All Dates That Indicate an October 1, 2013 Implementation Date Should Be Changed to State

ANSWER KEY

Chapter 1

2013 Updates

All dates that indicate an October 1, 2013 implementation date should be changed to state October 1, 2014.

Test Your Knowledge

3.D

5.A

Code Building

1.1This is a resection, as the complete body part, the gall bladder is removed. The definition for the root operation removal involves taking out a device from a body part.

1.2Resection, gallbladder

1.30FT

1.44—gallbladder

1.54—percutaneous endoscopic

1.6Z and Z for No Device and No Qualifier

1.70FT44ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Hepatobiliary System and Pancreas / Resection / Gallbladder / Percutaneous Endoscopic / No device / No qualifier
0 / F / T / 4 / 4 / Z / Z

3.1The main term orchiopexy has two cross references:see Repair, Male Reproductive System and see Reposition Male Reproductive System

3.2Because the objective of the procedure is to place the undescended testicles into their proper spot, the correct root operation, Reposition—moving to its normal location, or other suitable location, all or a portion of a body part, is selected

3.3Reposition, Male Reproductive System

3.40VS

3.5C for bilateral as the clinical documentation states testicles

3.60 for Open

3.7Z and Z for No Device and No Qualifier

3.80VSC0ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Male Reproductive System / Reposition / Testis, Bilateral / Open / No device / No qualifier
0 / V / S / C / 0 / Z / Z

Chapter 2

2013 Updates

Coding Guideline A5 on page 31 updated. The last sentence now reads “Example: In the Lower Joints body system, the device value 3 in the root operation Insertion specifies Infusion Device and the device value 3 in the root operation Replacement specifies Ceramic Synthetic Substitute.”

Coding Guideline B3.1b on page 35 updated. The Guideline now reads:

“Components of a procedure specified in the root operation definition and explanation are not coded separately. Procedural steps necessary to reach the operative site and close the operative site, including anastomosis of a tubular body part, are also not coded separately.”

Also, in this Guideline there is a sentence added to the Example that reads: “In a resection of sigmoid colon with anastomosis of descending colon to rectum, the anastomosis is not coded separately.”

New Coding Guideline B4.8 to be added on page 46

B4.8

In the Gastrointestinal body system, the general body part values Upper Intestinal Tract and Lower Intestinal Tract are provided as an option for the root operations Change, Inspection, Removal and Revision. Upper Intestinal Tract includes the portion of the gastrointestinal tract from the esophagus down to and including the duodenum, and Lower Intestinal Tract includes the portion of the gastrointestinal tract from the jejunum down to and including the rectum and anus.

Example:In the root operation Change table, change of a device in the jejunum is coded using the body part Lower Intestinal Tract.

Substitute the following Approach Decision Tree for Figure 2.5 on page 46

Answer Key

Check Your Understanding

1.c (B5.3a)

3.c (B3.4)

5.c (A9)

7.b (B3.10c)

9.c (B2.1b)

Case Studies

Case 1

a. Resection. Rationale: see Guideline B3.8—the entire body part is taken out

b. 2 the laparoscopic cholecystectomy and the liver biopsy

c. 0FT44ZZ, 0FB04ZX

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Hepatobiliary
System and Pancreas / Resection / Gallbladder / Percutaneous Endoscopic / No Device / No Qualifier
0 / F / T / 4 / 4 / Z / Z
Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Hepatobiliary
System and Pancreas / Excision / Liver / Percutaneous Endoscopic / No Device / Diagnostic
0 / F / B / 0 / 4 / Z / X

Case 3

a. 2

b. 0CBV8ZZ,0CBT8ZZ

Rationale: See the Index main term Excision, subterms Vocal Cord, Left, Vocal Cord, Right

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Mouth and Throat / Excision / Vocal Cord, Left / Via Natural or Artificial Opening, Endoscopic / No Device / No Qualifier
0 / C / B / V / 8 / Z / Z
Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Mouth and Throat / Excision / Vocal Cord, Right / Via Natural or Artificial Opening, Endoscopic / No Device / No Qualifier
0 / C / B / T / 8 / Z / Z

B3.2.a—multiple procedures are coded if the same root operation is performed on different body parts as defined by distinct values of the body part character.

B3.11a—Inspection of a body part(s) performed in order to achieve the objective of a procedure is not coded separately.

Chapter 3

2013 Updates

There are no 2013 updates for Chapter 3

1.b

3.c

5.b

7.d

Which Root Operation Is It?

Root Operation: Resection

ICD-10-PCS Code: 0FT20ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Hepatobiliary System and Pancreas / Resection / Liver, Left Lobe / Open / No Device / No Qualifier
0 / F / T / 2 / 0 / Z / Z

3.Root Operation: Extirpation

ICD-10-PCS Code: 0TC43ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Urinary System / Extirpation / Kidney Pelvis, Left / Percutaneous / No Device / No Qualifier
0 / T / C / 4 / 3 / Z / Z

5.Root Operation: Extraction

ICD-10-PCS Code: 07DR3ZX

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Lymphatic and Hemic Systems / Extraction / Bone Marrow, Iliac / Percutaneous / No Device / Diagnostic
0 / 7 / D / R / 3 / Z / X

7.Root Operation: Destruction

ICD-10-PCS Code: 015C3ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Peripheral Nervous System / Destruction / Pudendal Nerve / Percutaneous / No Device / No Qualifier
0 / 1 / 5 / C / 3 / Z / Z

9.Root Operation: Fragmentation

ICD-10-PCS Code: 0TF78ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Urinary System / Fragmentation / Ureter, Left / Via Natural or Artificial Opening, Endoscopic / No Device / No Qualifier
0 / T / F / 7 / 8 / Z / Z

Chapter 4

2013 Updates

There are no 2013 updates for Chapter 4

Check Your Understanding

3.a

5.c

7.c

9.d

Which Root Operation Is It?

Root Operation: Release

ICD-10-PCS Code: 0DN34ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Gastrointestinal
System / Release / Esophagus, Lower / Percutaneous
Endoscopic / No Device / No Qualifier
0 / D / N / 3 / 4 / Z / Z

3.Root Operation: Reposition

ICD-10-PCS Code: 0MSN4ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Bursae and Ligaments / Reposition / Knee Bursae and Ligaments, Right / Percutaneous
Endoscopic / No Device / No Qualifier
0 / M / S / N / 4 / Z / Z

5.Root Operation: Transfer

ICD-10-PCS Code: 01X50Z4

The Anterior Interosseous nerve is not listed under the main term Transfer, Nerve. See the Body Part Index and/or the Index under the Anterior Interosseous Nerve, use Nerve, Median.

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Peripheral Nervous
System / Transfer / Median Nerve / Open / No Device / Ulnar
Nerve
0 / 1 / X / 5 / 0 / Z / 4

7.Root Operation: Division

ICD-10-PCS Code: 0Q860ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Lower Bones / Division / Upper Femur, Right / Open / No Device / No Qualifier
0 / Q / 8 / 6 / 0 / Z / Z

9.Root Operation: Transplantation

ICD-10-PCS Code: 0TY00Z0

Medical and Surgical / Urinary System / Transplantation / Kidney, Right / Open / No
Device / Allogeneic
0 / T / Y / 0 / 0 / Z / 0

Chapter 5

2013 Updates

Which Root Operation Is It? #11 C. Change to read: What are the codes?

Check Your Understanding

3.c

5.b

7.b

Which Root Operation Is It?

Root Operation: Occlusion

ICD-10-PCS Code: 0DL34CZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Lower Veins / Occlusion / Gastric Vein / Percutaneous / No Device / No Qualifier
0 / 6 / L / 2 / 3 / Z / Z

3.Root Operation: Occlusion

ICD-10-PCS Code: 02L73DK

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Heart and Great Vessels / Occlusion / Atrium, Left / Percutaneous / Intraluminal Device / Left Atrial Appendage
0 / 2 / L / 7 / 3 / D / K

5.Root Operation: Supplement

ICD-10-PCS Code: 0SUS0BZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Lower Joints / Supplement / Hip Joint, Femoral Surface, Left / Open / Resurfacing Device / No Device
0 / S / U / S / 0 / B / Z

7.Root Operation: Restriction

ICD-10-PCS Code: 02VW0DJ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Heart and Great Vessels / Restriction / Thoracic Aorta / Open / Intraluminal
Device / Temporary
0 / 2 / V / W / 0 / D / J

9.Root Operation: Replacement, Valvuloplasty, see Replacement
Refer to Index under the term Sapien transcatheter aortic valve—use Zooplastic Tissue in Heart and Great Vessels

ICD-10-PCS Code: 02RF38Z

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Heart and Great Vessels / Replacement / Aortic Valve / Percutaneous / Zooplastic Tissue / No Device
0 / 2 / R / F / 3 / 8 / Z

11. a. 5

b. Bypass and Excision

c. 02100Z9, 02100AW, 021109W, 03BC4ZZ, 06BQ4ZZ

LIMA to LAD – 02100Z9

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Heart and Great Vessels / Bypass / Coronary Arteries, One Site / Open / No Device / Internal Mammary
0 / 2 / 1 / 0 / 0 / Z / 9

Aorta to PDA via Left Radial artery graft- 02100AW

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Heart and Great Vessels / Bypass / Coronary Arteries, One Site / Open / Autologous Arterial Tissue / Aorta
0 / 2 / 1 / 0 / 0 / A / W

Aorta to diagonal and obtuse marginal via Left saphenous graft -021109W

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Heart and Great Vessels / Bypass / Coronary Arteries, Two Sites / Open / Autologous Venous Tissue / Aorta
0 / 2 / 1 / 1 / 0 / 9 / W

Excision of left radial artery -03BC4ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Upper Arteries / Excision / Radial Artery, Left / Percutaneous Endoscopic / No Device / No Qualifier
0 / 3 / B / C / 4 / Z / Z

Excision of left saphenous graft-06BQ4ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Lower Veins / Excision / Greater Saphenous Vein, Left / Percutaneous Endoscopic / No Device / No Qualifier
0 / 6 / B / Q / 4 / Z / Z

Chapter 6

2013 Updates

Which Root Operation Is It?

Change #8 to read: “A patient undergoes a female to male gender reassignment operation in which a penis is created using autografts that were previously harvested from both arms and saved in a tissue bank.”

Check Your Understanding

3.c

7.c

Which Root Operation Is It?

1.Root Operation: Repair

ICD-10-PCS code: 0MQ24ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Bursae and Ligaments / Repair / Shoulder and Bursae and LigamentLeft / Percutaneous
Endoscopic / No Device / No Qualifier
0 / M / Q / 2 / 4 / Z / Z

3.Root Operation: Control

ICD-10-PCS code: 0W380ZZ

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Anatomical Regions, General / Control / Chest Wall / Open / No Device / No Qualifier
0 / W / 3 / 8 / 0 / Z / Z

5.Root Operation: Fusion

ICD-10-PCS code: 0SG00K1, 0SG30K1

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Lower Joints / Fusion / Lumbar Vertebral Joint / Open / Nonautologous Tissue Substitute / Posterior Approach, Posterior Column
0 / S / G / 0 / 0 / K / 1
Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Lower Joints / Fusion / Lumbosacral Joint / Open / Nonautologous Tissue Substitute / Posterior Approach, Posterior Column
0 / S / G / 3 / 0 / K / 1

7.Root Operation: Creation

ICD-10-PCS code: 0W4M070

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Anatomical Regions, General / Creation / Perineum, Male / Open / Autologous Tissue Substitute / Vagina
0 / W / 4 / M / 0 / 7 / 0

9.Root Operation: Fusion

ICD-10-PCS code: 0RGS04Z

Section / Body System / Root Operation / Body Part / Approach / Device / Qualifier
Medical and Surgical / Upper Joints / Fusion / Metacarpocarpal
Joint, Right / Open / Internal Fixation Device / No Qualifier
0 / R / G / S / 0 / 4 / Z

Chapter 7

2013 Updates

Update Guideline box B2.1b to read:Where the general bodypart values “upper” and “lower” are provided as an option in the Upper Arteries, LowerArteries, Upper Veins, Lower Veins,MusclesandTendons body systems, “upper” or“lower” specifiesbody parts located above or below the diaphragm, respectively.Example: Vein body parts abovethediaphragmare found in the Upper Veins body system; veinbody partsbelow the diaphragmare found in theLower Veins body system.

Update Coding Knowledge Check #2 to read “The surgeon repairs a traumatic complete right thumb amputation. How is this coded?”

Answer Key

Check Your Understanding

Answer: upper, scapula, clavicle

Rationale: The body part value Forequarter describes the entire upper limb plus the scapula and clavicle.

Answer: d

Rationale: This is a complete detachment of the 3rd day, based on the definition of amputation through the tarsal-metatarsal joint of the foot. This definition is the same as amputation at the most proximal portion of the metatarsal.

Answer: True

Rationale: The body part value describes the body part at the start of the procedure and the qualifier describes the body part created in the surgical procedure.

Procedure statement coding

Root: Repair; Code: 0WQ6XZ2

Rationale: This procedure involves the repair of the neck (Anatomical regions, general), rather than revision of the tracheostomy tube, therefore the root operation is Repair. The approach is X, External and the qualifier is 2, Stoma.

Root operation: Alteration; Code: 0Y0C3ZZ

Root operation: Alteration; Code: 0Y0D3ZZ

Root operation: Alteration; Code: 0W0F0ZZ

Rationale: These procedures are cosmetic in nature. There are individual body part values for each thigh region (upper leg). There is a single body part value for the abdominal wall. The liposuction is performed percutaneously and the abdominoplasty is an open procedure. No devices or qualifiers are appropriate for either procedure.

Root: Detachment;Code: 0X6W0Z0

Rationale: Because the supernumerary digit contains bone and nail, the root operation Detachment is coded. If the supernumerary digit was composed only of skin, the root operation Destruction would be assigned. The qualifier value 0 is for a complete amputation of the little finger of the left hand.

Case study coding

ICD-10-PCS code: 0W9900Z

Rationale: Insertion of a chest tube is coded to the root operation Drainage, with a device value of 0 for a drainage device. The body part value of 9 is assigned for the pleural cavity on the right side.

ICD-10-PCS code: 0YU60JZ

Rationale: The documentation states that mesh was implanted. Therefore, the root operation Supplement is assigned. The left inguinal region is body part value 6 and a device value of J, Synthetic substitute is assigned. No qualifier is appropriate.

ICD-10-PCS code: 0WPG3YZ, 0WHG3YZ

Rationale: The root operation is not Change because there was an incision made and the tube was placed in a new location. Therefore, this is the root operation Removal and the root operation Insertion.

ICD-10-PCS code: 0W33XZZ

Rationale: The root operation Control is coded because the bleeder is the result of a previous procedure. When cautery is used to stop post-op bleeding, Control is the appropriate root operation. The tonsillar area is coded to the body part value of 3, Oral cavity and throat. The approach value is X, External.

ICD-10-PCS code: 0Y910ZZ, 0WJP8ZZ

Rationale: The root operation Drainage is used to describe the incision and drainage procedure. The left buttock is identified with body part value 1 in the Anatomical Regions, Lower Extremities body system. The root operation Inspection is coded to the gastrointestinal tract. There is no index entry for rectum or anus under the root operation Inspection. The inspection is performed with an anoscope, which is an endoscopic instrument.

Chapter 8

2013 Updates

Update Figure 8.5 to read “Tibial” instead of Tinial as one of the lumbar nerves.

Update Procedure Statement Coding #1 to read “Submuscular transposition of pinched ulnar nerve, right elbow, open.”

Answer Key

Check Your Understanding

1.b

Rationale: Accessing the index under cubital nerve directs the coder to Use Nerve, ulnar. The root operation Repair is used to code procedures involving sutured lacerations. Under Repair, nerve, ulnar, the coder is directed to 01Q4. Therefore, the correct option is b.

3.c

Rationale: There are several large cisterns in the brain that may be documented with unique names such as magna, cerebromedullary, pontine, superior, or ambient.

5.cerebral, peritoneal

Rationale: The cerebral ventricle is the source of the bypass and the peritoneal cavity is the body part bypassed to, in a ventriculoperitoneostomy, also called a VP shunt procedure.

Procedure statement coding

Root Operation: Reposition; Code: 01S40ZZ

Rationale: The root operation Reposition is used to code transposition procedures where body parts are moved to a more suitable location. The body part value 4, Ulnar Nerve is assigned for this procedure using an open approach. No device or qualifier values are appropriate for this code.

Root Operation: Destruction; Code: 015H3ZZ

Rationale: The root operation Destruction is coded because the nerve is destroyed by the use of a neurolytic agent. The common fibular nerve is part of body part value H, Peroneal Nerve, based on the index cross-reference. The approach is percutaneous.

Root Operation: Excision; Code: 00B70ZX

Rationale: The root operation Excision is used to code this procedure. A portion of the parietal lobe of the brain is removed via an open approach (craniectomy). The index directs the coder to Use Cerebral Hemisphere. This is a biopsy because the pathological identification is not known at the start of the procedure. Therefore, the qualifier X, Diagnostic is assigned.

Root Operation: Map; Code: 00K83ZZ

Rationale: The root operation Map is coded for this procedure. The basal ganglia, body part value 8, is mapped using a percutaneous approach.

Case study coding

ICD-10-PCS code: 0PBH0ZX, 0JBG0ZX, 01N60ZZ

Rationale: The root operation Excision is used to code this procedure because debridement using a sharp instrument is Excision. Both the radius bone and the subcutaneous layer of the lower arm were excised. The root operation Release is used to code the freeing of the radial nerve from the scar tissue. All three procedures are performed using an open approach. The excised bone and subcutaneous tissue were sent for identification and, therefore, the qualifier X, Diagnostic is assigned.

ICD-10-PCS code: 00C40ZZ

Rationale: The root operation Extirpation is used to code the evacuation of the subdural hematoma. The craniotomy is the open approach for the procedure. The body part value is 4, subdural space because the hematoma was located subdurally. No device value is appropriate because the Jackson-Pratt drain is a short-term, post-operative drain. No qualifier value is appropriate for this code.