October 10, 2016

Transformation with Transplantation

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Are you an organ donor? Before October 2005, I did not think much about this question. You may ask what happened in October 2005. My cousin had a heart transplant that month. He had been on the heart transplant list since October 1996. My cousin was 45 years old and suffered a heart attack when closing his pool for the season. He went from admission for his heart attack to heart catheterization to coronary artery bypass graft to placement on the transplant list. Quite a blow for a man who served his country during the Vietnam War and then working at the local factory after his honorable discharge from the service.

I watched him and his wife struggle to determine what facilities were options based on insurance to dealing with his limitations. He had expressed anguished at watching his wife snowblow the driveway during the winter and not being able to help. His struggle also taught me not to make assumptions about handicapped stickers. If you met my cousin before his transplant, you would not have realized how sick he was.

The months turned into years waiting for a suitable donor. He had not experienced congestive heart failure, a common complication for patients with cardiomyopathy, which was inherited from our grandfather. In those intervening years, he had numerous cardiac catheterizations to monitor his disease as well as an automated defibrillator inserted to provide treatment in case his heart would stop or become arrhythmic. He was also able to celebrate the marriage of his daughter and the birth of his first grandchild. The long-awaited call finally came—a heart was available. At the time of the transplant, it was his wife’s first airplane ride. Today, he and his wife are retired and enjoying their family which now includes two daughters, one son-in-law, two grandchildren, and many cousins.

There are a number of stories about new types of transplants in the news. There was the heartbreaking story regarding the three women who had an unsuccessful uterus transplant, and a new story about another uterus transplant at Baylor University that looks promising. Nine women in Sweden have had uterus transplants, with five live births resulting from those transplants. The first full face transplant occurred in March 2011. Since then, multiple facilities have face transplant programs. In July 2015, a young boy underwent a double hand transplant. He was able to throw the first pitch at a Baltimore Orioles game in August 2016. The ability to perform successful body part transplants is growing!

Organ donors may be living or brain-dead. Organs that can be donated are liver, kidneys, heart, lungs, thymus, pancreas, and intestines. Tissue that can be donated includes bone, skin, tendons, corneas, heart valves, and veins. These tissues can be “banked,” or preserved, up to five years. If the patient donates their own tissue, it is considered an autograft. If the donation is from another person, then the donation is an allograft.

The Centers of Medicare and Medicaid Services (CMS) recognizes the expansion of transplantation. For FY17, the body parts of face, right hand, and left hand have been added to the root operation Transplantation tables in ICD-10-PCS.

Transplantation requires multiple layers of tissue, so these procedures are found in the General Anatomic Region (face) or General Anatomic Region, Upper Extremities (hands). The qualifier identifies the type of tissue with a choice between allogenic or syngeneic. Allogenic is defined as same species, while syngeneic means identical twin of the same species. Syngeneic is rare due to the birth rate of identical twins at 3 out of 1,000 births. There is only one choice for approach (open) and device (no device). There is no option for uterus yet in ICD-10-PCS Tables. CMS will need to be more proactive for transplantations.

Transplant patients are monitored for rejection, failure, and infections on a routine basis. Transplant complications do occur. In ICD-10-CM, these entries are found under Complication, transplant. The complication codes are found in the Tabular in category T86. The complications include failure, infection, rejection, or specified type. A malignancy of a transplanted organ (C80.2) is also considered a complication of the transplanted organ based on the 2017 ICD-10-CM Official Coding and Reporting Guidelines. The subcategory identifies the type of transplant such as bone marrow, kidney, etc. experiencing the complication. There is also a code instruction to use additional code to further specify the complication.

While transplantation can bring both joy and sorrow, I have seen the transformation of lives in my own life. It is truly the most altruistic action that one human can do for another.

So the next time you hear the question, “Are you an organ donor?”, I ask that you consider how your selection on a piece of paper or computer screen may impact someone’s life for good. 
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.
Laurie Johnson, MS, RHIA, CPC-H, FAHIMA, AHIMA-Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

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