Questions for this week:
- Cystoscopic dilation of right ureteral stricture, with stent placement
- PTCA of 3 coronary arteries, RCA, LAD and circumflex. The RCA and LAD were done with drug-eluting stents, and the left circumflex without a stent.
- 027134Z, 02703ZZ
ANSWER KEY RATIONALE
- Problem #1, Cystoscopic dilation R. ureteral stricture, with stent placement
To Locate: PCS Index > Dilation > Ureter > Right > 0T76 > Locate table 0T7 and go across the row to complete the code:
Cystoscopic dilation right ureter with intraluminal device, via natural or artificial opening Endoscopic
- Dilation procedures expand the diameter of a tubular body part, most often a blood vessel. A dilation root operation involves making the orifice or lumen of the tube larger rather than smaller. Anal sphincter dilation and ERCP with balloon dilation of bile duct are two examples of other types of dilation.
- Approach: Via Natural or Artificial Opening Endoscopic is defined as “Entry of instrumentation through a natural or artificial external opening to reach and ‘visualize’ the site of the procedure.” The scope is inserted through the urethra, a natural opening. Stent placement required the use of a scope, the cystoscope. Some other examples of this approach include EGD and sigmoidoscopy.
- Device: An intraluminal device is a device within the lumen of any tubular structure or organ. The lumen is the cavity or channel within a tube or tubular organ. In addition to our scenario of ureteral stent placement, some other examples include bare metal coils, esophageal stents and drug-eluting and non drug-eluting stents.
Problem #2, PTCA of 3 coronary arteries, RCA and LAD with drug eluting stents, left circumflex without stent
NOTE: When the identical procedure is not performed on all coronary artery sites (such as whether a device is used), the procedures must be coded separately. The 2 sites with drug-eluting stent placement may be coded as one Body Part value (Coronary Artery, Two Sites), reportable with one code, but the artery that did not have stent placement must be coded separately.
To Locate PTCA, 2 coronary arteries, with stent placement: PCS Index > Dilation > Artery > Coronary > 2 sites > 0271 > Locate table 027 and go across the row to complete the code:
Dilation of coronary artery, two sites with drug-eluting intraluminal device, percutaneous approach
- Drug-Eluting Stents: The drug is slowly released into the vessel wall tissue over a period of 30 to 45 days to prevent the build-up of scar tissue that can narrow the reopened artery.
- Percutaneous Approach: A blood vessel is punctured in the groin area. A stent is threaded through the blood vessel to the targeted site. “Puncture” meets the definition of Percutaneous approach: “Entry by puncture or minor incision….” Also see guideline B.54:
- Guideline B.54: Procedures performed percutaneously via a device placed for the procedure are coded to the approach Percutaneous.
- Device: Devices that remain in the body at the conclusion of the procedure should be coded.
- We still have to account for the circumflex artery. The angioplasty performed on the left circumflex artery, one of the major coronary arteries, was done without stent placement.
Problem #2 cont’d, Dilation of one coronary artery, percutaneous approach
To Locate: Dilation > Artery > Coronary > one site > 0270 > Locate table 027 and go across the row to finish building the code: