Navigating ICD-10-PCS: A Closer Look at Restriction and Occlusion Root Operations

Let's look at the root operations Restriction and Occlusion. Navigating these terms can often pose a significant challenge for coders, especially when determining the appropriate root operation for a procedure. Coders are responsible for analyzing the documentation within the medical record to accurately discern the objective of the procedures performed, which is the basis for the root operation selection. With physicians increasingly incorporating terms like restriction and occlusion into their statement of procedure, it's imperative that coders review the entire procedure note to determine the actual objective of the procedure 

Restriction: 

The objective of the root operation "Restriction," is partial closure of an orifice or the lumen of a tubular body part—a process often described as “partial occlusion”.  In ICD-10-PCS, tubular body parts are defined as hollow structures facilitating the passage of solids, liquids, or gases. Through the use of intraluminal and/or extraluminal devices, restriction procedures aim to narrow the diameter of a tubular body part or a natural or artificially created orifice. 

Examples of Procedures Reported with the Root Operation Restriction: 

• Gastroesophageal fundoplication 
• Cervical cerclage 
• Banding of the pulmonary artery using an extraluminal device 
• Clipping of a cerebral aneurysm (with the intention not to completely close it off) 
• Placement of a restrictive stent in the right lacrimal duct 
• Laparoscopic banding for obesity 
• Endovascular AAA repair with or without a device.

Occlusion: 

In contrast, the objective of the root operation "Occlusion," is completely closing an orifice or the lumen of a tubular body part. Through the use of intraluminal and/or extraluminal devices, a tubular body part or natural or artificial orifice is completely closed off, no longer allowing for the passage of solids, liquids or gases.  

Examples of Procedures Reported with the Root Operation Occlusion: 

• Bilateral tubal ligation with Hulka clips 
• Ligation of the esophageal vein 
• Embolization of an internal carotid-cavernous fistula 
• Embolization of the vascular supply to an intracranial meningioma 
• Embolization of the uterine artery 
• Banding of esophageal varices
• Banding of hemorrhoids 

Take Away:

 In essence, the key distinction between the root operations Restriction and Occlusion lies in their objective: restriction partially closes the orifice or lumen of a tubular body part, while occlusion completely closes it off. 

Deepen your understanding of the application of these and other root operations with   ICD-10-PCS Understanding Root Operations, instruction designed specifically to help you build proficiency in handling complex procedures. 

References: 
ICD-10-PCS Official Guidelines for Coding and Reporting  
ICD-10-PCS Reference Manual 
ICD-10-CM/PCS Coding Clinic, Third Quarter 2015 Page: 30 
ICD-10-CM/PCS Coding Clinic, Third Quarter 2014 Pages: 26-28 
ICD-10-CM/PCS Coding Clinic, First Quarter 2014 Pages: 9 & 24 
ICD-10-CM/PCS Coding Clinic, Second Quarter 2015 Page: 27 
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2014 Page: 37 
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2021 Page: 63 
ICD-10-CM/PCS Coding Clinic, Third Quarter 2021 Page: 23 

About our ICD-10-PCS Understanding Root Operations Course

In this coding course, participants will delve into the intricacies of ICD-10-PCS coding, focusing primarily on the Medical and Surgical Section. Through comprehensive readings from the ICD-10-PCS Reference Manual and Official Coding Guidelines, learners will gain a thorough understanding of root operations and their definitions, with a special emphasis on distinguishing between Control and more specific root operations. This course equips coders with the knowledge to make accurate code assignments when dealing with postprocedural or other acute bleeding scenarios. Practical examples and real-world cases, such as the management of bleeding duodenal ulcers and intraoperative hemorrhages, will be explored to reinforce these concepts.

HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for over 30 years—offers a comprehensive online education platform for medical coders. With a catalog of over 250 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection accredited by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPT, E/M, ICD-10-CM, ICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatient, outpatient, profee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CM, ICD-10-PCS, CPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams. With over 1,600 users already part of the HIAlearn community, the platform stands as a testament to its commitment to providing quality education and support for medical coders nationwide.

The information contained in this blog post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.