Previously we reviewed root operations that take out some or all of a body part, including excision, resection, detachment, destruction and extraction. You matched root operations with the appropriate procedure. This week you are going to code some of those procedures.
Coding questions for this week:
- Rectal polyp fulguration.
- Suction D&C via natural opening endoscopic.
- Below knee amputation, right leg, “high.”
Problem #1, Fulguration of rectal polyp via natural opening endoscopic
To Locate: PCS Index > Fulguration > see Destruction > 0D5P > Go to table 0D5 and then go across the row to finish building the code:
Destruction of rectum, via natural or artificial opening endoscopic
- Fulguration: Physical eradication of all or a portion of a body part by the direct use of energy, force or a destructive agent.
- Body Part: When the site of a procedure is around or surrounding a body part, the procedure is coded to the body part named. The polyp, not the rectum, was destroyed. It’s a little tricky because the wording makes it sound as if the rectum, not the polyp, was destroyed.
- Approach: Entry of instrumentation through a natural or artificial external opening to reach and ‘visualize’ the site of the procedure defines the approach, Via Natural or Artificial Opening Endoscopic. The scope was inserted through a natural opening, the anus, and the site of the procedure was the rectum. Other examples utilizing this approach include EGD, sigmoidoscopy, and urethroscopy.
Problem #2, Suction D&C (non-ob) via natural opening
To Locate: PCS Index > Suction curettage (D&C) > see Extraction, Endometrium > 0UDB
> Find table 0UD and go across the row to finish building the code:
Extraction of endometrium, via natural or artificial opening
- Extraction: Pulling or stripping out or off all or a portion of a body part by the use of force. Two other examples of extraction, for example, include forceps removal of teeth and vein stripping.
- Approach: Entry of instrumentation through a natural or artificial external opening to reach the site of the procedure defines the approach, Via Natural or Artificial Opening. No visualization instrument is utilized (e.g., scope.) Examples of procedures utilizing this same approach include transurethral prostatectomy, endotracheal intubation, trans-vaginal cervical cerclage.
Problem #3, Below-knee amputation, right leg, at the proximal tibia/fibula
To Locate: PCS Index > Amputation > see Detachment > Leg > Lower > Right > 0Y6C0Z > Even though the index gives you all but the 7th character, you should still verify the code by locating table 0Y6 and going across the row to validate characters 4, 5, and 6, plus assign the 7th character:
Detachment at right lower leg, high, open approach
- Detachment: Cutting off all or a part of the upper or lower extremities.
- Body Part: Amputation is performed by disarticulation or cutting through the bone. The body part value is the site of the detachment; the right leg in our scenario.
- Qualifier: A qualifier, if applicable, is assigned to further specify the level at which the extremity was detached. The disarticulation took place at the proximal portion of the shaft of the tibia/fibula, hence a qualifier of 1 is assigned to the 7th character.
- Note: “Detachment” procedures are found only in body systems “X” (“Anatomical Regions, Upper Extremities”) and “Y” (“Anatomical Regions, Lower Extremities”) because amputations are performed on the extremities, across overlapping body layers (e.g., skin, muscle, bone), and therefore cannot be coded to a specific musculoskeletal body system, such as bones or joints.
- ICD-10-PCS has codes for 3 different types of extremity amputations:
- High: Amputation at the proximal portion of the shaft of the tibia/fibula or radius/ulna
- Mid: Amputation at the middle portion of the shaft of the tibia/fibula or radius/ulna
- Low: Amputation at the distal portion of the shaft of the tibia/fibula or radius/ulna