Coding Tip: The Root Operation Restrictions and Occlusion in PCS Coding
RHIT, CDIP, CCS, CCS
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
This week’s coding tip focuses on the root operations restriction and occlusion in PCS coding. This can sometimes be challenging for coders when trying to determine the appropriate root operation (objective of procedure) to use. The onus is on the coder to determine what the physician performed based on the documentation in the record. Physicians are using restriction/occlusion and other procedure titles when performing procedures making it imperative that the coder review the entire procedure note.
- The root operation “restriction” is used when the surgeon partially closes (partial occlusion) an orifice or the lumen of a tubular body part. The tubular body parts are defined in ICD-10-PCS as those hollow body parts that provide a route of passage for solids, liquids, or gases. The objective of these procedures is to narrow the diameter and includes both intraluminal and extraluminal methods for narrowing the diameter.
Examples of Restriction:
- Gastroesophageal fundoplication
- Cervical cerclage
- Banding of pulmonary artery using extraluminal device
- Clipping of cerebral aneurysm (don’t want to completely close off)
- Placement of restrictive stent in right lacrimal duct
- Laparoscopic banding for obesity
- Endovascular AAA repair with/without device
- The root operation “occlusion” is used when the surgeon completely closes an orifice or the lumen of a tubular body part. The objective of these procedures is to close off a tubular body part or orifice and includes both intraluminal and extraluminal methods for occlusion/closure.
- If PCS contains a specific body part for anatomical subdivision of a body part “resection” would be used when all of the body part is cut out or off. (Lobectomy of RUL would be coded as a resection if all the RUL is removed even though the entire right lung was not removed).
Examples of Occlusion:
- Bilateral tubal ligation with Hulka clips
- Ligation of esophageal vein
- Embolization of internal carotid-cavernous fistula
- Embolization of vascular supply to intracranial meningioma
- Embolization of uterine artery
- Banding of esophageal varices
- Banding of hemorrhoids
ICD-10-PCS Official Guidelines for Coding and Reporting 2016
ICD-10-PCS Reference Manual
CC3Q2015 Page: 30; CC3Q2014 Page: 26, 27, and 28; CC1Q2014 Page: 9 and 24; CC2Q2015 Page 27; CC4Q2014 Page 37;
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.