PCS Coding Control vs. More Definitive Root Operation

Update as of 10/1/2021 -->  “Control is the root operation coded when the procedure performed to achieve hemostasis, beyond what would be considered integral to a procedure, utilizes techniques (e.g., cautery, application of substances or pressure, suturing or ligation or clipping of bleeding points at the site) that are not described by a more specific root operation definition, such as Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection. If a more specific root operation definition applies to the procedure performed, then the more specific root operation is coded instead of Control.”

The root operation of Control has proven to be confusing to coders since it has changed with each year of coding in ICD-10-PCS. Here are a few examples that will hopefully help coders know when to use or not to use the root operation “Control”.

Examples:
• Patient presented with GI bleeding and is found to have erosive gastritis during EGD. The area of bleeding is injected with epinephrine to help with control of bleeding and also clips were placed at the site to help with future bleeding. This would be coded using the root operation of Control. There is no other definitive root operation done for this finding, only control of bleeding.

• Patient presents with GI bleeding and is found during EGD to have bleeding esophageal varices. The patient has banding of the esophageal varices. This would be coded using the root operation of Occlusion. This is a more definitive root operation than just control of bleeding.

• Patient presents with epistaxis for the past several hours. In the ED, the patient receives nasal packing using tampon to help with the bleeding. This would be coded using the root operation of Packing.

• Patient presents to ED with nasal bleeding. This is treated with Silver nitrate cautery. This is coded to the root operation of control.

• Patient presents with internal injury due to MVA with internal bleeding noted in the ED. The patient is found to have severely lacerated kidney during exploratory laparotomy. During the surgery it is determined that the patient’s kidney is unsalvageable and decision to remove the kidney was made. The removal of the entire left kidney was performed. This would be coded using the root operation of Resection. Even though removing the kidney stopped the kidney bleeding/hemorrhage, the appropriate root operation is Resection and not Control. Resection is a more definitive root operation so that is what should be used.

• Patient presented with acute bleeding of an artery status post abdominal hysterectomy. The physician dissects down and then ligates the bleeding artery with a suture and closes the area. This would be coded using the root operation Control as there is not a more specific root operation other than repair.

Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P

References:

AHA Coding Clinic, Third Quarter 2019 Page: 4-5
AHA Coding Clinic, Fourth Quarter 2021 Page: 97-100
ICD-10-PCS Official Guidelines for Coding and Reporting 2022, Pages: 5, 7-8
ICD-10-PCS Official Guidelines for Coding and Reporting 2019, Page: 6
AHA Coding Clinic, Fourth Quarter 2017 Page: 105-106
AHA Coding Clinic, Fourth Quarter 2018 Page: 37-38 and 75-76
AHA Coding Clinic, First Quarter 2018 Page: 19-20
AHA Coding Clinic, Fourth Quarter 2017 Page: 105-106

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The information contained in this coding advice 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.