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ICD-10-PCS Root Operations – Extraction, Destruction, Detachment

By Lauri Gray, CPC, RHIT
January 04, 2012

Last month in the root operation series we discussed excision and resection which are two of the five root operations that are performed for the purpose of taking out or eliminating all or a portion of a body part. This article covers the remaining three operations in this category – extraction, destruction, and detachment. All five root operations are summarized in the table below.

Procedures That Take Out or Eliminate a Portion of a Body Part

Root Operation Definition

Value

Excision Cutting out or off, without replacement, a portion of a body part

B

Resection Cutting out or off, without replacement, all of a body part

T

Extraction Pulling or stripping out or off all or a portion of a body part by the use of force

D

Destruction Physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent

5

Detachment Cutting off all or a portion of the upper and lower extremities

6

Extraction

Extraction involves pulling or stripping out all or a portion of a body part using force. Minor cutting may be involved but the primary method employed to remove the body part must be physical force. When an extraction is performed to obtain tissue for diagnostic purposes, the 7th character qualifier X is used to identify the procedure as a diagnostic procedure or biopsy. Common terminology used to describe an extraction procedure includes:

  • Abrasion
  • Avulsion
  • Curettage
  • Debridement, nonexcisional
  • Decortication
  • Dermabrasion
  • Neurexeresis
  • Phacoemulsification, without lens implant
  • Phlebectomy
  • Removal
  • Stripping
  • Suction curettage

Two types of surgical instruments frequently used for extraction procedures are curettes and suction devices.

Examples of procedures coded as extraction include:

  • Bilateral ligation, division, and stripping long saphenous veins from saphenofemoral junction to knee
  • Forceps removal of right thumbnail
  • Nonexcisional debridement of skin of left lower leg
  • Suction dilation and curettage (D&C)
  • Endocervical tissue sample obtained by curettage
  • Lung decortication
  • Phacoemulsification lens, right eye, without IOL

Destruction

Destruction involves physical eradication or obliteration of all or a portion of a body part using energy, force or a destructive agent. Because none of the body part is removed, destruction procedures are never reported with the qualifier X for diagnostic. In addition, there is never a pathology report associated with the root operation destruction. Common terminology associated with destruction procedures includes:

  • Ablation
  • Cauterization
  • Chemodenervation
  • Chemosurgery
  • Coagulation
  • Cryoablation
  • Cryotherapy
  • Cyclodiathermy
  • Cyclophotocoagulation
  • Denervation
  • Electrocautery
  • Fulguration
  • Laser ablation/surgery
  • Neurotripsy
  • Obliteration
  • Photocoagulation
  • Sclerotherapy
  • Thermocautery
  • Thermotherapy

Instruments associated with destruction procedures include: cryoprobes, lasers, and thermal, electrical, and radiofrequency devices.

Examples of procedures coded as destruction include:

  • Endovenous laser ablation, right short saphenous vein
  • Ablation of endometrial implants in the fallopian tubes bilaterally
  • Lumbar facet joint radiofrequency denervation, L4
  • Destruction arrhythmogenic focus, A-V node
  • Percutaneous radiofrequency ablation pulmonary tumor of left upper lobe
  • Chemodenervation left trigeminal nerve
  • Cryosurgical ablation of prostate

Detachment

Detachment involves cutting off all or a portion of the upper or lower extremities. In other words, this is the root operation that describes an amputation procedure. Detachment procedure codes apply to only two body systems in ICD10PCS – Anatomical Regions, Upper Extremities (value X) and Anatomical Regions, Lower Extremities (value Y). The site of the amputation is designated by the body part value which is the fourth character in the 7 character procedure code. The site of the amputation may be further described by the qualifier value which is the seventh character in the procedure code.  The qualifiers for arm and leg amputations include:

  • High – amputation at the proximal portion (shaft) of the upper or lower arm or upper or lower leg
  • Mid – amputation at the mid-portion (shaft) of the upper or lower arm or upper or lower leg
  • Low – amputation at the distal portion (shaft) of the upper or lower arm or upper or lower leg

Qualifiers for amputations of the hands or feet are designated as either complete or partial. Complete amputation requires amputation through the carpometacarpal joint of the hand or through the tarsometatarsal joint of the foot. Partial amputation refers to amputation at any site along the metacarpal or metatarsal bone. The qualifiers for hand and foot amputations include:

  • Complete – the entire hand at the carpometacarpal joints or foot at the tarsometatarsal joints
  • Complete 1st ray – entire 1st metacarpal/metatarsal with phalanges
  • Complete 2nd ray – entire 2nd metacarpal/metatarsal with phalanges
  • Complete 3rd ray – entire 3rd metacarpal/metatarsal with phalanges
  • Complete 4th ray – entire 4th metacarpal/metatarsal with phalanges
  • Complete 5th ray – entire 5th metacarpal/metatarsal with phalanges
  • Partial 1st ray – part of the 1st metacarpal/metatarsal with phalanges
  • Partial 2nd ray – part of the 2nd metacarpal/metatarsal with phalanges
  • Partial 3rd ray – part of the 3rd metacarpal/metatarsal with phalanges
  • Partial 4th ray – part of the 4th metacarpal/metatarsal with phalanges
  • Partial 5th ray – part of the 5th metacarpal/metatarsal with phalanges

The qualifiers for the thumb, fingers, and toes include:

  • Complete – amputation at the metacarpophalangeal or metatarsophalangeal joint
  • High – amputation anywhere along the proximal phalanx
  • Mid – amputation through the proximal interphalangeal (PIP) joint or anywhere along the middle phalanx
  • Low – amputation through the distal interphalangeal (DIP) joint or anywhere along the distal phalanx

Common terminology used to describe detachment procedures includes:

  • Amputation
  • Disarticulation

Examples of detachment procedures include:

  • Right forequarter amputation
  • Left hindquarter amputation
  • Disarticulation at the left elbow
  • Midtarsal amputation left foot
  • Right great toe amputation at metatarsophalangeal joint
  • Re-amputation at mid-calf level right leg

Coding Examples

Example 1: Nonexcisional debridement skin of left lower leg

0HDLXZZ

0 Section – Medical and Surgical
H Body System – Skin and Breast
D Root Operation – Extraction
L Body Part – Left Lower Leg
X Approach – External
Z Device – No Device
Z Qualifier – No Qualifier

Example 2: Percutaneous radiofrequency ablation pulmonary tumor of left upper lobe

0B5G3ZZ

0 Section – Medical and Surgical
B Body System – Respiratory
5 Root Operation – Destruction
G Body Part – Left Lung, Upper Lobe
3 Approach – Percutaneous
Z Device – No Device
Z Qualifier – No Qualifier

Example 3: Right great toe amputation at metatarsophalangeal joint

0Y6P0Z0

0 Section – Medical and Surgical
Y Body System – Lower Extremity
6 Root Operation – Detachment
P Body Part – Right 1st Toe
0 Approach – Open
Z Device – No Device
0 Qualifier – Complete
 

More Articles in January 2012

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