Health Information Management

Secure your knowledge of root operation revision

HIM-HIPAA Insider, January 27, 2014

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What can we revise today at Stitch ‘Em Up Hospital?
First, we need to know what falls under root operation revision in ICD-10-PCS. Is it a procedure where the physician alters a body part, such as a revision rhinoplasty? Or maybe it involves the physician redoing a hip replacement. How about revising the pouch for a pacemaker?
In ICD-10-PCS, a revision is confined to correcting a malfunctioning or displaced device. So nose jobs need not apply for this root operation. (They fall under alteration, in case you’re wondering.)
Removing and replacing a hip replacement also does not qualify as a revision. The ICD-10-PCS Official Guidelines for Coding and Reporting tell us to code the complete or partial redo of a procedure to the root operation performed rather than revision.
You also wouldn’t code the revising of a pacemaker pouch using revision. However, if the physician is going in and readjusting the placement of the pacemaker leads, that does fall under root operation revision.
Revision can include correcting a malfunctioning or displaced device by taking out or putting in components of the device such as a screw.
Revision is one of the ICD-10-PCS root operations that always requires a device character. So you will never see Z as your sixth character. If you code a Z in sixth position, you’ve done something wrong. Most likely, that Z is supposed to be the seventh character (no qualifier) and somehow ended up in sixth position instead.
Don’t be fooled by the physician documentation. Just because the doctor calls it a revision doesn’t mean ICD-10-PCS classifies it as one. Look at what the physician actually did and use the objective of the procedure to select your root operation.
So let’s look at a couple of cases and see what we should code.
Dr. Gagnon removed and replaced a screw in a fracture plate located in the patient’s left tibia using an open approach. Dr. Gagnon performed the procedure because the device caused the screw to work loose.
This procedure falls under the objective of revision, so our code is 0QWH04Z (revision of internal fixation device in left tibia, open approach).
Dr. Giannotti revised a hip replacement because the patient suffered repetitive dislocation of a hip replacement. Dr. Giannotti decided to replace the entire prosthesis using a different device in hopes of a better outcome for the patient.
We need to really look at the documentation in this case. If Dr. Giannotti is simply recementing part of the hip replacement, we would use root operation revision.
In this case, he is removing the entire prosthesis (ball and socket) and inserting a new device. In essence he’s performing a second hip replacement procedure. We would not code the hip replacement revision using the root operation revision. Instead, we would use root operation replacement.
Our final example involves Dr. Andrews repositioning a Swan-Ganz catheter in the superior vena cava. Because the objective of the procedure is to correct a displaced device, we would use root operation revision. Our code for this procedure is 02WYX2Z (revision of monitoring device in great vessel, external approach).
If you don’t know the objective of the procedures your physicians currently perform, make friends with the docs or your clinical documentation improvement specialists and have them walk you through the procedure. (You can also use that time to educate them on what you need in the documentation.)
More of a visual learner? Ask if you can observe a procedure or Google it and find a video. Start now so when October 1 rolls around, you’ll have these root operations down pat.
This article originally appeared on HCPro’s ICD-10 Trainer blog.


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