Answer key chapter 1

Rationale: A scope is used to inspect the intestines. If a definitive procedure is not performed at the same operative session, the root operation Inspection is coded.

Rationale: The intestines have moved to an inappropriate location (twisted out of position) and are repositioned to the correct location.

Rationale: Figure 12.4 displays the cystic duct between the gallbladder and the common bile duct.

Root: Insertion; Code: 0DHA8UZ

Rationale: The root operation Insertion is used to code this procedure. The feeding device is placed via a natural orifice using an endoscope. Therefore, the approach value is 8. The body part value is A, jejunum and there is no qualifier value.
3.

Root: Excision; Code: 0DBL8ZX

Rationale: The root operation Excision is coded for the diagnostic excision of the transverse colon. The inspection of the colon is not code separately because a more definitive procedure was performed in the colon. The body part value is L, Transverse Colon and an approach value of 8 is assigned. There is no device value and the qualifier value is X, Diagnostic.
5.

Root: Dilation; Code: 0D770ZZ

Rationale: The root operation Dilation is coded because the intent of the procedure is to make the opening of a tubular body part larger. The pylorus of the stomach has a unique body part value of 7 and the approach is documented as open. There is no appropriate device value or qualifier value.
Case study coding
1.

Excision Code: 0DBA0ZZ

Rationale: The root operation Excision is used to code the removal of part of the jejunum. The findings paragraph identifies the exact location of the small intestine as the jejunum or body part value A. The approach is open and there is no appropriate device or qualifier value.
3.

Code: 0DBN0ZZ

Rationale: The entire sigmoid colon was not removed. Therefore, the root operation Excision is assigned. The body part value is N, Sigmoid Colon. The approach is open through a lower midline incision. There are no appropriate device or qualifier values.
5.

Bypass Code: 0B110F4

Insertion Code: 0DH64UZ

Rationale: The root operation Bypass is assigned to code the placement of the tracheostomy tube to form a bypass between the trachea and the skin. The body part value is 1, Trachea and the qualifier is value 4, Cutaneous. The tracheostomy is placed using an open approach. The root operation Insertion is used to code the insertion of the feeding device into the stomach. This is placed using a percutaneous endoscopic approach. The device value is U, Feeding Device, and there is no qualifier value.

Extirpation Code: 0DC38ZZ

Excision Code: 0DB68ZX

Rationale: The root operation Extirpation is used to code the removal of the foreign body. Even though the foreign body was not removed through the mouth, it was removed from the distal esophagus by sending it through the normal digestive route. The body part value of 3, Esophagus, Lower is assigned. There is no device or qualifier value. The root operation Excision is used to code the stomach biopsy. The body part value 6, Stomach is assigned and the qualifier value of X, Diagnostic is assigned because this was a biopsy. Both procedures are performed using an endoscopic approach through a natural opening, approach value 8.

Dilation Code: 0D774ZZ

Rationale: The root operation Dilation is used to code the enlargement of the diameter of the pylorus, a tubular body part. The approach is laparoscopic, or approach value 4, Percutaneous Endoscopic. There are no device or qualifier values.

Chapter 13
2013 Updates
Update Procedure Statement Coding #2 to read “Right thyroid lumpectomy, open approach.”
Update Procedure Statement Coding #3 to read “Open excision of the entire right axillary lymph node chain.”
Answer Key
Check Your Understanding
Coding Knowledge Check

1. thorax

Rationale: The body part key tells the coder that the body part is Lymphatic, Thorax.
3. b

Rationale: The root operation Release is used to code adhesiolysis. The body part being freed from an abnormal physical constraint is the spleen, body part value P.

Rationale: The section of this chapter on the organization of the Endocrine system lists the synonyms for the structures of the endocrine system. The para-aortic body is also called the corpus glomera aortica.

Procedure statement coding
1.

Root operation: Resection; Code: 0GTG0ZZ

Rationale: The root operation Resection is assigned when the entire body part is removed. The body part value for the left lobe of the thyroid gland is G. The approach is open and there are no device or qualifier values.
3.

Root operation: Resection; Code: 07T50ZZ

Rationale: Even though the procedure description states Excision, the root operation Resection is assigned when an entire lymph node chain is removed. The approach is open and there are no device or qualifier values.
5.

Root operation: Excision; Code: 0GB10ZZ

Rationale: Only a portion of the pineal body is removed, therefore the root operation Excision is assigned. Craniectomy indicates that the approach is open. There are no device or qualifier values.
Case study coding
1.

Code: 0GBG0ZX

Code: 0GTG0ZZ

Rationale: Based on Guideline B3.4 both the biopsy and the subsequent resection are coded, both of the same body part value, G, Thyroid Gland Lobe, Left. The procedures are performed with an open approach. The excision has a qualifier value of X, Diagnostic, and the Resection has no qualifier.

Resection Code: 0GT24ZZ

Rationale: The root operation Resection is used to code the removal of the entire left adrenal gland, with a body part value of 2. The approach is 4, Percutaneous Endoscopic. There is no device or qualifier.
5.

Code: 07DR3ZX

Rationale: Bone marrow biopsies are not coded to the root operation Excision. They are coded to the root operation Extraction. Aspiration procedures are performed percutaneously. The body part value in this case is R, Bone Marrow, Iliac. Bone marrow aspirations are biopsies and are coded with the qualifier X, Diagnostic.
7.

Resection Code: 07TP4ZZ

Rationale: The spleen is completely removed from this patient. This is coded with the root operation Resection, The approach is percutaneous endoscopic for the laparoscopy. There was no device or qualifier.

9.

Code: 07BJ0ZX

Rationale: The right wrist is part of the right lower arm, based guideline B4.6. When a laceration extends through overlapping layers, the body part value for the deepest structure is coded, based on guideline B3.5. This procedure is coded as 0JQG0ZZ.

Rationale: Reattachment is not an available root operation for the subcutaneous layer, only the skin. In ICD-10-PCS, the subcutaneous layer has separate body part values. Therefore, the default root operation of Repair must be used. This procedure is coded as 0JQ00ZZ.

Rationale: The root operation of Reposition is used to code this procedure. Hair is repositioned to the frontal scalp area. This procedure is coded as 0HSSXZZ. The root operation of Alteration is not used because the only body parts eligible for coding with the root operation are left, right, or bilateral breasts.

Procedure statement coding
1. Root operation: Excision; Code: 0JBG0ZZ

Root operation: Transfer; Code: 0JXG0ZB

Rationale: The root operation Transfer is coded for the advancement flap and the body part is coded to the deepest layer transferred. The qualifier describes all of the layers that were transferred. The root operation Transfer does not include the excision of the scar. The eschar removal is coded with the root operation Excision. This is coded to the subcutaneous tissue and fascia because a 3^rd degree burn goes through the depth of the subcutaneous layer.
3. Root operation: Extirpation; Code: 0HCQXZZ

Rationale: The root operation Extirpation is used to code the evacuation of the hematoma from under the fingernail. The approach is X, External. No device value or qualifier value is appropriate.

Rationale: The root operation Repair is used to code repair of lacerations. The body part value of R is assigned for the left foot subcutaneous tissue and fascia laceration. The approach is Open. No device value or qualifier value is appropriate.

Case study coding
1.

0HR8X74, 0HRHX74, 0HRJX74

Rationale: The root operation Replacement is used to code these free skin grafts. The grafts are placed on the buttocks, body part value 8; on the right upper leg, body part value H; and on the left upper leg, body part value J. The approach is X, External. The device value is 7, Autologous tissue substitute and the qualifier value is 4, Partial thickness. See the section on Devices and Qualifiers in this chapter for further details on tissue culturing.
3.

0HBT0ZZ

0JB70ZZ, 0JBL0ZZ, 0JBN0ZZ

Rationale: The root operation Excision is used to code all of these procedures. Three lesions are excised, one each from the back, right upper leg and left lower leg. The lesions are subcutaneous lesions and the approach is 0, Open. There is no device or qualifier value for any of these codes.
7.

0H0V0JZ

0JB10ZX

Check Your Understanding

Rationale: Based on guideline B4.7, the structures of the fingers are coded the hand when no specific body part value is available.

Rationale: A biceps tenodesis procedure moves the biceps tendon to the humerus. Therefore, the root operation Reposition is assigned.

Rationale: A bursa is the structure between a bone and tendon that forms a cushion.

Procedure statement coding
1. Root: Drainage; Code: 0M910ZZ

Rationale: Incision and drainage is the root operation Drainage. The body part value 1 for shoulder bursa is assigned. Incision indicates that the approach is open. No device value or qualifier value is appropriate for this code.

Rationale: The index directs the coder to use the lower leg muscle body part. The root operation Excision is used to code a biopsy. The approach is 3, Percutaneous. The qualifier value X, Diagnostic is assigned for a biopsy.

Rationale: The root operation Excision is used to code this procedure. The body part value N is assigned for the lower leg tendon, right. The approach is open, and no device value or qualifier value is appropriate for this code.

0LN70ZZ

0LB50ZZ

0PSR04Z, 0LQ70ZZ

Rationale: The root operation Reposition is used to code the fracture reduction. The body part value 7, Thumb Phalanx is assigned. The approach is open, and no device value or qualifier value is appropriate for this code. The root operation Repair is used to code the restoration of the extensor pollicus longus tendon, body part value 7. The approach is open, and no device value or qualifier value is appropriate for this code. The removal of the bone fragments is not coded separately because the removal is integral to the procedure of repositioning the fractured bone.
7.

0RHX04Z, 0LQ80ZZ

Rationale: An internal fixation device was inserted into the finger phalangeal joint, using an open approach. The device value 4 is assigned for an internal fixation device. No qualifier value is appropriate for this code. The root operation Repair is used to code the repair of the extension tendon of the finger, body part value 8, Hand Tendon. No device value or qualifier value is appropriate for this code.
9.

0RQX0ZZ, 0LQ80ZZ, 0MQ80ZZ

Rationale: The root operation Repair is used to code all three procedures—the repair of the joint capsule, the tendon, and the ligament. The body part value X is assigned for the left finger phalangeal joint. The body part value 8 is assigned for the left hand tendon and the left hand bursa, and ligament. All procedures used an open approach, and no device value or qualifier value is appropriate for any of these codes.
Chapter 16
2013 Updates
Update the B3.1b guideline box to read “Components of a procedure specified in the root operation definition and explanation are not coded separately. Procedural steps necessary to reach the operative site and close the operative site, including anastomosis of a tubular body part, are also not coded separately. Example: Resection of a joint as part of a joint replacement procedure is included in the root operation definition of Replacement and is not coded separately. Laparotomy performed to reach the site of an open liver biopsy is not coded separately. In a resection of sigmoid colon with anastomosis of descending colon to rectum, the anastomosis is not coded separately.”
Update the 2^nd paragraph following the B3.15 Guideline box to read “Vertebroplasty is performed when the vertebral body is fractured with the bone fragments that have not migrated and there is not significant loss of height in the vertebral body. The fractured vertebral body is stabilized with the introduction of acrylic bone cement to maintain vertebral height, prevent further injury, and to relieve pain. This is coded with the root operation Repair because the bone cement was used to restore the vertebral body and not a device. When Kyphoplasty is performed, the vertebral body has loss of height and needs to be repositioned. Additional acrylic bone cement is placed with the body to reposition the fracture. This is coded to the root operation Reposition because the vertebral body has suffered a displaced fracture.”
Update Procedure Statement Coding #2 to read “Posterior lumbar Interbody fusion (L4-L5), posterolateral fusion of the posterior spine with an allograft (L4-L5) and posterior lumbar nonsegmental instrumentation (L4-L5)”.
Answer Key
Check Your Understanding
Coding Knowledge Check
1. M

Rationale: Bone growth stimulator is device value M.

Rationale: The body of the vertebra is repaired by gluing the vertebra and restoring it to its normal anatomic structure and function. Therefore, the root operation Repair is coded.

Rationale: T1 means the vertebra itself. Corpectomy is the only procedure that is performed on the vertebra itself. Discectomy and fusion are performed on the space, such as T1-T2. Alteration is not an option because alteration is only done to improve the appearance of a body part.

Procedure statement coding
1.

Root: Reposition; Code: 0PSM0ZZ

Rationale: Repair of a displaced fracture is the root operation of Reposition. The right pisiform bone is one of the carpal bones. No device is used, and no qualifier is appropriate.
3.

Root: Replacement; Code: 0RRK00Z

Rationale: The left shoulder joint is replaced with a reverse prosthesis (ball on glenoid and socket on humerus) or device value 0, Synthetic substitute, reverse ball, and socket. The removal of the native shoulder joint is included in the replacement procedure and not coded separately.
5.

Root: Drainage; Code: 0R9W00Z

Rationale: Incision and drainage is root operation of Drainage using an open approach. A drainage device was left in place and coded with the device value of 0.
Case study coding
1.

Code: 0SRR019

Rationale: Replacement of the femoral surface of the right hip is body part value R. The prosthesis is a metal synthetic substitute 0, and the qualifier is value 9 for cemented. The removal of the native femoral head is included in the replacement procedure and not coded separately.
3.

Code: 0PPF04Z

Rationale: Removal of device from humerus, right is the root operation of Removal using an open approach. The lower humerus is the humeral shaft body part value. The device is an internal fixation device, coded with the device value of 4.
5.

Code: 01N10ZZ

Code: 0RG10A0

Code: 0RH104Z

Rationale: The nerve root at C5-C6 is released by the removal of some of the intervertebral disc. This is a cervical nerve, and the release is performed through an open approach. No device or qualifier is appropriate for this code. Fusion of a vertebral joint using a bone dowel interbody fusion device made of cadaver bone and packed with a mixture of local morselized bone and demineralized bone matrix is coded to the device Interbody Fusion Device. The spinal approach used is qualifier value 0 for anterior approach of the body and anterior approach to the spinal column. The use of plates and screws is an internal fixation device, coded with the root operation Insertion as device value 4, Internal Fixation Device.
7.

Code: 0SRN0JZ

Rationale: The root operation is Replacement and a synthetic substitute (Silastic) joint implant is placed in the first metatarsophalangeal joint of the left foot or device value J. An open approach is used. The removal of the native joint is included in the replacement procedure and is not coded separately.
9.

Code: 0SNCXZZ

Rationale: The root operation is Release. The knee is manipulated under anesthesia to release the joint from an abnormal constraint. The approach is external.

Chapter 17
2013 Updates
Update page 370, in the Approaches Use in the Urinary System, to read “nephrotomy” instead of “nephrostomy” and “pyelotomy” instead of “pyelostomy.”

Answer Key
Check Your Understanding
Coding Knowledge Check
1. a

Rationale: Ablation destroys the tissue and, therefore, Destruction is the appropriate root operation.

Rationale: Both the ileal conduit bypass and the laser destruction are coded.

Rationale: The needle is placed into the bladder through the skin above the pubic bone.

Rationale: The only root operation performed is Occlusion, the surgical ligation of the ureter to prevent further hemorrhage. The approach is 0, Open.

Rationale: The root operation Change is used to replace a ureterostomy tube because a device is removed and an identical device is placed in the body part without cutting or puncturing the skin. The approach is X, External because the skin is not opened.

Rationale: The root operation Insertion is used because a non-biological appliance is inserted to help the muscles of the bladder neck maintain urinary continence. The device value is L, Artificial sphincter. The open approach is specified.

Rationale: This procedure is performed on the urethra and not on the glans penis. The intent of the procedure is to reposition the urethra to the correct location in the tip of the glans penis and, therefore, the root operation Reposition is coded. An open approach is used.

Rationale: The inspection procedure is not coded separately when another root operation is performed. The intraluminal device is removed from the ureter. The root operation Removal is coded and a Via Natural or Artificial Opening Endoscopic approach is used.

Rationale: Two separate codes are assigned for the transplantation of the left kidney and the pancreas. The organs to be replaced may or may not be removed when a transplant takes place. In this case, they were not removed. Any removal of the replaced organs is included in the transplant and is not coded separately. The removal of the peritoneal dialysis catheter is coded with the root operation Removal and a device value of 0 for drainage device. The dialysis catheter is both an infusion and drainage device, but for the root operation Removal, it is coded as a drainage device.

Rationale: The root operation Extirpation is used to describe the removal of the stone from the bladder. The Open approach is used to remove the stone in a suprapubic fashion. The Jackson-Pratt drain is not coded, as the drain is relatively temporary.

Rationale: The Deflux injection is used to restrict the ureteral opening and prevent reflux of the urine up the ureters. The Deflux is a substance and not a device. This procedure is performed on bilaterally, however the root operation Restriction does not have a body part value defined for bilateral ureters. Two procedure codes are required to describe the procedures performed, once for each ureter. Approach value 8, Via Natural or Artificial Opening Endoscopic is used for both procedures.