ICD-10-CM/PCS, Digestive System 7 – Answer

ICD-10-CM/PCS, Digestive System 7 – Answer

C18.4:   Malignant neoplasm of transverse colon
0DTL4ZZ:   Resection of transverse colon, percutaneous endoscopic approach
0D1L4Z4:   Bypass transverse colon to cutaneous, percutaneous endoscopic approach


To Locate Dx/Px Codes:

  • C18.4:  Index > Neoplasm Table > Malignant Primary column > intestine > large > colon > transverse
  • 0DTL4ZZ:  Px Index > Resection > Colon > Transverse > 0DTL > locate table 0DT and go across the row to finish building the code:

Resection transverse colon, percutaneous endoscopic approach

Digestive System 7

 

  • Resection is defined in ICD-10-PCS as “Cutting out or off, without replacement all of a body part.” An ‘excision’ is coded when only a part of the organ is removed and there is a portion left behind. In our scenario, the entire transverse colon was resected.
  • Approach is assigned to percutaneous endoscopic because the procedure was done via a laparoscope. A puncture or small incision has to be made in order to insert the scope.
  • Directions for code assignment by coding directly from the table(s):  You can also build the code by going directly to the appropriate table. Identify the section, the body system and the root operation. The section is Med/Surg = 0; the body system is Gastrointestinal = D; the root operation is Resection = T. Note that the root operations are listed alphabetically. You now have the first 3 characters, 0DT, and this puts you in the correct table. To assign the 4 remaining values for characters 4-7, you must identify the body part, the approach, and devices and qualifiers, if any:
    • Body Part = L, Transverse colon
    • Approach = 4, Percutaneous endoscopic
    • Device = 0, No devices
    • Qualifier = 0, No qualifiers
    • You have now built the code, 0DTL4ZZ

 

  • 0D1L4Z4:  Px Index > Colostomy > see Gastrointestinal System > 0D1 > Locate table 0D1 and go across the row to finish building the code:

Bypass transverse colon to cutaneous, percutaneous endoscopic approach

Digestive System 7B

  • Bypass:  Altering the route of passage of the contents of a tubular body part, i.e., rerouting the contents from one area of a body part to a downstream area in the normal route.
  • Approach:  Because the approach was via a laparoscope, it is  considered to be percutaneous endoscopic.
  • A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. The attached stoma appliance provides an alternative channel for feces to leave the body.
  • Device:  Do not assign a value for device because the stoma appliance is an external, not an internal device. Only internal devices that remain after surgery are to be coded.
  • Directions to locate code using tables instead of the index:
    • Determine the section, Med/Surg = 0
    • Select the appropriate body system = D, GI System
    • Select the appropriate root operation = 1, Bypass
    • We now have the first 3 characters, 0D1, which puts us in the correct table.
  • To assign the 4 remaining values for characters 4-7, you must identify the body part, the approach, and devices and qualifiers, if any:
    • Body part = L, Transverse Colon
    • Approach = 4, Percutaneous Endoscopic
    • Device = Z, No Device
    • Qualifier  = 4, Cutaneous
    • You have now built the code, 0D1L4Z4

An elderly female who was diagnosed with adenocarcinoma of the colon underwent a laparoscopic resection of the transverse colon followed by formation of a temporary external stoma (colostomy), direct anastomosis.

 

How do you code for this?

K21.0:      Gastro-esophageal reflux disease with esophagitis
K22.4:     Dyskinesia of esophagus
0DJ08ZZ:     Inspection of upper intestinal tract, via natural or artificial opening endoscopic
4A0B78Z:     Measurement of gastrointestinal motility, via natural or artificial opening


To Locate Diagnosis Codes:

  • K21.0:  Index > Disease > gastro-esophageal reflux (GERD) > with esophagitis
  • K22.4:  Index > Dyskinesia > esophagus
  • 0DJ08ZZ:  Px Index > EGD (esophagogastroduodenoscopy) > 0DJ08ZZ. Even though the index gave you the entire code, you should still verify it by going to the correct table:

Digestive System 6

  • Inspection:  New terminology for ICD-10-PCS. Inspection is defined as “Visually and/or manually exploring a body part.”
  • Approach:  Entry of instrumentation through a natural or artificial external opening to reach and visualized the site of the procedure.
  • Directions to locate the code by going directly to the tables:
    • Determine the appropriate section, Med/Surg = 0
    • Select the appropriate body system = D, Gastrointestinal System
    • Select the appropriate root operation = J, Inspection, noting that the root procedures are listed alphabetically
    • We now have the first 3 characters, 0DJ, which puts us in the correct table.

To assign the 4 remaining values for characters 4-7, you must identify the body part, the approach, and devices and qualifiers, if any:

  • Body part = 0, Upper Intestinal Tract
  • Approach = 8, Via natural or artificial opening, endoscopic
  • Device = Z, No Device
  • Qualifier  = Z, No Qualifier = Z
  • You have now built the code, 0DJ08ZZ

Procedure Location Directions Continued:

  • 4A0B78Z:  Px Index > Measurement > Gastrointestinal > Motility > 4A0B > locate table 4A0 and go across the row to finish building the code:

Digestive System 6B

  • Physiological Systems:  The Administration section covers Administration, Placement, Measurement and Monitoring.
  • Measurement:  Measurement and Monitoring determines the level of a physiological or physical function repetitively over a period of time.  Repeated readings over a period of time is considered MONITORING, while a single reading is considered MEASUREMENT. An esophageal motility study is typically done to evaluate suspected disorders of peristalsis of the esophagus.
  • Function:  The function and device values in the Measurement and Monitoring section describe body functions such as movement, flow, electricity, metabolism, pressure and temperature.
  • Motility:  An esophageal motility study (EMS) or esophageal manometry is a test to assess motor function of the upper esophageal sphincter (UES), esophageal body and lower esophageal sphincter (LES).
  • Directions for locating the code going directly to the tables:  The first question you may have is how do you know in which section the EMS is located. You know from the wording of the question that a motility study was done. Go to the Table of Contents and look for the Measurement and Monitoring section. Once you locate this section, you are given the first 3 characters, 4A0. O = Measurement/Monitoring; Physiological Systems = A, and the root operation, Measurement = 0. Now that you are in table 4A0, the next thing to look for is the appropriate body system, Gastrointestinal = 4A0B. Then determine the approach, function and qualifier, if any. We know that the opening was through the mouth (7), hence it is via a natural opening. You are given 3 choices for the function. Since you know this was a motility study, assign the 8 value. Because there are no qualifiers, assign the Z value. You have now built the code, 4A0B78Z.

 

A patient with a history of GERD returns to his GI physician for a follow-up visit to assess the results of having been on Dexilant for 6 months, which proved to be of minimal to no relief. Following a diagnostic EGD, the physician determined that the patient’s condition had worsened and a diagnosis of reflux esophagitis was made, which was complicated by esophageal motility issues including peristaltic sequences of very high amplitude with simultaneous esophageal contractions, causing severe chest pain. In addition to the EGD, an esophageal motility study (measurement) was done. A catheter was placed in the mouth and guided into the stomach. As the catheter was withdrawn, pressure changes were noted.

How would you code for this?

K35.2:      Acute appendicitis with generalized peritonitis
E66.01:      Morbid (severe) obesity due to excess calories
0DTJ0ZZ:     Resection of appendix, open approach
0WJG4ZZ:     Inspection of peritoneal cavity, percutaneus endoscopic approach


To Locate Dx/Px Codes:

  • K35.2:  Index > Appendicitis > acute > with > peritonitis > with > perforation or rupture
  • E66.01:  Index > Obesity > morbid
  • 0DTJ0ZZ:  Px Index > Appendectomy > see Resection, Appendix > 0DTJ > Locate table 0DT and go across the row to finish building the code:

Resection of appendix, open approach
Digestive System 5A
 

  • Resection:   Cutting out or off, without replacement, all of a body part. The entire appendix was resected.
  • Directions to locate code using the tables instead of the index:
    • Determine the section, Med/Surg = 0
    • Select the appropriate body system = D, GI Sx
    • Select the appropriate root operation = T, Resection
    • We now have the first 3 characters, 0DT, which puts us in the correct table.
  • To assign the 4 remaining values for characters 4-7, you must identify the body part, the approach, and devices and qualifiers, if any:
    • Body part = J, Appendix
    • Approach = 0, Open
    • Device = Z, No Device
    • Qualifier  = Z, No Qualifier = Z
    • You have now built the code, 0DTJ0ZZ.
  • 0WJG4ZZ:  Px Index > Inspection > Peritoneal Cavity > 0DTJ > Locate table 0DT and go across the row to finish building the code:

Inspection of peritoneal cavity, percutaneous endoscopic approach

Digestive System 5B

  • Anatomical Regions, General:  The “anatomical regions” body system codes should only be used when the procedure is performed on an anatomical region rather than a specific body part. The peritoneal cavity is a body region, not a specific body part.
  • Inspection is defined in ICD-10-PCS as “Visually and/or manually exploring a body part.”
  • Approach is assigned to percutaneous endoscopic because the inspection was done with the assistance of a laparoscope and a puncture or small incision is made in order to insert the scope.
  • Coding guideline:  When a laparoscopic appendectomy converts to an open procedure, it is coded to an open procedure. Why then, are we coding the laparoscopic piece of the procedure? We still have to account for the fact that an inspection was conducted via laparoscopy.
  • Directions to locate code using tables instead of the index:
    • Determine the section, Med/Surg = 0
    • Select the appropriate body system = W, Anatomical Regions
    • Select the appropriate root operation = J, Inspection
    • We now have the first 3 characters, 0WJ, which puts us in the correct table.
  • To assign the 4 remaining values for characters 4-7, you must identify the body part, the approach, and devices and qualifiers, if any:
    • Body part = G, Peritoneal Cavity
    • Approach = 4, Percutaneous Endoscopic
    • Device = Z, No Device
    • Qualifier  = Z, No Qualifier = Z
    • You have now built the code, 0WJG4ZZ

The patient was admitted through the ER with acute RLQ pain and was taken to surgery for removal of a ruptured appendix. At the time of the appendectomy, generalized peritonitis was observed. The attempted laparoscopic approach failed secondary to the patient’s morbid obesity. The approach was then changed to open and an incision was made through the abdomen.

How would you code for this?

K56.5     Intestinal adhesions (bands) with obstruction (postprocedural) (postinfectional)
0DNE0ZZ     Release large intestine, open approach

To Locate Diagnosis Code:

  • K56.5:  Index > Adhesions, adhesive > with intestinal obstruction

Feedback for Diagnosis Code:

  • Nonessential Modifiers:  Parentheses are used in ICD-10 to enclose supplementary words that may be either present or absent in the diagnostic statement without affecting the code to which it is assigned. Such terms are considered to be nonessential modifiers. The terms postprocedural and postinfectional are nonessential modifiers.

To Locate Procedure Code:

  • 0DNE0ZZ:  Px Index > Lysis > see Release > Intestine > Large > 0DNE > locate table 0DN and go across the row to finish building the code:

Digestive System 4

  • Release is defined as “freeing a body part from an abnormal physical constraint.”
  • You can also build the code by going directly to the appropriate table.

Identify the section, the body system and the root operation. The section is Med/Surg = 0; the body system is Gastrointestinal = D; the root operation is Release = N. NOTE that the root operations are listed alphabetically. You now have the first 3 characters, 0DN, and this puts you in the correct table. To assign the 4 remaining values for characters 4-7, you must identify the body part, the approach, and devices and qualifiers, if any:

Body part – intestine = E
Approach – Open = 0
Device – No Device = Z
Qualifier  – No Qualifier = Z

You have now built the code, 0DNE0ZZ.

 

A 45-year-old male was diagnosed with intestinal obstruction due to a peritoneal adhesive band for which he was treated by open lysis of the adhesive band, large intestine.

How would you code for this?

K42.1    Umbilical hernia with gangrene
0WUF4JZ        Supplement abdominal wall with synthetic substitute, percutaneous endoscopic approach

 To Locate Diagnosis Code:

  • K42.1:  Index > Hernia > umbilicus, umbilical > with > gangrene (and obstruction) > verify in Tabular

Feedback for Diagnosis Code:

  • K42.1:  Umbilical hernias have gained little attention from surgeons in comparison with other types of abdominal wall hernias. However, the primary suture for umbilical hernia is associated with a recurrence rate of 19-54%. Most of the ICD-10-CM hernia diagnoses codes make accommodations for recurrence, but NOT for umbilical hernias.

To Locate Procedure Code:

  • 0WUF4JZ:  Px Index > Herniorrhaphy > with synthetic substitute > see Supplement, Anatomical Regions, General > 0WU > locate table 0WU and go across the row to finish building the code. NOTE:  The instructions to see Anatomical Regions, applies to the table, not the Index. At any rate, the table is:

Digestive System 3

For body systems, 2nd character, ICD-10-PCS includes Anatomical Regions, General, which describe general locations of the body. We know from the instructions given in the PCS Index that the body system we need to locate is Anatomical Regions, General, and the root operation, which we also need to locate, is Supplement. For a more detailed explanation on body systems, either read the last paragraph of this tidbit or just skip it altogether.

Supplement is defined as “Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a body part.” This applies to mesh insertion, synthetic. Because the approach was via laparoscope, the approach value is 4, percutaneous endoscopic. This approach is defined as entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure. When you see the approach described as laparoscopic in any Med/Surg procedure, the value in the this section will always be 4. And finally, because mesh was inserted, we have to account for the device.

You can also build the code by going directly to the appropriate table. Identify the section (Med/Surg), the body system (Anatomical Regions, General), and the root operation (Supplement). NOTE that the root operations are listed alphabetically. This gives you the values for the 1st 3 characters, 0WU, and puts you in the correct table.  To assign the 4 remaining values for characters 4-7,  you must identify the body part, the approach, devices and qualifiers, if any:

  • Body part – Abdominal wall, with a value of F
  • Approach – Percutaneous endoscopic, with a value of 4
  • Device – Synthetic substitute, with a value of J
  • Qualifier – No qualifier, with a value of Z = 0WUF4JZ

Supplementary Reading:  These general locations are for use in coding when procedures are performed on multiple body part and through various types of structures such as skin, muscles, arteries, nerves, and bone, all within one area of the body. This facilitates coding of procedures that involve all of these structures and reduce the number of codes required to correctly describe complex procedures performed in these areas. For example, amputation of the right arm at midshaft, below the elbow, is coded with one code – 0X6D0Z2- rather than multiple codes from several body systems, such as the skin, musculoskeletal system, nervous system, and circulatory system.

An elderly male patient, 80 years of age, has had ongoing problems with an umbilical hernia for which he had surgical correction 3 years ago. Not only did the umbilical hernia return, it is also gangrenous. He underwent a laparoscopic herniorrhaphy of the gangrenous umbilical hernia, with mesh (synthetic) insertion.

How do you code for this?

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ICD-10-CM/PCS, Digestive System 7 – Answer

C18.4:   Malignant neoplasm of transverse colon 0DTL4ZZ:   Resection of transverse colon, percutaneread more