The Root Operation Restriction and Occlusion in ICD-10-PCS Coding

This week’s coding tip focuses on the root operations restriction and occlusion in ICD-10-PCS coding. This can sometimes be challenging for coders when trying to determine the appropriate root operation (objective of procedure) to use. The onus is on the coder to determine what the physician performed based on the documentation in the record. Physicians are using restriction/occlusion and other procedure titles when performing procedures making it imperative that the coder review the entire procedure note.

Restriction:

• The root operation “restriction” is used when the surgeon partially closes (partial occlusion) an orifice or the lumen of a tubular body part. The tubular body parts are defined in ICD-10-PCS as those hollow body parts that provide a route of passage for solids, liquids, or gases.  The objective of these procedures is to narrow the diameter and includes both intraluminal and extraluminal methods for narrowing the diameter. Restriction can be performed in a natural or artificially created orifice.

Examples of Restriction:

• Gastroesophageal fundoplication
• Cervical cerclage
• Banding of pulmonary artery using extraluminal device
• Clipping of cerebral aneurysm (do not want to completely close off)
• Placement of restrictive stent in right lacrimal duct
• Laparoscopic banding for obesity
• Endovascular AAA repair with/without device

Occlusion:

• The root operation “occlusion” is used when the surgeon completely closes an orifice or the lumen of a tubular body part.  The objective of these procedures is to close off a tubular body part or orifice and includes both intraluminal and extraluminal methods for occlusion/closure. Occlusion may be performed on a natural or artificially created orifice. This differs from Restriction in that it completely closes and not partially.

Examples of Occlusion:

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

Take Away: The difference in restriction and occlusion is that restriction partially closes the orifice or lumen of a tubular body part and occlusion completely closes the orifice or lumen of a tubular body part.

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

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

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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.