Presented by:THIMA ICD 10 Committee
THE OBJECTIVE
OR
ACTION OF THE PROCEDURE
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Alteration Division Inspection Reposition
Bypass Drainage Map Resection
Change Excision Occlusion Restriction
Control Extirpation Reattachment Revision
Creation Extraction Release Supplement
Destruction Fragmentation Removal Transfer
Detachment Fusion Repair Transplantation
Dilation Insertion Replacement
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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
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Character 1
Section
Character 2
Body
System
Character 3
Root Operation
Character 4
Body Part
Character 5
Approach
Character 6
Device
Character 7
Qualifier
5
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Excision
Resection
Extraction
Destruction
Detachment
A Portion of a body part
Without replacing the body part
EXAMPLE: Sigmoid polypectomy
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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)
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
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
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All of a body partWithout replacing a body part
EXAMPLE: Total nephrectomy
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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
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
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.
All or a portion of a body part
Without replacing a body part
EXAMPLE: Toenail extraction Non Excisional
Debridement
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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)
All or a portion of a body part
by the direct use of energy, force, or a destructive agent
EXAMPLE: Rectal polyp fulguration
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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
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)
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
All or a portion of an extremity
Without replacing extremity
EXAMPLE: Below knee amputation
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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
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
OPERATION ACTION TARGET CLARIFICATION EXAMPLE
Excision Cutting out or off
Portion of a body part
Without replacing a body part
Sigmoid polypectomy
Resection Cutting out or off
All of a body part
Without replacing a body part
Total nephrectomy
Extraction Pulling out or off by physical force
All or a portion of the body part
Without replacing a body part
Toenail extraction
Destruction Eradicating All or a portion of the body part
Without replacing a body part
Rectal polyp fulguration
Detachment Cutting off All or a portion of an extremity
Without replacing extremity
Below knee amputation
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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
ICD-9 Procedure Term ICD-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
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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
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