August 20, 2013

100 Tips for ICD-10-PCS Coding: Tips 71-80

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ICD-10-PCS represents a major departure from ICD-9-CM procedure coding, and as such, many coding specialists find ICD-10-PCS much more challenging to learn than ICD-10-CM (which still shares many similarities with ICD-9-CM). In order to ease the transition from one code set to the other, we are providing tips for coding under this system.

 

To download the newly released 2014 ICD-10-PCS root operation tables and resources, go online to http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html.

Tip No. 71

In the ICD-10-PCS root operation table B24, “pediatric heart” is listed as a body part value. There is, however, no definition of “pediatric” in ICD-10-PCS. Consider using the American Academy of Pediatrics (AAP) definition of pediatric patients, which is children of ages 1 to 18.

For example, if an aortic ultrasound with contrast is performed on a 16-year-old patient, code B24DYZZ is to be assigned; if an aortic ultrasound with contrast is performed on a 65-year-old patient, code B24BYZZ is assigned.

Section

B

Imaging

Body System

2

Heart

Type

4

Ultrasonography: Real-time display of images of anatomy or flow information developed from the capture of reflected and attenuated high-frequency sound waves

 

Body Part

Contrast

Qualifier

Qualifier

0 Coronary Artery, Single

1 Coronary Arteries, Multiple

4 Heart, Right

5 Heart, Left

6 Heart, Right and Left

B Heart with Aorta

C Pericardium

D Pediatric Heart

 

 

 

 

Y Other Contrast

 

 

 

 

Z None

 

 

 

 

Z None

 

0 Coronary Artery, Single

1 Coronary Arteries, Multiple

4 Heart, Right

5 Heart, Left

6 Heart, Right and Left

B Heart with Aorta

C Pericardium

D Pediatric Heart

 

 

 

 

Z None

 

 

 

 

Z None

 

 

 

3 Intravascular

4 Transesophageal

Z None

 

 


 

Tip No. 72

In the ICD-10-PCS root operation table 302, there is no single substance value for fresh frozen plasma. There is no official ICD-10-PCS guideline to address this issue; the only guideline that even comes close is guideline B3.2/multiple procedures: “During the same operative episode, multiple procedures are coded if the same root operation is performed on different body parts, as defined by distinct values of the body part character.”

For the infusion of fresh frozen plasma, consider assigning two codes: one for the “frozen plasma” substance and one for the “fresh plasma” substance. For example, if a patient has donor-fresh frozen plasma transfused through a central venous line, assign codes 30243K1 and 30243L1.

(This is an excerpt only from table 302; this is not the entire table.)

Section

3

Administration

Body System

0

Circulatory

Operation

2

Transfusion: Putting in blood or blood products

 

Body System/Region

Approach

Substance

Qualifier

 

 

 

 

 

 

3 Peripheral Vein

4 Central Vein

 

 

 

 

 

 

 

0 Open

3 Percutaneous

 

 

G Bone Marrow

H Whole Blood

J Serum Albumin

K Frozen Plasma

L Fresh Plasma

M Plasma Cryoprecipitate

N Red Blood Cells

P Frozen Red Cells

Q White Cells

R Platelets

S Globulin

T Fibrinogen

V Antihemophilic Factors

W Factor IX

X Stem Cells, Cord Blood

Y Stem Cells, Hematopoietic

 

 

 

 

 

 

 

0 Autologous

1 Nonautologous

 

 

 


 

Tip No. 73

An internal guideline/policy may be needed to clarify when exactly a drainage device should be coded separately. ICD-10-PCS guideline B6.2/drainage device states “a separate procedure to put in a drainage device is coded to the root operation Drainage with the device value Drainage Device.”

The internal guideline/policy should be written after consulting with the coding specialists, to identify procedures that the coding specialists are likely to find challenging when applying this guideline. It is important that all coding specialists are consistent in their reporting of drainage devices as separate procedures.

 

 

Tip No. 74

The ICD-10-PCS Imaging section only includes transplant body part values for renal artery transplant (such as in table B42) and kidney transplant (such as in table BT3). In this section, there are no body part values for heart transplant, liver transplant, lung transplant, pancreas transplant, or intestinal transplant.

Use the body part value for the actual body part when coding the imaging of a transplanted organ. For example, for the imaging of a heart transplant use the heart body part value.

 

Section

B

Imaging

Body System

T

Urinary system

Type

3

Magnetic resonance imaging (MRI): Computer-reformatted digital display of multiplanar images developed from the capture of radiofrequency signals emitted by nuclei in a body site excited within a magnetic field

 

Body Part

Contrast

Qualifier

Qualifier

0 Bladder

1 Kidney, Right

2 Kidney, Left

3 Kidneys, Bilateral

9 Kidney Transplant

 

 

Y Other Contrast

 

 

0 Unenhanced and Enhanced

Z None

 

 

Z None

 

0 Bladder

1 Kidney, Right

2 Kidney, Left

3 Kidneys, Bilateral

9 Kidney Transplant

 

 

Z None

 

 

 

Z None

 

 

 

Z None

 

 

 

 


 

Tip No. 75

ICD-10-PCS root operation table BW0 includes a body part called “long bones, all.”  There is, however, no definition of this body part in ICD-10-PCS.

Consider using the National Cancer Institute’s definition of “long bones,” which includes bones of the thigh (femur), leg (tibia and fibula), arm (ulna and radius), and forearm (humerus) (Source: http://training.seer.cancer.gov/anatomy/skeletal/classification.html).

 

Section

B

Imaging

Body System

W

Anatomical Regions

Operation

0

Plain Radiography: Planar display of an image developed from the capture of external ionizing radiation on photographic or photoconductive plate

 

Body Part

Contrast

Qualifier

Qualifier

0 Abdomen

1 Abdomen and Pelvis

3 Chest

B Long Bones, All

C Lower Extremity

J Upper Extremity

K Whole Body

L Whole Skeleton

M Whole Body, Infant

 

 

 

 

 

 

Z None

 

 

 

 

 

Z None

 

 

 

 

 

Z None

 

 

Tip No. 76

In order to code flap procedures (such as fasciocutaneous flaps and muscle flaps) in ICD-10-PCS, the donor site used to harvest the flap must be documented in the medical record.

For example, if the OR report only states “muscle flap closure of the postpneumonectomy empyema,” there is insufficient documentation for coding because, again, the donor site for the muscle flap is not documented. This means the coding specialist won’t know which body part value to select from the “transfer” root operation table.

 


 

 

Tip No. 77

In the ICD-10-PCS tables, use the “via natural or artificial opening” approach for drugs/medical substances that are inhaled. Inhalation involves drawing a substance into the lungs by breathing through the nostrils, which is a natural opening in the body.

 

Tip No. 78

Consider using the “products of conception, retained” body part value for the evacuation of a blighted ovum. According to the American Pregnancy Association, “blighted ovum is also called an anembryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. Often there is a gestational sac with or without a yolk sac, but there is an absence of fetal growth.” (Source: http://americanpregnancy.org/pregnancycomplications/miscarriage.html).

Section

1

Obstetrics

Body System

0

Pregnancy

Operation

D

Extraction: Pulling or stripping out or off all or a portion of a body part by the use of force

 

Body Part

Approach

Device

Qualifier

 

0 Products of Conception

 

 

 

0 Open

 

 

Z No Device

 

0 Classical

1 Low Cervical

2 Extraperitoneal

 

 

 

0 Products of Conception

 

 

7 Via Natural or Artificial Opening

 

 

Z No Device

 

3 Low Forceps

4 Mid Forceps

5 High Forceps

6 Vacuum

7 Internal Version

8 Other

 

 

1 Products of Conception, Retained

2 Products of Conception, Ectopic

 

 

7 Via Natural or Artificial Opening

8 Via Natural or Artificial Opening Endoscopic

 

 

Z No Device

 

 

Z No Qualifier

 

 


 

Tip No. 79

In ICD-10-PCS, two codes will be assigned when coding an amniocentesis performed on a twin pregnancy. Women with twins or other multiples will need sampling from each amniotic sac in order to study each baby.

ICD-10-PCS guideline B3.2/multiple procedures states that “during the same operative episode, multiple procedures are coded if the same root operation is performed on different body parts as defined by distinct values of the body part character.”

A diagnostic amniocentesis performed (using a needle) on a twin pregnancy is coded as 10903ZU and 10903ZU.

Section

1

Obstetrics

Body System

0

Pregnancy

Operation

9

Drainage: Taking or letting out fluids and/or gases from a body part

 

Body Part

Approach

Device

Qualifier

 

0 Products of Conception

 

 

 

0 Open

3 Percutaneous

4 Percutaneous Endoscopic

7 Via Natural or Artificial Opening

8 Via Natural or Artificial Opening Endoscopic

 

 

 

Z No Device

 

9 Fetal Blood

A Fetal Cerebrospinal Fluid

B Fetal Fluid, Other

C Amniotic Fluid, Therapeutic

D Fluid, Other

U Amniotic Fluid, Diagnostic

 

 

Tip No. 80

In an operative report, if a surgeon uses the term “en bloc resection” without further clarification about the portion(s) of an organ or body part that was removed, do not assume that the entire organ or body part was removed. Review the pathology report to determine how much of the organ or body part was removed. If the operative and pathology reports are inconclusive, query the surgeon for more clinical details.

En bloc resection may be coded to an “excision” or “resection” root operation, depending on the actual procedure performed.

In ICD-10-PCS:

  • Resection is defined as cutting out or off, without replacement, all of a body part.
  • Excision is defined as cutting out or off, without replacement, a portion of a body part.

 

Read all previous coding tips

Read Coding Tips 91-100

Read Coding Tips 81-90

Read Coding Tips 71-80

Read Coding Tips 61-70

Read Coding Tips 51-60

Read Coding Tips 41-50

Read Coding Tips 31-40

Read Coding Tips 21-30

Read Coding Tips 11-20

Read Coding Tips 1-10

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Lolita M. Jones, RHIA, CCS

Lolita M. Jones, RHIA, CCS, is the principal of Lolita M. Jones Consulting Services (LMJCS), founded in October 1998 in Fort Washington, MD. Ms. Jones has over 25 years of experience in coding and consulting. She started preparing for the implementation of ICD-10-CM/PCS by going back to school. On September 12, 2010, Ms. Jones became an AHIMA-approved ICD-10-CM/PCS trainer.