Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA Kuehn Consulting, LLC Waukesha, WI 53186 (262) 574-1064 l [email protected] Cardiovascular Coding with ICD-10-PCS 1

Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA

Kuehn Consulting, LLC

Waukesha, WI 53186

(262) 574-1064 l [email protected]

Cardiovascular Coding with ICD-10-PCS

1

2© Kuehn Consulting, LLC 2

Our Topics Today….Our Topics Today….

• What is ICD-10-PCS and how does it work?

• Root Operations commonly performed on cardiovascular structures– Definitions– Details

• Common endovascular procedures and their coding


Procedure Code Structure

ICD-9-CM Procedures

ICD-10-PCS.33 99 22 99

00 44 11 LLKK 00 JJ

Fem-Pop Bypass with Gore-Tex Graft


What is ICD-10-PCS?What is ICD-10-PCS?

• ICD-10 (international version) does not contain a procedure coding system

• CMS contracted to develop a new procedure coding system

• The new system is intended to replace ICD-9-CM Volume 3 for reporting inpatient procedures

• CPT and HCPCS will still be used where currently in place


ICD-10-PCS Code StructureICD-10-PCS Code Structure

• Codes comprised of seven components, called characters

• Individual units for each character have a letter or number assigned as a “value”

• 34 possible values:– Digits 0-9– Letters A-H, J-N, and P-Z– No I or O


11 22 33 44 55 66 77

Body System

Section Root Root OperationOperation

Body PartBody Part

Approach

Device

QualifierQualifier

ICD-10-PCS Code Structure


ICD-10-PCS Coding ProcessICD-10-PCS Coding Process

• Analyze documentation• Apply definitions• Select Root Operation• Reference Alphabetic Index• Verify in PCS Table


Analyze DocumentationAnalyze Documentation

Procedure: Right Femoro-Popliteal Above-the-Knee Bypass with Gore-Tex Graft

This patient had painful cramping in his calf, due to occlusion of his superficial femoral artery. Due to severe varicose veins, a prosthetic Gore-Tex graft was used for the conduit.

Procedure: After placement of an epidural catheter for spinal anesthesia, the patient was prepped and draped in the usual sterile fashion. An incision was made in the patient’s groin and the right femoral artery was exposed. An incision was approximately 2 cm about the patient’s knee joint to expose the popliteal artery. Gore-Tex graft length is approximated and tunneled between the two sites. The graft is sutured to the femoral artery for the proximal anastomosis and then sutured to the above knee popliteal artery for the distal anastomosis. Both wounds are closed.

Root Opera-

tion

Device

Approach

Origin

Destina-tion


Alphabetic IndexAlphabetic Index

• Root Operations• Reference for:

– Body Parts– Devices

10

© Kuehn Consulting, LLC 10

PCS Table Excerpt - 041PCS Table Excerpt - 041

041K0JL Fem-Pop Bypass with Gore-Tex

11


System Structure

• Medical and Surgical

• Obstetrics • Placement • Administration • Measurement and

Monitoring • Extracorporeal Assistance

and Performance • Extracorporeal Therapies • Osteopathic • Other Procedures

• Chiropractic

• Imaging

• Nuclear Medicine

• Radiation Oncology

• Physical Rehabilitation and Diagnostic Audiology • Mental Health • Substance Abuse Treatment

Body System

Body PartRoot

OperationSection Approach Device Qualifier

12


Section Section

• Defines the general type of procedure

• Medical and Surgical Section begins with “0”

13


Body SystemBody System• Body System or Anatomical Regions

• Examples:– Lower arteries

– Tendons

– Respiratory system

– Endocrine system

– Upper Joints

Body System

Body PartRoot


14


Root OperationRoot Operation

• Distinct definitions• Intent of procedure• Key to coding

Body System

Body PartRoot


15


Med-Surg Root Operations

Alteration Bypass ChangeControlCreationDestructionDetachmentDilationDivisionDrainage

ReleaseRemovalRepairReplacementRepositionResectionRestrictionRevisionSupplementTransferTransplantation

ExcisionExtirpationExtractionFragmentationFusionInsertionInspectionMapOcclusionReattachment

16


Body Part Body Part• Anatomical Site of Procedure• Driven by documentation:

Body System

Body PartRoot


17


Body Part Value Dependent on

Body System Value

18


Index by Body PartIndex by Body Part

• It means that PCS:– Refers to the external

pudendal artery as the femoral artery, left or right

– Refers to the external pudendal vein as the greater saphenous vein, left or right

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=t3Q4hGVvrkVF2M&tbnid=9yKnkKoSb4CUIM:&ved=0CAUQjRw&url=http%253A%252F%252Fwww.daviddarling.info%252Fencyclopedia%252FF%252Ffemoral_artery.html&ei=RYtgUajqFYrZ0QHC_IGQDw&bvm=bv.44770516,d.dmQ&psig=AFQjCNESr1w8T89r_pgX_9qlN9DZJm5SFw&ust=1365368001186138

19


Body System Vs Body Part

Body System Body Part

.

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=4r1jSZ4a8HrulM&tbnid=vIuiqB0cYT9jAM:&ved=0CAUQjRw&url=http%253A%252F%252Fmedicalterms.info%252Fanatomy%252FArteries-of-the-Pelvis%252F&ei=1o1gUbqtAsyF0QGQvYHABA&psig=AFQjCNFPVj0C0fiKO-T-MZVHcL8c9NbAmQ&ust=1365368369952209

20


ApproachApproach

• Technique used to reach the site of the procedure

• Approach values:– Open

– Percutaneous

– Percutaneous Endoscopic

– Via Natural or Artificial Opening

– Via Natural or Artificial Opening Endoscopic

– Via Natural or Artificial Opening with percutaneous endoscopic assistance

– ExternalBody

SystemBody Part

Root Operation

Section Approach Device Qualifier

21


Through the SkinThrough the Skin

Open Cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure

Example: Open CABGExample: Abdominal hysterectomy

22


Through the SkinThrough the Skin

Percutaneous Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedureExample: LiposuctionExample: Needle biopsy of liver

Percutaneous endoscopic

Entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedureExample: Laparoscopic cholecystectomyExample: Arthroscopy

Approach Decision Tree

Start Incision? OpenYes

No

Through Skin?

Through Scope?

Yes

No

YesPercutaneous Endoscopic

PercutaneousYes

No

Through Opening?

No

External

Through Scope?

WithPercutaneous Endoscopic Assistance?

Yes Via Natural or Artificial Opening

Endoscopic

Via Natural or Artificial Opening

with Percutaneous Endoscopic Assistance

No

No

Yes

Via Natural or Artificial Opening

©Kuehn Consulting, LLC

24


Approaches

Open

Percutaneous

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=EYyMK81fo-zyFM&tbnid=mBDFa93nOBO5jM:&ved=0CAUQjRw&url=http%253A%252F%252Fwww.cardiacsurgeryacademy.org%252FChoice-of-Grafts-for-CABG.html&ei=q5ZgUZuyBanS0gHYiIHQCw&bvm=bv.44770516,d.dmg&psig=AFQjCNGmGTfH4E3y9-6bMujk2ZcvWHiVNQ&ust=1365370901903995

25


Combined 0pen and Percutaneous

26


Device Device

• Devices that remain after procedure – Monitoring device– Intraluminal– Synthetic– Autologous tissue– Nonautologous tissue

Body System

Body PartRoot


27


Device Types

Artificial Sphincter Endobronchial valveInterbody Fusion

DeviceSpinal Stabilization Device;

Facet Replacement

Cardiac Lead Endotracheal airwayInternal Fixation

DeviceSpinal Stabilization Device; Interspinous Process Device

Cardiac Rhythm Related Device

External Fixation Device

Intramedullary Internal Fixation

Device

Spinal Stabilization Device; Pedicle-Based Device

Contraceptive Device

Extraluminal Device Liner Stimulator Generator

Contractility Modulation Device

Feeding Device Monitoring Device Stimulator Lead

DefibrillatorHearing Device, Bone Conduction

Pacemaker, Single or Dual

Tracheostomy device

Diaphragmatic pacemaker lead

Hearing Device, Cochlear Prosthesis

Radioactive ElementVascular Access Device,

Reservoir or Pump

Drainage Device Infusion device Spacer

28


Qualifier Qualifier

• Additional attribute• Narrow application • Examples:

– Source of transplanted tissue– Diagnostic– Other additional data

Body System

Body PartRoot


29


5 PCS Tables5 PCS Tables

• Heart and Great Vessels• Upper Arteries• Lower Arteries• Upper Veins• Lower Veins

30


Axillo-Femoral BypassAxillo-Femoral Bypass

• Femoral Femoral component

31


Excision

Definition: Cutting out or off, without replacement, A PORTION OF a body part

Uses sharp instrument such as scalpel, wire, scissors, bone saw, electrocautery tip

Explanation:

The qualifier Diagnostic is used to identify excision procedures that are biopsies.Examples:• Sigmoid polypectomy• Renal biopsy

32


Resection

Definition:

Cutting out or off, without replacement, ALL of a body part

Examples:

• Total nephrectomy • Total lobectomy of lung

Note: Lobes of the lung are the complete body part. Body part is not always the same as entire organ.

33


Destruction

Definition:

Physical eradication of all or a portion of a body part by the direct use of energy, force or a destructive agent.

Note: None of the body part is physically taken out. There is no tissue to be sent for pathology because the tissue is destroyed.

Examples:

• Fulguration of bleeder• Cautery of skin lesion• Cryocautery of lesion

34


Case to CodeCase to Code

The surgeon harvests the left radial artery through an incision for use in another simultaneous procedure.

What root operation is this?

Excision

35


03B Table Excerpt03B Table Excerpt

03BC0ZZ

36


Surgeon Note:Surgeon Note:

• Linguistically, we often transpose resection and excision. I personally would probably dictate this as a resection whether or not this fits with your coding rules.

37


ExtractionExtraction

• Definition: Pulling or stripping out or off all or a portion of a body part by the use of force

• Explanation: The qualifier Diagnostic is used to identify extraction procedures that are biopsies

38


Root Operations – ExtractionRoot Operations – Extraction

• Classic examples:– Tooth extraction– Vein stripping

• More challenging examples:– Bone marrow or

endometrial biopsy – Removal of intraocular

lens without replacement by implant

– Non-excisional debridement of skin

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=-IAglQdpYBy-YM&tbnid=AWlXFIkrbNiyjM:&ved=&url=http%253A%252F%252Fvenacure-evlt.com%252Fvaricose-veins%252Fvein-disease%252Ftreatment-optionsrecovery%252F&ei=n19tUd7kLJbj4APLzoHIBw&bvm=bv.45175338,d.dmg&psig=AFQjCNEIdNmGuh2xIyecJ_DSN4zbQIQbBw&ust=1366208800050700

39


Extraction: Surgeon commentsExtraction: Surgeon comments

Stripping Stab Phlebectomy

Deep System Superficial system

40


Extirpation

Definition:

Taking or cutting out solid matter from a body part

Explanation:The solid matter may be

an abnormal byproduct of a biological function or a foreign body. The solid matter may or may not have been previously broken into pieces. No appreciable amount of the body part is taken out.Examples: •Thrombectomy •Choledocholithotomy•Removal of retained, infected suture

41


ExtirpationExtirpation

The objective is to remove solid material such as a foreign body, thrombus, or calculus from the body

part.NOTE:

42


Carotid Endarterectomy

Sources: http://www.nhlbi.nih.gov/health/health-topics/topics/carend/ and http://www.mayoclinic.com/health/medical/IM01657

Root operation = Extirpation

http://www.nhlbi.nih.gov/health/health-topics/topics/carend/

43


03C Table Excerpt03C Table Excerpt

Let’s code that last picture: Open endarterectomy of the right internal carotid artery

03CK0ZZ

44


Root Operation GroupRoot Operation Group

• Procedures that alter the diameter/route/of a tubular body part– Restriction – Occlusion – Dilation – Bypass

45


Tubular Body PartsTubular Body Parts

• Hollow structures that carry fluid or gas/air

• No openings – Circulatory and Lymphatic systems

• Opening at one end – Respiratory and nose, Genitourinary, ear canal

• Opening at both ends – GI system, including hepatobiliary tree

46


RestrictionRestriction

• Definition: Partially closing the orifice or lumen of a tubular body part

• Explanation: The orifice can be a natural orifice or an artificially created orifice

• Classic examples:– Esophagogastric fundoplication

– Cervical cerclage

• More challenging example:– Clipping of cerebral aneurysm

– Placement of restrictive stent in lacrimal duct

47


Restriction

Percutaneous Restriction (Coiling)

• Endovascular Coil placement

• Root operation = Restriction

• Device = Intraluminal device

48


Surgeon Notes: Banding

48

49


Endovascular “Repair”

Abdominal Aortic Aneurysm

• Intraluminal device

• Bifurcated prosthesis

• Root operation = Restriction

• Device = Intraluminal device

50


Case to CodeCase to CodeThe surgeon performs a clipping of an unruptured aneurysm of the basilar artery via a craniotomy.


51


03V Table03V Table

03VG0CZ

52


OcclusionOcclusion

Definition:

Completely closing the orifice or lumen of a tubular body part

Explanation:The orifice can

be a natural orifice or an artificially created orifice.

Examples:

•Fallopian tube ligation•Embolization of vascular supply, intracranial meningioma•Ligation of inferior vena cava

53


OcclusionOcclusion

• The root operation Occlusion is coded when the objective of the procedure is to close off a tubular body part or orifice.

• Occlusion includes both intraluminal and extraluminal methods of closing off the body part.

• Division of the tubular body part prior to closing it is an integral part of the Occlusion procedure.

54


Surgeon Notes Restriction vs. Occlusion for embolization

Surgeon Notes Restriction vs. Occlusion for embolization

55


Endovenous Laser TreatmentEndovenous Laser Treatment

Through a tiny incision at the knee, a small tube is placed into the greater saphenous vein. Then, a laser or radiofrequency fiber is passed through the tube into the vein. Once in place, the fiber is activated, delivering very localized heat to the vein wall. In response, the vein closes down and becomes permanently blocked.

Source: http://www.ohsu.edu/dotter/venous_ablation.htm

http://www.ohsu.edu/dotter/venous_ablation.htm

56


06L Table

57


Dilation

Definition:

Expanding an orifice or the lumen of a tubular body part

Explanation:The orifice can be a

natural orifice or an artificially created orifice. Accomplished by stretching a tubular body part using intraluminal pressure or by cutting part of the orifice or wall of the tubular body part.

Examples:•Percutaneous transluminal angioplasty with or without stent•Pyloromyotomy

58


Coronary Sites Treated

Coding Note: In ICD-10-PCS, the classification of the coronary arteries is as a single body part. It doesn’t matter what the number of arteries treated is (i.e., right coronary artery, left anterior descending, or left circumflex, or the branches). The distinguishing factor is the number of sites treated.

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=h-mSS7Oia8TMxM&tbnid=jD6OHXhc_cKGvM:&ved=0CAUQjRw&url=http%253A%252F%252Fnyp.org%252Fhealth%252Fcardiac-arteries.html&ei=cRBaUbfqOsfH4APy3oGYAg&bvm=bv.44442042,d.dmg&psig=AFQjCNHVRnojt8UFnsFqRgLWdyfFjkaRIA&ust=1364943323270131

59


Percutaneous Transluminal

Coronary Angioplasty (PTCA) and Stenting

Percutaneous Transluminal

Coronary Angioplasty (PTCA) and Stenting

Therapeutic procedure used to treat the stenotic (narrowed) coronary arteries found in coronary heart disease.

Root Operation = Dilation

Device = Various types of intraluminal devices

Source: http://www.infobarrel.com/Risk_factors_and_the_management_of_Angina

http://www.infobarrel.com/Risk_factors_and_the_management_of_Angina

60


Different Devices?Different Devices?

• What if different devices are used on different sites?

• ICD-10-PCS Guidelines tell us:– Anytime a body part, approach, device

or qualifier is different, separate codes are assigned

– Dilate two unique body part values = two codes

– Dilate two sites of a body part using different devices = two codes

61



The cardiologist stents two sites, proximal and mid, of the left anterior descending artery with CYPHER drug-eluting stents.


Dilation

62


027 Table027 Table

027134Z

63


BypassBypass

• Definition: Altering the route of passage of the contents of a tubular body part

• Explanation: Rerouting contents around an area of a body part to another distal (downstream) area in the normal route; rerouting the contents to another different but similar route and body part; or to an abnormal route and another dissimilar body part. It includes one or more concurrent anastomoses with or without the use of a device such as autografts, tissue substitutes and synthetic substitutes

64


BypassBypass

• Classic examples:– Coronary artery bypass– AV fistula or graft creation

Type of Tissue

Device Characte

r

Definition

Autologous (vein or artery)

9 or A Referring to a graft in which the donor & recipient areas are in the same individual

Synthetic Substitute

J Any type of synthetic substitute

Nonautologous Tissue Substitute

K Nonautologous allogeneic donor tissue implanted from one human to another

65


Coronary Artery Bypass Grafting

• CABG (Bypass)• Free Vein Graft:

– Greater Saphenous Vein

• Free Artery Grafts:– Right Internal Mammary

– Radial Artery

• Pedicle Artery Graft:– Left Internal Mammary

artery

Source: http://www.hakeem-sy.com/main/node/25417

http://www.hakeem-sy.com/main/node/25417

66


Non-Coronary

Downstream route

Coronary ArteryBody Part Qualifier

FROM TO

Body Part Qualifier

NUMBER OF SITES

FROM

Bypass

Coronary Sites

Reminder: The excision of the autograft is

coded as a separate procedure. (Guideline B3.9)

67



• Femoral Femoral component

68



Synthetic substitute used to create bypass

Right axillary artery to upper leg artery, right = 03150J6

Right axillary artery to upper leg artery, bilateral = 03150J8

69


Case to CodeCase to CodeProcedure: CABG

Description of Procedure: The chest was opened through a median sternotomy incision. The pericardium was opened. Cardiopulmonary bypass was initiated. The greater saphenous vein was harvested via incision from the left lower extremity. The patient was cooled and cross-clamped. The cold blood cardioplegia solution was administered. Individual segments of saphenous vein were sewn to the obtuse marginal, to the posterolateral branch of the circumflex artery, and to the distal right coronary artery respectively. Each of these anastomoses were carried out with running sutures of 7-0 Prolene.

At the termination of this, warm blood cardioplegia was administered and the aortic cross-clamp was then released. A partial occluding clamp was placed on the aorta. Three buttons of aortic tissue were excised and used as three proximal anastomoses for the saphenous grafts which were carried out with running sutures of 6-0 Prolene. With the patient fully re-warmed, the heart resumed a good contractility and resumed a normal sinus rhythm. The patient was weaned from cardiopulmonary bypass. The chest was closed in layers in the usual fashion and dry sterile dressing was applied.

70


CABGCABG

How many procedures must be coded?

Three

What are the root operations?

Bypass

Excision

Performance

71


AnswersAnswers

021209W, 06BQ0ZZ, 5A1221Z

72


InsertionDefinition:

Putting in a non-biological appliance that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part

Examples:

• Insertion of:

–radioactive implant

–central venous catheter

–Pacemaker

Note: Index states “Insertion of device in….” to remind you that this always involves a device

73


InsertionInsertion

The root operation Insertion represents those procedures where the sole objective is to put in a device without doing anything else to a body part. Procedures typical of those coded to Insertion include putting in a vascular catheter, a pacemaker lead, or a tissue expander.

74


Perm-A-CathPerm-A-Cath

Central Venous Catheter (Infusion Device)

Insertion, Heart and great vessels, infusion device

Code body part as where catheter stops

75


Reservoir and PumpReservoir and Pump

Implantable VAD Reservoir

Implantable VAD Reservoir and Pump

Insertion, SubQ,Vascular access device

Insertion, SubQ,Infusion device, pump

76


PacemakerPacemaker

• Medical device that delivers electrical impulses to the heart muscles using electrodes

• Regulates the beating of the heart

• Maintains an adequate heart rate when:– Heart too slow– Block in conduction

mechanism

http://en.wikipedia.org/wiki/File:St_Jude_Medical_pacemaker_with_ruler.jpg

77


DefibrillatorDefibrillator

• An implantable cardioverter-defibrillator (ICD) is a small battery-powered electrical impulse generator:– Patient at risk for sudden

cardiac death due to:• Ventricular fibrillation• Ventricular tachycardia

• Programmed to detect cardiac arrhythmia and correct it by delivering a jolt of electricity

http://en.wikipedia.org/wiki/File:AICD.jpg

78


RemovalRemoval

• Definition: Taking out or off a device from a body part

• Explanation: The procedure for taking out the device is coded to the root operation Removal and the procedure for putting in the new device is coded to the root operation performed.

79


RemovalRemoval

• Classic examples:– Drainage tube removal – Cardiac pacemaker removal

• More challenging examples:– Removal of infected surgical mesh, or

neurostimulator lead

80



PROCEDURE: Pacemaker generator replacement.

PROCEDURE IN DETAIL: With the patient under monitored anesthesia care, the patient's left upper chest and neck were sterilely prepped. The previous pacemaker scar was incised. The subcutaneous tissues were divided with electrocautery. The fibrous capsule was opened and the pacemaker explanted. The lead was loosened and removed from the pacemaker generator and quickly attached to the pacemaker cable for pacing and testing, as the patient is pacemaker dependent. Pacing parameters were excellent. The lead was then inserted into the receptacle of the pacemaker generator and tightened down.

The pocket was irrigated with antibiotic solution. Hemostasis was good. The generator was inserted into the pocket. The incision was closed in layers with continuous Vicryl sutures including the subcuticular layer.

81


PacemakerPacemaker

How many procedures are there?

Two

What are the root operations?

1.Removal (of device from…)

2.Insertion

82


0JP Table0JP Table

0JPT0PZ

83


0JH Table0JH Table

0JH604ZLeads are not changed – if done, additional code(s)

84


ReplacementReplacement

• If the body part has been previously replaced, a separate Removal procedure is coded for taking out the device used in the previous replacement

• Classic examples:– Total hip replacement, – Bone graft or free skin graft

• More challenging examples:– Corneal transplant from donor– Mitral valve replacement, porcine valve

85


Cardiac Valve ReplacementCardiac Valve Replacement

• Biologic vs. Mechanical Replacement– Aortic Valve– Tricuspid Valve– Mitral Valve

• Root Operation = Replacement

• Device = Synthetic or Zooplastic

86


SupplementSupplement

• Definition: Putting in or on biological or synthetic material that physically reinforces or augments the function of a body part

• Explanation: The biological material is non-living, or the biological material is living and from the same individual. The body part may have been previously replaced. If the body part has been previously replaced, the Supplement procedure is performed to physically reinforce and/or augment the function of the replaced body part

87


SupplementSupplement

• Classic examples:

– Herniorrhaphy using mesh

– Free nerve graft– Mitral valve ring

annuloplasty

88


Atrial Septal Defect Closure

• Catheter Based:– Femoral vein– Double “Umbrella”

Closure device

• Open surgical approach:– Dacron Patch

• Root operation = Supplement

• Device = SyntheticSource: http://www.scubamed.com/PFO_page.html

http://www.scubamed.com/PFO_page.html

89



The surgeon performs open heart surgery to repair an atrial septal defect with mesh. What root operation is this?

Supplement

Which body part value will we pick?

Atrial septum

90


02U Table02U Table

02U50JZ

91


Supplement ExamplesSupplement Examples

Wrapping, whether inside or outside the vessel, is

Supplement

Not a stent

92


Surgeon Note:Surgeon Note:

• I have trouble with this.• We don’t call this supplementation,

and don’t conceive of it this way. This is an aneurysm exclusion or and aneurysm replacement in our language

• The wrapping is for convenience really and other more subtle functions. It is NOT the purpose of this operation.

93


Repair

Definition:

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

Explanation:

Used only when the method to accomplish the repair is not one of the other root operations

Examples:•Suture of VSD•Suture of laceration

94


Cardiac Valve Repair

• Repair–Using sutures

• Root operation = Repair

Source: http://www.heart-valve-surgery.com/heart-valve-repair-valvuloplasty-annuloplasty.php

http://www.heart-valve-surgery.com/heart-valve-repair-valvuloplasty-annuloplasty.php

95


Repair Decision Tree

Procedure performed to restore body part

Yes

Code Repair

No

Code Supplement

Body part remains in

place?

Yes

Code root operation

performed, such as Replacement

No

Body part reinforced with

device?

96


Name That Root!

• Endovascular laser treatment– Occlusion

• Clamping of artery for patient with aneurysm– Restriction

• Suture of laceration of artery– Repair

• Heart valve annuloplasty

– Supplement

• Angioplasty for plaque

– Dilation

• Pacemaker placement

– Insertion

97


Review QuestionsReview Questions

A patient has a PTCA of two sites of the LAD utilizing one drug-eluting stent and one bare metal stent. How many codes are assigned?

A.OneB.TwoC.Need additional information

Answer: B. Two

98



In CABG procedures, the 4th character (body part) indicates:

A.The location that the blood is flowing “from”B.The number of sites treatedC.Need additional information

Answer: B. The body part indicates the number of sites treated.

99



In pacemaker insertion procedures, the pacemaker is inserted into the:

A.Chest wallB.Subcutaneous tissue of the chestC.HeartD.Atrium or Ventricle

Answer: B. Subcutaneous tissue of the chest

100


101


Thank you!

Contact Information:

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

1155 S. Springdale Road Waukesha, WI 53186

O: 262-574-1064

F: 262-574-0828

[email protected] www.KuehnConsulting.com

Documents

Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA Kuehn Consulting, LLC Waukesha, WI 53186 (262) 574-1064 l [email protected] Cardiovascular Coding with ICD-10-PCS 1