Answer key chapter 1

9. Root Operation: Fusion

ICD-10-PCS code: 0RGS04Z

Section	Body System	Root Operation	Body Part	Approach	Device	Qualifier
Medical and Surgical	Upper Joints	Fusion	Metacarpocarpal Joint, Right	Open	Internal Fixation Device	No Qualifier
0	R	G	S	0	4	Z

Chapter 7
2013 Updates
Update Guideline box B2.1b to read: Where the general body part values “upper” and “lower” are provided as an option in the Upper Arteries, Lower Arteries, Upper Veins, Lower Veins, Muscles and Tendons body systems, “upper” or “lower” specifies body parts located above or below the diaphragm, respectively. Example: Vein body parts above the diaphragm are found in the Upper Veins body system; vein body parts below the diaphragm are found in the Lower Veins body system.
Update Coding Knowledge Check #2 to read “The surgeon repairs a traumatic complete right thumb amputation. How is this coded?”
Answer Key
Check Your Understanding
1.

Answer: upper, scapula, clavicle

Rationale: The body part value Forequarter describes the entire upper limb plus the scapula and clavicle.
3.

Answer: d

Rationale: This is a complete detachment of the 3^rd day, based on the definition of amputation through the tarsal-metatarsal joint of the foot. This definition is the same as amputation at the most proximal portion of the metatarsal.
5.

Answer: True

Rationale: The body part value describes the body part at the start of the procedure and the qualifier describes the body part created in the surgical procedure.

Procedure statement coding

Root: Repair; Code: 0WQ6XZ2

Rationale: This procedure involves the repair of the neck (Anatomical regions, general), rather than revision of the tracheostomy tube, therefore the root operation is Repair. The approach is X, External and the qualifier is 2, Stoma.
3.

Root operation: Alteration; Code: 0Y0C3ZZ

Root operation: Alteration; Code: 0Y0D3ZZ

Root operation: Alteration; Code: 0W0F0ZZ

Rationale: These procedures are cosmetic in nature. There are individual body part values for each thigh region (upper leg). There is a single body part value for the abdominal wall. The liposuction is performed percutaneously and the abdominoplasty is an open procedure. No devices or qualifiers are appropriate for either procedure.
5.

Root: Detachment; Code: 0X6W0Z0

Rationale: Because the supernumerary digit contains bone and nail, the root operation Detachment is coded. If the supernumerary digit was composed only of skin, the root operation Destruction would be assigned. The qualifier value 0 is for a complete amputation of the little finger of the left hand.
Case study coding
1.

ICD-10-PCS code: 0W9900Z

Rationale: Insertion of a chest tube is coded to the root operation Drainage, with a device value of 0 for a drainage device. The body part value of 9 is assigned for the pleural cavity on the right side.
3.

ICD-10-PCS code: 0YU60JZ

Rationale: The documentation states that mesh was implanted. Therefore, the root operation Supplement is assigned. The left inguinal region is body part value 6 and a device value of J, Synthetic substitute is assigned. No qualifier is appropriate.
5.

ICD-10-PCS code: 0WPG3YZ, 0WHG3YZ

Rationale: The root operation is not Change because there was an incision made and the tube was placed in a new location. Therefore, this is the root operation Removal and the root operation Insertion.
7.

ICD-10-PCS code: 0W33XZZ

Rationale: The root operation Control is coded because the bleeder is the result of a previous procedure. When cautery is used to stop post-op bleeding, Control is the appropriate root operation. The tonsillar area is coded to the body part value of 3, Oral cavity and throat. The approach value is X, External.
9.

ICD-10-PCS code: 0Y910ZZ, 0WJP8ZZ

Rationale: The root operation Drainage is used to describe the incision and drainage procedure. The left buttock is identified with body part value 1 in the Anatomical Regions, Lower Extremities body system. The root operation Inspection is coded to the gastrointestinal tract. There is no index entry for rectum or anus under the root operation Inspection. The inspection is performed with an anoscope, which is an endoscopic instrument.

Chapter 8
2013 Updates
Update Figure 8.5 to read “Tibial” instead of Tinial as one of the lumbar nerves.
Update Procedure Statement Coding #1 to read “Submuscular transposition of pinched ulnar nerve, right elbow, open.”
Answer Key
Check Your Understanding
1. b

Rationale: Accessing the index under cubital nerve directs the coder to Use Nerve, ulnar. The root operation Repair is used to code procedures involving sutured lacerations. Under Repair, nerve, ulnar, the coder is directed to 01Q4. Therefore, the correct option is b.

Rationale: There are several large cisterns in the brain that may be documented with unique names such as magna, cerebromedullary, pontine, superior, or ambient.

Rationale: The cerebral ventricle is the source of the bypass and the peritoneal cavity is the body part bypassed to, in a ventriculoperitoneostomy, also called a VP shunt procedure.

Procedure statement coding
1.

Root Operation: Reposition; Code: 01S40ZZ

Rationale: The root operation Reposition is used to code transposition procedures where body parts are moved to a more suitable location. The body part value 4, Ulnar Nerve is assigned for this procedure using an open approach. No device or qualifier values are appropriate for this code.
3.

Root Operation: Destruction; Code: 015H3ZZ

Rationale: The root operation Destruction is coded because the nerve is destroyed by the use of a neurolytic agent. The common fibular nerve is part of body part value H, Peroneal Nerve, based on the index cross-reference. The approach is percutaneous.
5.

Root Operation: Excision; Code: 00B70ZX

Rationale: The root operation Excision is used to code this procedure. A portion of the parietal lobe of the brain is removed via an open approach (craniectomy). The index directs the coder to Use Cerebral Hemisphere. This is a biopsy because the pathological identification is not known at the start of the procedure. Therefore, the qualifier X, Diagnostic is assigned.
7.

Root Operation: Map; Code: 00K83ZZ

Rationale: The root operation Map is coded for this procedure. The basal ganglia, body part value 8, is mapped using a percutaneous approach.

Case study coding

ICD-10-PCS code: 0PBH0ZX, 0JBG0ZX, 01N60ZZ

Rationale: The root operation Excision is used to code this procedure because debridement using a sharp instrument is Excision. Both the radius bone and the subcutaneous layer of the lower arm were excised. The root operation Release is used to code the freeing of the radial nerve from the scar tissue. All three procedures are performed using an open approach. The excised bone and subcutaneous tissue were sent for identification and, therefore, the qualifier X, Diagnostic is assigned.
3.

ICD-10-PCS code: 00C40ZZ

Rationale: The root operation Extirpation is used to code the evacuation of the subdural hematoma. The craniotomy is the open approach for the procedure. The body part value is 4, subdural space because the hematoma was located subdurally. No device value is appropriate because the Jackson-Pratt drain is a short-term, post-operative drain. No qualifier value is appropriate for this code.
5.

ICD-10-PCS code: 01N50ZZ

Rationale: The root operation Release is used to code this procedure. The body part being released is the median nerve, body part value 5, not the carpal tunnel. The procedure is performed with an open approach. No device or qualifier values are appropriate for this code.
7.

ICD-10-PCS code: 00C00ZZ, 00Q20ZZ, 0NU00JZ

Rationale: The root operation Extirpation is used to code the removal of the indriven bone in the brain, body part value 0. The approach was open. No device or qualifier values are appropriate for this code. The root operation Repair is used to code the repair of the dura mater, body part value 2. The approach is open. No device or qualifier values are appropriate for this code. The root operation Supplement is used to code the closure of the skull fracture with the use of mesh to support the fractured bone. The approach is open. The device value is J, Synthetic Substitute. No qualifier value is appropriate for this code.

Chapter 9
2013 Updates
Update the description of the Frontal Sinus on page 172 to read “Within the frontal bone behind the forehead.”
Update Table 9.4, Device value 4 to read “Hearing device.” The words “bone conduction” were eliminated.

Answer Key
Check Your Understanding

Coding Knowledge Check

Rationale: figure 9.4 shows the eustachian tube from the middle ear to the pharynx.

Rationale: The ethmoid sinus is located in the ethmoid bone, between the nose and the eyes.

Rationale: This airway device is a nasal trumpet or a nasopharyngeal airway between the nose and the nasopharynx.

Root Operation: Dilation; Code: 087X0DZ

Rationale: The osteotomy is the approach to the lacrimal duct which was dilated. The root operation Dilation is coded and the body part value X, Lacrimal Duct, Right is assigned. The approach is open. The device value D, Intraluminal Device is assigned with no qualifier.
3.

Root Operation: Occlusion; Code: 08LY7DZ

Root Operation: Occlusion; Code: 08LX7DZ

Rationale: This procedure is the reverse of procedure statement #1. In this case, the lacrimal duct is completely closed with an intraluminal device called a duct plug or punctal plug.

Root Operation: Insertion; Code: 09HE04Z

Root Operation: Insertion; Code: 0NH60SZ

Rationale: The root operation Insertion is used to code both procedures. The first procedure is the implantation of the bone anchored hearing aid (BAHA). The body part value E, Inner Ear, Left is assigned, along with the device value 4, Hearing Device, Bone Conduction and no qualifier. The second procedure is the implantation of the external hearing device into the temporal bone. The body part value 6, Temporal Bone is assigned, along with the device value S, Hearing Device, Bone Conduction and no qualifier. Both procedures are completed using an open approach.

ICD-10-PCS code: 08RK3JZ

Rationale: The root operation Replacement is coded because the intraocular lens is implanted at the same session during which the native lens is removed. The body part value K, Lens, Left is assigned. The approach is percutaneous because the lens is being removed through the small slit in the anterior chamber, not through an open incision. The device value J, Synthetic Substitute is assigned because the device is a manufactured item. No qualifier is appropriate for this code.
3.

ICD-10-PCS code: 09C47ZZ, 09BM0ZZ, 09BL0ZZ, 09BL0ZZ

Rationale: This procedure requires four codes. The first is the extirpation of the foreign body from the external auditory canal, left ear through a natural opening. The second code is the excision of the nasal septum using an open approach. The third and fourth procedures are the excision of the nasal turbinates using an open approach. The body part value, L, Nasal Turbinate is assigned. Because the same procedure is performed on two different parts of a body part identified by the same value, two codes are required. None of these codes require a device or qualifier value. The nasal endoscopy is not coded because inspection is not coded when a definitive procedure is also performed.
5.

ICD-10-PCS code: 08ND3ZZ

Rationale: Synechia is the condition of adhesions between the pupil and the iris. Synechiolysis is the release of those adhesions, coded with the root operation Release. The body part value, D, Iris, Left is assigned because the iris is being released. OS means Oculus Sinister, or the left eye. The approach value is 3, Percutaneous. No device and qualifier values are appropriate for this code.
7.

ICD-10-PCS code: 095KXZZ

Rationale: The root operation Destruction is used to code the electrocautery of the nose. The body part value, K, Nose is assigned. This body part value refers to the inside of the nose because the skin of the nose is found in a different body system. The approach is X, External because the cautery of the nose was completed without the use of instruments to reach the operative site. No device or qualifier values are appropriate for this code.
9.

ICD-10-PCS code: 08BW0ZX

Rationale: The root operation Excision is coded for the biopsy of the lacrimal gland. The orbiotomy indicated that the approach of the procedure is open. The qualifier X, Diagnostic is assigned because this is a biopsy.

Chapter 10
2013 Updates
Update Coding Knowledge Check #2 to read “The surgeon performs a reversal of a previous lip augmentation procedure by making an incision along the length of both lips, inside the mouth. A strip of tissue is removed from each lip to thin the lips and pull them inward because the patient was not happy with the previous augmentation. How is this coded?”
Answer Key
Check Your Understanding

1. 
   b
   

Rationale: The carina is the triangular piece of tissue that forms the connection between the trachea and the two bronchial openings that branch off from the trachea.

Rationale: The root operation Resection is used because the entire body part is removed. A wire snare is appropriate for use as a cutting instrument to perform the resection.

Rationale: The placement of the intraluminal device, endobronchial valve is coded with the root operation of Insertion. Even through the endobronchial valve does restrict airflow somewhat, there is no device value for endobronchial valve in the 0BV table. The root operation Insertion is the only available option. The endobronchial valve is device value G.

Rationale: The frenulum is the small piece of tissue that holds the tongue to the floor of the mouth. Cutting into the frenulum releases the tongue to correct the ankyloglossia (tongue-tie). The root operation Release is coded with a body part value of 7, Tongue. The approach is X, External because the frenulum is visible within the oral cavity. No device or qualifier values are appropriate for this code.

Root operation: Resection; Code: 0BTD0ZZ

Rationale: Two codes are required to code this procedure. Because the procedure was discontinued due to the pleural effusion, the root operation Inspection is coded for the initial endoscopic evaluation, with a percutaneous endoscopic approach. The root operation Resection is coded for the completed procedure of the open lobectomy of the lung, because the right middle lobe is an entire body part in ICD-10-PCS. Neither code has a device of qualifier value that is appropriate.
Case study coding
1.

ICD-10-PCS code: 0B538ZZ, 0B538ZZ

Rationale: Laser photoresection is coded to the root operation Destruction because the tissue is completely eliminated. The approach value is 8, Via Natural or Artificial Opening Endoscope. No device or qualifier values are appropriate for this code. Two lesions were treated.
3.

ICD-10-PCS code: 0BBJ8ZX, 0BBH8ZX

Rationale: The bronchoscopy is the approach to the bronchial tubes. The biopsies are taken of the lung through the bronchial wall. The locations are the left lower lobe and the lingula. The root operation Excision is used to code both biopsies. The approach is 8, Via Natural or Artificial Opening Endoscopic. There is no device value and both qualifiers are X, Diagnostic to describe the biopsy.
5.

ICD-10-PCS code: 0CB4XZX, 0CU4XKZ

Rationale: The root operation Excision is coded to describe the removal of the lesion of the buccal mucosa. The approach is X, External because the buccal mucosa can be visualized without instruments or incision. There is no device value, and the qualifier is X, Diagnostic. In addition, the defect was closed using a nonautologous Oasis graft. The root operation Supplement is used to code this graft, which is not synthetic. It is manufactured from the small intestinal submucosa (the SIS in Oasis) of an animal. The only appropriate device value is K, Nonautologous. There is no qualifier for this code.
7.

ICD-10-PCS code: 0CQXXZ1, 0CQWXZ1, 0CDWXZ1, 0CDXXZ1

Rationale: Dental restorations are coded with the root operation Repair because they are restoring the body part to its normal anatomic structure. Tooth numbers 2, 4, 12 and 15 are upper teeth. Tooth numbers 30 and 31 are lower teeth. Both of these codes have the qualifier of 1, Multiple, because multiple upper and lower teeth were restored. The method of restoration is not identified in the ICD-10-PCS code. The root operation Extraction is used to code dental extraction because the teeth are being pulled out. Tooth numbers 1 and 16 are upper teeth and tooth numbers 17 and 32 are lower teeth. Both of these codes have the qualifier of 1, Multiple, because multiple upper and lower teeth were extracted. All of the procedures are coded with the approach value of X, External because teeth can be visualized without the use of instruments or incision.
9.

ICD-10-PCS code: 09JH7ZZ, 09JJ7ZZ, 0C5PXZZ, 0C5QXZZ

Rationale: The examination of the ears under anesthesia is coded separately because a more definitive procedure on the ears is not performed at the same time. The root operation Inspection is used to code this procedure. There is no bilateral body part value, therefore, the procedures on both ears are coded separately. The approach is 7, Via natural or artificial opening. No device or qualifier values are appropriate for these codes. The root operation Destruction is used to code both the coblation of the tonsils and the suction cautery of the adenoids. The approach for both of these procedures is X, External as both body parts can be visualized through the mouth. No device or qualifier values are appropriate for these codes.

Chapter 11
2013 Updates
Update Figure 11.3 by changing Branchial artery and Deep branchial artery to read “Brachial artery” and “Deep brachial artery” on the left side of drawing.
Update Figure 11.4 by changing Branchial veins and Median antebranchial vein to read “Brachial veins” and “Median antebrachial vein.”
Update the first sentence of the last paragraph on page 219 to read “Coronary artery bypass procedures performed with the use of a cardiopulmonary bypass machine require an additional code for the circulatory performance during the procedure.”
Delete the last 2 sentences of the 2^nd paragraph under Devices Common to the Circulatory System. The paragraph should end with the word “diaphragm”.
Update Procedure Statement Coding #1 to read “Double coronary artery bypass, open approach (left internal mammary artery to left anterior descending; left greater saphenous vein to diagonal, open harvesting). Do not code use of cardiopulmonary bypass equipment).
Update Case Study #3 to read “Procedure: Insertion of tunneled multi-lumen catheter” and change “central venous system” to read “subclavian vein” in line 10 and line 13 of the body of the report.
Update Case Study #10 to read “left greater saphenous vein” in the last line of page 242.
Answer Key
Check Your Understanding
1. d

Rationale: Supplement is used because the ring augments the function of the valve and does not reroute the blood flow, dilate the valve or restrict the valve.

3. Lower arteries

Rationale: The abdominal aorta is below the level of the diaphragm and is therefore a lower artery.

Rationale: The ablation procedure destroys tissue and therefore the root operation is Destruction.

Root Operation: Bypass, Coronary artery, one site; Code: 02100Z9

Root Operation: Bypass, Coronary artery, one site; Code: 021009W

Root Operation: Excision, Greater saphenous vein; Code: 06BQ0ZZ

Rationale: See Code Building section of this chapter for a complete discussion of coronary artery bypass coding.
3.

Root Operation: Excision; Code: 03BT0ZX

Rationale: The left temporal artery has a unique body part value of T. The qualifier value of X is assigned because this procedure is a biopsy.
5.

Root Operation: Excision, atrial septum; Code: 02B50ZZ

Rationale: The Blalock-Hanlon procedure is an excision of the atrial septum to create an atrial septal opening. The atrial septum has a unique body part value of 5, and no device or qualifier values are appropriate for this code.
Case study coding
1.

Code: 06H033Z

Rationale: The root operation Insertion is used to code this procedure. The device is inserted into the inferior vena cava. The percutaneous access point is through the right femoral vein. The device value is 3, Infusion Device, and no qualifier value is appropriate for this procedure.
3.

Code: 05H533Z, 0JH63XZ

Rationale: The root operation Insertion is used to code this procedure. The catheter is placed within the right subclavian vein (an upper vein) because the documentation states that good venous blood flow was aspirated. The approach is percutaneous and the device value is 3, Infusion Device. No qualifier value is appropriate for this code. The tunneled portion is inserted into the Subcutaneous layer of the chest. The device value is X, Vascular Access Device.
5.

Code: 027034Z

Rationale: The root operation Dilation is used to code this PTCA. The left anterior descending is a coronary artery and one site was treated. Therefore, the body part value of 0, Coronary Artery, One Site is assigned. The approach is percutaneous through the femoral artery. The device value is 4, Intraluminal Device, Drug-eluting, and no qualifier value is appropriate for the code.
7.

Code: 02703DZ

Rationale: The root operation Dilation is used to code this PTCA. One site of the right coronary artery is treated. The approach is percutaneous. Even though two stents were deployed, only one site was treated. The occlusion was too long to be spanned by one stent and two overlapping stents were deployed at the same site. The device value D, Intraluminal Device is coded because the Vision stent is a bare metal stent. There is no qualifier value for this code.
9.

Code: 041L0JH, 04CK0ZZ

Rationale: The root operation Bypass is used to code the fem-fem bypass procedure. The origin of the bypass is the left common femoral artery (body part value) and the body part bypassed to is the right common femoral artery (qualifier value). An open approach was used, and a synthetic prosthetic graft was used. In addition, a thrombectomy was performed in the right superficial femoral artery. This is coded with root operation Extirpation with a body part value of K, Femoral Artery, Right. The approach is open, and no device or qualifier values are appropriate for this code.