Coding Root Operations with ICD-10-PCS: Understanding Insertion, Supplement, and Removal (2023)

By Theresa Rihanek, MHA, RHIA, CCS

Editor’s note: This is the eighth in a series of 10 articles discussing the 31 root operations of ICD-10-PCS.

In this article, the Journal of AHIMA continues the 10-part Coding Notes series focusing on the 31 root operations of ICD-10-PCS. This article will describe three of the root operations in the Medical and Surgical Section that always involve a device:

  • Insertion
  • Supplement
  • Removal

Insertion: Root Operation H

The definition for the Insertion root operation provided in the 2014 ICD-10-PCS Reference Manual is “Putting in a non-biological device that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part.” The body part value represents the site that the device was placed. The device value represents the type of device that was inserted, such as cardiac lead, intraluminal device, or hearing device.

It is important for coders to remember that if a device is inserted to meet an objective other than Insertion, then the root operation of the underlying objective of the procedure should be used. For example, if a procedure to insert a coronary stent during percutaneous coronary angioplasty is performed, the root operation is Dilation and the intraluminal device is captured in the sixth character. The root operation Dilation is assigned as the objective if the procedure is to expand the lumen of the coronary artery and maintain it with the stent placement.

Some examples of Insertion procedures include placement of a pin in a nondisplaced fracture, placement of a Port-A-Cath, open insertion of a multiple channel cochlear implant of the right ear, and cystoscopy with placement of brachytherapy seeds in the prostate gland.

Comparing ICD-9-CM and ICD-10-PCS: Insertion

The following is an example of how ICD-9-CM and ICD-10-PCS compare when assigning codes for Insertion procedures.

Endobronchial Valve Placement

A patient with a long history of emphysema presents for endobronchial valve placement. The flexible fiberoptic bronchoscope is introduced via the nose and is advanced into the bronchus of the right lower lobe. The valve is released and placement is confirmed.

(Video) ICD-10-PCS Character 3 Root Operations

In ICD-9-CM, the Alphabetic Index main term entry is Insertion; subterms Valve(s), Bronchus, Single Lobe which identifies code 33.71, Endoscopic insertion or replacement of bronchial valve(s), single lobe. This code may be used for either the initial insertion or the replacement of an endobronchial valve. Code 33.71 does not distinguish the specific lobe of the lung that is involved in the procedure.

In ICD-10-PCS, the root operation for this procedure is Insertion as the sole objective of the procedure is to put in a device. The index main term entry is Insertion of device in; subterms include Bronchus, Lower Lobe, Right which directs the user to Table 0BH.

The ICD-10-PCS procedure code for this procedure is 0BH68GZ. The fourth character (6) identifies the body part as the right lower lobe bronchus and the fifth character (8) identifies the approach or technique used to reach the operative site as via natural or artificial opening, endoscopic. The sixth character (G) identifies the device as an endobronchial valve.

Supplement: Root Operation U

The definition for the root operation Supplement provided in the 2014 ICD-10-PCS Reference Manual is “Putting in or on biologic or synthetic material that physically reinforces and/or augments the function of a portion of a body part.” The biologic or synthetic material that is used is captured in the device character as autologous tissue substitute, synthetic substance, nonautologous tissue substitute, and in some cases zooplastic tissue. In Supplement procedures, the body part is not removed—although it may have been previously removed in another procedure.

Examples of Supplement procedures include aortic valve ring annuloplasty, open anterior colporrhaphy with polypropylene mesh reinforcement, and an open resurfacing procedure of the left femoral head.

Comparing ICD-9-CM and ICD-10-PCS: Supplement

The following is an example of how ICD-9-CM and ICD-10-PCS compare in code assignment for Supplement procedures.

Left Inguinal Herniorrhaphy

The patient presents with a left inguinal hernia in need of herniorrhaphy. A groin incision is made and the indirect hernia sac is identified and dissected free. The hernia sac was then ligated. The posterior wall was repaired with Marlex mesh.

In ICD-9-CM, the Alphabetic Index main term entry is Repair, subterms Hernia NEC, Inguinal (unilateral), Indirect, Other and Open, with Prosthesis or Graft. This directs users to code 53.04, Other and open repair of indirect inguinal hernia with graft or prosthesis. This code indicates the procedure was unilateral but does not specify the laterality further.

(Video) Coding With Kate: ICD-10-PCS Root Operations Section 1

The index entry main term is Herniorrhaphy, subterm With Synthetic Substitute, which provides two directional notes—see Supplement, Anatomical Regions, General (0WU) and see Supplement Anatomical Regions, Lower Extremities (0YU). The inguinal region body part is classified in Table 0YU for Anatomical Regions, Lower Extremities. Refer to Coding Guideline B2.1a for further detail, included in the sidebar on page 70.

The ICD-10-PCS procedure code for this scenario is 0YU60JZ. The fourth character (6) identifies the body part as left inguinal region. The sixth character (J) specifies the device as a synthetic substance.

ICD-10-PCS codes do not express diagnostic information in the code descriptor. Notice that the procedure code for the hernia repair in ICD-9-CM specifies the indirect inguinal hernia in the code description.

Removal: Root Operation P

The definition for the root operation Removal provided in the 2014 ICD-10-PCS Reference Manual is “Taking out or off a device from a body part.” Procedures that are classified as Removal encompass a wide array of procedures outside of those for removing devices contained in the root operation Insertion. The root operation Removal is used when the procedure to remove a device is not a component of another root operation. The root operation Removal may be used regardless of the approach or the original root operation by which the device was placed. The sixth character specifies the type of device that is being removed.

Example procedures include non-incisional removal of Swan-Ganz catheter from right pulmonary artery, extubation, endotracheal tube, and removal of external fixator device from left ulnar fracture.

ICD-10-PCS Coding Guidelines: Device General Guidelines

Coding Guideline B6.1a
A device is coded only if a device remains after the procedure is completed. If no device remains, the device value No Device is coded.

Coding Guideline B6.1b
Materials such as sutures, ligatures, radiological markers and temporary post-operative wound drains are considered integral to the performance of a procedure and are not coded as devices.

(Video) ICD-10-PCS Identifying Root Operations

Coding Guideline B6.1c
Procedures performed on a device only and not on a body part are specified in the root operations Change, Irrigation, Removal and Revision, and are coded to the procedure performed.

Source: Centers for Medicare and Medicaid Services. “ICD-10-PCS Draft Coding Guidelines 2014.” 2013. http://www.cms.gov/Medicare/Coding/ICD10/Downloads/PCS-2014-guidelines.pdf.

Comparing ICD-9-CM and ICD-10-PCS: Removal

The following is an example of how ICD-9-CM and ICD-10-PCS compare in code assignment in a Removal procedure.

Removal of Painful Hardware

The patient previously underwent a left ankle fusion five years ago and now presents with painful hardware. An incision was made into the subcutaneous tissue at the lateral malleolus. Screws were identified, removed one after the other in their entirety, and the incision was closed with 0-Vicryl.

In ICD-9-CM, the Alphabetic Index main term entry is Removal; subterms, Fixation Device, Internal, Fibula which direct the coder to 78.67, Removal of implanted devices from bones, tibia and fibula.

The objective of this procedure is to take out the device from the lateral malleolus which equates to the root operation Removal. The Body Part Key may be accessed to identify that the
anatomical term, Lateral malleolus, uses the PCS description Fibula, Right or Left. Another way to identify the anatomical term is through the Alphabetic Index, where there is a main term for Lateral malleolus which states to use Fibula, Right or Left.

The index main term entry is Removal of device from, subterm, Fibula, Left which directs the user to Table 0QP. The complete code for this scenario is 0QPK04Z. The fourth character (K) identifies the body part as the left fibula, the fifth character (0) identifies this as an open procedure, and the sixth character (4) denotes the device that was removed as an internal fixation device. Unlike ICD-9-CM, the ICD-10-PCS procedure code specifies the type of implanted device and specific site.

ICD-10-PCS Coding Guidelines: Body System General Guideline

Coding Guideline B2.1a
The procedure codes in the general anatomical regions body systems should only be used when the procedure is performed on an anatomical region rather than a specific body part (i.e., root operations Control and Detachment, Drainage of a body cavity) or on the rare occasion when no information is available to support assignment of a code to a specific body part.

Source: Centers for Medicare and Medicaid Services. “ICD-10-PCS Draft Coding Guidelines 2014.” 2013. http://www.cms.gov/Medicare/Coding/ICD10/Downloads/PCS-2014-guidelines.pdf.

(Video) ICD-10-PCS Medical and Surgical Section Root Operations

References

Centers for Medicare and Medicaid Services. “2014 Code Tables and Index.” 2013. http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html.

Centers for Medicare and Medicaid Services. “2014 ICD-10-PCS Official Guidelines for Coding and Reporting.” 2013. http://www.cms.gov/Medicare/Coding/ICD10/Downloads/PCS-2014-guidelines.pdf.

Centers for Medicare and Medicaid Services. “2014 ICD-10-PCS Reference Manual.” 2013. http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html.

Theresa Rihanek (theresa.rihanek@ahima.org) is a director of HIM practice excellence at AHIMA.

Article citation:
Rihanek, Theresa. "Coding Root Operations with ICD-10-PCS: Understanding Insertion, Supplement, and Removal" Journal of AHIMA 85, no.1 (January 2014): 68-70.

FAQs

What is an example of a root operation in an ICD-10-PCS code? ›

Root Operations that Take Out Some or All of a Body Part

Excision. Resection. Detachment. Destruction.

How do you find the root operations in ICD-10-PCS? ›

The root operation is the third character in the PCS code and describes the intent or the objective of the procedure. Most PCS codes reported for the inpatient setting are found in the Medical and Surgical section of ICD-10-PCS. There are 31 root operations in this section.

Which of the following procedures would be coded using root operation insertion? ›

The insertion root operation represents those procedures where the sole objective is to put in a device without doing anything else to a body part. Procedures typical of those coded to insertion include putting in a vascular catheter, a pacemaker lead, or a tissue expander.

What does the root operation supplement involve? ›

The definition for the root operation Supplement provided in the 2014 ICD-10-PCS Reference Manual is “Putting in or on biologic or synthetic material that physically reinforces and/or augments the function of a portion of a body part.” The biologic or synthetic material that is used is captured in the device character ...

How many root operations are there in ICD-10-PCS? ›

Basics about Root Operation of ICD-10-PCS

Root operations of ICD-10- PCS include total 31 root operations. Each root operation is aunique by its definition. ICD-10-PCS will be used in place of Volume 3 codes of ICD 9, so it is very essential to get familiar with root operation of ICD -10-PCS.

Which component of the root operation should be coded separately? ›

What component of the Root Operation should be coded separately? subsequent procedures.

What are the steps to be taken to locate an ICD 10 CM code? ›

A Five-Step Process
  1. Step 1: Search the Alphabetical Index for a diagnostic term. ...
  2. Step 2: Check the Tabular List. ...
  3. Step 3: Read the code's instructions. ...
  4. Step 4: If it is an injury or trauma, add a seventh character. ...
  5. Step 5: If glaucoma, you may need to add a seventh character.

What are the three basic steps for locating a diagnosis code? ›

Accomplish this by doing the three-step approach in finding the condition in the alphabetic index, verifying the code and looking for the highest specificity in the tabular index, and reviewing the chapter-specific coding guidelines for any additional guidance.

Which ICD-10-PCS section has only the one root operation of treatment? ›

The Osteopathic section is one of the smallest sections in ICD-10-PCS with only a single body system, Anatomic Regions, and a single root operation, Treatment.

What is the root operation for cutting out or off without replacement All of a body part? ›

Example for Root operation Excision

“Excision” is defined as cutting out or off, without replacement, “a portion” of a body part, while “Resection” is cutting out or off, without replacement, “all” of a body part.

Which root operation means cutting off all or a portion of the upper or lower extremities? ›

The root operation Excision is used when a portion of a body part is cut out, while the root operation Resection is used when all of a body part as defined by the body part value is cut out.

Which of the following root operations is altering the route of passage of the contents of a tubular body part? ›

Bypass-Root Operation 1

Bypass is defined as altering the route of passage of the contents of a tubular body part.

How do supplements prepare for surgery? ›

Therapeutic Supplements for Surgery Recovery
  1. Broad Spectrum Multi Vitamin and Mineral. All known vitamins and minerals are essential before, during and after surgery either to promote healing, enhance immunity or both. ...
  2. Protein. ...
  3. Vitamin C. ...
  4. Zinc. ...
  5. Probiotics. ...
  6. Vitamin D. ...
  7. Curcumin.
5 Jan 2022

What supplements are best for surgery recovery? ›

Vitamins C and E : These antioxidants help the body recover and manage cell damage. Vitamin C helps improve collagen strength, while vitamin E assists in stabilizing cells.

Why is resection The root operation? ›

The root operation “resection” takes out some all of a body part without replacement (all of a body part… no portion of the organ left behind). If PCS contains a specific body part for anatomical subdivision of a body part “resection” would be used when all of the body part is cut out or off.

How many root operations are included in the group procedures that put in put back or move some all of a body part? ›

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.

What is the total number of root operations located within the obstetrics section of ICD-10-PCS? ›

There are a total of 12 root operations in the Obstetrics section, as outlined in Table 2 below. Only two of these root operations are unique to the Obstetrics section—Abortion and Delivery.
...
Table 2: Obstetrics Section Root Operations.
Section ValueSection
HInsertion
JInspection
PRemoval
QRepair
8 more rows

What are the 7 approaches in ICD-10-PCS? ›

ICD-10-PCS describes seven different approaches: open, percutaneous, percutaneous endoscopic, via natural or artificial opening, via natural or artificial opening endoscopic, via natural or artificial opening with percutaneous endoscopic assistance, and external.

Which procedure should be sequenced first when the same root operation is performed on different body parts with distinct values? ›

exam
QuestionAnswer
When the same Root Operation is performed on different body parts with distinct values, the coder shouldassign separate codes for each Body Part character.
What are the appropriate steps when assigning ICD-10-PCS codes?Abstract, assign, arrange
58 more rows

What root operation is assigned for putting back in or on all or a portion of a separated body part to its normal location or other suitable location? ›

Root Operation S: Reposition

The range of Reposition procedures includes moving a body part to its normal location, or moving a body part to a new location to enhance its ability to function.

Which root operations and qualifiers are used to code biopsies? ›

Biopsies are coded to the root operations excision, extraction, or drainage (with the qualifier diagnostic). When only fluid is removed during a needle aspiration biopsy, the root operation would be “drainage”.

What are the 7 steps to accurate coding? ›

7 steps for accurate surgical coding:
  • Review the header of the report.
  • Review the CPT code book.
  • Review the documentation.
  • Make preliminary code selection.
  • Review the guidelines for preliminary codes.
  • Review policies and eliminate the extras.
  • Add any needed modifiers.
27 Apr 2021

What are the basic steps of coding? ›

Basic Steps of Coding
  • Review the health record.
  • Identify the diagnoses and procedures to be coded.
  • Identify the principal diagnosis and the principal procedure.
  • Identify main term(s) in the Alphabetic Index.
  • Review any subterms under the main term in the Alphabetic Index.
3 Jun 2017

What is the first main section of the ICD-10 coding manual? ›

The first three characters of ICD-10-CM are the “category.” The category describes the general type of the injury or disease. The category is followed by a decimal point and the subcategory.

What is the golden rule of medical coding? ›

The golden rule of healthcare billing and coding departments is, “Do not code it or bill for it if it's not documented in the medical record.” Providers use clinical documentation to justify reimbursements to payers when a conflict with a claim arises.

What are the six steps in the coding process? ›

6 Key Steps in the Medical Coding Process
  1. Action 1. Abstract the documentation. ...
  2. Action 2. Query, if necessary. ...
  3. Action 3. Code the diagnosis or diagnoses.
  4. Action 4. Code the procedure or procedures. ...
  5. Action 5. Confirm medical necessity. ...
  6. Action 6. Double-check your codes.
4 Dec 2019

What is the number one rule to remember coding diagnosis? ›

What is the number one rule to remember when coding diagnoses? Never code directly from the index.

What are the root operations in ICD-10-PCS? ›

One of the keys to understanding ICD-10-PCS are the many new definitions and descriptions used to describe the various components of a performed procedure. This article focuses on the definitions of four of the root operations-Division, Release, Control, and Repair-in the Medical and Surgical section.

What is the root operation for pulling or stripping out or off all or a portion of a body part by the use of force? ›

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.

Which of the following route operations is an example of a root operation to take out some or all of a body part? ›

Root operations that take out some or all of a body part include Excision, Resection, Detachment, Destruction, and Extraction. Root operations that take out solids/fluids/gases from a body part include Drainage, Extirpation, and Fragmentation.

What is the root operation for treatment of a non displaced fracture with cast application only? ›

Treatment of a nondisplaced fracture is coded to the procedure performed. Examples: Casting of a nondisplaced fracture is coded to the root operation Immobilization in the Placement section.

Which of the following is an example of the root operation release? ›

Examples: Freeing a nerve root from surrounding scar tissue to relieve pain is coded to the root operation Release. Severing a nerve root to relieve pain is coded to the root operation Division.

What does root operation extraction mean? ›

The definition for the root operation Extraction provided in the ICD-10-PCS Reference Manual is "Pulling or stripping out or off all or a portion of a body part by the use of force." Extraction is coded when the method employed to take out the body part is pulling or stripping, and any minor cutting-such as that used ...

Why do supplements need to be stopped before surgery? ›

For many, it is part of their daily routine. But if you're planning to have surgery, you may need to take a break from some supplements and medications that can interfere with anesthesia. Surgical complications could include heart or bleeding problems, prolonged anesthesia effects, or increased blood pressure.

What supplements should I take before and after surgery? ›

Therapeutic Supplements for Surgery Recovery
  • Broad Spectrum Multi Vitamin and Mineral. All known vitamins and minerals are essential before, during and after surgery either to promote healing, enhance immunity or both. ...
  • Protein. ...
  • Vitamin C. ...
  • Zinc. ...
  • Probiotics. ...
  • Vitamin D. ...
  • Curcumin.
5 Jan 2022

Should magnesium be stopped before surgery? ›

Magnesium will not present any issues with surgery, anesthesia or healing. There would be no reason to stop it.

When should I resume supplements after surgery? ›

One Week Post-Op

One week after your surgery or procedure, you're able to resume your supplement routine. “That's about the time the stitches come out,” Dr. Rabach says.

What is the difference between resection and removal? ›

In the ICD-10-PCS medical coding system, an excision indicates a procedure where a portion of the body is cut out or cut off. A resection is when an entire body part is cut out or cut off. But this doesn't have to be an entire organ or tissue, as often they are coded as a portion of an organ.

What is the difference between resection and biopsy? ›

These are biopsy, the surgical sampling of a small amount of tumor tissue, or resection, where as much as possible of the tumor is surgically removed. Tissues from both operations are then histologically examined to give a definitive diagnosis of the type and grade (severity) of the tumor.

What character position represents the root operation in the ICD-10-PCS code? ›

The third character indicates the root operation, or specific objective, of the procedure (e.g., excision). The fourth character indicates the specific body part on which the procedure was performed (e.g., duodenum). The fifth character indicates the approach used to reach the procedure site (e.g., open).

What is an example of a root operation quizlet? ›

Taking out or off a device from a body part. If a device is taken out and a similar device put in without cutting or puncturing the skin, the procedure is coded to the root operation CHANGE otherwise it is coded REMOVAL. eg. Drainage tube removal; cardiac pacemaker removal.

Which of the following is an example of an ICD-10-PCS code? ›

Here is an example of what an ICD-10-PCS code looks like: 047K0ZZ. This is the ICD-10-PCS code for the dilation of a right femoral artery using an open approach.

How many root operation terms are listed in the Obstetrics section of the ICD-10-PCS book? ›

There are a total of 12 root operations in the Obstetrics section, as outlined in Table 2 below.

How many root operation choices do we have in the extracorporeal or systemic therapies section? ›

The Extracorporeal Assistance and Performance section, for procedures where equipment outside the body is used to assist/perform physiological function, has three unique root operations: Assistance, Performance, and Restoration.

Which root operation is used for control of post procedural bleeding? ›

Control-Root Operation 3

Control is defined as stopping, or attempting to stop, postprocedural bleeding. In the control root operation, the site of the bleeding is coded as an anatomical region and not to a specific body part.

What is the difference between excision and extraction? ›

Definitions of Excision and Extraction: Excision is the cutting out or off, without replacement, a portion of a body part. Extraction is the pulling or stripping out or off all or a portion of a body part with the use of force.

Which is the best example of an operational definition? ›

An Operational Definition is the definition of a variable in terms of the operations or techniques used to measure or manipulate it. Examples: -"Height" as defined by the number of feet/inches a person is tall.

How many characters are used in all ICD-10-PCS codes? ›

There are seven (7) characters in each ICD-10-PCS (Procedural Coding System) code. Each character has a slightly different meaning related to that particular section meaning related to that particular section. Surgical, obstetric, imaging, etc.

What is the easiest way to find ICD-10 codes? ›

A Five-Step Process
  1. Step 1: Search the Alphabetical Index for a diagnostic term. ...
  2. Step 2: Check the Tabular List. ...
  3. Step 3: Read the code's instructions. ...
  4. Step 4: If it is an injury or trauma, add a seventh character. ...
  5. Step 5: If glaucoma, you may need to add a seventh character.

What are the 7 characters of an ICD-10-PCS code? ›

Below are the seven characters that make up an ICD-10-PCS code:
  • 1st character is Section.
  • 2nd character is Body System.
  • 3rd character is Root Operation.
  • 4th character is Body Part.
  • 5th character is Approach.
  • 6th character is Device.
  • 7th character is Qualifier.
5 May 2022

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4. How to find PCS root operations - PCS coding for beginners
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