June 18, 2013

One Hundred Tips for ICD-10-PCS Coding: Tips 51-60

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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. 51

In ICD-10-PCS root operation table B51 (imaging, veins, fluoroscopy), the body part value “W Dialysis Shunt/Fistula” is actually a surgically created access used for dialysis administration. Only assign this value if an arteriovenous (AV) fistula or graft is imaged (an AV shuntogram or AV fistulogram).

“A surgeon creates an AV fistula by connecting an artery directly to a vein, frequently in the forearm. Connecting the artery to the vein causes more blood to flow into the vein. As a result, the vein grows larger and stronger, making repeated needle insertions for hemodialysis treatments easier,” the National Kidney and Urologic Diseases Information Clearinghouse reported in 2010. “If you have small veins that won’t develop properly into a fistula, you can get a vascular access that connects an artery to a vein using a synthetic tube, an AV graft, implanted under the skin in your arm. The graft becomes an artificial vein that can be used repeatedly for needle placement and blood access during hemodialysis. A graft doesn’t need to develop as a fistula does, so it can be used sooner after placement, often within 2 or 3 weeks”

Forearm Arteriovenous Fistula


Source: http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/#what

One Kind of AV Graft


Source: http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/#what

Tip No. 52

According to the ICD-10-PCS Index, when coding evacuation of a hematoma, use the root operation Extirpation; for evacuation of other fluids, use the root operation Drainage.

Tip No. 53

To ensure that a Revision root operation table (0SW, for example) only is selected when appropriate, educate your physicians about the importance of clearly documenting whether a procedure is a revision or a complete re-do.

According to the 2014 version of the ICD-10-PCS Reference Manual (page 71), “revision is coded when the objective of the procedure is to correct the position or function of a previously placed device, without taking the entire device out and putting a whole new device in its place. A complete re-do of a procedure is coded to the root operation performed.”

Tip No. 54

ICD-10-PCS contains separate body part values for the hard palate and soft palate (such as in root operation table 0C5), so please educate your physicians about the importance of differentiating between them in documentation – a generic reference to the “palate” will be insufficient for coding purposes.

Tip No. 55

There is no listing for excision of supernumerary digits (fingers or toes) in the 2014 ICD-10-PCS index or root operation tables. Below is an actual operative report for the excision of bilateral supernumerary fingers.

Excision of bilateral polydactyly to bilateral hands: The patient is a 2-year-old female who has congenital bilateral polydactyly of the hands. There are two small buds growing out of the ulnar side of her bilateral small finger. The patient was taken to the operating room, where she underwent general anesthesia without incident. The patient’s bilateral upper extremities were then prepped and draped in the usual sterile fashion. Using a 15-blade, the budding extranumerary digit on the ulnar side of the small finger to her bilateral hands was excised en bloc and passed off to pathology. The neurovascular bundle that was going into this extranumerary digit was cauterized. The wound was then copiously irrigated with normal saline, followed by wound closure using a 5-0 chromic suture. The patient tolerated the procedure well.

According to the 2014 version of the ICD-10-PCS Reference Manual (p. 76), “the root operation Repair represents a broad range of procedures for restoring the anatomic structure of a body part such as suture of lacerations. Repair also functions as the “not elsewhere classified (NEC)” root operation, to be used when the procedure performed does not meet the definition of one of the other root operations.”

Until an official ICD-10-PCS coding guideline is published, consider coding the excision of supernumerary fingers using the right and/or left hand body part value(s) in the 0XQ root operation table, and consider coding the excision of supernumerary toes using the right and/or left foot body part value(s) in the 0YQ root operation table.

 


 

Tip No. 56

ICD-10-PCS contains separate body part values for the greater omentum and lesser omentum (such as in root operation table 0DR), so please educate your physicians about the importance of differentiating between them in documentation – a generic reference to the “omentum” will be insufficient for coding purposes.

Section

0

Medical and surgical

Body System

D

Gastrointestinal system

Operation

R

Replacement: Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part

 

Body Part

Approach

Device

Qualifier

 

5 Esophagus

 

 

 

0 Open

4 Percutaneous Endoscopic

7 Via Natural or Artificial

Opening

8 Via Natural or Artificial Opening Endoscopic

 

7 Autologous Tissue Substitute

J Synthetic Substitute

K Nonautologous Tissue Substitute

Z No Qualifier

 

R Anal Sphincter

S Greater Omentum

T Lesser Omentum

V Mesentery

W Peritoneum

 

 

0 Open

4 Percutaneous Endoscopic

 

 

7 Autologous Tissue Substitute

J Synthetic Substitute

K Nonautologous Tissue Substitute

 

Z No Qualifier

 

 

 


 

Tip No. 57

Some ICD-10-PCS root operation tables contain separate body part values for the esophagus (such as in root operation table 0DQ), so please educate your physicians about the importance of documenting the specific region of the esophagus on which a procedure is performed.

Section

0

Medical and surgical

Body System

D

Gastrointestinal system

Operation

Q

 

Repair: Restoring, to the extent possible, a body part to its normal anatomic structure and function

 

 

 

Body Part

Approach

Device

Qualifier

 

1 Esophagus, Upper

2 Esophagus, Middle

3 Esophagus, Lower

4 Esophagogastric

Junction

5 Esophagus

6 Stomach

7 Stomach, Pylorus

8 Small Intestine

9 Duodenum

A Jejunum

B Ileum

C Ileocecal Valve

E Large Intestine

F Large Intestine, Right

G Large Intestine, Left

H Cecum

J Appendix

K Ascending Colon

L Transverse Colon

M Descending Colon

N Sigmoid Colon

P Rectum

 

0 Open

3 Percutaneous

4 Percutaneous Endoscopic

7 Via Natural or Artificial Opening

8 Via Natural or Artificial Opening Endoscopic

 

 

 

Z No Device

 

Z No Qualifier

 

 

 

 

Q Anus

 

0 Open

3 Percutaneous

4 Percutaneous Endoscopic

7 Via Natural or Artificial Opening

8 Via Natural or Artificial Opening Endoscopic

X External

 

Z No Device

 

 

Z No Qualifier

 

 

R Anal Sphincter

S Greater Omentum

T Lesser Omentum

V Mesentery

W Peritoneum

 

0 Open

3 Percutaneous

4 Percutaneous Endoscopic

 

 

Z No Device

 

Z No Qualifier

 

 


 

Tip No. 58

Per the 2014 version of the ICD-10-PCS Reference Manual (Page 50), “the root operation Division is coded when the objective of the procedure is to cut into, transect, or otherwise separate all or a portion of a body part. When the objective is to cut or separate the area around a body part, the attachments to a body part, or between subdivisions of a body part that are causing abnormal constraint, then the root operation Release is coded instead.”

 

Tip No. 59

Use a Repair root operation table for an ostomy takedown/reversal, such as a colostomy takedown (Source: ICD-10-PCS Definitions, Medical and Surgical, Character 3 – Operation).

 

Tip No. 60

Consider using root operation table F08 to report maggot debridement therapy (MDT), which is the medical use of live maggots (fly larvae) for treating non-healing wounds. MDT is a form of  biodebridement; it is also simply called maggot therapy, larval therapy, larva therapy, and larvae therapy (Source: Wound Care Information Network, 2010).

According to the ICD-10-PCS Definitions, Section F – Physical Rehabilitation and Diagnostic Audiology, Character 5 – Type Qualifier, “wound management includes/examples:non-selective and selective debridement (enzymes, autolysis, sharp debridement), dressings (wound coverings, hydrogel, vacuum-assisted closure), topical agents, etc.”

Since the maggots perform the debridement and not a clinician, the “5 Wound Management” and “Z None” values appear to be the most appropriate type and equipment values to select from the table F08.

 

Excerpt from Root Operation Table F08 (This is not the entire table):

Section

F

Physical Rehabilitation and Diagnostic Audiology

Body System

0

Rehabilitation

Operation

8

 

Activities of Daily Living Treatment: Exercise or activities to facilitate functional competence for activities of daily living

 

 

 

Body System/Region

Type Qualifier

Equipment

Qualifier

 

D Integumentary System – Head and Neck

F Integumentary System – Upper Back / Upper Extremity

G Integumentary System – Lower Back / Lower Extremity

H Integumentary System - Whole Body

J Musculoskeletal System – Head and Neck

K Musculoskeletal System – Upper Back / Upper Extremity

L Musculoskeletal System – Lower Back / Lower Extremity

M Musculoskeletal System – Whole Body

 

5 Wound Management

 

 

 

 

 

B Physical Agents

C Mechanical

D Electrotherapeutic

E Orthosis

F Assistive, Adaptive, Supportive or

Protective

U Prosthesis

Y Other Equipment

Z None

 

Z None

 

 

 

 

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

Notes

The National Kidney and Urologic Diseases Information Clearinghouse, Bethesda, Md.:

http://kidney.niddk.nih.gov/kudiseases/pubs/vascularaccess/#what

Wound Care Information Network, 2010: http://www.medicaledu.com/maggots.htm

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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.