Updated on: September 23, 2013

ICD-10-CM Transition Tips and Tools: Inpatient Surgical Coding Exercise

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Original story posted on: August 1, 2011

Below is an example of a liver transplant procedure as well as the ICD-9-CM and ICD-10-CM codes that should be assigned for this inpatient procedure.  Due to the length of this type of procedure, the operative report has been condensed.

Inpatient Case Study

Postoperative Diagnoses:

End-stage liver disease due to chronic HSV hepatitis with encephalopathy

Cryptogenic cirrhosis with ascites

Portal hypertension

Procedure: Hepatectomy with orthotopic liver transplantation from cadaver donor

Anesthesia: General endotracheal

Estimated Blood Loss: 1 liter

Intraoperative Fluids:

4.5 liters of crystalloid, 3 units of fresh frozen plasma, 5 units of packed red blood cells

Procedure Description: After informed consent the patient was brought to the operating room and positioned supine on the operating table and general endotracheal anesthesia was induced.  A Foley catheter was placed in the bladder and deep venous thrombosis prophylaxis was obtained. Preoperative antibiotics were administered. The anesthesiologist also placed a central line and a PA catheter along with an arterial line for hemodynamic monitor and fluid infusions.  The patient’s abdomen and chest were prepped with Betadine soap and solution and draped into a sterile field.

A bilateral subcostal incision was now placed on the patient’s abdomen with a midline extension to get exposure. The abdomen was opened. Approximately 5 to 6 liters of ascites was drained.  There was a significant amount of portal hypertension as evidenced by oozing from the skin vessels, as well as from the abdominal vessels as we opened the abdomen. There were adhesions between the omentum, the bottom of the liver, the left lobe of the liver, and the diaphragm. These adhesions were carefully released to identify the hilum of the liver.  Suitable retractors were applied, following which the hilum of the liver was exposed.

The right and left hepatic arteries were identified ligated and divided. Further dissection was carried out to isolate the portal vein and the bile duct. The bile duct, cystic duct, and hepatic duct were all ligated separately. The right and left lobes of the liver were then released from their attachments, and the liver was then completely freed from the retrohepatic cava and removed from the patient. Once we confirmed hemostasis, the donor liver was brought into the field.

The donor liver was placed and anastomosis to all arteries, veins, and ducts was performed without incident. The wound was checked for bile leak and hemostasis. The abdomen was then irrigated with copious amounts of antibiotic solution. Hemostasis was checked again and closure of the abdominal wound was completed. The patient was awakened from anesthesia, but remained intubated and moved to the surgical ICU for monitoring. The patient was stable but critical.

ICD-9 and ICD-10 Code Assignments

Listed below in the first table is a comparison of the ICD-9 diagnosis codes and the ICD-10 diagnosis codes. As you can see, although the codes differ, the descriptors are similar.

ICD-9-CM Diagnosis Codes

ICD-10-CM Diagnosis Codes

572.8  Sequelae of chronic liver disease

K72.11 Chronic hepatic failure with coma

070.49  Viral hepatitis with hepatic coma

B18.8  Other chronic viral hepatitis

571.5  Cirrhosis of liver w/o mention of alcohol

K74.69 Other cirrhosis of liver

572.3  Portal hypertension

K76.6  Portal hypertension

789.59  Ascites

R18.8  Other ascites

As mentioned in previous columns, each digit of the of the ICD-10 diagnosis code is a specific identifier.  Here is what the above code K72.11 indicates:

K = Chapter 11 – Diseases of the Digestive System

72 = Hepatic failure, not elsewhere classified

1 = Chronic hepatic failure

1 = With coma

The second table below compares the ICD-9 procedure codes against the ICD-10 procedure codes, where you will see a wide variance in the descriptions of the codes.  You will also note that there is not a matching ICD-10-PCS code for each ICD-9-CM code that is reported.  The term “allogenic” in the ICD-10 code identifies where the transplant comes from, therefore a separate code is not required.

ICD-9-CM Procedure Codes

ICD-10-PCS Procedure Codes

50.59  Liver transplant

0FY00Z0 Transplantation, liver, open, allogenic

00.93  Transplant from cadaver

 

99.04  Transfusion of packed cells

30253N1 Transfusion, peripheral artery, percutaneous, red blood cells, nonautologous

99.07  Transfusion of serum

30253K1 Transfusion, peripheral artery, percutaneous, frozen plasma, nonautologous

Like the ICD-10 diagnosis codes, each digit in the ICD-10-PCS code identifies a specific feature.  The first procedure code identifies the following:

0 = Medical and surgical

F = Hepatobiliary system and pancreas

Y = Transplantation

0 = Liver

0 = Open approach

Z = No device

0 = Allogenic

Remember that the letters I and O are not used in ICD-10-PCS coding so that they are not confused with numerals 1 and 0.

Information Sources: The following are links to access the latest version of ICD-10-CM and ICD-10-PCS.

http://www.cdc.gov/nchs/icd/icd10cm.htm#10update

http://www.cms.gov/ICD10/11b_2011_ICD10PCS.asp#TopOfPage

About the Author

Susan Howe is a senior healthcare consultant with Medical Learning, Inc., St. Paul, MN.

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