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ICD-10-PCS Medical and Surgical Root Operations That Always Involve Devices, Part 2

By Lauri Gray, CPC, RHIT
March 08, 2012

Last week 3 of the 6 Medical and Surgical Section root operations that always involve the use of devices, insertion, replacement and removal, were reviewed. This week’s article will discuss change, supplement, and revision.

Before discussing these root operations the ICD-10-PCS definition of a device must be understood. ICD-10-PCS recognizes four general types of devices which include:

  • Biological or synthetic material that takes the place of all or a portion of a body part, such as a skin graft or a joint prosthesis
  • Biological or synthetic material that assists or prevents a physiological function, such as an intrauterine device
  • Therapeutic material that is not absorbed by, eliminated by, or incorporated into a body part, such as a radioactive implant
  • Mechanical or electronic appliances used to assist, monitor, take the place of or prevent a physiological function, such as a cardiac pacemaker or orthopedic pin

For ICD-10-PCS coding purposes only devices that remain in place after the procedure has been completed are included. In addition, materials incidental to a procedure, such as clips, ligatures, and sutures are not considered devices.

One of the key components of the root operations included in this category is that these procedures always involve devices. There are procedures that sometimes require the use of devices but do not always involve devices, such as the root operation reposition. Reposition is the root operation assigned for fracture reduction. Fracture reduction sometimes requires the use of devices, such as pins, screws, and/or plates; however, fracture reduction does not always involve the use of a device. Therefore, reposition is not included in the same category as insertion, replacement, removal, change, supplement and revision.

Procedures That Always Involve Devices

Root Operation Definition


Insertion Putting in a nonbiological appliance that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part


Replacement Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part


Removal Taking out or off a device from a body part


Change Taking out or off a device from a body part and putting back an identical or similar device in or on the same body part without cutting or puncturing the skin or a mucous membrane


Revision Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device


Supplement Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part



The root operation change is reported only for procedures that involve:

  • Removal of a device followed by immediate insertion of a similar device.
  • Exchange of the device without making an incision or puncturing the skin or mucous membrane

Types of procedures reported as root operation change include:

  • Change of a drainage tube
  • Change of a feeding tube

Two other characteristics of change procedures include:

  • All change procedures are coded using the approach external
  • When a specific body part value is not in the table, a general body part value is used

Examples of procedures coded as change include:

  • Exchange of drainage tube right hip joint
  • Exchange of tracheotomy tube
  • Change of chest tube
  • Exchange of ventriculostomy drainage tube
  • Foley catheter change


Revision involves correcting a malfunctioning or displaced device that was placed during a previous intervention. This may involve taking out and replacing device components or moving the device to a new position so that it functions properly. Revision does not involve taking the entire device out and putting in a new device, which would be coded to the root operation that describes the procedure performed.

Examples of procedures coded as revision include:

  • Reposition of Swan-Ganz catheter in the superior vena cava
  • Open revision right hip prosthesis using bone cement to secure loose femoral component
  • Percutaneous repositioning pacemaker lead in left ventricle
  • Screw removal and new screw placement in fracture plate, left tibia, due to loosening of the device


Supplement involves putting in a device that reinforces or augments the function of some or all of a body part. Some characteristics of supplement procedures include:

  • The body part is not taken out during the same procedure, although it may have been taken out during a previous encounter
  • The body part may have been previously replaced but may require reinforcement or augmentation to ensure proper function of the replaced body part
  • The device may be biological or synthetic material
  • If biological material is used it may be living or non-living
  • Biological material may come from the same individual or a donor or donor bank

A key difference between revision and supplement root operations is that a revision procedure is performed on the device to reposition or restore function of the device while supplement procedures are performed on the body part to reinforce or augment function of the body part. A key difference between the root operation change and the root operations removal followed by supplement is the approach. Change procedures do not involve incision or puncture of the skin or mucous membrane so they are always reported as external approach while a removal procedure performed in conjunction with a supplement procedure involves either an open or endoscopic approach.

Supplement encompasses a wide range of procedures. Some examples include:

  • Left inguinal herniorrhaphy with mesh reinforcement
  • Free nerve autograft right median nerve percutaneous endoscopic approach
  • Ring annuloplasty mitral valve open approach
  • Open placement of resurfacing device right femoral head
  • Exchange of liner in femoral component of left total hip prosthesis. Note the removal of the liner is reported separately using the root operation removal

Coding Examples

Example 1: Change of percutaneous endoscopic gastrostomy (PEG) tube


0 Section – Medical and Surgical
D Body System – Gastrointestinal System
2 Root Operation – Change
0 Body Part – Upper Intestinal Tract
X Approach – External
U Device – Feeding Device
Z Qualifier – No Qualifier

Example 2: Reposition Swan-Ganz catheter in superior vena cava


0 Section – Medical and Surgical
2 Body System – Heart and Great Vessels
W Root Operation – Revision
Y Body Part – Great Vessel
X Approach – External
2 Device – Monitoring Device
Z Qualifier – No Qualifier

Example 3: Anterior colporrhaphy with polypropylene mesh reinforcement, open approach


0 Section – Medical and Surgical
U Body System – Female Reproductive System
U Root Operation – Supplement
G Body Part – Vagina
0 Approach – Open
J Device – Synthetic Substitute
Z Qualifier – No Qualifier

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