September 15, 2011

ICD-10-PCS Procedure Coding of PTCA with Insertion of Coronary Artery Stents

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As we prepare and progress in our understanding of the future ICD-10 coding system, we continue to uncover the differences from the ICD-9 system. This article will review the difference between the current procedural coding guidelines of ICD-9-CM and the ICD-10-PCS as they relate to the coding of a percutaneous transluminal coronary angioplasty (PTCA) procedure with insertion of coronary artery stents.

 

Guidelines Give Direction

Current ICD-9-CM procedural coding guidelines require that a minimum of four procedure codes be assigned to describe a PTCA procedure with insertion of coronary artery stent. The codes describe not only the PTCA procedure with insertion of the specific type of stent but also specify the number of stents inserted as well as the number of vessels included in the procedure performed.

For example, the physician may perform a PTCA procedure with insertion of two drug-eluting stents inserted at two different sites within the left anterior descending coronary artery. ICD-10-PCS captures the number of sites treated regardless of the number of vessels. The following ICD-9-CM procedure codes would be assigned:

  • 00.66 for the PTCA;
  • 36.07 for the PTCA and the insertion of the type of stent as drug-eluting;
  • 00.46 to show that two vascular stents were inserted; and
  • 00.40 to describe the procedure was performed on a single vessel.

Let’s review the 2012 Official ICD-10-PCS Coding Guidelines, B. Medical and Surgical Section Guidelines, B4. Body Part, and B4.4, Coronary Arteries. Section B4.4 explains that the coronary arteries are classified as a single body part and also further specifies the number of sites treated within that single body part, not by the name of the coronary artery or the number of arteries treated.  If the same procedure is performed on multiple sites in the coronary arteries, the separate body part values are used to specify the number of sites treated.

However, if angioplasty is performed at one site within the left anterior descending coronary artery and angioplasty with drug-eluting stent insertion is performed at a different site within the left anterior descending coronary artery, then these procedures are coded separately, because their device value assignments are different. Specifically, one procedure is coded with a value of “no device” and the other with a value of “drug-eluting stent.”

Code Assignments

The table below shows the rationale behind the ICD-10-PCS code assignment of 027134Z for PTCA performed with insertion of two drug-eluting stents at two different sites within the left anterior descending coronary artery.

Section

Medical and surgical

0

Body System

Heart and great vessels

2

Operation

Dilation

7

Body Part

Coronary artery, two sites

1

Approach

Percutaneous

3

Device

Drug-eluting intraluminal device

4

Qualifier

No qualifier

Z

 


 

For the additional above example of angioplasty performed at one site within the left anterior descending artery and angioplasty with drug-eluting stent insertion performed at a different site, the two procedures are captured with the ICD-10-PCS codes of 02703ZZ0 and 027034Z and the rationales for these assignments are demonstrated in the tables below.

Section

Medical and surgical

0

Body System

Heart and great vessels

2

Operation

Dilation

7

Body Part

Coronary artery, one site

0

Approach

Percutaneous

3

Device

No device

Z

Qualifier

No qualifier

Z

 

Section

Medical and Surgical

0

Body System

Heart and Great Vessels

2

Operation

Dilation

7

Body Part

Coronary Artery, One Site

0

Approach

Percutaneous

3

Device

Drug-eluting Intraluminal Device

4

Qualifier

No Qualifier

Z

For More Information

The latest version of 2012 Official ICD-10-PCS Coding Guidelines are available at the following web site: http://www.cms.gov/ICD10/Downloads/PCS_2012_guidelines.pdf

 

Read 1861 times Updated on March 14, 2016
Lynn Cleasby, RHIT, AHIMA-Approved ICD-10-CM/PCS Trainer

Lynn’s expertise includes inpatient HIM coding audits and coding staff training. She also performs CDIP analysis and CDIP staff and Physician training projects. She is also an AHIMA certified ICD-10 Trainer.