Inpatient Facility Coding & Compliance Alert

Key in to root operations for help with other sections.

If you’re looking for a succinct ICD-10-PCS section to examine, then check out the Obstetrics Section 1. Because this section includes only procedures performed on a pregnant female, it’s small — and therefore perfect for using as an example for the rest of ICD-10-PCS.  

Highlight These 2 Guidelines for Obstetrics

In this section, you’ll find two guidelines: a single guideline related to products of conception and a single guideline related to procedures following delivery or abortion. The ICD-10-PSC Official Guidelines for Coding and Reporting state:

“C.1. Products of Conception

Procedures performed on the products of conception are coded to the Obstetrics section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Medical and Surgical section.

Example: Amniocentesis is coded to the products of conception body part in the Obstetrics section. Repair of obstetric urethral laceration is coded to the urethra body part in the Medical and Surgical section.

C.2 Procedures following delivery or abortion

Procedures performed following a delivery or abortion for curettage of the endometrium or evacuation of retained products of conception are all coded in the Obstetrics section, to the root operation Extraction and the body part Products of Conception, Retained. Diagnostic or therapeutic dilation and curettage performed during times other than the postpartum or post-abortion period are all coded in the Medical and Surgical section, to the root operation Extraction and the body part Endometrium.”

The Root Operations Limit PCS Tables

This section contains a single body system value — pregnancy (0)— along with 12 root operation values and three body part values: Products of Conception (0), Products of Conception, Retained (1), and Products of Conception, Ectopic (2). Because you only have one body system and 12 root operations, you will find only 12 tables available in the Obstetrics section from which to construct procedure codes.

The root operations are as follows:

• Abortion
• Change
• Delivery
• Drainage
• Extraction
• Insertion
• Inspection
• Removal
• Repair
• Reposition
• Resection
• Transplantation

Benefit: “While there are two root operations that apply only to Obstetrics, the other 10 root operations also are used in the Medical and Surgical section,” says Lauri Gray, RHIT, CPC, Clinical/Technical Editor at Contexo Media in Salt Lake City. “Learning the definitions of those 10 root operations common to both sections and learning how these definitions are applied in the Obstetrics section will help coders understand how they are used and applied in the Medical and Surgical section as well.” 

“In the process of learning ICD-10-PCS Obstetrics coding, coders also will become familiar with the format of the tables and will be able to learn how to easily use these tables to construct a code,” Gray adds.

Underline Abortions, Deliveries, and Extractions

The “abortion” and “delivery” root operations are specific to this section. 

The root operation Abortion (A) applies only to artificially terminated pregnancies. It is “subdivided according to whether an additional device such as a laminaria or abortifacient is used, or whether the abortion was performed by mechanical means.”

If either a laminaria or abortifacient is used, then the approach is “Via Natural or Artificial Opening.” All other abortion procedures are those done by mechanical means (the products of conception are physically removed using instrumentation), and the device value is “Z, No Device.”

Caution: You should not report the root operation Abortion for “manually assisted spontaneous abortion. Manually assisted spontaneous abortion is reported with the root operation Delivery (E).”

Additionally, “do not report the root operation Abortion for missed or incomplete abortion requiring suction and/or curettage of products of conception. Suction/curettage of nonviable products of conception is reported with the root operation Extraction (D).”

If you’re reporting a Delivery (E), you need to check out these highlights: 

• “The root operation Delivery applies only to manually assisted vaginal delivery of the products of conception.
• The products of conception may be a full-term viable fetus or nonviable products of the conception.
• There is a single code that can be constructed from Table 10E, 10E0XZZ Delivery of Products of Conception, External Approach.”

Reporting an Extraction (D)? Check out these must-know tips:

• “The root operation Extraction applies to Cesarean deliveries and to vaginal deliveries requiring the use of forceps, vacuum or internal version.
• Cesarean deliveries always are reported with the approach value 0 for open approach and require a qualifier to more specifically identify the approach as Classical (0), Low Cervical (1) or Extraperitoneal (2).
• Vaginal extractions always are reported with the approach value 7, Via Natural or Artificial Opening, and require a qualifier to specifically identify the type of assisted vaginal delivery as Low Forceps (3), Mid Forceps (4), High Forceps (5), Vacuum (6), Internal Version (7) or Other (8).”

Try Your Hand at These Examples

Example 1: Suppose your physician performs a transvaginal abortion using vacuum aspiration technique. How should you report this in ICD-10-PCS?

Solution 1: You should go to the Obstetrics Section 1, highlight “0” for the single body system of pregnancy, and then decide what root operation this is — which is an abortion, “A.” This means your first three characters are “10A.” 

The physician is removing “products of conception” (0) “via natural/artificial opening” (7). He did not use a device, because the physician manually removed this using instrumentation, so you should say “no device” (Z). Finally, the last character qualifier is “vacuum” (6).

Your complete code is therefore 10A07Z6.

Example 2: Suppose your physician performed a manually assisted delivery. How should you report this with ICD-10-PCS?

Solution 2: Again, you should go to the Obstetrics Section 1, highlight “0” for the single body system of pregnancy, and then decide what root operation this is — which is “delivery” (E). This means your first three characters are “10E.” 

The physician is removing “products of conception” (0) via an “external” (X) approach. He did not use a device, so you should say “no device” (Z). Finally, the last character qualifier is “no qualifier” (Z).

Therefore, your complete code is 10E0XZZ. You’ll eventually memorize this code, because you will be reporting this often.