Complex Coding Decisions Using ICD-10-PCS, Part 4 Coding Decisions Using ICD-1Complex Coding Decisions Using ICD-10-PCS, Part 4 Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA Kuehn Consulting,

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  • Complex Coding Decisions

    Using ICD-10-PCS, Part 4

    Lynn Kuehn, MS, RHIA, CCS-P, FAHIMAKuehn Consulting, LLC

    Waukesha, WI 53186

    (262) 574-1064

    LKuehn1@wi.rr.com

    http://www.wha.org/Data/Sites/1/education/icd-10/12092014icd10part4.mp3

  • Learning Objectives

    At the conclusion of this program, you will be

    able to:

    Describe the system design for ICD-10-PCS

    Compare and contrast the root operation groups

    Differentiate between similar root operations using

    critical thinking skills

    Identify the root operations assigned for 10

    common PCS cases

    Determine the remaining characters in each code

    for 10 common PCS cases

    2

  • PCS Files

    Download the PCS files from:

    http://www.cms.gov/Medicare/Coding/ICD

    10/2015-ICD-10-PCS-and-GEMs.html

    2015 Code Tables and Index

    2015 Official ICD-10-PCS Coding

    Guidelines

    2015 ICD-10-PCS Reference Manual

    Use electronic version too big to print

    3

    http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-PCS-and-GEMs.html

  • Code Structure

    2 3 4 5 6 71

    Section

    Body

    System

    Root

    Operation

    Body

    Part

    Approach

    Device

    Qualifier

    4

  • ICD-10-PCS Index

    Provides the first three or four

    characters of the code

    Refers the coder to the correct code

    table

    The code tables must always be used to

    obtain the complete code

    5

  • ICD-10-PCS Tables

    Each table contains four columns and a

    varying numbers of rows

    Column: Specifies the allowable values for

    characters 4 through 7

    Row: Specifies the valid combinations of

    values

    6

  • Root OperationsAlteration

    Bypass

    Change

    Control

    Creation

    Destruction

    Detachment

    Dilation

    Division

    Drainage

    Release

    Removal

    Repair

    Replacement

    Reposition

    Resection

    Restriction

    Revision

    Supplement

    Transfer

    Transplantation

    Excision

    Extirpation

    Extraction

    Fragmentation

    Fusion

    Insertion

    Inspection

    Map

    Occlusion

    Reattachment

    7

  • Nine Root Operation Groups

    Root operations that take out some or all of

    a body part

    Root operations that take out solids, fluids, or gases from a body

    part

    Root operations that involve cutting or separation only

    Root operation that put in, put back, or move some or all of a body

    part

    8

  • Nine Root Operation Groups

    Root operations that always

    involve a device

    Root operations that involve examination

    only

    Root operations that define other repairs

    Root operations that define other objectives

    Root operations that alter the

    diameter or route of a tubular body

    part

    9

  • What is the intent of the

    procedure?

    10

  • Take Out Group

    11

  • To determine whether

    its Excision or

    Resection, always

    start in the Index

    under the heading

    Resection.

    All body parts can be

    Excised.

    12

  • Resection vs Excision

    1. Excision of left lobe

    of thyroid gland

    2. Excision of apex of

    tongue

    3. Excision pylorus of

    stomach

    4. Excision of left

    testis

    13

  • Answers

    1. Excision of left lobe of thyroid gland

    Resection

    2. Excision of apex of tongue

    Excision

    3. Excision pylorus of stomach

    Resection

    4. Excision of left testis

    Resection

  • Table 0BT

    15

  • Answers

    Resection Excision Resection x 2

  • Case #1

    He presents with a right upper lobe pulmonary nodule. The

    patient was taken to the OR and an incision was made over

    the sixth rib. The lung was explored and only the single lung

    nodule was found.

    The wedge resection was performed using a tissue stapler,

    removing the lesion and a 2 cm margin. The specimen was

    sent for frozen section. The findings returned as metastatic

    colon cancer, with clear margins in the specimen. The ribs

    were approximated and the chest wall was closed in layers.

    The subcutaneous tissue and skin were approximated.

    17

  • Decision to be made?

    18

  • Case #1 Poll Question

    Which root operation is it?

    1. Excision

    2. Resection

    3. Extraction

    19

  • Case #1

    Which root operation?

    Excision

    Which body part value

    will we pick?

    Right upper lobe of the

    lung

    20

  • Case #1

    0BBC0ZX21

  • Gunk Group

    22

  • Excision and

    Extraction removes

    body parts

    Extirpation removes

    foreign objects from

    a body part

    23

  • Case #2

    PREOPERATIVE DIAGNOSIS: Abnormal EKG suggestive of anterior

    ischemia.

    POSTOPERATIVE DIAGNOSIS: 1.Coronary artery disease

    2. Thrombus in proximal diagonal branch with severe stenosis

    PROCEDURES:

    1. Left heart catheterization with pressure readings

    2. Left ventricular angiography, right and left coronary

    angiography using Isovue-370

    3. Diagonal branch mechanical thrombectomy, angioplasty and

    stenting with a 2.5 x 12 mm long Promus Element DES stent

    4. Angio-seal deployment for hemostasis

    24

  • Case #2

    Root operations to assign?

    Extirpation

    Dilation

    Measurement

    Fluoroscopy

    25

  • Case #2

    26

    02C03ZZ, 027034Z

  • Case #2

    4A023N7, B2151ZZ , B2111ZZ27

  • Case #2

    02C03ZZ Thrombectomy (Extirpation)

    027034Z PTCA (Dilation) with Drug-

    eluting stent

    4A023N7 Left heart catheterization

    B2151ZZ Left ventriculogram with low

    osmolar contrast

    B2111ZZ Coronary angiogram (multiple)

    with low osmolar contrast28

  • Cutting Group

    29

  • Fasciotomy is a

    surgical procedure

    where the fascia is

    cut to relieve tension

    or pressure and

    restore circulation to

    an area of tissue or

    muscle.

    30

  • Case #3

    PREOPERATIVE DIAGNOSIS: Left lower extremity with ischemic leg.

    POSTOPERATIVE DIAGNOSIS: Ischemic leg with diseased left common femoral

    artery.

    OPERATION: 4-Compartment left lower extremity fasciotomy

    PROCEDURE AS FOLLOWS: The patient was taken to the operating room, placed on

    the operating room table in the supine position. After an adequate level of general

    endotracheal anesthesia was obtained, his left lower extremity was prepped and draped

    in the usual sterile fashion with Chloraprep. Intravenous antibiotics were provided. Four

    compartment fasciotomies were performed through medial and lateral incisions

    exposing the musculature of both the lateral, anterior, and both the deep and superficial

    posterior compartments and these were viable. Due to lack of additional significant

    swelling, the skin was closed utilizing staples. Patient was awakened, extubated, and

    transferred to recovery room in stable condition. He has a palpable left dorsalis pedis

    pulse that is 1+, mildly diminished. He tolerated the procedure well.

    31

  • Case #3 Poll Question

    Which root operation is it?

    1. Division

    2. Release

    3. Excision

    32

  • Case #3

    Which root

    operation is it?

    Release

    Which body part?

    Muscle, lower leg

    33

  • Release

    0KNT0ZZ x4

    34

  • Repair Group

    35

  • Repair tables

    always say No Device in the Device character.

    Why?

    36

  • 0TQ versus 0TU

    37

  • Device Group

    38

  • The Device Group

    root operation must

    always involve a

    device.

    Removal and

    revision are only

    coded for devices.

    39

  • AV Fistula vs AV Graft

    Device

    40

  • Not a Native Vessel

    All work done to

    fix the graft itself

    is coded in the

    Device Group

    41

  • Case #4

    DIAGNOSIS: Thrombosed right arm arteriovenous Gortex graft.

    PROCEDURE: Balloon catheter thrombectomy of right lower arm

    arteriovenous graft and angioJet thrombectomy of right lower arm

    arteriovenous graft.

    DESCRIPTION OF OPERATION: A Glidewire and then a 6-

    French sheath was inserted into the graft and then a 5 mm x 2 cm

    balloon catheter was passed over the Glidewire into the graft and a

    thrombectomy was performed. Thrombectomy was not complete.

    At this point, an AngioJet thrombectomy catheter was advanced

    over the Glidewire and two passes of the AngioJet was performed.

    Satisfied with the thrombectomy results, the sheaths were removed

    and pressure held over the puncture site. The patient tolerated the

    procedure well.

    42

  • Case #4

    Which root operation is it?

    1. Extirpation

    2. Extraction

    3. Revision

    43

  • Case #4

    44

    Which root operation

    is it?

    Revision

    Which body part?

    Upper artery

  • Case #4

    45

    03WY3JZ

  • Supplement is the

    partner root

    operation to Repair.

    Supplement is

    repair of a body part

    using a device.