Q&A: Control versus other root operations

Q: We had a patient with hemorrhagic cystitis. Our preprocedural plan was a cystoscopy with a bladder biopsy and cauterization. How should this be reported in ICD-10-PCS? We are having trouble choosing between Control or another root operation, and we are getting different MS-DRGs depending how the procedure is reported.

A: There is no Coding Clinic that addresses this issue, only a guideline for the root operation Control found in the 2019 ICD-10-PCS Official Guidelines for Coding and Reporting that states:

The root operation Control is defined as, “Stopping, or attempting to stop, postprocedural or other acute bleeding.” If an attempt to stop postprocedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing a more definitive root operation, such as Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then the more definitive root operation is coded instead of Control.

Example: Resection of spleen to stop bleeding is coded to Resection instead of Control.

My opinion is that this would be reported as a Destruction procedure with ICD-10-PCS code 0T5B8ZZ (Destruction of bladder, via natural or artificial opening endoscopic). I would also report 0TBB8ZX (Excision of bladder, via natural or artificial opening endoscopic, diagnostic) for the biopsy based on the intent of the procedure and the biopsy and cauterization performed, which was a more definitive procedure.  

Keep in mind, the root operations given in the guidelines state “such as,” so you would not be limited to just “Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection.”

I think this procedure would be grouped to MS-DRGs 668-670 (Transurethral Procedures) as opposed to MS-DRGs 662-664 (Minor Bladder Procedures), and, although it’s the higher-paying MS-DRG, it is more clinically accurate.

Editor’s note: Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, director of HIM and coding for HCPro, a Simplify Compliance brand, in Middleton, Massachusetts, answered this question.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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