Introduction for ICD-10-PCS root operation

Excision word is very familiar with all of us. Medical coders should be aware about what are the codes leads to excision. However, we are not here to learn the CPT codes of Excision, we are here to learn about the root operation Excision. Now, if you are aware of ICD-10 codes, you will also be aware about the ICD-10-PCS (Procedure Coding System). ICD-10-PCS the new coding system that will be used in place of Volume 3 codes of ICD-9. ICD-10 is very uniquely different from ICD-9.  Root operations are a part of ICD-10-PCS, which majorly define the objective of the procedure. ICD-10-PCS codes consist of seven characters and root operations are placed in third character. Below picture can give you a small idea about how the codes are given in ICD-10-PCS.

image courtesy: http://www.g2n.org/

Basics about Root operation Excision

The third character of ICD-10-PCS defines the root operation. Some other examples of root operations are Bypass, Drainage, and Reattachment etc. When used in the third character of the code, the value B represents Excision. There is a particular character value assigned for each root operation either Numerical or alphabet. For excision, we have a character value alphabet ‘B’.

Definition of Excision: Cutting out or off, without replacement, a portion of a body part

Example for Root operation Excision

To help distinguish biopsies done in the excision category, the seventh character qualifier, X–Diagnostics, has been established. For example, a needle biopsy of the left lobe of the liver is coded to 0FB20ZX. The characters are defined as follows:
    Section: 0 Medical and Surgical
    Body System: F Hepatobiliary System and Pancreas
    Operation: B Excision
    Body Part: 2 Liver, left lobe
    Approach: 0 Open
    Device: Z No device
    Qualifier: X Diagnostic

Read also: Coding tips for Root Operation Resection in ICD 10 PCS coding

Excision versus Resection

“Excision” is defined as cutting out or off, without replacement, “a portion” of a body part, while “Resection” is cutting out or off, without replacement, “all” of a body part. This distinction is a key concept within ICD-10-PCS; “all” of a body part is uniquely defined in ICD-10-PCS, and it can vary for different organs. For example, a breast lumpectomy is “Excision,” while a total mastectomy is “Resection.” When the excision is a biopsy, the qualifier “diagnostic” is used.

Excision is coded when a portion of a body part is cut out or off using a sharp instrument. All root operations that employ cutting to accomplish the objective allow the use of any sharp instrument, including but not limited to
Scalpel
Wire
Scissors
Bone saw
Electrocautery tip

Exception in Root operation Excision

There are certain exceptions about excision. All biopsies are not Excision like bone barrow aspiration or biopsies. Bone marrow and endometrial biopsies are not coded to the root operation Excision. They are coded to Extraction, with the qualifier Diagnostic. Bone marrow biopsies fall under root operation “extraction” and hence should not be taken under root operation excision. The root operation “extraction” is used to identify procedures where all or a portion of a body part is removed by pulling out or off, such as stripping and scraping.