02100Z9: Bypass coronary artery, one site from left internal mammary artery, open approach
5A1221Z: Performance of cardiac output, continuous
To Locate 02100Z9:
- 02100Z9: Px index > Bypass > Artery > Coronary > 0210 > locate table 021 and go across the row to assign the remaining characters:
Section 0 Body System
Body System 2 Heart and Great Vessels
Root Operation 1 Bypass
Body Part 1 Coronary Artery, One Site (Vessel bypassed to)
Approach 0 Open
Device 0 No Device
Qualifier 9 Internal Mammary, Left (Vessel bypassed from)
The heart receives its own blood supply from the coronary arteries. When these arteries become blocked by the build up of plaque, coronary artery bypass grafting (CABG) is done to improve blood flow to the heart.
Coronary arteries are classified by the number of distinct sites treated, not by the name or the number of the coronary arteries. For coronary artery bypass procedures, rather than identifying the body part bypassed from, the body part identifies the number of coronary arteries sites bypassed to, and the qualifier specifies the vessel bypassed from.
The body part value of 0 refers to one coronary artery site and the qualifier of 9 describes the origin of the bypass as the left internal mammary artery. Note that when the left internal mammary artery (LIMA) is used to perform the bypass, no device value is assigned because the internal mammary artery is not disconnected from its blood supply, ie, not a free graft that is excised and moved, autologous or synthetic (Rather, it remains connected and is sutured to the bypass location(s), ie, the LIMA is sutured into the aorta just beyond the site of the blockage. The use of this artery to form the bypass is coded in the 7th character.
A separate procedure is coded for each coronary artery site that uses a different device and/or qualifier. For example, if both an aortocoronary artery bypass and an internal mammary artery bypass are performed, they are coded separately.
- To locate 5A1221Z: Px index > Performance > Cardiac > Continuous Output > 5A1221Z: locate table 5A1 and verify that the code is correct:
Section 5 Extracorporeal Assistance and Performance
Body System A Physiological Systems (General)
Root Operation 1 Performance
Body System 2 Cardiac (Specific)
Duration 2 Continuous
Function 1 Output
Qualifier Z No Qualifier
The Extracorporeal Assistance and Performance section covers procedures such as cardiopulmonary, ventilator management, hyperbaric wound therapy and hemodialysis. The root operation, performance, means completely taking over a physiological function by extracorporeal means. With respect to duration, the 5th character value describes whether the procedure was performed on a single occasion or multiple occasions, or on an intermittent or continuous basis. The 6th character value, function, refers to cardiac output during the procedure.
- AHIMA: ICD-10-PCS, An Applied Approach, Lynn Kuehn and Therese Jorwic, pp. 94-99, 229,456-457.
- ICD-10-CM-PCS Official Coding Guidelines, 2013, p. 6