This week we will continue to focus on procedures in the Administration section. If you need to review anything from last week’s discussion, please refer to the 1/20/15 tidbit.
Coding Problems for this week:
- Chemical pleurodesis through chest tube with injection of tetracycline.
- Open implantation of antimicrobial envelope with cardiac pacemaker placement (do not code pacemaker.
Problem #1, Chemical pleurodesis through chest tube with injection of tetracycline.
To Locate: PCS Index > Introduction of Substance In or on > Pleural Cavity > Destructive Agent > 3E0L3TZ > Locate table 3E0 and after locating the appropriate row, go across the row to confirm that the code listed in the Index is correct:
Introduction of Destructive Agent into Pleural Cavity, Percutaneous Approach
- Always start your Index search by first referring to the Root Operation. In our scenario, it is Introduction. Introduction is defined as “Putting in or on a therapeutic, diagnostic, nutritional, physiological or prophylactic substance except blood or blood products.” Think of injections when you come across the term Introduction. Introduction, in fact, is part of the new terminology found in ICD-10-PCS with Introduction replacing Injection.
- Pleurodesis is a medical procedure in which the pleural space is artificially obliterated. It involves the adhesion of the two pleurae. Chemicals such as bleomycin, tetracycline, et al, or iodine, or a slurry of talc can be introduced into the pleural space through a chest drain. The instilled chemicals cause irritation between the parietal and the visceral layers of the pleura which closes off the space between them and prevents further fluid from accumulating. Well, what do you know – I had no idea tetracycline was anything other than an anti-infective.
- Once you are in table 3E0, search very carefully for the 4th character Body Part. There are multiple rows in table 3E0, so don’t stop when you come to the first ‘L.” Keep going.
Problem #2, Open implantation of antimicrobial envelope with cardiac pacemaker placement (do not code pacemaker.)
To Locate: PCS Index > Introduction of substance in or on > Subcutaneous Tissue > Anti-infective > 3E01 > Locate table 3E0 and then 1) locate the appropriate row and 2) go across the row to finish building the code:
Introduction of Anti-infective Envelope into Subcutaneous Tissue, Open Approach
- This was harder to code, at least for me. The first place I went to in the Index was Implantation where there are instruction to see either Insertion or Replacement. Insertion made sense, but it didn’t take me to the correct table. You don’t have to rely on the Index. Many coders find it easier to go directly to the tables. However, you need to develop a strong comfort zone before working directly with the tables.
- How do you know the Body Part is subcutaneous tissue? You will know this based on your experience. It is standard procedure to place an envelope or battery just under the skin in the chest area.
- The Qualifier let us know more about the procedure. In this instance it tells us that the device inserted is an anti-infective envelope.