Exploring Root Operations for ICD-10-PCS

Occlusion and restriction are ICD-10-PCS root operations that alter the diameter or route of a tubular body part.

Definitions
Occulsion: Completely closing an orifice or lumen of a tubular body part
Restriction: Partially closing an orifice or the lumen of a tubular body part

An occlusion is coded when the surgeon is closing a vessel completely. If the surgeon is narrowing the vessel, then the root operation is restriction. ICD-10-PCS guideline B3.12 provides more detail. (Access the guidelines on the CMS website.)

A fallopian tube ligation is an example of an occlusion. During this procedure the fallopian tube is completely closed off; some describe this as “having your tubes tied.” If we index the main term ligation in the PCS index, a coding instruction will say, “see Occlusion.” Now referencing the main term occlusion, and sub-term fallopian tube we have a good start at finding the correct PCS code.

An example of a restriction is a gastroesophageal fundoplication. In this procedure a portion of the stomach is wrapped around the esophagus and sewn into place, strengthening the valve between the esophagus and stomach. This procedure is performed on patients with GERD, and it helps prevent acid from coming back up the esophagus. When we index the main term fundoplication, a note states to “see Restriction, Esophagogastric Junction” and provides the first four charaters: 0DV4. The next characters are selected based on how the procedure was performed and if any devices were used.