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

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
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