By Ann Barta, MSA, RHIA
Root Operations that Take Out Solids, Fluids, Gases from a Body Part, Involve Cutting or Separation Only, and Put In OR put Back or Move Some OR All of a Body Part
The medical and surgical procedure section of ICD-10-PCS contains most, but not all, procedures typically coded and reported in the hospital inpatient setting. This article is the second in a series explaining ICD-10-PCS root operation groupings in this important and largest section of ICD-10-PCS.
There are 31 root operations in the medical and surgical procedure section of ICD-10-PCS. These root operations are arranged into nine groups that share similar attributes. This article will focus on three of these groups: root operations that take out solids/fluids/gases from a body part; root operations involving cutting or separation only; and root operations that put in/put back or move some/all of a body part.
Root Operations That Take Out Solids, Fluids, Gases from a Body Part
This group of operations includes:
Drainage-Root Operation 9
Drainage is defined as taking or letting out fluids or gases from a body part. The drainage root operation is coded for both diagnostic and therapeutic drainage procedures. When a drainage procedure includes putting in a catheter, the sixth character of the code is the device value “drainage device.”
The qualifier “diagnostic” is available to identify drainage procedures that are biopsies. The qualifier is the seventh character of an ICD-10-PCS code.
Examples of drainage procedures include diagnostic paracentesis, thoracentesis, incision and drainage of abscess, chest tube placement, and Foley catheter placement.
Extirpation-Root Operation C
Extirpation is defined as taking or cutting out solid matter or material from a body part. This root operation represents a range of procedures where the body part itself is not the focus of the procedure. Instead, the objective of an extirpation procedure is to remove solid material such as a foreign body, thrombus, or calculus from the body part with no appreciable amount of the actual body part being taken out.
The solid material may be an abnormal byproduct of a biological function or a foreign body. Additionally, it may be either imbedded in the lumen of a tubular body part or within a body part.
Examples of extirpation include thrombectomy, removal of foreign body, choledocholithotomy, and removal of calculus.
Fragmentation-Root Operation F
Fragmentation is defined as the breaking apart of solid matter in a body part. An important distinction of a fragmentation procedure is that the solid matter is fragmented but not removed from the body. Instead, the pieces of the solid matter are either eliminated or absorbed through normal biological functions.
The fragmented solid material may be either an abnormal byproduct of a biological function or a foreign body.
During a fragmentation procedure, physical force (e.g., ultrasonic, manual) is applied directly or indirectly through intervening body parts to break the solid matter into pieces. Both direct and extracorporeal fragmentation procedures are coded using this root operation.
Examples of fragmentation include extracorporeal shockwave lithotripsy, transurethral cystoscopy with fragmentation of calculus, endoscopic retrograde cholangiopancreatography with lithotripsy, and transurethral lithotripsy.
Root Operations Involving Cutting or Separation Only
This group of operations includes:
Division-Root Operation 8
Division is defined as cutting into a body part without draining fluids or gases from the body part in order to separate or transect the body part. During a division procedure either all or a portion of the body part can be separated into two or more portions.
The division root operation is coded when the objective of the procedure is to cut into, transect, or otherwise separate all or a portion of a body part. When the objective is to cut or separate the area around a body part, the attachments of a body part, or between subdivisions of a body part that are causing abnormal constraints, then release is the correct root operation.
Examples include osteotomy, sacral rhizotomy, anal sphincterotomy, division of a tendon, and spinal cordotomy.
Release-Root Operation N
Release is defined as freeing a body part from an abnormal physical constraint by cutting or by use of force. During a release procedure some of the restraining tissue may be removed but none of the actual body part is removed or taken out.
The objective of procedures represented in the release root operation is to free a body part from abnormal constraint. Release procedures are coded to the body part being freed and not the tissue being manipulated or cut to free the body part. A release procedure can be performed on the area around a body part, on the attachments to a body part, or between subdivisions of a body part that are causing the abnormal constraint.
Examples of release procedures include carpal tunnel release, adhesiolysis, frenulotomy for treatment of tongue-tie syndrome, tendon release, and manual rupture of joint adhesions.
Root Operations That Put in or Put Back or Move Some or All of a Body Part
This group includes the following root operations:
Transplantation-Root Operation Y
Transplantation is defined as putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place or function of all or a portion of a similar body part. During the transplantation procedure the native body part may or may not be removed.
The transplantation root operation represents a small number of procedures and includes only the body parts currently being transplanted. The qualifier, the seventh character of the code, captures the genetic compatibility of the body part transplanted.
Examples include kidney, heart, and liver transplants.
Reattachment-Root Operation M
Reattachment is putting back in or on all or a portion of a separated body part to its normal location or other suitable location. Procedures coded to the reattachment root operation include putting back a body part that has been cut off or avulsed. In the performance of a reattachment procedure the nerves and blood vessels may or may not be reconnected.
Examples of reattachment procedures include reattachment of a severed left ear, reattachment of an avulsed kidney, and replantation of avulsed teeth.
Transfer-Root Operation X
Transfer is defined as moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part. During a transfer procedure the body part is moved to another location without disrupting its vascular and nervous supply. Therefore the body part transferred remains connected to its vascular and nervous supply.
Examples of transfer procedures include skin pedicle flap transfer, skin transfer flap, tendon transfer, TRAM pedicle flap reconstruction, and nerve transfer.
Reposition-Root Operation S
To reposition is to move all or a portion of a body part to its normal location or other suitable location. The reposition root operation is used for those procedures where a body part is moved or relocated to a new position or location. The range of reposition includes moving the body part to its normal location or a new location to enhance the body part’s ability to function.
Examples of reposition procedures include reduction of fractures, reposition of undescended testicle, transposition of a nerve, and repositioning of a ligament.
Centers for Medicare and Medicaid Services (CMS). “2010 ICD-10-PCS Code Tables and Index.” Available online at www.cms.hhs.gov/ICD10.
CMS. “2010 ICD-10-PCS Reference Manual.” Available online at www.cms.hhs.gov/ICD10.
CMS. “ICD-10-PCS Draft Coding Guidelines.” Appendix B in “2010 ICD-10-PCS Reference Manual.” Available online at www.cms.hhs.gov/ICD10.
Ann Barta (firstname.lastname@example.org) is a professional practice resource specialist at AHIMA.
"ICD-10-PCS Root Operation Groups, Part 2"
Journal of AHIMA