ICD-10-PCS, Root Operations – Part 35, Procedures: Question

ICD-10-PCS, Root Operations – Part 35, Procedures: Question

Coding problem for this week:

  1. Diagnostic excision of left lobe of liver and pancreas, percutaneous approach.

Today we are going to discuss when it is appropriate to assign more than one code to a procedure when it is done under the same episode of care.

This week’s coding problem

  1. Attempted laparoscopy with ablation of endometrium was made. However, due to some unexpected complications, this procedure had to be converted to open ablation of endometrium.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key

  1. 0U5B0ZZ; 0UJD4ZZ

 

Problem #1, Part 1:  An attempted laparoscopy with ablation of endometrium was made. However, due to some unexpected complications, this procedure had to be converted to open ablation of endometrium.

  • To Locate Part 1: PCS Index > Ablation > see Destruction > Endometrium > 0U5B> Locate table 0U5 and go across the row to finish building the code:

Destruction of Endometrium, Open Approach

PCS Root Ops 34A

Comments:

  • If you know that ablation is a form of destruction, don’t waste your time by going to Ablation first.
  • Destruction is defined as “Physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent.”
  • Guideline B3.2.d.:  During the same operative episode, multiple procedures are coded if:
    • The intended root operation is attempted using one approach, but is converted to a different approach. Code both the discontinued procedure to the root operation performed and the definitive procedure. We are coding the definitive procedure first. The procedure started out using a laparoscope but had to be converted to an open approach to complete destruction of the endometrium.
    • The above-referenced table is coded to open approach.
  • Since we have to code the discontinued laparoscopy based on guideline B.3.2.d., here we go:
  • To Locate, Part 2:  PCS Index > Inspection > Uterus > 0UJD > Locate table 0UJ and go across the row to finish building the code.

 

Inspection of Uterus, Percutaneous Endoscopic Approach

PCS Root Ops 34B

Comments:

  • This is the first part of the procedure in which they inserted the laparoscope.
  • The approach is Percutaneous Endoscopic because a laparoscope was used.
  • Inspection is one of the new terms and is defined as visually and/or manually exploring a body part.

 

Last week we stated that we would not continue our discussion of procedures in the Administrative section after 2/10/15. However, we are behind schedule so for this week only, we are going to do some more review of procedures coded to the Administrative section.

 

Problems for this week:

  1. Esophagogastroscopy with Botex injection into esophageal sphincter.
  2. Sclerotherapy of brachial plexus lesion, alcohol injection.

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

  1. 3E0G8GC
  2. 3E0T3TZ vs 0153

 

Problem #1, Esophagogastroscopy with Botox injection into esophageal sphincter.

To Locate:  PCS Index > Introduction of substance in or on > Gastrointestinal tract > Upper > Destructive Agent > 3E0G > Locate table 3E0 and go across the row to finish building the code:

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

ICD-10 Root Ops Part 33A

Comments:

  • When you have to scan several rows until you come to the correct row, first look for the 4th character value, ‘G’ under the appropriate Root Operation, Introduction. And don’t necessarily stop at the first row you come to that has the 4th character value you are looking for as it may not contain the remaining character values, 5 – 7 —- keep looking.
  • Introduction is part of the new terminology for ICD-10-PCS. In ICD-9-CM, Introduction is referred to as Injection.
  • When coding procedures in the Administration section, the approach is usually Percutaneous. In our scenario the scope is entered through a natural opening, hence a character value of 8 is assigned to account for the endoscope as well as to account for its insertion via a natural opening.
  • The substance is Botox but ICD-10-PCS does not have a code for Botox, at last in this instance; hence, “Other Therapeutic Substance” is assigned; likewise for 7th character, C, “Other substance.” Some examples include anti-infectives, anti-neoplastics, etc.
  • Botulinum toxin is a paralyzing agent with temporary effects; it does not sclerose or destroy the nerve.

 

Problem #2, Sclerotherapy of brachial plexus lesion, alcohol injection.

To Locate:  PCS Index > Introduction of substance in or on > Nerve > Plexus > Destructive Agent > 3E0T3TZ > Locate table 3E0 and after locating the appropriate row, continue across the row to validate that the code given in the Index is correct.

Introduction of Destructive Agent into Peripheral Nerves and Plexi, Percutaneous Approach 

ICD-10 Root Ops Part 33B

Comments:

  • The brachial plexus is a network of nerves that originate in the neck region and branch off to form most of the other nerves that control movement and sensation in the upper limbs, including the shoulder, arm, forearm, and hand. The radial, median, and ulnar nerves originate in the brachial plexus.
  • When you see “Introduction” or “Injection,” you know that a puncture was made, hence the approach is percutaneous.
  • Just as our first problem didn’t have a code for Botox, ditto for this problem – there is no code for alcohol. However, we know that alcohol is used as a destructive agent to deaden nerves.

We have been focusing on procedures in the Administration section for the past few weeks. This will be our last week to discuss procedures in this section.

Problems for this week

  1. Epidural blood patch
  2. Transfusion of embryonic stem cells into central vein.
  3. Infusion of chemotherapy peripheral vein insertion.

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key

  1. 3E0S3GC
  2. 30243AZ
  3. 3E03305

 

Problem #1, Epidural blood patch.

To Locate:  PCS Index > Introduction of substance in or on > Epidural Space > 3E0S3GC >

Locate table 3E0 and then scan the rows, looking for the character value S. Although it doesn’t

apply to this scenario, don’t necessarily stop at the first 4th character value you come to in a

particular row. Also remember that you have to stay within the same row. At any rate, we got a

break again, with the Index giving us the entire code. You should still locate the appropriate row

in table 3E0 and go across the row to validate that the code listed in the Index is correct:

Introduction of Other Therapeutic Substance into Epidural Space, Percutaneous Approach

PCS Root Ops 32A

Comments:

  • An epidural blood patch is a surgical procedure that uses auatologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. The procedure can be used to relieve post dural puncture headaches caused by a spinal tap.
  • How it works:  A small amount of the patient’s blood is injected into the epidural space near the site of the original puncture; the resulting blood clot blood then “patches” the meningeal leak. An epidural needle is inserted into the epidural space at the site of the cerebrospinal fluid leak and blood is injected. The clotting factors of the blood close the hole in the dura.
  • It is also postulated that the relief of the headache after an epidural blood patch is due to more of a compression effect than sealing the leak. Because the fluid column in the lumbar spine is continuous with the fluid around the brain, the blood exerts a “squeeze” and relieves the low pressure state in the head.
  • By now you should be sufficiently aware of some of the new terminology, eg, Introduction is the new term for Injections.

 

Problem #2, Transfusion of embryonic stem cells into central vein.

To Locate:  PCS Index > Transfusion > Vein > Central > Stem Cells > Embryonic > 302 > Locate table 302 and go across the row to finish building the code:

Transfusion of Embryonic Cells into Central Vein, Percutaneous Approach

PCS Root Ops 32B

Comments:

  • There are 3 body system (character 2) values in this section:  Circulatory (0), Indwelling Device (C) and Physiological Systems and Anatomical Regions (E).
  • Blood products are classified to the root operation “Transfusion”; Cleansing substances are classified to  “Irrigation.” All other therapeutic, diagnostic, nutritional, physiological, or prophylactic substances administered are classified to “Introduction.”
  • Catheter utilization to introduce substances into the circulatory system is classified to the Percutaneous approach.

 

Problem #3, Infusion of chemotherapy peripheral vein insertion.

To Locate:  PCS Index > Introduction of substance in or on > Vein > Peripheral > Antineoplastic > 3E03 > locate table 3E0 and go across the row to finish building the code:

Introduction of Other Antineoplastic Peripheral Vein, Percutaneous Approach

PCS Root Ops 32C

Comments:

  • Remember that character value 3 is always used for the Administration section.
  • It is very tempting to go to Infusion in the Index. If you do, it will send you to Introduction. Antineoplastics are therapeutic and therapeutic substances are classified to Introduction.
  • By now you know that the approach in the Administration section is almost always going to be Percutaneous. This approach is used for intradermal, subcutaneous, and intramuscular injections.
  • Qualifiers carry additional information for a particular procedure; in this in instance all we know is that chemotherapy was administered.

We have spent the last two weeks focusing on procedures in the Administration section. We’ll continue on the same topic this week. I haven’t yet mentioned that cast application, cervical traction, and cystometrograms are also considered Administrative procedures.

 

Coding problems for this week:

  1. Percutaneous irrigation of ankle joint.
  2. Administration of a hepatitis B vaccine, IM.
  3. Peritoneal dialysis via indwelling catheter.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key

  1. 3E1U38Z
  2. 3E0234Z
  3. 3E1M39Z

 

Problem #1, Percutaneous irrigation of ankle joint.

To Locate:  PCS Index > Irrigation > Irrigating Substance > 3E1U38Z > Locate table 3E1 and go across the row to validate that the code listed in the Index is correct:

Irrigation of Joints Using Irrigating Substance, Percutaneous Approach

PCS Root Ops 31A

Comments:

  • Root Operation: Irrigation is defined as “Putting in or on a cleansing liquid substance.” Some examples include Peritoneal dialysis via indwelling catheter, percutaneous irrigation of knee joint, and gastric lavage.
  • Approach:  A puncture is made to access the knee joint, so the obvious answer is Percutaneous. Making it even easier is the fact that table 3E1 only lists one approach, Percutaneous.
  • Qualifier:  You have two choices in table 3E1 for the Qualifier, either Diagnostic or No Qualifier. I opted for the latter because there is no indication that this procedure was done for biopsy purposes. It was done to clean the area out.

 

Problem #2, Administration of a hepatitis B vaccine, IM.

To Locate:  PCS Index > Introduction of substance in or on > Muscle > Vaccine > 3E0234

Introduction of Serum, Toxoid and Vaccine into Muscle, Percutaneous Approach

PCS Root Ops 31B

Comments:

  • You got a break with this one because the Index gave you the whole code. However, you should still verify it by going to the appropriate row in the tables section.
  • The approach value for intradermal, subcutaneous, and intramuscular Introduction (ie, Injections) is always Percutaneous.

 

Problem #3, Peritoneal dialysis via indwelling catheter.

To Locate:  PCS Index > Irrigation > Peritoneal Cavity > Dialysate > 3E1M39Z > Locate table 3E1 and then go across the row to validate that the code listed in the Index is correct:

Irrigation of Peritoneal Cavity Using Dialysate, Percutaneous Approach

PCS Root Ops 31C

Comments:

  • I always advise you to go to the Root Operation when you start your Index search. However, there’s usually more than one way to skin a cat. If you refer to the main term Dialysis and the sub-term Peritoneal, it also gives you the same code, 3E1M39Z. Not every procedure is listed in the Index. When this happens, what are you going to do? You’ll need to go directly to the tables. This is why its important to develop a comfort level with the tables. So here we go:
      1. Locate the Administration section in the PCS-10 coding book.
      2. Locate the Root Operation, Irrigation (every table lists the Root Operation alphabetically.)
      3. You should now be in the correct table, 3E1.
      4. Continue across the row to assign the remaining 4 character values.
  • Irrigation is defined as “Putting in or on a cleaning substance.” Dialysis is a process for removing waste (diffusion) and excess water (ultrafiltration) from the blood and is used primarily as an artificial replacement for lost kidney function in people with renal failure. In other words, dialysis cleans the blood by removing the waste products such as urea and creatinine.
  • Approaches involving catheterization are coded to Percutaneous.

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:

  1. Chemical pleurodesis through chest tube with injection of tetracycline.
  2. Open implantation of antimicrobial envelope with cardiac pacemaker placement (do not code pacemaker.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

  1. 3E0L3TZ
  2. 3E0102A

 

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

PCS Root Ops 30A

Comments:

  • 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

PCS Root Ops 30B

Comments:

  • 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.

This week we’re going to focus on the Administration section. This section involves procedures such as transfusions, infusions, injections, and irrigations. With the exception of the 6th character Substance, the characters are the same as those in the Med/Surg section.

 

Coding problems for this week:

  1. Autologous bone marrow transplant via CVC (central venous catheter.)
  2. Epidural injection of mixed steroid and local anesthetic for pain control.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

 

Answer Key:

  1. 30243G0
  2. 3E0S33Z

 

Characters in the Administrative Section:

  • Character 1, Section:  Always 3, Administration
  • Character 2, Body System:  There are only 3 valid character values:  Circulatory (0), Indwelling Device (C), Physiological Systems and Anatomical Regions (E)
  • Character 3, Root Operation:  There are only 3 valid character values:  Introduction, Irrigation, Transfusion.
  • Character 4, Body Region:  The values in this section relate to the substance being administered. For transfusion procedures, the values include only valid routes of administration as through a vein or artery whereas the root operation Introduction contains 33 routes of administration.
  • Character 5, Approach:  The approach is almost always going to be Percutaneous with one exception:  Irrigations of indwelling devices are always coded to External approach.
  • Character 6, Substance:  This character provides broad categories of substances such as anesthetics, anti-inflammatories, antineoplastics and destructive agents, etc.
  • Character , Qualifier:  This character designates more specific information about the substance administered, such as whether a transfusion blood product was Autologous (0), or it provides further specificity about the substance. For example, the 6th character in a code may be 0, Antineoplastic, and the 7th character Qualifier value may be M for Monoclonal Antibody, which further describes the specific type of chemotherapy.

 

Problem #1, Autologous bone marrow transplant via CVC (central venous catheter.)

To Locate:  PCS Index > Transfusion >Vein > Central > Bone Marrow > 3024 > Locate table 302 and go across the row to finish building the code:

Transfusion of Autologous Bone Marrow into Central Vein, Percutaneous Approach

PCS Root Ops 29A

Comments:

  • Root Operation:  Always being your search in the Index by referring to the Root Operation.
  • There are only 3 valid character values in the Administration section of which Transfusion is one of the 3 characters.
  • As previously stated, the approach is almost always Percutaneous. Subcutaneous, intradermal, and intramuscular injections are other examples of the Percutaneous approach.
  • Substance:  If the substance administered is blood or blood products, the Root Operation Transfusion is assigned.
  • The 7th character designates more specific information about the substance administered, such as whether a transfusion was Autologous.

 

Problem #2, Epidural injection of mixed steroid and local anesthetic for pain control.

Introduction of Anti-Inflammatory into Epidural Space, Percutaneous Approach.

PCS Root Ops 29B

Comments:

  • Body System:  ICD-10-PCS does not classify regions of the body by the traditional abdominopelvic quadrant divisions. The anatomical regions are defined as the general regions, the upper extremity regions, and the lower extremity regions. The epidural space is considered a general region.
  • Root Operation:  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 root operation Introduction.
  • Substance:  Steroids are considered to be anti-inflammatories. There are multiple rows for the tables in 3E0. Don’t give up if you can’t locate the substance because it is listed. Quickly go through the 3E0 tables; first locate the Body Part, 4th character value of S. Once you have 3E0S, you can scan the rows looking for the Substance, anti-inflammatory.
  • The 6th character Substance is coded to 3 Anti-inflammatory because the steroid was the main substance introduced. The local anesthetic was mixed in to lessen the pain of the injection itself.

Today will be our final discussion on procedures in the Obstetrics section.

 

Coding problems for this week:

  1. Abortion by dilation and evacuation following laminaria insertion.
  2. Laparoscopy with total excision of tubal pregnancy.
  3. Open in utero repair of congenital diaphragmatic hernia.

 

 

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

 

Answer Key:

  1. 10A07ZW
  2. 10T24ZZ
  3. 10Q00ZK

 

Problem #1, Abortion by dilation and evacuation following laminaria insertion.

To Locate:  PCS Index >Abortion > Laminaria > 10A07ZW > Locate table 10A and validate that the code listed in the Index is correct.

Abortion of Products of Conception, Laminaria Via Natural or Artificial Opening

PCS Root Ops 28A

  • Start with the root operation in the Index.
  • Laminaria is a seaweed product inserted into the cervix for 3-4 hors, which is usually enough time for the cervix to soften and dilate, after which the products of conception are evacuated.

 

Problem #2, Laparoscopy with total excision of tubal pregnancy.

To Locate:  PCS Index > Resection > Products of Conception, Ectopic >10T2 > locate table 10T and go across the row to finish building the code.

Resection of Products of Conception, Ectopic, Percutaneous Approach

PCS Root Ops 28B

  • Resection, the root operation, is defined as “Cutting out or off, without replacement all of a  body part.” How would you know to go to resection? Well, you won’t find anything under excision or dilation that works. In ectopic pregnancies, the entire fetus must be removed. Therefore, resection rather than excision applies.
  • Approach:  Any time a laparoscope is used it is considered percutaneous endoscopic. A puncture is made, after which the scope is inserted.

 

Problem #3, Open in utero repair of congenital diaphragmatic hernia.

To Locate:  PCS Index > Repair > Products of Conception > 10Q0 > Locate table 10Q and go across the row to finish building the code:

Repair Respiratory System in Products of Conception, Open Approach

PCS Root Ops 28C

  • I thought these in utero repairs would be difficult to code, but they’re not. As usual, go to the root operation when using the Index rather than the tables.
  • The diaphragm is classified to the Respiratory body system in the Med/Surg section although we are staying in the OB section, not the Med/Surg section.
  • No guesswork for the approach, as the first word in the first sentence is Open.

For the past several weeks we have focused on Obstetric procedures. We will continue to give you more obstetric coding problems so you can test your skill set based on what you have learned to date.

 

Coding problems for this week:

  1. Intrauterine pregnancy term, delivered full term infant. Episiotomy extended to 2nd-degree lacerations, perineum. A low-forceps delivery with episiotomy and repair of perineal laceration.
  2. Induction of labor by cervical dilation.
  3. Termination of pregnancy as 12 weeks after studies showed the fetus to be anencephalic. A laminaria stick produced an incomplete abortion. This was followed by a D&C.

 

 

 

 

 

Who We Are

 

 

 

 

 

 

 

Answer Key:

  1. 10D07Z3, 0W8NXZZ, 0WQNXZZ
  2. 0U7C7ZZ
  3. 10A07ZW, 10D17ZZ

 

Problem #1, Intrauterine pregnancy, delivered full term infant. Episiotomy extended to 2nd-degree lacerations, perineum. A low-forceps delivery followed by episiotomy and repair of perineal laceration transpired.

To Locate Delivery:  PCS Index > Delivery > Forceps > see Extraction, Products of Conception > 10D0 > Extraction > Products of Conception > Low Forceps > 10D07Z3 > Locate table 103D and validate that the code listed in the Index is correct:

Extraction of Products of Conception, Low Forceps, Via Natural or Artificial Opening

PCS Root Ops 27A 

Comments:

  • If you refer to the root operation, Delivery, Forceps it gives you two instructions: either go to table 10D (listed as 10D0 in the Index) or refer to the root operation Extraction, which gives you the entire code. Regardless of which root operation you referred to, you should still locate the table to verify that the code given in the Index is correct.
  • It is always faster to refer to the root operation in the Index.
  • The Qualifier, which gives us more information about the code, indicates that this was a low forceps delivery.

 

Problem #1 cont’d, to locate Episiotomy:  PCS Index > Episiotomy > see Division, Perineum, Female > 0W8N > locate table 0W8 and go across the row to finish building the code:

Division of Female Perineum, External Approach

PCS Root Ops 27B

Comments:

  • Definition of Division:  Cutting into a body part without draining fluids and/or gases from the body part in order to separate or transect a body part.
  • The External approach is assigned for procedures performed directly on the skin.
  • Note that we have gone from the Obstetrics section to the Med/Surg section. Procedures performed on the pregnant female other than the products of conception are coded to the appropriate root operation in the Med/Surg section.
  • Review:  Products of conception refer to all components of pregnancy including fetus, embryo, amnion, umbilical cord, and placenta.

 

Problem #1 cont’d, to locate repair of perineal laceration:

To Locate:  PCS Index > Perineum > Female > 0WQN > locate table 0WQ and go across the row to finish building the code:

Repair Female Perineum, External Approach

PCS Root Ops 27C

 

Problem #2, Induction of labor by cervical dilation.

To Locate:  PCS Index > Induction > Cervix > 0U7C > Locate table 0U7 and go across the row to finish building the code:

Dilation of Cervix, Via Natural or Artificial Opening

PCS Root Ops 27D 

Comments:

  • We have once again gone from the Obstetrics section to the Med/Surg section. Refer to problem #1 for explanation.
  • Note that the Body Part character value (character 4) is dependent upon the assignment of the Body System character value (character 2). The cervix is considered part of the female reproductive system.

 

Problem #3, Termination of pregnancy as 12 weeks after studies showed the fetus to be anencephalic. A laminaria stick produced an incomplete abortion. This was followed by a D&C.

To Locate abortion:  PCS Index > Abortion > Laminaria >10A07ZW > locate table 10A and go across the row to finish building the code: 

PCS Root Ops 27E

Comments:

  •  A laminaria stick is a thin rod of dried kelp used in Obstetrics for surgical procedures such as abortions. The rods are inserted into the cervix, and over the course of several hours, they slowly absorb water and expand, dilating the cervix and prompting labor.
  • Since the rods are injected into the cervix, it is logical to assign the approach as percutaneous. However, the ICD-10-PCS coding book does not give you a choice. The only approach listed is Via Natural or Artificial Opening.

 

Problem #3 cont’d, to locate D&C:

PCS Index > Extraction > Products of Conception > Retained > 10D1 > locate table 10D and go across the row to finish building the code:

Extraction of Products of Conception, Retained, Via Natural or Artificial Opening

PCS Root Ops 27F

Comments: 

  • Extraction is defined as “Pulling or stripping out or off all or a portion of a body part by the use of force.”
  • This is a good example of when it is better to go directly to the tables rather than rely on the Index. There is nothing under the main term, Dilation. If you go to curettage, you are instructed to see Extraction or Excision. Practice some problems by going to the tables rather than rely solely on the Index. I realize that I have given you instructions in almost all the coding problems to go to the Index first. As you develop a comfort level with ICD-10-PCS, try to use the tables rather than just the Index.

 

We will continue our discussion of the Obstetrics section this week. As promised, I will give you some coding problems to do, but no discussion of guidelines. You should be able to successfully work these problem based on last week’s discussion. Because this is a holiday week and many of us still have last-minute shopping to do, I am only giving you three problems.

 

Coding problems for this week:

  1. Manually assisted delivery.
  2. Fetal spinal tap, percutaneous.
  3. Laparoscopic total removal of tubal pregnancy.

 

 

 

 

 

 

Who We Are

 

 

 

 

 

 

Answer Key:

  1. 10E0XZZ
  2. 10903ZA
  3. 10T24ZZ

 

Problem #1, Manually assisted delivery.

To Locate:  PCS Index > Delivery > Products of Conception > 10E0XZZ > That was easy, but as you all know, I still want you to locate table 10E and verify that the code given in the Index is correct:

Delivery of Products of Conception, External Approach

PCS Root Ops 26A

Comments:

  • Refer to the root operation, Delivery, for the fastest and most efficient was to locate the code and/or the correct table.
  • Review of Table 10E reveals that there is only one code in ICD-10-PCS for the root operation, Delivery.
  • Its fairly easy to determine the approach, External, because there were no incisions, no use of an endoscope.

 

Problem #2, Fetal spinal tap, percutaneous.

To Locate:  PCS Index > Drainage > Products of Conception > Fetal Cerebrospinal Fluid > 1090 > Locate table 109 and go across the row to finish building the code:

Drainage, Products of Conception, Fetal Cerebrospinal Fluid

PCS Root Ops 26B

Comments:

  • The correct body part for a fetal spinal tap is Products of Conception, which is the body part for all the Obstetrics codes.
  • There are several choices for the approach. Since a puncture was made, you know the correct choice is percutaneous. Since there is no mention of an endoscope, the approach, Percutaneous Endoscopic, is quickly ruled out.
  • The procedure is coded to the Obstetrics section because it was performed on the fetal spinal fluid. The fetus is specifically referenced as being a part of the Products of Conception.

 

Problem #3, Laparoscopic total removal of tubal pregnancy.

To Locate:  PCS Index > Resection > Products of Conception, Ectopic > 10T2 > locate table 10T and go across the row to finish building the code:

Resection Products of Conception, Ectopic, Percutaneous Endoscopic Approach

PCS Root Ops 26C 

Comments:

  • The Body Part of Products of Conception, Ectopic, should be assigned since the procedural statement indicated a tubal pregnancy.
  • Resection is the most appropriate Root Operation because the entire Products of Conception tissue was removed. Resection is defined as “Cutting out or off, without replacement, all of a body part.
  • The approach, Percutaneous Endoscopic, is assigned because the procedure was done laparoscopically after which instruments are inserted through the scope to carry out the desired procedure.

From the Blog

ICD-10-PCS, Root Operations – Part 35, Procedures: Question

Coding problem for this week: Diagnostic excision of left lobe of liver and pancreas, percutaneoread more