ICD-10-PCS root operations
Character three of a PCS code is the objective of the procedure. Choose it wrongly and you usually still get a valid code — one describing an operation that did not happen. These are the official definitions, with the distinctions that actually cause rework.
The Medical and Surgical section defines these root operations. Sections beyond it — Imaging, Radiation Therapy, Physical Rehabilitation and the rest — use their own value set on character three, which is why the axis is called "Type" rather than "Operation" there.
The definitions, explanations and examples below are quoted verbatim from the CMS ICD-10-PCS definitions file. They are the normative wording coders are held to, so they are not paraphrased.
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Alteration
Official definition: Modifying the anatomic structure of a body part without affecting the function of the body part
Explanation: Principal purpose is to improve appearance
Examples: Face lift, breast augmentation
What it gets confused with: The only root operation defined by intent rather than by act: modifying a body part for appearance, with no functional purpose. If the procedure corrected function, it is not Alteration.
Coverage: 8 tables · 8 body systems · 618 codes
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Bypass
Official definition: Altering the route of passage of the contents of a tubular body part
Explanation: Rerouting contents of a body part to a downstream area of the normal route, to a similar route and body part, or to an abnormal route and dissimilar body part. Includes one or more anastomoses, with or without the use of a device
Examples: Coronary artery bypass, colostomy formation
What it gets confused with: The qualifier carries the destination, which is what makes bypass codes long. Altering the route of passage of a tubular body part; the body part is where the bypass starts and the qualifier is where it ends.
Coverage: 17 tables · 17 body systems · 6,039 codes
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Change
Official definition: Taking out or off a device from a body part and putting back an identical or similar device in or on the same body part without cutting or puncturing the skin or a mucous membrane
Explanation: All CHANGE procedures are coded using the approach EXTERNAL
Examples: Urinary catheter change, gastrostomy tube change
What it gets confused with: Always coded with the approach External, by definition, and only when an identical or similar device is swapped without cutting or puncturing. Anything else is Removal plus Insertion.
Coverage: 26 tables · 26 body systems · 204 codes
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Control
Official definition: Stopping, or attempting to stop, postprocedural or other acute bleeding
Examples: Control of post-prostatectomy hemorrhage, control of intracranial subdural hemorrhage, control of bleeding duodenal ulcer, control of retroperitoneal hemorrhage
What it gets confused with: Confused with Repair. Control is only for stopping post-procedural or other acute bleeding. If the bleeding was stopped by a more specific root operation — tying off the vessel, removing the body part — that operation is coded instead, and Control is not.
Coverage: 4 tables · 4 body systems · 182 codes
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Creation
Official definition: Putting in or on biological or synthetic material to form a new body part that to the extent possible replicates the anatomic structure or function of an absent body part
Explanation: Used for gender reassignment surgery and corrective procedures in individuals with congenital anomalies
Examples: Creation of vagina in a male, creation of right and left atrioventricular valve from common atrioventricular valve
What it gets confused with: Rare and narrow: making a new body part that did not exist, used for genital reconstruction and for making a valve where there was none. Not the same as Bypass, which reroutes something that already exists.
Coverage: 2 tables · 2 body systems · 18 codes
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Destruction
Official definition: Physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent
Explanation: None of the body part is physically taken out
Examples: Fulguration of rectal polyp, cautery of skin lesion
What it gets confused with: Confused with Excision. Destruction eradicates a body part by energy, force or a destructive agent — ablation, fulguration, cautery — with nothing taken out. If there is a specimen, it was not Destruction.
Coverage: 28 tables · 28 body systems · 2,415 codes
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Detachment
Official definition: Cutting off all or a portion of the upper or lower extremities
Explanation: The body part value is the site of the detachment, with a qualifier if applicable to further specify the level where the extremity was detached
Examples: Below knee amputation, disarticulation of shoulder
What it gets confused with: Confused with Resection. Detachment applies only to extremities, and it is the root operation for every amputation. The qualifier carries the level — complete, high, mid, low — so the body part and the qualifier together say where the limb was taken.
Coverage: 2 tables · 2 body systems · 157 codes
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Dilation
Official definition: Expanding an orifice or the lumen of a tubular body part
Explanation: The orifice can be a natural orifice or an artificially created orifice. Accomplished by stretching a tubular body part using intraluminal pressure or by cutting part of the orifice or wall of the tubular body part
Examples: Percutaneous transluminal angioplasty, internal urethrotomy
What it gets confused with: Confused with Bypass. Dilation widens an existing lumen; Bypass creates a new route around it. A stent placed to hold a vessel open is Dilation with a device, not Insertion.
Coverage: 15 tables · 15 body systems · 3,426 codes
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Division
Official definition: Cutting into a body part, without draining fluids and/or gases from the body part, in order to separate or transect a body part
Explanation: All or a portion of the body part is separated into two or more portions
Examples: Spinal cordotomy, osteotomy
What it gets confused with: Confused with Release and with Drainage. Division separates or transects a body part with nothing removed. If the cut was made to let fluid out, the objective was Drainage.
Coverage: 18 tables · 18 body systems · 743 codes
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Drainage
Official definition: Taking or letting out fluids and/or gases from a body part
Explanation: The qualifier DIAGNOSTIC is used to identify drainage procedures that are biopsies
Examples: Thoracentesis, incision and drainage
What it gets confused with: Confused with Extirpation and Extraction. Drainage takes out fluids or gases. If what came out was solid matter that did not belong there, that is Extirpation. Diagnostic drainage takes the qualifier X.
Coverage: 30 tables · 30 body systems · 6,834 codes
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Excision
Official definition: Cutting out or off, without replacement, a portion of a body part
Explanation: The qualifier DIAGNOSTIC is used to identify excision procedures that are biopsies
Examples: Partial nephrectomy, liver biopsy
What it gets confused with: Confused with Resection. Excision takes a portion, Resection takes all of a body part — and "all" means all of a body part as the PCS body part key defines it, not as the surgeon phrased it. Decide the body part value first, then ask whether the whole of it came out. A biopsy is not a root operation of its own: guideline B3.4a codes it to Excision, Extraction or Drainage with the qualifier X, Diagnostic.
Coverage: 31 tables · 31 body systems · 4,619 codes
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Extirpation
Official definition: Taking or cutting out solid matter from a body part
Explanation: The solid matter may be an abnormal byproduct of a biological function or a foreign body; it may be imbedded in a body part or in the lumen of a tubular body part. The solid matter may or may not have been previously broken into pieces
Examples: Thrombectomy, choledocholithotomy
What it gets confused with: Confused with Extraction and Fragmentation. Extirpation takes solid matter out of a body part — a thrombus, a stone, a foreign body. Fragmentation breaks it up and leaves it. Extraction pulls out part of the body part itself.
Coverage: 29 tables · 29 body systems · 2,253 codes
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Extraction
Official definition: Pulling or stripping out or off all or a portion of a body part by the use of force
Explanation: The qualifier DIAGNOSTIC is used to identify extraction procedures that are biopsies
Examples: Dilation and curettage, vein stripping
What it gets confused with: Confused with Excision. Extraction pulls or strips a body part out by force rather than cutting it out — a vein stripping, a dilation and curettage. If an instrument cut the tissue free, it is Excision.
Coverage: 21 tables · 21 body systems · 772 codes
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Fragmentation
Official definition: Breaking solid matter in a body part into pieces
Explanation: Physical force (e.g., manual, ultrasonic) applied directly or indirectly is used to break the solid matter into pieces. The solid matter may be an abnormal byproduct of a biological function or a foreign body. The pieces of solid matter are not taken out
Examples: Extracorporeal shockwave lithotripsy, transurethral lithotripsy
What it gets confused with: Confused with Extirpation. Fragmentation breaks solid matter into pieces and leaves them to pass or be absorbed. If the pieces were then taken out, the removal is Extirpation and Fragmentation is not coded as well.
Coverage: 14 tables · 14 body systems · 490 codes
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Fusion
Official definition: Joining together portions of an articular body part rendering the articular body part immobile
Explanation: The body part is joined together by fixation device, bone graft, or other means
Examples: Spinal fusion, ankle arthrodesis
What it gets confused with: The qualifier and device together carry the technique and the graft material, so spinal fusion codes need the operative report for both. The body part value is the joint being fused, and the number of vertebral joints decides how many codes you need.
Coverage: 2 tables · 2 body systems · 963 codes
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Insertion
Official definition: Putting in a nonbiological appliance that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part
Examples: Insertion of radioactive implant, insertion of central venous catheter
What it gets confused with: Confused with Replacement and Supplement. Insertion puts in a device that neither takes the place of a body part nor reinforces one — a pacemaker lead, an infusion device.
Coverage: 31 tables · 31 body systems · 4,072 codes
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Inspection
Official definition: Visually and/or manually exploring a body part
Explanation: Visual exploration may be performed with or without optical instrumentation. Manual exploration may be performed directly or through intervening body layers
Examples: Diagnostic arthroscopy, exploratory laparotomy
What it gets confused with: Coded alone only when nothing more definitive was done. An inspection that leads to a therapeutic procedure on the same body part through the same approach is not reported separately — a rule that catches diagnostic scopes converted to treatment mid-procedure.
Coverage: 31 tables · 31 body systems · 808 codes
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Map
Official definition: Locating the route of passage of electrical impulses and/or locating functional areas in a body part
Explanation: Applicable only to the cardiac conduction mechanism and the central nervous system
Examples: Cardiac mapping, cortical mapping
What it gets confused with: Used only on the cardiac conduction mechanism and the central nervous system. Locating electrical impulses or functional areas — not a diagnostic version of Inspection.
Coverage: 2 tables · 2 body systems · 28 codes
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Occlusion
Official definition: Completely closing an orifice or the lumen of a tubular body part
Explanation: The orifice can be a natural orifice or an artificially created orifice
Examples: Fallopian tube ligation, ligation of inferior vena cava
What it gets confused with: Confused with Restriction. Occlusion closes a lumen completely; Restriction narrows it. Tying off a vessel is Occlusion; banding one is Restriction.
Coverage: 14 tables · 14 body systems · 2,133 codes
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Reattachment
Official definition: Putting back in or on all or a portion of a separated body part to its normal location or other suitable location
Explanation: Vascular circulation and nervous pathways may or may not be reestablished
Examples: Reattachment of hand, reattachment of avulsed kidney
What it gets confused with: Confused with Reposition. Reattachment puts back a body part that was severed, at its normal location. Reposition moves a body part that was never fully detached. Whether the part came off completely is the deciding fact, and it is in the report.
Coverage: 17 tables · 17 body systems · 451 codes
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Release
Official definition: Freeing a body part from an abnormal physical constraint by cutting or by the use of force
Explanation: Some of the restraining tissue may be taken out but none of the body part is taken out
Examples: Adhesiolysis, carpal tunnel release
What it gets confused with: Confused with Division. Release cuts the tissue around a body part to free it and takes nothing out; Division cuts into the body part to separate it. A carpal tunnel release cuts the ligament compressing the nerve — the objective is freeing the nerve, so the body part coded is the nerve, not the ligament.
Coverage: 28 tables · 28 body systems · 2,299 codes
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Removal
Official definition: Taking out or off a device from a body part
Explanation: If a device is taken out and a similar device put in without cutting or puncturing the skin or mucous membrane, the procedure is coded to the root operation CHANGE. Otherwise, the procedure for taking out a device is coded to the root operation REMOVAL
Examples: Drainage tube removal, cardiac pacemaker removal
What it gets confused with: Confused with Revision and with the operations that take out body parts. Removal takes out a device, not tissue. Revision corrects a device that is still in place.
Coverage: 31 tables · 31 body systems · 5,287 codes
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Repair
Official definition: Restoring, to the extent possible, a body part to its normal anatomic structure and function
Explanation: Used only when the method to accomplish the repair is not one of the other root operations
Examples: Colostomy takedown, suture of laceration
What it gets confused with: The fallback. Repair is only used when no other root operation applies — restoring a body part to its normal structure by means the classification does not already name. Reaching for Repair usually means one of the more specific operations was missed.
Coverage: 31 tables · 31 body systems · 2,598 codes
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Replacement
Official definition: Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
Explanation: The body part may have been taken out or replaced, or may be taken out, physically eradicated, or rendered nonfunctional during the Replacement procedure. A Removal procedure is coded for taking out the device used in a previous replacement procedure
Examples: Total hip replacement, bone graft, free skin graft
What it gets confused with: Confused with Supplement and with Insertion. Replacement puts biological or synthetic material in the place of a body part, so the body part is physically taken over. Insertion puts in a device that does not take the place of anything.
Coverage: 26 tables · 26 body systems · 3,589 codes
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Reposition
Official definition: Moving to its normal location, or other suitable location, all or a portion of a body part
Explanation: The body part is moved to a new location from an abnormal location, or from a normal location where it is not functioning correctly. The body part may or may not be cut out or off to be moved to the new location
Examples: Reposition of undescended testicle, fracture reduction
What it gets confused with: Confused with Transfer. Reposition moves a body part back to, or toward, its normal location — reducing a fracture, for instance. Transfer moves it somewhere it does not belong in order to take over a function.
Coverage: 27 tables · 27 body systems · 2,306 codes
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Resection
Official definition: Cutting out or off, without replacement, all of a body part
Examples: Total nephrectomy, total lobectomy of lung
What it gets confused with: Confused with Excision and with Detachment. Removing an entire lung lobe is Resection because the lobe is itself a body part; removing a wedge of it is Excision. Amputations of extremities are never Resection — they are Detachment.
Coverage: 22 tables · 22 body systems · 921 codes
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Restriction
Official definition: Partially closing an orifice or the lumen of a tubular body part
Explanation: The orifice can be a natural orifice or an artificially created orifice
Examples: Esophagogastric fundoplication, cervical cerclage
What it gets confused with: Confused with Occlusion. Restriction partially closes a lumen and leaves it patent. If nothing can pass afterwards, it was Occlusion.
Coverage: 13 tables · 13 body systems · 2,018 codes
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Revision
Official definition: Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device
Explanation: Revision can include correcting a malfunctioning or displaced device by taking out or putting in components of the device such as a screw or pin
Examples: Adjustment of position of pacemaker lead, recementing of hip prosthesis
What it gets confused with: Confused with Removal and Replacement. Revision corrects the position or function of a device already in place. Taking the old one out and putting a new one in is Removal plus Insertion, not Revision.
Coverage: 31 tables · 31 body systems · 5,799 codes
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Supplement
Official definition: Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part
Explanation: The biological material is non-living, or is living and from the same individual. The body part may have been previously replaced, and the Supplement procedure is performed to physically reinforce and/or augment the function of the replaced body part
Examples: Herniorrhaphy using mesh, mitral valve ring annuloplasty, put a new acetabular liner in a previous hip replacement
What it gets confused with: Confused with Replacement. Supplement reinforces a body part that is still there; Replacement puts material in place of one that is not. Mesh in a hernia repair is Supplement. A total hip is Replacement.
Coverage: 30 tables · 30 body systems · 5,363 codes
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Transfer
Official definition: Moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part
Explanation: The body part transferred remains connected to its vascular and nervous supply
Examples: Tendon transfer, skin pedicle flap transfer
What it gets confused with: Confused with Reposition and Transplantation. Transfer moves a body part to another location while keeping its blood and nerve supply. Cut it free entirely and it becomes Transplantation.
Coverage: 13 tables · 13 body systems · 931 codes
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Transplantation
Official definition: Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part
Explanation: The native body part may or may not be taken out, and the transplanted body part may take over all or a portion of its function
Examples: Kidney transplant, heart transplant
What it gets confused with: Confused with Replacement and Transfer. Transplantation puts in living tissue from another individual or animal to take over the function of the body part. Non-living or synthetic material is Replacement; moving the patient's own tissue with its blood supply intact is Transfer.
Coverage: 11 tables · 11 body systems · 83 codes
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