Supplement vs replacement root operations blog

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Supplement (U) and Replacement (R) root operations are found in the Medical & Surgical Section “0”. They are a part of the group of Root Operations that “always involve a device” (ICD-10 PCS Training …

Supplement (U) and Replacement (R) root operations are found in the Medical & Surgical Section “0”. They are a part of the group of Root Operations that “always involve a device” (ICD-10 PCS Training Manual, 2014). REMEMBER: In the root operations Supplement and Replacement, a device is left in or on a body part after the procedure is concluded and can be removed in subsequent procedures. The root operation Supplement is defined as putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part. One of the more common procedures is the repair of prolapsed pelvic organs using a vaginal mesh. The mesh is used to strengthened or reinforce the weak tissues that support the vagina and uterus. While Replacement is defined as 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. One of the more common procedures is total knee replacement. When the patient undergoes a total knee replacement, the surgeon removes damaged cartilage and bone from the surface of the knee joint and replaces them with a man-made surface of metal and plastic

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  • 1. SUPPLEMENT VS REPLACEMENT ROOT OPERATIONS Supplement (U) and Replacement (R) root operations are found in the Medical & Surgical Section “0”. They are a part of the group of Root Operations that “always involve a device” (ICD-10 PCS Training Manual, 2014). REMEMBER: In the root operations Supplement and Replacement, a device is left in or on a body part after the procedure is concluded and can be removed in subsequent procedures. The root operation Supplement is defined as putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part. One of the more common procedures is the repair of prolapsed pelvic organs using a vaginal mesh. The mesh is used to strengthened or reinforce the weak tissues that support the vagina and uterus. While Replacement is defined as 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. One of the more common procedures is total knee replacement. When the patient undergoes a total knee replacement, the surgeon removes damaged cartilage and bone from the surface of the knee joint and replaces them with a man-made surface of metal and plastic. The Table below depicts the body systems that have both of the root operations and there devices: BODY SYSTEM SUPPLEMENT DEVICES REPLACEMENT DEVICES HEART & GREAT VESSELS Autologous Tissue Substitute; Zooplastic Tissue; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Zooplastic Tissue; Synthetic Substitute; Nonautologous Tissue UPPER ARTIERIES Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue LOWER ARTERIES Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue UPPER VEINS Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue LOWER VEINS Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue EYE Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue; Intraocular Telescope EAR, NOSE, SINUS Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue MOUTH & THROAT Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue GASTROINTESTINAL SYSTEM Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue HEPATOBILIARY SYSTEM & PANCREAS Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue SKIN & BREAST Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Nonautologous Tissue SUBCUTANEOUS & FASCIA Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue TENDONS Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue HEAD & FACIAL BONES Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue UPPER BONES Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue LOWER BONES Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue UPPER JOINTS Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute, Reverse Ball & Socket; Nonautologous Tissue LOWER JOINTS Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue; Liner, Resurfacing Device Autologous Tissue Substitute; Synthetic Substitute (Metal, Metal Polyethylene, Ceramic, Metal on Polyethylene); Nonautologous Tissue URINARY SYSTEM Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue MALE REPRODUCTIVE SYSTEM Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Synthetic Substitute ANATOMICAL REGION, UPPER EXTREMITIES Autologous Tissue Substitute; Synthetic Substitute; Nonautologous Tissue Autologous Tissue Substitute
  • 2. So far, the distinction between the correct applications of the root operations is clear; but what happens when the distinction is not so clear? Deciding when to use the correct root operation in the body systems that have both root operations can be perplexing. One example would be when a graft is being used as a device to replace or supplement a portion of or all of a body part. One clue would be that in the root operation Replacement “the body part or a portion of the body part requiring the graft would have to be taken out or replaced, or may be taken out, physically eradicated, or rendered nonfunctional during the replacement procedure” (ICD-10 PCS Training Manual, 2014). REMEMBER: If a Replacement device is being removed; the root operation is Removal (P). The most common form of graft replacement is the skin graft. Skin grafts are often employed after serious injuries when some of the body’s skin is damaged. Surgical removal of the damaged skin is followed by skin grafting. The grafting serves two purposes: reduce the course of treatment needed and improve the function and appearance of the area of the body which receives the skin graft. On the other hand, when a graft is being used to augment a portion of or all of a body part the root operation Supplement is appropriate. The difference is that a portion of or all of the body part may have been taken out prior to the surgery or not at all unlike in a Replacement where a portion of or all of the body part is taken out during the procedure. A form of graft augmentation would be nerve grafting. Nerve grafting is a readily available solution for the problem of gapping caused by a nerve injury. In this procedure the damaged nerve is reconstructed by bridging the defective gap between two ends of a nerve to restore its function. The graft does not take the place of the nerve; but its purpose is to eliminate the gap caused by the injury so that the function of the nerve is not impeded.
  • 3. Cynthia Brown, MBA, RHIT, CCS AHIMA Approved ICD-10 CM/PCS Trainer CyntCoding Health Information Services Phone: 404-992-8984/E-Fax: 678-805-4919 P.O. Box 3019 Decatur, GA 30031 cyntcoder@cyntcodinghealthinformationservices.com www.cyntcodinghealthinformationservices.com http://cyntcodinghealthinformationservices.blogspot.com Coding Yesterday’s Nomenclature Today® CCHIS PRODUCTS & SERVICES CODING YESTERDAY’S NOMENCLATURE TODAY TERMS AND CONDITIONS OF USE All content provided on this “CODING YESTERDAY’S NOMENCLATURE TODAY” blog is for informational purposes only. The owner of this blog makes no representations as to the accuracy or completeness of any information on this site or found by following any link on this site. The owner of http://cyntcodinghealthinformationservices.blogspot.com will not be liable for any errors or omissions in information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information. The terms and conditions are subject to change at any time with or without notice.