Root Operation 6 Procedures that Always Involve Devices

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Root Operation 6Procedures that Always Involve
Devices

• Presented by
• THIMA ICD 10 Committee

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Procedures that always involve devices
Operation Action Target Clarification Example
Insertion (H) Putting in Device in or on a body part Does not physically take the place of a body part Pacemaker insertion
Replacement (R) Putting in or on Biological or synthetic material or living tissue taken from same individual Physically takes the place of all or a portion of a body part Total hip replacement
Supplement- (U) Putting in or on Biological or synthetic material or living tissue taken from same individual Physically reinforces or augments a body par Herniorrhaphy with mesh
Removal (P) Taking out or off Device from a body part N/A Cardiac pacemaker removal
Change (2) Taking out or off and putting back Identical or similar device in or on a body part Without cutting or puncturing skin or mucous membrane Drainage tube change
Revision (W) Correcting Malfunctioning or displaced device in or on a body part To the extent possible Hip prosthesis adjustment
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Insertion Root Operation H

• Putting in a non-biological appliance that
  monitors, assists, performs, or prevents a
  physiological function but does not physically
  take the place of a body part.

Example Percutaneous placement of pacemaker
lead into the left atrium
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Lets code percutaneous placement of lead into
left atrium.

1. Insertion of device, atrium, left 02H7
2. Go to table 02H with body part 7 (atrium, left)
3. Approach - Percutaneous -3
4. Device Cardiac Lead Pacemaker J
5. Qualifier Z No qualifier
6. 02H73JZ

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Replacement Root Operation R

• 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
• Example Total left knee arthroplasty with
  insertionof total knee prosthesis

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Coding NoteReplacement includes taking out the
body part
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Lets code total left knee arthroplasty with
uncemented insertion of total knee prosthesis.

1. Replacement, joint, knee left 0SRD
2. Go to table 0SR with body part D (knee joint,
   left)
3. Approach open 0
4. Device synthetic substitute J
5. Qualifier uncemented A
6. 0SRD0JA

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Supplement Root Operation U

• Putting in or on biologic or synthetic material
  that physically reinforces and/or augments the
  function of a portion of a body part
• Example Laparoscopic rightinguinal hernia
  repair with Marlex mesh

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Lets code laparoscopic right inguinal hernia
repair with Marlex mesh.

• Supplement, inguinal region, right 0YU5
• Go to table 0YU with body part 5 (inguinal
  region, right)
• Approach - percutaneous endoscopic - 4
• Device - Synthetic substitute J
• Qualifier - No qualifier Z
• 0YU54JZ

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Removal Root Operation P

• Taking out or off a device from a body part
• Example Removal of an endotracheal tube

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What body system would you use for the pulmonary
artery?

1. Upper arteries
2. Heart and great vessels

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Coding NoteIn the root operation removal,
general body part values are used when the
specific body part value is not in the table

• Example Removal of Swan Ganz catheter from
  right pulmonary artery
• Body part is Y Great Vessel

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Lets code removal of an endotracheal tube.

• Removal device from trachea 0BP1
• Go to table 0BP with body part 1 (trachea)
• Approach - External X
• Device endotracheal device E
• Qualifier no qualifier Z
• 0BP1XEZ

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Change Root Operation 2

• 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.
• Example Tracheostomy tube exchange

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Lets code a tracheostomy tube change.

• Change, by device, tracheostomy device, trachea
  0B21
• Go to table 0B2 with body part 1 (trachea)
• Approach external X
• Device tracheostomy device F
• Qualifier no qualifier Z
• 0B21XFZ

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Revision Root Operation W

• Correcting, to the extent possible, a
  malfunctioning or displaced device
• Example Open revision of left hip replacement,
  with adjustment of the prosthesis

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Lets code an open revision of left hip
replacement, with adjustment of the prosthesis

• Revision of device in, joint, hip, left 0SWB
• Go to table OSW with body part B (hip joint,
  left)
• Approach open 0
• Device synthetic substitute J
• Qualifier no qualifier - Z
• 0SWB0JZ

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How to Master Root Operation Coding

• Practice
• Review the exercises and match the root
  operations to procedures
• Continue to practice, practice, and more practice
  to help you master procedure coding involving one
  of these devices

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Your Turn to Practice
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Match the procedure on the left with the correct
root operation on the right.

• Casting of nondisplaced fracture
• Reduction of displaced fracture
• Putting a pin in a nondisplaced fracture

• Immobilization
• Insertion
• Reposition

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Chest tube replacement
Change
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Relocation of pacemaker pocket
Revision
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Right mastectomy with free TRAM flap
reconstruction
Replacement
Image breastcancer.org
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Percutaneous placement of bone growth stimulator
electrode, left femoral shaft
Insertion
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Cystoscopy with retrieval of right ureteral stent
Removal
Image mayoclinic.org
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Open anterior colporrhaphy with polypropylene
mesh reinforcement
Supplement
Image urogyn-nj.com
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Questions
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