Wiki ICD 10 PCS coding question Excision vs Extirpation

[snwhite0730]

Hello Fellow Coders,

I'm hoping someone can help me to get a better understanding of a PCS code. I am doing self-study for PCS coding in hopes of taking the CIC certification test later this year. I purchased the Optum ICD PCS 2023, in Appendix M they have a large range of procedures to code for coding practice. One of the procedures I'm stuck on is a Sigmoidoscopy with sigmoid polypectomy. I chose 0DCN8ZZ (root operation C Extirpation). Checking the answer key, they have 0DBN8ZZ (root operation B Excision).

I'm confused why excision would be the correct root operation based on the definition of excision given in the book as Cutting out or off, without replacement, a portion of a body part; since a polyp is a collection of cells or growths inside the colon (in this case) and the definition for extirpation is a better fit (in my opinion) Taking or cutting out solid matter from a body part. The explanation goes on to state: 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.

I am completely new to PCS coding and by no means think I have this figured out, but this one is very baffling to me. If anyone could shed a little light on this I would really appreciate it, since as I said I am doing self-study and still debating if I want to take the CIC training class.

Thank you!

 

[sls314]

Hello Fellow Coders,

I'm hoping someone can help me to get a better understanding of a PCS code. I am doing self-study for PCS coding in hopes of taking the CIC certification test later this year. I purchased the Optum ICD PCS 2023, in Appendix M they have a large range of procedures to code for coding practice. One of the procedures I'm stuck on is a Sigmoidoscopy with sigmoid polypectomy. I chose 0DCN8ZZ (root operation C Extirpation). Checking the answer key, they have 0DBN8ZZ (root operation B Excision).

I'm confused why excision would be the correct root operation based on the definition of excision given in the book as Cutting out or off, without replacement, a portion of a body part; since a polyp is a collection of cells or growths inside the colon (in this case) and the definition for extirpation is a better fit (in my opinion) Taking or cutting out solid matter from a body part. The explanation goes on to state: 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.

I am completely new to PCS coding and by no means think I have this figured out, but this one is very baffling to me. If anyone could shed a little light on this I would really appreciate it, since as I said I am doing self-study and still debating if I want to take the CIC training class.

Thank you!

Are you using the index in your ICD-10-PCS book? Polypectomy specifically indexes to 0DB, so if you were using the index you'd have been lead to the correct code choice.

In my opinion, ICD-10-PCS is a tough thing to self-study from scratch. It's not something I would have been comfortable learning on my own, and I usually lean towards self-study for most things.

PCS is such a different beast from all the other code sets. I've self-studied for many of my credentials, but I wouldn't have wanted to learn PCS on my own. (I have taken the CIC course, but haven't gotten around to taking the exam yet. Maybe one day? Working outpatient now, so I'm not in a huge rush.)

If you don't want to take the full CIC course, I think it's at least worth doing some education specific to root operations. Maybe webinars or YouTube videos?

Root operations were the hardest concept for me to get comfortable with. I had to keep reviewing information from a variety of sources until I established a solid comfort level with it. (That was just my personal experience - others may have found it easy.)

This link explains Excision in more detail: https://bok.ahima.org/doc?oid=98647
This link explains Extirpation in more detail: https://library.ahima.org/doc?oid=106401

Hope this helps!

 

[snwhite0730]

Susan, Thank you! I am using the index, but obviously, not correctly smh. I went straight to extripartation based on the definition instead of looking up polypectomy. I have been watching a ton of YT videos related to PCS coding but the more I watch I see that I have to look up another video to understand something they went over in that video. I have been in the medical industry for over ten years and I think my problem is stemming from the terminology used in PCS is very different from the medicine side if that makes sense. You really do have to retrain your brain to think about these procedures in a completely different way.

I currently work at an IP acute care behavioral health hospital and most of my coding is ICD 10 and a lot of it is repeat coding or using the F section of the ICD 10. While I do enjoy what I am doing now, I miss coding procedures/CPT coding and the complexity that comes with coding procedures. Since the hospital system I work for is large and also have IP acute care hospitals, I figured I'd go for my CIC in hopes of moving into IP facility coding for the same company.

I think you are correct, this is not a case where I can study on my own and take the exam and pass. I enjoy a challenge and doing things that are more difficult but I DO want to succeed in them, not just learn them! I will have to bite the bullet and pay for the CIC course.

Thank you so much for the advice and reality check!