructive agent. This would include fulgaration, ablation, cryotherapy and cautery. Note: None of the body part is taken out.
  • Extractions (Root Operation D) refer to pulling or stripping out or off all or a portion of a body part with force. Examples include nonexcisional debridement of skin, teeth extraction, bone marrow biopsy, endometrial biopsy, dilation and curettage, vein stripping, and liposuction. The Qualifier “Diagnostic” is used to identify extraction procedures that are biopsies.

Next month: A review of operations that take solids, fluids or gases from a body part.

Reference: CMS: “2010 ICD-10-PCS Reference Manual” Available online at www.cms.hhs.gov/ICD10

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