6/25/2015
TOP 20
ICD‐10‐PCS
Questions Answered
ICD‐10 Coding Readiness
Top 20 Questions Answered Education Series (Session 2 of 3)
Presented June 30, 2015
by Ed O’Beirne, MHS, CCS, Senior Managing Consultant
Questions and Answers
derived from AHA Coding Clinic® and are subject to change
ICD‐10‐PCS Guidelines = Constitution
Coding Clinic = Supreme Court
Use discretion
Stay current
Always for coding correctness, not reimbursement
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The Zen of Procedure Coding
•
•
•
•
See the procedure in your mind’s eye
Understand the root operation Know the body part
Don’t be distracted by “doctor‐ese”
• (*get the concepts, don’t worry about the PCS codes)
No. 1 Fiducial Markers
Q
How would we code for bronchoscopy with placement of a gold fiducial marker for guidance of radiotherapy for lung cancer?
A
0BJL8Z Inspection of the left lung, via natural or artificial opening, endoscopic. ICD‐10‐PCS Official Guidelines for Coding and Reporting,
B6.1b, “Materials such as sutures, ligatures, radiological markers and temporary post‐operative wound drains are considered integral to the performance of a procedure and are not coded as devices.” Titanium
Gold
Stainless Steel
Image courtesy of JRT Associates
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No. 1 Fiducial Markers
FIDES (Latin): faithful, loyal, trustworthy
No. 2 Drainage vs. Insertion
Q Code: A biliary catheter inserted
percutaneously using CT guidance to bypass
an obstruction caused by liver cancer.
What is it we are really doing?
A 0F9630Z Drainage of left hepatic duct, with drainage device, percutaneous approach.
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No. 3 Products of Conception
Q
A
For ICD‐10‐PCS coding, what do these two procedures have in common?
1.
Suction D&C of miscarriage
2.
Vacuum‐assisted delivery of a healthy baby
10D07Z6 Fourth character (body part) “0” is for any products of conception.
No. 4 Non‐Excisional Debridement
Q
Code: Pulsavac irrigation lavage of left groin subcutaneous wound to remove necrotic tissue
A
0JDC0ZZ • Extraction of pelvic region subcutaneous tissue and fascia, open approach
• Extraction “pulling or stripping out or off all or a portion of a body part by the use of force”
Bonus Q and A
Why not code groin as an anatomical region body part?
No root operation extraction
for anatomical regions.
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No. 5
Q
A
Colon Resection and Anastomosis
How many ICD‐10‐PCS codes? “Laparotomy with right colon resection and side‐to‐side anastomosis”
0DTF0ZZ Resection of right large intestine, open approach
• “Inspection” aspect of laparotomy is included
• Functional end‐to‐end anastomosis is included
ICD‐10‐PCS Official Guidelines for Coding and Reporting, Section B3.1b, clarifies that procedural steps necessary to close the operative site, including anastomosis of a tubular body part, are not coded separately. This guideline would apply regardless of whether the procedure is an end‐to‐end or a side‐to‐side anastomosis.
No. 6 Joint Operations
Q
How many body parts and root operations are in this left knee arthroscopic operation?
• Lateral meniscectomy
• ACL debridement
• Abrasion chondroplasty of femoral condyles
• Medial synovectomy
• Osteophytectomy of articular patella
A PCS coding nightmare?!?ll\
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No. 6 Joint Operations
A ONE!
0SBD4ZZ Excision of left knee joint, percutaneous endoscopic approach.
The joint is comprised of all articular or supportive structures between bones.
No. 7 Radical Prostatectomy
Q
How to code for a laparoscopic radical prostatectomy?
In this patient, complete removal of:
Prostate gland
Bilateral seminal vesicles
Bilateral vas deferens
(consider the body parts)
A
0VT04ZZ Prostate resection
0VT34ZZ Bilat. seminal vesicles resection
0VBQ4ZZ Bilateral vas deferens resection
• All separate named body parts
• All completely removed = resection
• All done by percutaneous endoscopic
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No. 8 Cosmetic Surgery
lifting and suturing the eyebrows.
Q Code a browpexy• –Is that eyelid?
•
•
•
•
Supplement?
Excision?
Repair?
Reposition?
A 0W020ZZ Alteration of face, open approach
No body part for eyebrow
No option: “alteration of skin, face”
“‐pexy” = fixation of a structure
No. 8 Cosmetic Surgery
If it is only for looks
not function
Think ALTERATION
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No. 9 Skin‐sparing Mastectomy
Q Skin‐sparing mastectomy: Resection or Excision?
What comprises the body part: breast
A
0HTT0ZZ Resection of right breast, open approach
Glandular and fat tissue only, skin not required.
Body system H = “skin and breast”
No. 10 Multiple Approaches
Q
A patient has an attempted laparoscopic hysterectomy, converted to open total hysterectomy and bilateral salpingo‐oophorectomy. How do we code?
A
0UJD4ZZ Inspection uterus & cervix, percutaneous endoscopic approach
0UT90ZZ Resection of uterus, open approach
0UTC0ZZ Resection of cervix, open approach
0UT70ZZ Resection of bilat. fallopian tubes, open approach
0UT20ZZ Resection of bilateral ovaries, open approach
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No. 10 Multiple Approaches
A
Approach is where the work happens:
LAVH
0UT9FZZ
Work done
vaginally, laps assist
Laps hysterectomy
0UT94ZZ
Uterus delivered
vaginally
No. 11 Discontinued Procedures
Q
A
An ER physician attempts to remove a right corneal foreign body without success. The patient is admitted for OR care. What is the code for the initial procedure?
Extirpation?
Excision?
Drainage?
08J0XZZ Inspection of
right eye, external approach
ICD‐10‐PCS guideline B3.3
Code only as far as they went
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No. 12 Blood Clots
Q
A patient has an interventional radiology catheter‐
based mechanical thrombectomy of a blood clot in the left femoral artery. What is the root operation?
Is the blood:
• Body part?
• Fluid?
• Matter?
No. 12 Blood Clots
A
04CL3ZZ Extirpation of matter from left femoral artery, percutaneous approach
Taking or cutting out solid matter from a body part.
•
•
•
Blood = fluid = drainage
Blood clot = matter = extirpation
Hemolyzed clot = fluid = drainage
Hemolysis (G: blood + releasing) is breakdown of RBCs
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No. 13 Control of Bleeding
Q
A patient is returned to the OR for evacuation of a hematoma overlying a newly‐created left arm dialysis shunt. The leaking venous branch is tied off. What is/are the PCS code(s)? determine the
For these cases, it would be appropriate to use the A
0X370ZZ Control bleeding in left upper extremity, open approach
All work to control bleeding comes under “control” root operation
• evacuation of hematoma
• tying off or ligation of vessels
• cauterization of vessels
No. 14 Epistaxis
Q
A nosebleed is treated by placing a suture around a small bleeding artery in the anterior nose. The PCS code is….
A
09QKXZZ Repair nose, external approach
Control root operation only for postoperative
Repair of face artery cannot be done via open approach
Becomes “repair” of vascular intranasal tissue
EPISTAXIS CONTROL:
By cautery: 095KXZZ Destruction
By packing: 2Y41X5Z Packing (placement section of PCS)
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No. 15 Anatomical Region vs. Body Part
Q
A patient has a large right groin abscess incised and drained in the OR. What is the PCS code?
A
0Y950ZZ Drainage of right inguinal region,
open approach
• Only region is specified
• May involve more than one system
Bonus Q and A
But what if…
“I&D subcutaneous abscess right thigh”?
0J9L0ZZ Drainage of subcutaneous tissue and fascia, right upper leg, open approach
No. 16 Amputation
Q
What are the PCS codes when a left midfoot amputation is done, consisting of:
•
•
•
•
•
•
A
Circumferential skin incision
Division of tendons
Excision of ligaments
Ligation of arteries and veins
Disarticulation of TMT joints
Burying cut nerve ends
0Y6N0Z0 Detachment at left foot, complete, open approach
• A package deal of body parts and root operations
• Tarsometatarsal or carpometacarpal amputation = “complete”
• High/Mid/Low only for arm, finger, leg, toe
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No. 17 Many Procedures – One Intent
Q
A right reverse total shoulder arthroplasty is done, requiring:
• Rotator cuff repair
• Biceps tenodesis
• Latissimus dorsi transfer to humerus
How do you code under PCS?
A
0RRJ00Z Replacement of right shoulder joint with reverse ball and socket, synthetic substitute, open approach
• All work done towards replacing the joint
• One PCS code • Reverse ball‐and‐socket is always glenoid and humeral No. 18
Q
Malpositioned Body Part
Do you use the same or different PCS code for:
1. Correction of congenital femur valgus deformity
2. ORIF of femur fracture
(left, open, with plate & screws)
A
0QSC04Z Reposition left lower femur with internal fixation device, open approach
REPOSITION = moving to its normal location or other suitable location all or a portion of a body part.
Abnormal position by development, trauma, or degeneration.
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No. 19 Malpositioned Device
Q
A basilar artery coil migrates out of the treated aneurysm into the artery. In Radiology, a stent is placed to “trap” the coil and prevent migration down the arm.
What PCS code(s) is/are needed?
A
03WY3DZ Revision of intraluminal device in upper artery, percutaneous approach
REVISION: Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device.
REVISION for device
REPOSITION for body part
No. 20 AAA Repair
Q
An abdominal aortic aneurysm is repaired by insertion
of a stent graft which is dilated to size by an intravascular balloon?
What is the PCS operation?
A
04V03DZ Restriction of
abdominal aorta with
intraluminal device,
percutaneous approach
Aneurysm is widening
of vessel lumen.
The fix is to RESTRICT.
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6/25/2015
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