Problems for this week – Code the following:
- Laparoscopic cholecystectomy converted to an open and complete cholecystectomy.
- Liposuction, right upper leg.
Answer Key Rationale
Problem #1, Laparoscopic cholecystectomy converted to open, complete
To Locate: PCS Index > Cholecystectomy > see Resection, Gallbladder > 0FT4 > Locate table 0FT and go across the row to finish building the code:
Resection of gallbladder, open approach
- Resection: The PCS Index gives you two choices: Resection or Excision. We went with Resection because the entire gallbladder was removed. In resection procedures, the entire organ is removed, whereas in excision procedures, only part of an organ is removed. Resection is the root operation because the entire gallbladder was removed. Resection is defined as cutting out or off, without replacement, all of a body part
- Open Approach: Even though the procedure started out laparoscopically, it was converted to an open procedure. Open is defined as cutting through the skin or mucous membrane and any other body layers necessary to expose the site of the procedure.
- Converted to Open: A laparoscopic procedure was attempted but was converted to an open procedure. 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. Laparoscopic cholecystectomy converted to an open cholecystectomy is coded as percutaneous endoscopic Inspection and open Resection. Therefore, codes that capture both of these approaches are coded.
Problem #1 cont’d, to account for inspection of gallbladder
To Locate: PCS Index > Inspection > Gallbladder > 0FJ4 > Locate table 0FJ and go across the row to finish building the code:
Inspection of gallbladder, percutaneous endoscopic approach
- Inspection is defined as visually or manually exploring a body part. The gallbladder was inspected before the procedure was converted to an open approach. Don’t let this confuse you with the rule that procedures performed using an open approach with percutaneous endoscopic assistance are coded only to approach value ‘0’ Open. We still have to account for the inspection as well as follow guideline B3.2.d.
- The approach is considered Percutaneous Endoscopic because the procedure started out laparoscopically.
Problem #2, Liposuction for medical purposes, right upper leg
To Locate: PCS Index > Extraction > Subcutaneous Tissue and Fascia > Upper Leg > Right > 0JDL > Locate table 0JD and go across the row to finish building the code:
Extraction of right upper leg subcutaneous tissue and fascia, percutaneous approach
- If you can’t locate a main term for liposuction, where do you go? This is when it helps to familiarize yourself with some of the new terminology found in ICD-10. Extraction is defined as pulling or stripping out or off all or a portion of a body part by the use of force.
- Percutaneous Approach: The Percutaneous approach is inherent in the liposuction technique. To select the body system and body part, Subcutaneous Tissue and Fascia is selected because this procedure occurs under the skin into the subcutaneous tissue and fat.
- Note that if liposuction is done for medical purposes, it is considered Extraction. If it is done for cosmetic purposes, it is considered Alteration.