(posts in this series: part 1, part 2, part 3, part 4)

Note: The ICD-10-PCS Root Operations Flash Cards have been fully updated to 2017

The Orange Card – Guidelines:
B3.6a Bypass Procedures and B3.12 Occlusion vs. Restriction for vessel embolization procedures

Remember, the orange card covers those “totally tubular” body parts. If the root operation performed is on a body part that isn’t tubular, put this card away and move to another card.

Guideline B3.6a reminds me of Google Maps for those non-coronary tubular body parts. In order to get directions, I have to tell the program my starting point and my destination. It’s the same for the PCS code. It’s the road map for the bypass procedure. It lets the reader know the starting point and the destination. How does it do that? The starting point is identified by the body part in the fourth character of the code and the destination is identified by the qualifier in the 7th character in the code.

Here’s an example of a bypass from the stomach to the jejunum using a laparoscopic approach.

0D168ZA – 6 defines the starting point of the stomach and A – defines the destination of the jejunum.

Do you remember which character defines the approach?

It’s very important in PCS to read the whole definition of the root operations and apply them accordingly. Occlusion and Restriction are certainly no exception. They are very close in their definitions. They both involve closing off the orifice or lumen of a tubular body part. However, Occlusion means total and Restriction means partial. Guideline B3.12 explains that embolization can be used for either Occlusion or Restriction and we need to be sure to read the documentation to determine the intent of the procedure.

Examples:
Embolization of uterine fibroid by totally occluding the blood vessel, coded to the root operation Occlusion – check out table 04LE and 04LF to find this procedure.

Embolization of a cerebral aneurysm by partially filling the aneurysm with the coil, narrowing the lumen, is coded to the root operation Restriction – see table 03VG.

The Green Card – Guidelines:
B6.1a – B6.1c and B6.2 Drainage devices

In order to use the green card, the procedure being performed must be on a device and not a body part. However, a coder first has to understand what a device is and isn’t. These guidelines help us determine that by first defining the sixth character of the PCS code for us, the device. A device is only coded if it’s left in the body after the procedure is completed. The device left behind cannot be sutures, ligatures, radiological markers or temporary post-operative wound drains. Anything else qualifies as a device.

The drainage device guideline tells us to use the drainage root operation when a device is put in for the sole purpose of drainage with the device value of drainage device. This probably belongs on the yellow card, but I kept it with the device guidelines on my green card. Feel free to do with it whatever works best for you.

Next time we’ll look at the purple and fuchsia cards. Until then, hang 10!


For the complete set of the guidelines, click here.

To learn more about the ICD-10 Root Operations Flash Cards, as well as to view a free video tutorial, click here.