ICD-10-CM/PCS – Part 52: Question & Answer

ICD-10-CM/PCS – Part 52: Question & Answer

We will continue to give you problems that include both diagnoses and procedures. This week we are focusing on a problem from the Diseases of the Musculoskeletal System and Connective Tissue, Chapter 13.

 

Problem for the week: After falling from a ladder while working on his house, the patient was brought to the ER where he was admitted. He sustained contusions of the scalp and face and an open type I intertrochanteric fracture of the right femur. The fracture site was excisionally debrided, and an open reduction with internal fixation was carried out. Don’t assign E codes except for the external cause of the injury.

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

  • S72.141B: Displaced intertrochanteric fracture of the right femur, initial encounter, for open fracture type I or II
  • S00.03xA: Contusion of scalp
  • S00.83xA: Contusion of other part of head
  • W11.xxxA: Fall from ladder
  • 0QS604Z: Open reduction with internal fixation (reposition right upper femur)
  • 0QB60ZZ: Debridement (root operation “Excision”)

 

Breakdown of S72.141B

S72 = Fracture of Femur

S72.1 = Pertrochanteric fracture

S72.14 = Intertrochanteric fracture of femur

S72.141B = Displaced intertrochanteric fracture of right femur; initial encounter, for open fracture type I or II

 

To locate S00.03xA: Alphabetic Index > Contusion > scalp > S00.03 > Tabular to obtain remaining digits (all ICD-10-CM codes are 7 digits long) > 7th digit required > the next 6th character is x, placeholder in ICD-10-CM > S00.03x > S00.03xA (A is initial encounter.)

To Locate S00.83xA: Alpha Index > Contusion > face NEC > S00.83 > Go to the Tabular to assign remaining digits so you come out with a total of 7 digits > S00.83x > (x is the placeholder for ICD-10-CM, just as Z is the placeholder for procedures) > S00.83xA (A is for initial encounter.)

To Locate W11.xxxA: Index to External Causes > Fall, falling > from, off, out of > ladder > W11 > Tabular: 3rd, 4th, and 5th character, placeholder is x > W11.xxx > 7th character is the A-initial encounter > W11.xxxA.

To Locate 0QS604Z > PCS Index > Reposition > Femur > Upper > Right > 0QS6 > locate table 0QS and go across the row to finish building the code, remembering to verify the 4th character:

 

Reposition Right Upper Femur with Internal Fixation Device, Open Approach

PCS Root Ops 52A

Comments:

  • PCS divides the bones into upper and lower. Anything above the diaphragm is considered an upper bone and anything below the diaphragm would be considered a lower bone.
  • There are some new terms in ICD-10-PCS and this is a good example. Reposition replaces Reduction.
  • Reposition is defined as “Moving to another location or other suitable location all or a portion of a body part.
  • An intertrochanteric fracture involves the proximal femur, which consists of the femoral head, the femoral neck, and the trochanteric region (including the greater and lesser trochanters.
  • The bone was fixated with an internal fixation device. A device is used only to specify devices that remain after the procedure is completed

 

To Locate 0QB60ZZ: PCS Index > Debridement > Excisional > see Excision > Femur > Upper > Right > 0QB6 > locate table 0QB and go across the row to finish building the code, and remember to verify the 4th character:

Excision of Right Upper Femur, Open Approach

PCS Root Ops 52B

Comments:

  • Before setting the bone, some debridement of the femur was required. Excision is defined as ‘Cutting out or off, without replacement, a portion of a body part.”
  • Upper versus lower bones applies to this part of the problem.

 

Directions for Locating the Codes by Going Directly to the Tables

REPOSITION OF FEMUR WITH ORIF

0QS604Z

  1. Step #1 is to locate the correct section in your PCS coding book. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
  2. Step 2: Determine the correct Body System – lower bones. Since you are dealing with the Musculoskeletal System (MS) and since you know that the femur is part of the MS System, it should be easy to determine the body system. PCS divides the bones into upper and lower. Thus far, we have identified the first two characters, 0Q.
  3. Step 3: Determine the root operation. You know you have to be in a table that starts with 0Q. The root operations are listed alphabetically, so it shouldn’t be hard to find the correct root operation. Our root operation is Reposition. We now have the first three characters, 0QS, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Lower Bones; the root operation, Reposition.
  4. Step 4: Identify the Body Part to determine the 4th character value. The Body Part, upper right femur, should relate to the root operation, Reposition, because it was the femur that was repositioned. We now have 4 character values 0QS6.
  5. Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done via an open approach. We should now have 5 characters, 0QS60.
  6. Step 6: Determine whether or not a device was left in the patient postoperatively. This procedure an ORIF (open “reposition” with internal fixation) was carried out. This clearly indicates that a device was left in place. We should now have 6 characters, 0QS604.
  7. Step 7: There is no qualifier, so we now have our code of 0QS604Z. Z functions as a placeholder in ICD-10-PCS.

For the past few weeks we have given you coding problems that require assignment of both diagnoses and procedures. With respect to the breakdown of diagnostic codes, a new feature, we will only do that for the PDx. This week you will be given a problem to solve from the Digestive System, Chapter 11. As a reminder, directions for coding directly from the tables will always be the last item and it only gives directions for the principal procedure.

 

Problem for the week: A patient with a 20-year history of severe complicated ulcerative colitis was admitted for surgical intervention. A total abdominal colectomy with ileostomy was performed via open approach.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

 

 

Answer Key:

K51.919: Ulcerative colitis, unspecified with unspecified complications

0DTE0ZZ: Resection of large intestine, open approach

0D1B0Z4: Bypass ileum to cutaneous, open approach

 

Breakdown of K51.919:

K51 = Ulcerative colitis

K51.9 = Ulcerative colitis, unspecified

K51.91 = Ulcerative colitis, unspecified, with complications

K51.919 = Ulcerative colitis, unspecified with other complication

 

To Locate K51.919: Colitis > ulcerative > with > complications > K51.919 > verify in

Tabular.

To Locate 0TDE0ZZ: Resection > Intestine > Large > 0DTE > locate table 0DT and go across the row to finish the code, verifying the 4th character:

Resection of Large Intestine, Open Approach

PCS Root Ops 51A

Comments:

  • Resection versus excision: Resection is cutting out or off without replacement, all of a body part. The entire large intestine was removed.
  • Excision is cutting out of or off, without replacement a portion of a body part. If only a portion of the large intestine had been removed, you would code it to excision.
  • Å colectomy neither cures nor eliminates Ulcerative Colitis/Crohn’s disease; instead it removes the entire diseased large intestine.
  • Ileostomy is a surgical opening (stoma) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin and to the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an artificial external pouching system, which is adhered to the skin.

 

To Locate 0D1B0Z4: PCS Index > Bypass > Ileum > 0D1B > locate table 0D1 and go across the row to finish building the code, and also verify that the 4th character of Ileum is correct:

Bypass Ileum to Cutaneous, Open Approach

PCS Root Ops 51B

Comments:

  • Bypass is defined as “Altering the route of passage of the contents of a tubular body part.”
  • There are three methods and more specifically, they are:
    • Rerouting contents from one area of a body part to a downstream area in the normal route;
    • Rerouting the contents to a similar route and body part, or to an abnormal route and a dissimilar body part. Includes one or more anastomoses, with or without the use of a device.
    • Guideline B3.6a indicates that the “fourth character body part specifies the body part bypassed from, and the qualifier specifies the body part bypassed to.” In this scenario, the ileum is redirected to the external cutaneous part of the body. In other words, the 4th character, ileum, is the origin of the bypass, and the 7th character, cutaneous, is the destination of the bypass.

 

 

Directions for Locating the Codes by Going Directly to the Tables

0DTE0ZZ

  1. Step #1 is to locate the correct section in your PCS coding book. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
  2. Step 2: Determine the correct Body System – Gastrointestinal System. Since you are dealing with the large intestine and since you know that the large intestine is part of the GI System, it should be easy to make this determination. Thus far, we have identified the first two characters, 0D.
  3. Step 3: Determine the root operation. You know you have to be in a table that starts with 0D. From this point I would look for the root operation, Resection, by scanning through the tables. The root operations are listed alphabetically, so it shouldn’t be hard to find the correct root operation. Our root operation is Resection. We now have the first three characters, 0DT, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Gastrointestinal System; the root operation, Resection.
  4. Step 4: Identify the Body Part to determine the 4th character value. The Body Part, large intestine, should relate to the root operation, Resection. We now have 4 character values 0DTE.
  5. Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done via an open approach. We should now have 5 characters, 0DTE0.
  6. Step 6: Determine whether or not a device was left in the patient postoperatively. In the case of our procedure, there was no devices left after surgery, so we should now have 6 characters, 0DTE0Z.
  7. Step 7: There is no qualifier, so we now have our code of 0DTE0ZZ. Z functions as a placeholder in ICD-10-PCS.

As we have stated over the past two weeks, we are going to give you problems that include assignment of both diagnoses and procedure codes. This week we will focus on a problem from the Circulatory System, Chapter 9.

Problem for this week: Patient has severe aortic valve stenosis and left ventricular hypertrophy. The aortic valve was replaced with a prosthesis, after which the patient was weaned from the cardiopulmonary bypass machine. To access the valve, a median sternotomy was done.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

 

Answers for this week:

  • I35.0: Nonrheumatic aortic (valve) stenosis
  • I51.7: Cardiomegaly
  • 02RF0JZ: Replacement of aortic (valve) stenosis
  • 5A1221Z: Performance of cardiac output, continuous

 

Breakdown of diagnostic code, I35.0

I35 = Non-rheumatic aortic valve disorders

I35.0 = Non-rheumatic aortic (valve) stenosis 

To Locate I35.0: Alphabetic Index > Stenosis, stenotic > aortic valve > I35.0 > verify in Tabular.

COMMENTS:

  • This procedure is used when the patient’s aortic valve is failing.
  • The failing aortic valve is replaced with an artificial heart valve.
  • Don’t be mislead by the word “replacement.” The patient’s original valve was replaced by a prosthetic valve; it is not a prosthetic valve being replaced by another prosthetic valve.

To Locate I51.7: Cardiomegaly > see also Hypertrophy, cardiac > I51.7.

To Locate 02RF0JZ: PCS Index > Replacement > Valve > Aortic > 02RF > Locate table 02R and go across the row to finish building the code as well as verify that the 4th digit of F is correct:

Replacement of Aortic Valve with Synthetic Substitute, Open Approach

PCS Root Ops 50A

Comments:

  • Replacement is defined as “Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part.”
  • Once the pericardium has been opened, the patient is put on a cardiopulmonary bypass machine.
  • A cut is made in the aorta and a cross-clamp applied. The diseased aortic valve is then removed and a mechanical or tissue valve is put in its place.

To Locate 5A1221Z, Extracorporeal Circulation: PCS Index > There is no listing in the Index for Extracorporeal Circulation. In the Table of Contents, look for Extracorporeal Assistance and Performance found under “ICD-10 Tables” > go to the correct page (p. #440 for the Optum 2015 edition) and there you will find table 5A1 > go across the row to finish building the code:

Performance of Cardiac Output, Continuous

PCS Root Ops 50B

Comments:

  • Extracorporeal Circulation is classified to the Extracorporeal Assistance and Performance section.
  • The root operation is Performance because the machine has taken over the patient’s cardiac function during the procedure.
  • The machine takes over the task of breathing for the patient and pumping their blood around while the surgeon replaces the heart valve.
  • Note that the 5th character, Approach and Device (Med/Surg section), have been replaced by Duration and Function in the Extracorporeal Assistance and Performance section, respectively.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Aortic Valve Replacement 

02RF0JZ

  1. Step #1 is to locate the correct section in your PCS coding book. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
  2. Step 2: Determine the correct Body System – Heart and Great Vessels. You are dealing with a heart valve, so it should be easy to determine the correct section. Thus far, we have identified the first two characters, 02.
  3. Step 3: Determine the root operation. You know you have to be in a table that starts with 02. From that point I would look for the root operation, Replacement, by scanning through the tables. The root operations are listed alphabetically, so it shouldn’t be hard to find the correct root operation. Our root operation is Replacement. We now have the first three characters, 02R. And this puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Heart and Great Vessels; the root operation, Replacement.
  4. Step 4: Identify the Body Part to determine the 4th character value. The Body Part, aortic valve, should relate to the root operation, Replacement. We now have 4 character values 02RF.
  5. Step 5: Determine the Approach. A sternotomy was made to access the valve. This is obviously an open approach. We should now have 5 characters, 02RF0.
  6. Step 6: Determine whether or not a device was left in the patient postoperatively. A synthetic valve replaced the diseased valve. A synthetic valve isn’t a device, per se, but it is a non-organic substitute and will function as the new valve. We should now have 6 characters, 02RF0J.
  7. Step 7: There is no qualifier, so we now have our code of 02RF0JZ. Z functions as a placeholder in ICD-10-PCS.

We will continue to focus on problems that include assignment of both diagnostic/procedural codes. This week we are working a problem from the Endocrine, Nutritional and Metabolic Diseases chapter, Chapter 4.

Problem for this week: A patient was admitted for severe malnutrition and hematuria secondary to amyotrophic lateral sclerosis. Due to her malnutrition, a nasogastric feeding tube was placed under fluoroscopy.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

Answer Key:

  • E43: Unspecified severe protein-calorie malnutrition
  • G12.21: Amyotrophic lateral sclerosis (ALS)
  • R31.9: Hematuria, unspecified
  • 3E0G36Z: Introduction of nutritional substance into upper GI, percutaneous approach

 

To Locate Severe protein-calorie malnutrition: Alphabetic Index > Malnutrition > severe (protein energy) > E43 > Go to the Tabular to verify the code. While you’re in training and using your coding books, be aware of why its important to refer to the Tabular before going on to the next code because the Tabular is where you’ll find instructional notes, Includes/Excludes, et al.

Comments

  • Admission was necessitated by malnutrition, not the underlying ALS. Therefore, severe malnutrition is the condition requiring placement of a feeding tube, and it is the PDx.

To Locate ALS: Alphabetic Index >Amyotrophia > lateral sclerosis> G12.21 > verify in Tabular.

To Locate hematuria: Alphabetic Index >Hematuria > R31.9 > go to Tabular to verify. NEVER code from the Index.

To Locate nasogastric feeding tube: PCS Index > Introduction of substance in or on > Gastrointestinal tract > Upper > Nutritional substance > 3E0G > locate table 3E0 and then go across the row to finish building the code:

Introduction of Nutritional Substance Into Upper GI, Percutaneous Approach

PCS Root Op 49

Comments:

  • The Administration section includes services such as injections, infusions, and transfusions.
  • There are 3 root operations in the Administration section, and they are classified according to the broad category of substance administered. In our scenario, a nutritional substance was “Introduced,” resulting in a character value of 0. There is new terminology in the ICD-10 code set and Introduction/Injection is a good example: Introduction replaces Injections.
  • In the PCS Index, how would you know to go to “Introduction” rather than “Insertion” or Implantation?” Insertion is ruled out because the main term states “Insertion of device in.” In the PCS Index, after locating the main term, “Implantation” there is a subterm, “Insertion.” You know that isn’t going to work because it includes devices.
  • Introduction is defined as “Putting in or on a therapeutic, diagnostic, physiological, or prophylactic substance except blood products.” You may find the definition of “Introduction” in the tables itself, as the definition of the root operations are located on the top of all PCS tables.
  • In ICD-10-PCS, the GI tract has subterms that are divided by Upper GI and Lower GI tracts.
  • How do we know the approach is percutaneous? We know the feeding tube was placed under fluoroscopy. This is known as a radiologically-guided feeding tube placement. A nick is made in the stomach to allow passage of the feeding tube.
  • For the 6th character, substance replace Device in the Administration section; otherwise the remaining characters are the same as those found in the Med/Surg section.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Placement of Naso-gastric Feeding Tube

  1. Step #1 is to locate the correct section in your PCS coding book. Based on the above-referenced explanation, you know you should be in the Administration section. But what if you didn’t know that? Then you would refer to the Table of Contents and look for the heading (in bold), “ICD-10 PCS Tables,” followed by the listing of Administration under this category (p. 429 in the 2015 Optum edition.) If you don’t have coding books, buy them. It is far more difficult to learn ICD-10-CM-PCS coding from encoders. Also note that the first character in the Administration section is always 3.
  2. Step 2: Determine the correct Body System — Physiological Systems and Anatomical Regions. Although there are other values for the second character, such as 0 –Circulatory, and C –Indwelling device, the Body System character value in this particular case is E in the Administration section. This character indicates the general physiological system or anatomical region involved (gastrointestinal, for example.) Thus far, we have identified the first two characters, 3E.
  3. Step 3: Determine the root operation. Ask yourself what the object of the procedure is. The goal is to insert a feeding tube into the stomach. We can safely assume that either a small incision or a prick was made to accommodate the feeding tube. Our root operation is Introduction. We now have the first three characters, 3E0. And this puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Administration; the body system, Physiological Systems and Anatomical Regions; and it gives the root operation, Introduction.
  4. Step 4: Identify the Body System/Region to determine the 4th character value. The Body System/Region should relate to the root operation. In our scenario the key word is region. Region refers to general rather than specific anatomical sites. PCS divides the GI Tract into Upper/Lower parts. We are in the upper GI tract, the stomach area. We now have 4 character values 3E0G. Coding Tip: There are multiple rows for the table 3E0. The quickest way to locate the correct row is to scan the first column (Body System/Region), looking for the letter G. Don’t stop at the first G you come to because there is more than one G and it must include the Substance administered in the Substance column. If it doesn’t include nutritional substance, then keep looking. We are up to 5 characters, 3E0G3.
  5. Step 5: Determine the Approach. A needle prick is required to accommodate the Introduction of the feeding tube. We should now have 5 characters, 3E0G3.
  6. Step 6: Determine the substance administered. It is a nutritional substance, with a character value of 6. We should now have 3E0G36.
  7. Step 7: There is no qualifier, so we now have our code of 3E0G36Z. Z is the placeholder in ICD-10-PCS.

Last week we stated that from here on we would be coding problems that require assignment of both diagnoses and procedures. With respect to the breakdown of diagnostic codes, a new feature, we will only do that for the PDx.

Problem for this week:  A patient 6-months pregnant was diagnosed with iron-deficiency anemia and was admitted for transfusion of non-autologous packed red blood cells via a peripheral vein.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:

O99.012          Anemia complicating pregnancy, second trimester

D50.9              Iron-deficiency anemia, unspecified

30233N1         Transfusion of red blood cells

 

To Locate dx code of anemia complicating pregnancy:  Alphabetic Index > Anemia > complicating pregnancy, childbirth, and puerperium > see Pregnancy complicated by (management affected by), anemia > O99.01- > Go to the Tabular to verify the code and pick up the remaining digit(s) needed to complete this code. A dash following a character is your clue that you haven’t yet finished building the code, and it indicates that another digit is required. That digit is 2 for a code of O99.012. Obstetric codes always begin with the letter O, not to be confused with the number zero.

Breakdown of O99.012

O99 = Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium

O99.0 = Anemia complicating pregnancy, childbirth, and the puerperium

O99.01 = Anemia complicating pregnancy

O99.012 = Anemia complicating pregnancy, second trimester

 

Comments – O99.012

  • 099.012 is assigned as the PDx because the anemia is complicating the pregnancy.
  • Second trimester is assigned because the patient is six months pregnant.
  • ICD-10-CM defines the second trimester as between the range of 14 weeks and 0 days to less than 28 weeks and 0 days. Providers may document the unit of the trimester in either week or months.

To Locate dx code of iron-deficiency anemia:  Alphabetic index > Anemia > deficiency > iron > D50.9 > Locate D50.9 in the Tabular to verify the code.

Comments – D50.9:

  • We know this patient has anemia, but adding code D50.9, iron-deficiency anemia, adds greater specificity as to the type of anemia.

To Locate px, Transfusion of red blood cells:  PCS Index > Transfusion > Vein > Peripheral > Blood > Red Cells > 3023 > Locate table 302, and then go across the row to finish building the code:

Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Percutaneous Approach

PCS Root Op 48 Comments:

  • The Administration section includes services such as injections, infusions, and transfusions.
  • There are 3 root operations in the Administration section and they are classified according to the broad category of substance administered. For example, blood products are classified to the root operation “Transfusion.”
  • Substance replaces Device as the 6th character value. Device is assigned to the Med/Surg section, not the Administration section.
  • A needle is inserted into the patient’s vein, so the obvious answer for Approach is percutaneous.
  • The substance is packed RBCs. What is the difference between packed RBCs and regular RBCs? In transfusion medicine, packed red blood cells (aka stored packed red blood cells or packed cells) are red blood cells (also called erythrocytes) that have been collected, processed, and stored in bags as blood product units available for blood transfusion.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Blood Transfusion 

  1. Step 1: Locate the correct section in your PCS coding book. Based on the above-referenced explanation, you know you should be in the Administration section. But what if you didn’t know that? Then you would refer to the Table of Contents and look for the heading (in bold), “ICD-10 PCS Tables,” followed by the listing of Administration under this category (p. 429 in the 2015 Optum edition.) If you don’t have coding books, buy them. It is far more difficult to learn ICD-10-CM-PCS coding from encoders. Also note that the first character in the Administration section is always 3.
  2. Step 2:  Determine the correct Body System. The substance is blood, which, in our scenario, is the Circulatory System. The character value for the Circulatory System is always 0. Thus far, we have identified the first two characters, 30.
  3. Step 3:  Determine the root operation. You already know the root operation is transfusion, with a character value of 2. We now have the first three characters, 302. And this puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives us the section, Administration; it gives us the body system, Circulatory; and it gives us the root operation, Transfusion.
  4. Step 4: Identify the body system/region to determine the 4th character value. This is easy. As you probably know, the Body System/Region should relate to the root operation. The Body System/Region is a peripheral vein and the root operation is Transfusion. The area used most frequently to draw blood is a vein. So far we have 4 character values, 3023.
  5. Step 5:  Determine the Approach. This too should be easy. A needle prick is required to draw blood, which is considered a Percutaneous Approach. We now have 5 characters, 30233.
  6. Step 6:  Identify the substance administered, the 6th character value, N. Blood was drawn for transfusion, then prepared for packaging. We’re up to 6 character values, 30233N. Remember, in the Administration section Substance replaces Device.
  7. Step 7:  Qualifiers augment, i.e., tell us more about the procedure. The 7th character value in our scenario is 1, Nonautologous for a code of 30233N1.

For the past several months the Coding Tidbits have focused on procedure coding. With ICD-10-CM and ICD-10-CM-PCS Coding on the horizon (hopefully), from here on out you will be given problems requiring assignment of both diagnostic and procedural codes.

Problem for this week:  A patient was admitted with occlusion of the right common carotid artery due to plaque. An open carotid endarterectomy was carried out with extracorporeal circulation (continuous cardiac output).­­­­­­

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key: 

I65.21:  Occlusion and stenosis of right carotid artery

03CH0ZZ:  Extirpation of matter from the right common carotid artery, open approach

5A1221Z:  Performance of cardiac output, continuous (extracorporeal circulation).

 

Problem #1, Occlusion of right common carotid artery for which patient underwent an open carotid endarterectomy accompanied by extracorporeal circulation.

To Locate Dx code:  Alphabetic Index > Occlusion > Artery > Carotid > I65.2 > go to the Tabular to verify the code and see if additional digits/characters are assigned > Occlusion and stenosis of right carotid artery > I65.21.

 

Breakdown of I65.21:

I65 = Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction

I65.2 = Occlusion and stenosis of carotid artery

I65.21 = Occlusion and stenosis of right carotid artery

 

Problem #1 cont’d

To Locate endarterectomy Px:  PCS Index > Endarterectomy > see Extirpation, upper arteries > Extirpation > Common Carotid > Right > 03CH > locate table 03C and go across the row to finish building the code, making sure that the 4th character listed in the Index is correct:

 

Extirpation of Matter from the Right Common Carotid Artery, Open Approach

PCS Root Ops 47A

Comments:

  • Always start your PCS Index search by going to the root operation – Extirpation.
  • Extirpation is defined as “Taking or cutting out solid matter from a body part.”
  • Our diagnostic statement (coding problem) does not state Internal/External Common Carotid Artery; rather, it states common carotid artery. Don’t be misled by the statement, because the external/internal carotid arteries and the common carotid artery are not the same thing. The External Carotid Artery is a major artery of the head and neck. It arises from the common carotid artery. The Index distinguishes, as subterms, between the common carotid artery, the internal carotid artery and the external carotid artery under Extirpation.
  • The internal carotid artery is a major paired artery one on each side of the head and neck. They arise from the common carotid arteries where these bifurcate into the internal and external carotid arteries
  • The objective of the carotid endarterectomy is to take out or cut out the solid matter (plaque) occluding the carotid artery. Therefore the procedure is coded to the root operation, Extirpation.
  • NOTE:  Directions for locating endarterectomy of the right common carotid artery by directly using the tables are located at the end of this tidbit.

 

Problem #1 cont’d

To Locate Extracorporeal Circulation > PCS Index > There is no listing in the Index for Extracorporeal Circulation. In the Table of Contents, look for Extracorporeal Assistance and Performance found under  “ICD-10 Tables” > go to the correct page (p. #440 for the Optum 2015 edition and there you will find table 5A1 > go across the row to finish building the code:

 

Performance of Cardiac Output, Continuous

PCS Root Ops 47B

Comments:

  • Extracorporeal Circulation is classified to the Extracorporeal Assistance and Performance section.
  • The root operation is Performance because the machine has completely taken over the patient’s cardiac function during the procedure.
  • Note that the 5th character, “Approach” and the 6th character “Device” in the Med/Surg section have been replaced by the 5th character “Duration” and the 6th character “Function” in the Extracorporeal Assistance and Performance section.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Endarterectomy of Right Common Carotid Artery

 

  1. The first thing you should do is determine which section the common carotid artery is located. ICD-10-PCS separates upper arteries from lower arteries. The common carotid artery is of course considered an upper artery. You can either refer to the Table of Contents or you can flip through the PCS coding book to be in the correct section. If you don’t have ICD-10-CM/PCS coding books, it is highly recommended that you buy them. It is far more difficult to learn ICD-10-CM-PCS coding from encoders.
  2. The first character in the Med/Surg section is always 0.
  3. Next determine which Body System you should be in. We determined that in step 1 we are in the Upper Artery Section, which is represented by value a value of 3. We have the first two characters, 0 and 3. In addition, the first 3 characters values are listed for you at the top of the table, 03C, which puts you in the correct table. It gives you the correct section (Med/Surg), the Body System (Upper Arteries), and the Root Operation (Extirpation). So far we have identified the first 3 characters.
  4. After identifying the 4th character, H, the Body Part for the Right Common Carotid Artery you, have only 3 characters left to assign. At no time do you have to assign 7 characters because the tables ALWAYS give you the first 3 character values and sometimes the Index gives you the 4th character value as well. So far we have the character values 03CH.
  5. It isn’t always easy to determine the Approach although in our scenario it’s easy. We know from the diagnostic statement that the Approach was Open. Now we are up to 5 characters, 03CH0.
  6. Because no device was left in place postoperatively, the character value is Z. We now have 6 character values, 03CH0Z.
  7. The 7th and last character value is the Qualifier. Since there is no Qualifier, the character value is Z, placeholder, for a code of 03CH0ZZ

Problem for this week:  Right trigeminal neuralgia for which the patient underwent destruction of the trigeminal nerve. The operation consisted of right sterotactic radiofrequency destruction of the nerve using a radiofrequency needle. The treatment was done 3 times along the clival line of the nerve.

 

 

 

 

 

 

Who We Are

 

 

 

 

Answer Key:  005K3ZZ

To recap, we have spent the last two weeks reviewing the Substance Abuse and Mental Health sections. This week we are going back to random review of procedure(s) in the Med/Surg Section.

 

Problem:  Destruction Trigeminal Nerve

To Locate:  PCS Index > Destruction > Nerve > Trigeminal > 005K > locate table 005 and go across the row to finish building the code, making sure that the body part given in the Index is correct:

Destruction of Trigeminal Nerve, Percutaneous Approach

PCS Root Ops 46

Comments

  • When coding from the Index, always start by looking up the Root Operation first.
  • Destruction is defined as the physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent.
  • Approach:  Since a needle was used to advance the needle to the operative site, this is your clue that the procedure was done percutaneously. A nick is made for needle access, but a nick certainly doesn’t constitute an open procedure.
  • Three treatments were done but we’re only coding the procedure once. The needle was not reintroduced each time and the ablation/destruction was all on the same branch of the trigeminal nerve.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Destruction of Trigeminal Nerve

  1. The first thing you should do is determine which section the trigeminal nerve would most logically be located. Obviously, you want to be in the Nervous System section but which one – Cerebral versus Peripheral Nervous System? If you look up the Root Operation for both Nervous Systems, you will see that there is no listing of destruction in the Peripheral Nervous System section. That leaves only the Central Nervous System. And, of course, you can always refer to the table of contents at the beginning of your PSC coding book. If you do not have a coding book, it is recommended that you buy one. It is far more difficult to learn ICD-10-PCS coding from encoders.
  2. Determine which Body System you should be in. We determined that in step 1 we are in the Central Nervous System. You should be in the correct table. The first 3 characters values are listed for you at the top of the table, 005, gives you the Section, Body system, and Root Operation. So far we have identified the first 3 characters.
  3. We don’t have to locate the root operation, 3rd character, because we established that in step #2. The root operations are arranged alphabetically. We are looking for Destruction, character value of 5.
  4. After identifying the 4th character, K, the Body Part for the trigeminal nerve you, have only 3 characters left to assign. At no time do you have to assign 7 characters because the tables ALWAYS give you the first 3 character values and sometimes the Index gives you the 4th character value as well. So far we have the character values 005K.
  5. It isn’t always easy to determine the Approach although in our scenario it is isn’t that difficult. Since a needle was “introduced,” we know that the Approach is Percutaneous Now we are up to 5 characters, 005K3.
  6. Because no device was left in place postoperatively, the character value is Z. We now have 6 character values, 005K3Z.
  7. The 7th and last character value is the Qualifier. Since there is no Qualifier, the character value is Z, placeholder, for a code of 005K3ZZ.

Coding problems for this week:

  1. Individual cognitive therapy.
  2. Electroconvulsive Therapy (ECT), unilateral for multiple seizures.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:

  1. GD52ZZZ
  2. GZB1ZZZ

 

Last week we discussed substance abuse procedures. This week we are going to focus on mental health procedures. The structure of both Substance Abuse and Mental Health are very similar. This will be our only discussion on Mental Health. The Mental Health section is relatively small and makes use of only 3 of the PCS. Values in characters 2, 5, 6, and 7 just as is true for Substance Abuse, are always ZZZ, None, and are used as placeholders.

Character 1, Section:  The first character is always G.

Character 2, Body System:  Assign value Z, None. At this time there are no specific characters for the 2nd character field.

Character 3, Root Type:  There are 12 Root Type values in this section, as follows:

  • Psychological Tests (character value of 1)
  • Crisis Intervention (2)
  • Medication Management (3)
  • Individual Psychotherapy (5)
  • Counseling (6)
  • Family Psychotherapy (7)
  • Electroconvulsive Therapy (B)
  • Biofeedback (C)
  • Hypnosis (F)
  • Narcosynthesis (G)
  • Group Psychotherapy (H)
  • Light Therapy (J)

Character 4, Type Qualifier:  There are 25 different Type Qualifiers in this section. They describe the type of treatment indicated by the Root Type specified in character 3. Examples include specific types of Psychological Tests and different types of Individual Psychotherapy.

Characters 5 – 7:  Assign value Z, None. There are no specific characters for the 5th, 6th, and 7th character fields at this time.

 

Problem #1, Individual cognitive therapy.

To Locate:  PCS Index > Psychotherapy > Individual > see Psychotherapy, Individual, Mental Health Services > Cognitive > GZ52ZZZ > Locate Table GZ5 to validate that this code is correct:

Individual Psychotherapy, Cognitive

PCS Root Ops 45A

Comments:

  • This is an easy problem to code because the Index gives us the code. We only have to verify that the 3rd character value of 5 (Root Type), Individual Psychotherapy and the 4th character value of 2 (Type Qualifier), Cognitive, are correct.
  • Remember to go to the Root Type first when coding from the Index.
  • The Index instructs us to see Psychotherapy, Individual, Mental Health Services. The 3rd sub-term under Psychotherapy is “Individual.” However, there is no listing for Individual under Mental Health Services. Just go to Mental Health Services and you’ll see the listing for Cognitive.

 

Locating the Code(s) by Going Directly to the Tables

Directions for Individual Cognitive Therapy

  1. How do you know where to start? You can either flip through the coding tables, looking for Mental Health Services or you can go to the Table of Contents where you’ll find a listing for Mental Health Services.
  2. All Mental Health Service procedures begin with the character value of G.
  3. You don’t have to worry about locating the 2nd character value because there is none at this time for the 2nd character field. Instead, look for the Root Type, Individual Cognitive Therapy, keeping in mind that all Root Types are arranged alphabetically. In our scenario, the Root Type has a character value of 5.You should now be in the correct table, GZ5. The first 3 character values are always listed at the top of each table. The table gives us GZ5. Now you have only to verify that the 3rd and 4th character values of 5 and 2 respectively, are correct.
  4. So far we have the character values of GZ52.
  5. In Table GZ5 the 5th, 6th, and 7th characters are left blank at this time, so those characters are assigned to Z. And bingo, we have our code, GZ52ZZZ.

 

Problem #2, Electroconvulsive Therapy (ECT), unilateral for multiple seizures.

To Locate:  PCS Index > Electroconvulsive Therapy > Unilateral-Multiple Seizure > GZB1ZZZ > Even though the Index gives you the code, I still want you to go locate table GZB and verify that the code listed in the Index is correct.

Electroconvulsive Therapy, Unilateral – Multiple Seizure

PCS Root Ops 45B

Comments:

  • Once again the Index gives us the code. Mental Health codes are very simple to solve. You have only two characters to verify, Root Type of B and Type Qualifier of 1.
  • Go to the Root Type first when coding from the Index.
  • As you can see after coding these 2 problems, Mental Health Services coding problems are quite easy to code. In both instances, the Index gave us the entire code. All we had to do was verify that the code is correct by locating the appropriate table(s).
  • We are not going to include directions for coding from the tables because it would be redundant.

Coding Problems for this week:  

  1. Medication monitoring of patient on methadone maintenance.
  2. Group cognitive-behavioral counseling for substance abuse.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:  

  1. HZ81ZZZ
  2. HZ42ZZZ

 

For the past couple weeks we have reviewed randomly selected problems from the Med/Surg section and the Placement/Administration/Measurement and Monitoring section. This week we are going to review Substance Abuse Treatment, quite a departure from what we’ve accomplished to date. The Substance Abuse section, similar to the Mental Health section, only makes use of three of the PCS characters. Values in characters 2, 5, 6, and 7 are always Z – None, the placeholder. Because Substance Abuse Treatment Services are so easy to code, this will be our one and only session on this topic. Next week we will discuss the Mental Health Section.

Substance Abuse Therapy:

There are two terms to know when coding substance abuse problems:

  1. Abuse: Problematic use of drugs or alcohol but without dependence.
  2. Dependence:  Increased tolerance to drugs or alcohol with a compulsion to continue taking the substance, despite the cost; withdrawal symptoms often occur upon cessation.

Character Values for Substance Abuse Treatment Section

  • Character 1, Section:  The first character is always H.
  • Character 2, Body System:  Assign value Z, None, for all procedures.
  • Character 3, Root Type:  There are 7 root-type values in this section, differentiated by type of treatment:
    • Detoxification Services
    • Individual Counseling
    • Group Counseling
    • Individual Psychotherapy
    • Family Counseling
    • Medication Management
    • Pharmacotherapy
  • Character 4, Type Qualifier:  Each of the root types referred to above have 12 or 13 different specific types of services associated with them, with the exception of Detoxification and Family Counseling. These root types are represented by the Type Qualifier, 4th character value. I’m not going to list them here, as they are listed in your in the PCS coding book. However, I will give you a few examples:
    • Specific types of counseling and psychotherapy such as Cognitive, Behavioral, Vocational etc.
    • Distinct general categories of Medication and Management and Pharmacotherapy such as Antabuse, Clonidine, Methadone Maintenance, etc.
    • At this time there are no specific valid characters for the 5th, 6th, and 7th- character fields for Substance Abuse Treatment procedures, so assign the value Z for the last three characters.

 

Problem #1, Medication monitoring of patient on methadone maintenance:

To Locate:  PCS Index > Substance Abuse Treatment > Medication Management > Methadone Maintenance > HZ81ZZZ > locate table HZ8 and go across the row to finish building the code. There isn’t much to build but I want you to go to the table to verify the code listed in the Index is correct:

Medication Management for Substance Abuse Treatment, Methadone Management

PCS Root Ops 44A Comments:

  • This is an easy coding problem to solve because the Index gives us the code. We only have to verify that the 3rd character value of 8, Medication Management, and the 4th  character Type Qualifier, Methadone Maintenance, are correct.
  • Remember to go to the Root Type first when coding from the Index.

Locating the Code(s) by Going Directly to the Tables

Directions for Methadone Maintenance Management

    1. How do you know where to start? You can either flip through the coding tables, looking for Substance Abuse Treatment or you can go to the Table of Contents where you’ll find a listing for Substance Abuse Treatment.
    2. All Substance Abuse procedures begin with the character value of H.
    3. You don’t have to worry about locating the 2nd character value because there is none at this time for the 2nd character field. Instead, look for the Root Type, Medication Management, keeping in mind that all Root Types are arranged alphabetically. In our scenario, the Root Type has a character value of 8.You should now be in the correct table, HZ8. The first 3 values are always listed at the top of each table. So far you have identified the first 3 character values, HZ8, which puts you in the correct table.
    4. Now you must identify the 4th character value, Type Qualifier, Methadone Maintenance, with a character value of 1. So far we have the character values HZ81.
    5. In Table HZ8 the 5th, 6th, and 7th characters are left blank at this time, so those characters are assigned to Z. And bingo, we have our code, HZ81ZZZ.

 

Problem #2, Group cognitive-behavioral counseling for substance abuse.

To Locate:  PCS Index > Substance Abuse Treatment > Counseling > Group > Cognitive-Behavioral > HZ42ZZZ > locate table HZ4 and go across the row, verifying that the character values listed in the Index for this code are correct:

Group Counseling for Substance Abuse Treatment, Cognitive-Behavioral

PCS Root Ops 44B

Comments:

  • The two problems we did today clearly demonstrate just how easy Substance Abuse Treatment problems are to code.
  • Even if the Index doesn’t list the entire code, there are only 1-2 character values that you have to identify in the table.

 

NOTE

We are not giving directions for locating the codes from the table for Group Counseling because it would redundant. The instructions for problem #2 are almost the same as for problem #1.

Problem for this week:  Esophagogastroscopy with Botox injection into esophageal sphincter.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:  3E0G8GC

For the past two weeks we have given you randomly selected coding problems. We reviewed a sigmoidoscopy from the Med/Surg section and an arm compression from the Placement section. This week we are going to code a Botox injection from the Administration Section. Administration procedures involve services such as transfusions, infusions, injections, and irrigations, and the first character is always 3. There was an extensive review on the Administration section in the 11/26/14 Tidbit.

To Locate:  PCS Index > Esophagogastroscopy > 0DJ68ZZ > Locate table 0DJ and verify whether the code is correct or not. It is not the correct code. You know right away because the root operation given in this table is Inspection, Not Introduction.  Back to the Index:  Introduction of substance in or on > Gastrointestinal Tract > Upper > All the sub-terms under GI Tract, Upper, lists 3E0G. One of the sub-terms is Diagnostic Substance, Other, but this too is incorrect because this is a therapeutic procedure, not a diagnostic procedure > Locate table 3E0 and go across the row to finish building the code after verifying that the 4th digit listed in the Index is correct:

Introduction of Other Therapeutic Substance into Upper GI, Via Natural or Artificial Opening Endoscopic

PCS Root Ops 43

Comments:

  • Remember that it is always a good idea to look for the root operation when you start coding a problem. If you went to Esophagogastroscopy, it gives you code 0DJ68ZZ, incorrect for our scenario.
  • Injection is now referred to as Introduction in keeping with some of the new terminology in ICD-10-PCS.
  • Approach:  The scope is inserted through the mouth, a natural opening. The fact that this procedure was done through a scope indicates that this is an endoscopic procedure.
  • Botulinum toxin is a paralyzing agent with temporary effects; it does not sclerose or destroy the nerve.
  • One main difference between the Med/Surg section and the Administration section is that the value for the 6th character is Substance rather than Device. The substance is coded to the character value of G, Other Therapeutic Substance, because there is no listing for Botox.
  • Qualifiers contain unique values for individual procedures. For example, the qualifier can be used to identify the destination site in a bypass, although in our scenario, the qualifier “Other Substance” doesn’t add anything to the clinical picture as far as I can tell.

Locating the Code(s) by Going Directly to the Tables

Directions for Botox Injection

  1. How do you know where to start? If you recall that Introduction/Injection procedures are found in the Administration section, you know you’re in the right place. What if you didn’t know that? Then you’d go to the Table of Contents and look for Administration.
  2. All Administrative procedures begin with the character of 3.
  3. Don’t worry about locating the Body System. Instead, look for the Root Operation, keeping in mind that all Root Operations are arranged alphabetically. In our scenario, the Root Operation is Introduction, with a character value of 0. You should now be in the correct table, 3E0. The reason you don’t have to worry about identifying the correct  Body System is because the first 3 character values include the Body System  as well as the Section (Administration), and Root Operation (Introduction). These 3 values are always listed at the top of each table. So far you have identified the first 3 character values, 3E0.
  4. Now you must identify the 4th character value, Body Part, Upper GI, with a character value of G. There are multiple rows that begin with 3E0, so don’t stop at the 1st G you come to because you may not necessarily be in the correct row. Note that table 3E0 only lists Upper and Lower GI. The specific Body part, Esophageal Sphincter, is not listed. When deciding on the selection of the row for 4th character for 3E0G, you may notice there are actually 5 rows with the 4th character, G, to choose from. Looking at the 6th character, “substance,” is an expeditious way to locate the correct coding row. So far we have the character values 3E0G.
  5. Table 3E0 lists three choices for Approach. The scope is entered through the mouth, a natural opening. The fact that this procedure was done through a scope indicates that this is an endoscopic procedure. We are up to 5 characters, 3E0G8 – 8 represents via Natural Opening Endoscopic.
  6. When considering whether to code an inspection procedure, the Medical and Surgical section Guideline B3.11a states that “Inspection of a body part(s) performed in order to achieve the objective of a procedure is not coded separately.” In our case, the esophagogastroscopy was performed in order to reach the main objective of the procedure which is the injection of Botox, so it is not coded separately.
  7. The substance injected or introduced is Botox. Identifying the substance is a snap because Table 3E0 only lists one substance, Other Therapeutic Substance. We now have 6 character values, 3E0G8G.
  8. The 7th and last character value is the Qualifier. Again, we don’t have to make a choice for the Qualifier because the only substance listed is Other Substance, C. W now have our code, 3E0G8GC.

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