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31 Cards in this Set
- Front
- Back
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Alteration- Modifying the anatomic structure of a body part without affecting the function of the body part
Principal purpose is to improve appearance |
Examples:
Face lift, breast augmentation |
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Bypass - Altering the route of passage of the contents of a tubular body part
Rerouting contents around an area of a body part to another distal (downstream) area in the normal route, rerouting the contents to another different but similar route and body part; or to an abnormal route and another dissimilar body part. It includes one or more concurrent anastomoses with or without the use of a devise such as autograts, tissue substitutes and sympathetic substitutes |
Examples:
Coronary artery bypass, colostomy formation |
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Change - taking out or off a device from a body part and putting back in identical or similar device in or on the same body part without cutting or puncturing the skin or a mucous membrane.
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Examples:
Urinary catheter change, gastrostomy tube change |
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Control- stopping, or attempting to stop post-procedural bleeding
The site of the bleeding is coded as an anatomical region and not to a specific body part. |
Example:
Control of post-postatectomy hemorrhage, control of post-tonsillectomy hemorrhage |
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Destruction- Eradicating all or a portion of a body part.
Used for the actual physical destruction of all or a portion of a body part by the direct use of energy, force or a destructive agent. None of the body part is taken out. |
Examples:
Fulguration of rectal polyp, Cautery of skin lesion |
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Detachment - cutting off all or a portion of an extremities.
Cutting off all or part of the upper or lower extremities |
Example:
Below knee amputation, Disarticulation of shoulder |
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Dilation- Expanding an orifice or the lumen of a tubular body part
The orifice can be a natural orifice or an artificially created orifice. Accomplished by stretching a tubular body part using intraluminal pressure or by cutting part of the orifice or wall of the tubular body part. |
Examples:
Percutaneous transluminal angioplasty, pyloromyotomy |
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Division - Separating without taking out a body part
All or a portion of the body part is separated into two or more portions |
Examples:
Spinal cardotomy, osteotomy |
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Drainage - Taking or letting out fluids and/or gases from a body part.
The qualifier DIAGNOSTIC is used to identify drainage procedures that are biopsies |
Examples:
Thoracentesis, incision and drainage |
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Excision - Cutting out or off, without replacement a portion of a body part.
The qualifier DIAGNOSTIC is used to identify excision procedures that are biopsies |
Examples:
Partial nephrectomy, liver biopsy |
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Exterpation- Taking or cutting out solid matter from a body part
The solid matter may be an abnormal by product of a biological function or a foreign body. The solid matter is imbedded in a body part or is in the lumen of a tubular body part. The solid matter may or may not have been previously broken into pieces. No appreciable amount of the body part is taken out |
Examples:
Thrombectomy, choledocholithotomy |
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Extraction- Pulling or stripping out or off all or a portion of a body part.
The body part is pulled or stripped from its location by the use of force (e.g., manual, suction). The qualifier DIAGNOSTIC is used to identify extraction procedures that are biopsies. |
Examples:
Dilation and curettage, vein stripping |
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Fragmentation- Breaking solid matter in a body part into pieces.
The solid matter may be an abnormal byproduct of a biological function or a foreign body. Physical force (e.g., manual, ultrasonic) applied directly or indirectly through intervening body parts is used to break the solid matter into pieces. The pieces of solid matter are not taken out, but are eliminated or absorbed through normal biological functions. |
Examples:
Extracorporeal shockwave lithrotripsy, translucent lithrotripsy |
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Fusion - Joining together portions of an articular body part rendering the articular body part immobile. The body part is joined together by fixation device, bone graft, or other means.
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Example:
Spinal fusion, ankle arthrodesis |
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Insertion: Putting in a non-biological device that monitors, assists, performs or prevents a physiological function but does not physically take the place of a body part.
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Examples:
Insertion of radioactive implants, insertion of central venous catheter. |
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Inspection- Visually and/or manually exploring a body part. Visual exploration may be performed with or without optical instrumentation.
Manual exploration may be performed directly or through intervening body layers. |
Examples:
Diagnostic arthroscopy, exploratory laparotomy |
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Map- Locating the route of passage or electrical impulses and/or locating functional areas in a body part.
Applicable only to the cardiac conduction mechanism and the central nervous system. |
Examples:
Cardiac mapping, cortical mapping |
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Occlusion- Completely closing orifice or the lumen of a tubular body part.
The orifice can be a natural or artificially created orifice. |
Examples:
Fallopian tube ligation, ligation of inferior vena cava |
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Reattachment - Putting back in or on all or a portion of a separated body part to its normal location or other suitable location.
Vascular circulation and nervous pathways may or may not be reestablished. |
Examples:
reattachment of hand, reattachment of avulsed kidney. |
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Release- Freeing a body part. Eliminating an abnormal constraint of a body part by cutting or by use of force. Some of the restraining tissue may be taken out but none of the body part is taken out.
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Example:
Adhesiolysis, carpal tunnel release. |
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Removal - Taking out or off a device from a body part. If taking out a device and putting in a similar device is performed with an external approach, the procedure is coded to the root operation CHANGE. Otherwise, the procedure for taking out the device is coded to the root operation REMOVAL and the procedure for taking out the device is coded to the root operation REMOVAL and the procedure for putting in the new device is coded to the root operation performed.
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Example:
Drainage tube removal, cardiac pacemaker removal |
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Repair - Restoring, to the extent possible a body part to its normal anatomic structure and function.
Used only when the method to accomplish the repair is not of the other root operations. |
Examples:
Herniorrhaphy, suture of laceration |
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Replacement - Putting in or on biological or synthetic material that physically takes the place or a portion of a body part. The biological material is non-living or the biological material is living and from the same individual. The body part may have been previously taken out, previously replaced, or may be taken out concomitantly with the Replacement procedure. If the body part has been previously replaced, a separate Removal procedure is coded for taking out the device used in the replacement.
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Examples:
Total hip replacement, free skin graft |
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Reposition - Moving to its normal location or other suitable location all or a portion of a body part.
The body part is moved to a new location from an abnormal location, or from a normal location where it is not functioning correctly. The body part may or may not be cut out or off to be moved to the new location. |
Examples:
Reposition of undescended testicles, fracture reduction |
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Resection - Cutting out or off, without replacement, all or a body part.
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Examples:
Total nephrectomy, total lobectomy of lung |
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Restriction- Partially closing an orifice or the lumen of a tubular body part.
The orifice can be a natural orifice or an artificially created orifice. |
Examples:
Esophagogastric fundoplication, cervical cerclage |
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Revision - Correcting to the extent possible a malfunctioning or displaced device by taking out or pulling in components of the device such as a screw or pin.
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Example:
Adjustment of pacemaker lead, adjustment of hip prosthesis |
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Supplement- Putting in or on biologic or synthetic material that physically reinforces and/or augments the function of a portion of the body. The biological material is non-living or the biological material is living and from the same individual. The body part may have been previously replaced. If the body part has been previously replaced, the SUPPLEMENT procedure is performed to physically reinforce and/or augment the function of the replaced body part.
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Example:
Herniorrhaphy using mesh, free nerve graft, mitral valve ring annuloplasty, put a new acetabular liner in a previous hip replacement, abdominal wall herniorrhaphy using mesh. |
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Transfer - Moving without taking out all or a portion of a body part to another location to take the function of all or a portion of a body part. The body part transferred remains connected to its vascular supply.
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Example:
Tendon transfer, skin pedicle flap transfer |
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Transplantation - Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part. The native body part may or may not be taken out, and the transplanted body part may take over all or a portion of its function.
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Example:
Kidney transplant, heart transplant |
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Creation- Making a new structure that does not physically take the place of a body part. Used only for sex change operations where genitalia are made.
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Examples:
Creation of vagina in a male Creation of penis in a female |
