Dive into ICD-10-PCS root operations involving repositioning and replacing body parts

Root operations are a new concept in ICD-10-PCS. Coders will need to understand the intent of the procedure in order to select the correct root operation, something they don’t need to do to assign an ICD-9-CM Vol. 3 code.

 

Although the healthcare industry is still waiting for a new ICD-10 implementation date, coders can and should continue learning the root operations definitions, says Gerri Walk, RHIA, CCS, AHIMA-approved ICD-10 trainer, and senior manager of technical training for HRS in Baltimore.

 

The more comfortable coders are with the root operations definitions, the easier it will be for them to code in ICD-10-PCS, Walk says. If coders know the definitions well and are comfortable finding information in the operative reports, organizations should see less of a productivity decline after ICD-10 implementation, she adds.

 

The root operation character sits in the third slot in an ICD-10-PCS code and coders are the ones who decide which root operation to select. According to the ICD-10-PCS Official Guidelines to Coding and Reporting, guideline A11:

 

 

Coders will need to carefully read the operative report to distinguish between the root operations, Walk says.

 

The 31 ICD-10-PCS root operations in the Medical and Surgical section can be divided into nine different categories. One of those groups involves procedures that put in, put back, or move some or all of a body part.

 

Four root operations fall within this group.

 

A strong foundation in anatomy and physiology will also help coders with procedures involving these root operations, says Mark Dominesey, RN, BSN, MBA, CCDS, CDIP, CHTS-CP, director of auditing and CDI Services for TrustHCS in Springfield, Mo.

 

Reattachment (third character M) involves putting back in or on all or a portion of a separated body part to its normal location or other suitable location.

 

Reattachment procedures include putting back a body part that has been cut off or avulsed. The physician may reconnect nerves and blood vessels during the procedure.

 

A physician may reattach a variety of body parts. For example a physician may reattach a severed hand or an avulsed kidney.

 

ICD-10-PCS includes specific qualifiers for the body parts upper tooth and lower tooth to indicate whether a single tooth, multiple teeth, or all teeth were reattached.

 

Reattachment procedures include:

In some cases, a physician may move all or part of a body part to its normal location or another suitable location. These procedures fall under root operation Reposition (S). A common example involves open reduction and internal fixation of a fracture.

 

For example, the physician may perform an open reduction, internal fixation of a left distal humerus fracture. The physician documents the following:

 

 

ICD-10-PCS table 0PS (reposition of upper bones) does not include a body part value for the distal end of the humerus. It includes body part values for the right and left humeral shaft and right and left humeral head. For procedures performed on the distal end of the humerus, use the humeral shaft body part value (see guideline B4.9), Dominesey says.

 

Root operation Transfer(X) denotes 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. The physician does not interrupt the vascular or nervous supply of the body part being moved.

 

Be careful not to confuse Transfer and Reattachment. Transfer involves not only moving a body part but also taking over the function of a body part. Reattachment simply involves putting a separated body part back in or on its normal location or another suitable location. The entire root operation definition must apply to the procedure, Dominesey says.

 

Another thing to note is the body system value. The body system value describes the deepest tissue layer in a flap transfer.

 

In the body systems that classify the subcutaneous tissue, fascia, and muscle body parts, coders will find qualifiers to specify when more than one tissue layer was used in the transfer procedure, such as a musculocutaneous flap transfer.

 

For example, if the physician performs a transfer involving the muscles, coders will choose between these four options:

 

 

For transfers of muscles of the right or left abdomen, coders will find one additional qualifier: 6 (transverse rectus abdominis myocutaneous flap).

 

If the physician performs a transfer of the right neck muscle with subcutaneous tissue using an open approach, report 0KX20Z1.

 

If the physician performs a skin transfer flap closure of complex open wound of the left lower back, report 0HX6XZZ.

 

Certain procedures can fall under more than one root operation depending on the exact intent of the procedure. For example, for reimplantation, the ICD-10-PCS Alphabetic Index directs coders to see:

 

Transplantation(Y)involvesputting in or on all or a portion of a body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part. Examples include kidney transplant and heart transplant.

 

Note that a bone marrow transplant is not included under this root operation, because it is actually an infusion and is coded using a code from the Administration section.

 

Coders will need to know the type of tissue the physician is using so they can choose the correct seventh character:

An allogeneic transplant comes from a non-identical donor of the same species—one person donates a kidney to another person. It can be a family member or a complete stranger.

 

A syngeneic transplant involves an organ from an identical member of the same species (think identical twin).

 

A zooplastic transplant involves a transplant from one species to another, such as pig heart valves implanted into humans.

 

Transplantation includes a small number of procedures and includes only the body parts currently being transplanted.

 

For a liver transplant with donor matched liver, report 0FY00Z0. For a right lung transplant using an organ donor match, report 0BYK0Z0. If the donated lung comes from an identical twin, report 0BYK0Z1.