Control is explained in the PCS guidelines at B3.7. In the guidelines for FY 2016, Control was defined as “Stopping, or attempting to stop, postprocedural bleeding.” The guideline went on to state:
As you can see, this was a very limited view of the root operation Control. It left coding professionals wondering how to code for stopping other acute bleeding that might occur, such as epistaxis. So, in the FY 2017 update, the definition was updated to: “Stopping, or attempting to stop, postprocedural or other acute bleeding. The remainder of the guideline stayed the same.
You would think that the incorporation of “other acute bleeding” might have been the end of the revisions, but you would be wrong. In FY 2018, the B3.7 guideline was tinkered with again, this time removing the word “initially” in the following:
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.
As you can see, there was also a change to the end of the guideline where the phrase “then that root operation” is replaced with “then the more definitive root operation”.
We got a reprieve from change in FYs 2019, 2020, and 2021, with the guideline remaining as it was refined in FY 2018:
Control vs. more definitive root operations
B3.7
Control vs. more definitive root operations B3.7 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 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.
So, just when we thought the changes to guideline B3.7 were finished, along comes the updates for FY 2022, and we see, yet again, change-this one being rather substantial. First the title of the guideline has changed. The phrase “more definitive”, has been replaced with “more specific” when talking about other root operations.
Control vs. more specific root operations
B3.7
The root operation Control is defined as, “Stopping, or attempting to stop, postprocedural or other acute bleeding.” 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. Example: Silver nitrate cautery to treat acute nasal bleeding is coded to the root operation Control. Example: Liquid embolization of the right internal iliac artery to treat acute hematoma by stopping blood flow is coded to the root operation Occlusion. Example: Suctioning of residual blood to achieve hemostasis during a transbronchial cryobiopsy is considered integral to the cryobiopsy procedure and is not coded separately.
As you can see, the definition of Control has not changed, but the explanation of it has been expanded. Coding professionals are reminded that Control is not to be assigned for the routine hemostasis performed during a procedure. Most surgical procedures are going to require a degree of hemostasis be achieved as part of the procedure. That degree of Control is integral to the procedure. It is when something additional, or out of the ordinary, must be done, then the root operation Control applies.
Again, it is important to remember that if another root operation more specifically identifies how that stoppage of blood flow was achieved, then that root operation is assigned instead of Control. There are now three examples in guideline B3.7 to illustrate the appropriate root operation assignments.
Dare we think this is the last change we’ll see to Control? Only time will tell.
In the meantime, Now you are In the kNOW!!
About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP is
OHIMA's Coding Education Coordinator. Dianna has been an HIM
professional for 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.
