Health Information Management

Q&A: Resection or excision in ICD-10

CDI Strategies, October 27, 2011

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Q:I am unsure how “ribs” are categorized in ICD-10. I don’t understand if taking one rib is considered a resection or an excision and why. The coder coded the following record to total ostectomy-rib.  If you crosswalk the ICD-9-CM Level 3 code to ICD-10-PCS, it maps to a resection. I think that is correct, but I’m not sure if we should query the physician to find out if the physician considers the procedure an excision. Here is summary of the key findings from the report:

A female developed a left arm DVT [deep vein thrombosis], was treated with anticoagulation and a subsequent venogram revealed compression of the left axial subclavian vein with elevation of the arm. With the arm in neutral position, the vein flow was normal. Her arm swelling subsequently resolved and DVT then resolved. She was then referred for first rib resection.
During the operation, an incision was made in the axilla and dissection proceeded down onto the chest wall. The chest wall dissection proceeded up to the first rib. The first rib was cleared of its surrounding tissue using Bovie cautery. The scalene muscles were resected off of the rib. Once we adequately cleared the rib of surrounding tissue posteriorly beyond the edge of the nerve and anteriorly to the junction with the manubrium, the rib was cut posteriorly and avulsed anteriorly.
A 1-centimeter hole in the pleura was discovered upon inspection. After attempting to simply close this we continued to have a small air leak, therefore, a 24-French chest tube was selected and placed into the pleura with a purse-string of 3-0 Vicryl around it. The chest tube was secured through a separate stab incision on the lateral chest wall.
The wound was copiously irrigated and closed in multiple layers with 2-0 and 3-0 Vicryl sutures in the soft tissues and 4-0 Monocryl in the skin.
A:In reviewing my ICD-10-CM/PCS training materials, I believe this is a resection. The ICD-10-PCS coding guidelines (section B3.8) indicate:
“PCS contains specific body parts for anatomical subdivisions of a body part, such as lobes of the lungs or liver and regions of the intestines...”
Also, in the 2011 edition of AHIMA’s ICD-10-PCS training manual, it states:
“Resection is similar to Excision except Resection includes all of a body part, or any subdivision of a body part that has its own body part value in ICD-10-PCS. Resection of the specific body part is coded whenever all of the body part is cut out or off, rather than coding Excision of a less specific body part...”
In reviewing the root operation table for 0PT, it has the body part value of rib, right and rib, left. If it had said ribs, then my answer would be different because one rib would be only part of ribs so I would go with excision.
In my opinion, the correct ICD-10-PCS code would be:
  • 0PT10ZZ for the right rib
  • 0PT20ZZ for the left rib
Editor’s Note: Heather Taillon, RHIA, manager of coding compliance at Franciscan St Francis Health in Beech Grove, IN, answered this question following the September 27 audio conference “ICD-10 for CDI: Improve Documentation Now for Effective Transition Later.” Taillon is an AHIMA- Approved ICD-10-CM/PCS Trainer. This Q&A was originally published on the ACDIS Blog.

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