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ICD-10-PCS Says Extirpation – What Does the Physician’s Documentation Say?

By Lauri Gray, CPC, RHIT
February 01, 2012

If you have not glanced at the Operations Table in ICD-10-PCS and reviewed the 31 root operations listed there for the Medical and Surgical section of ICD-10-PCS, you might wonder what the word “extirpation” has to do with coding. The word extirpation is not one that most of us see in documentation of surgical procedures. Searching Google for the word extirpation brought up a definition on the Wikipedia website of “local extinction of a species or other taxon, the condition where a species ceases to exist in a geographic area in which it had previously existed but continues to exist elsewhere.” Another definition found in Merriam-Webster online was “complete excision or surgical destruction of a body part.” That definition brings us a little closer to the ICD-10-PCS definition, but it is still not the exact definition used for coding purposes.

For ICD-10-PCS coding purposes, extirpation is defined and explained as follows:

ExtirpationRoot Operation Value – C Definition Taking or cutting out solid matter from a body part
Explanation The solid matter may be an abnormal product of a biological function or a foreign body; it may be imbedded in a body part or the lumen of a tubular body part. The solid matter may or may not have been previously broken into pieces.

Armed with this definition and explanation of the procedure, it is the coder’s job to determine what the current procedural terminology is for procedures that will be coded as extirpation. The operations table provides two examples, thrombectomy and choledocholithotomy. These are both examples of an abnormal product of a biological function (blood clot, calculus) contained within the lumen of a tubular body part (blood vessel, bile duct). Also included in the scope of extirpation are procedures involving the removal of a foreign body in the lumen of a tubular body part, such as removal of an aspirated peanut from the trachea, or from other sites, such as removal of a metal fragment from the sclera or loose cartilage from the knee joint.

Related Procedures

There are a number of helpful tables in ICD-10-PCS that define terms, such as Operations and Approaches, and one that groups similar procedures together. Extirpation is grouped with two other procedures, drainage and fragmentation, as operations that have the objective of taking out or eliminating solid matter, fluids, or gases from a body part. Drainage and fragmentation were discussed in more detail in last week’s article. The table below compares and contrasts these three procedures to help the coder understand the concept of extirpation better.

Procedures That Take Out Solid Matter, Fluids, or Gases from A Body Part

Operation Action Target Clarification Example
Drainage Taking or letting out Fluids and/or gases from a body part Without taking out any of the body part Incision and drainage
Extirpation Taking or cutting out Solid matter in a body part Without taking out any of the body part Thrombectomy
Fragmentation Breaking down Solid matter in a body part Without taking out any of the body part or any solid matter Lithotripsy of gallstones

While drainage is easily distinguishable from extirpation, fragmentation and extirpation procedures have the potential to be confused. The key difference between extirpation and fragmentation is that for extirpation, the solid matter is removed, while in fragmentation it is not removed but rather eliminated or absorbed through normal biological functions. So, lithotripsy of a ureteral calculus without removal would be reported as fragmentation while lithotripsy of the calculus with removal would be reported as extirpation.

Coding Examples – Extirpation

Example 1:  Open choledocholithotomy –  0FC90ZZ

0 Section – Medical and Surgical
F Body System – Hepatobiliary system and pancreas
C Root Operation – Extirpation
9 Body Part – Common bile duct
0 Approach – Open
Z Device – No Device
Z Qualifier – No Qualifier

Example 2:  Tracheoscopy with extraction of peanut partially obstructing trachea –  0BC18ZZ

0 Section – Medical and Surgical
B Body System – Respiratory
C Root Operation – Extirpation
1 Body Part – Trachea
8 Approach – Via Natural or Artificial Opening Endoscopic
Z Device – No Device
Z Qualifier – No Qualifier

Example 3:  Exploration of right eye with removal of BB gun pellet from sclera –  08C6XZZ

0 Section – Medical and Surgical
8 Body System – Eye
C Root Operation – Extirpation
6 Body Part – Right Sclera
X Approach – External
Z Device – No Device
Z Qualifier – No Qualifier
 

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