ICD-10: Operations on Tubular Body Parts by Dr. Helen Walker
The 3rd Character in Procedure coding for ICD-10-PCS is the Root Operation. This is the objective of the Procedure. Let’s look at Root Operations that can be performed only on tubular body parts. These include bypass, dilation and either partial (restriction) or complete occlusion.
Root Operation 1: Bypass
Code the operation as a “Bypass” when the route of passage of a tubular body part is altered. The new route of passage can be a normal or abnormal one. Think anastomosis, shunting, diversion and bypass procedures. Examples include gastric bypass, tracheostomy formation, fem-pop artery bypass, pleuroperitoneal shunt, urinary diversion, coronary artery bypass, and colostomy formation.
Root Operation 7: Dilation
If the objective of the procedure is to expand the orifice or the lumen of a tubular body part, code it as “Dilation”. Note that the orifice can be either a natural or an artificially created one. Methods may be by stretching it or by cutting part of the orifice or wall of the tubular body part. These procedures will be easy to spot as they are usually described with the term “dilation”. Examples include percutaneous transluminal angioplasty, balloon dilation of common bile duct, dilation of bladder neck stricture, trans-nasal dilation of lacrimal duct, and pyloromyotomy.
Root Operation L: Occlusion
An operation is an “Occlusion” when an orifice or lumen of a tubular body part. Is completely closed. The orifice can be a natural or an artificially created one. Terms to look for are ligation, embolization, and occlusion. Fallopian tube ligation, embolization of internal carotid-cavernous fistula, and ligation of inferior vena cava are examples of occlusion procedures.
Root Operation V: Restriction
When the orifice or lumen of a tubular body part is partially closed, the procedure is called “restriction”. As in the occlusion and dilation procedures, the orifice can be either a natural or an artificially created one. These terms may be used in describing restriction procedures: “cerclage, banding, restriction, and clipping. Examples include esophagogastric fundoplication, banding of pulmonary artery, clipping of cerebral aneurysm and cervical cerclage.
Reference: CMS: “2010 ICD-10-PCS Reference Manual” Available online at www.cms.hhs.gov/ICD10