For the past several months the Coding Tidbits have focused on procedure coding. With ICD-10-CM and ICD-10-CM-PCS Coding on the horizon (hopefully), from here on out you will be given problems requiring assignment of both diagnostic and procedural codes.
Problem for this week: A patient was admitted with occlusion of the right common carotid artery due to plaque. An open carotid endarterectomy was carried out with extracorporeal circulation (continuous cardiac output).
I65.21: Occlusion and stenosis of right carotid artery
03CH0ZZ: Extirpation of matter from the right common carotid artery, open approach
5A1221Z: Performance of cardiac output, continuous (extracorporeal circulation).
Problem #1, Occlusion of right common carotid artery for which patient underwent an open carotid endarterectomy accompanied by extracorporeal circulation.
To Locate Dx code: Alphabetic Index > Occlusion > Artery > Carotid > I65.2 > go to the Tabular to verify the code and see if additional digits/characters are assigned > Occlusion and stenosis of right carotid artery > I65.21.
Breakdown of I65.21:
I65 = Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction
I65.2 = Occlusion and stenosis of carotid artery
I65.21 = Occlusion and stenosis of right carotid artery
Problem #1 cont’d
To Locate endarterectomy Px: PCS Index > Endarterectomy > see Extirpation, upper arteries > Extirpation > Common Carotid > Right > 03CH > locate table 03C and go across the row to finish building the code, making sure that the 4th character listed in the Index is correct:
Extirpation of Matter from the Right Common Carotid Artery, Open Approach
- Always start your PCS Index search by going to the root operation – Extirpation.
- Extirpation is defined as “Taking or cutting out solid matter from a body part.”
- Our diagnostic statement (coding problem) does not state Internal/External Common Carotid Artery; rather, it states common carotid artery. Don’t be misled by the statement, because the external/internal carotid arteries and the common carotid artery are not the same thing. The External Carotid Artery is a major artery of the head and neck. It arises from the common carotid artery. The Index distinguishes, as subterms, between the common carotid artery, the internal carotid artery and the external carotid artery under Extirpation.
- The internal carotid artery is a major paired artery one on each side of the head and neck. They arise from the common carotid arteries where these bifurcate into the internal and external carotid arteries
- The objective of the carotid endarterectomy is to take out or cut out the solid matter (plaque) occluding the carotid artery. Therefore the procedure is coded to the root operation, Extirpation.
- NOTE: Directions for locating endarterectomy of the right common carotid artery by directly using the tables are located at the end of this tidbit.
Problem #1 cont’d
To Locate Extracorporeal Circulation > PCS Index > There is no listing in the Index for Extracorporeal Circulation. In the Table of Contents, look for Extracorporeal Assistance and Performance found under “ICD-10 Tables” > go to the correct page (p. #440 for the Optum 2015 edition and there you will find table 5A1 > go across the row to finish building the code:
Performance of Cardiac Output, Continuous
- Extracorporeal Circulation is classified to the Extracorporeal Assistance and Performance section.
- The root operation is Performance because the machine has completely taken over the patient’s cardiac function during the procedure.
- Note that the 5th character, “Approach” and the 6th character “Device” in the Med/Surg section have been replaced by the 5th character “Duration” and the 6th character “Function” in the Extracorporeal Assistance and Performance section.
Locating the Code(s) by Going Directly to the Tables
Directions for Endarterectomy of Right Common Carotid Artery
- The first thing you should do is determine which section the common carotid artery is located. ICD-10-PCS separates upper arteries from lower arteries. The common carotid artery is of course considered an upper artery. You can either refer to the Table of Contents or you can flip through the PCS coding book to be in the correct section. If you don’t have ICD-10-CM/PCS coding books, it is highly recommended that you buy them. It is far more difficult to learn ICD-10-CM-PCS coding from encoders.
- The first character in the Med/Surg section is always 0.
- Next determine which Body System you should be in. We determined that in step 1 we are in the Upper Artery Section, which is represented by value a value of 3. We have the first two characters, 0 and 3. In addition, the first 3 characters values are listed for you at the top of the table, 03C, which puts you in the correct table. It gives you the correct section (Med/Surg), the Body System (Upper Arteries), and the Root Operation (Extirpation). So far we have identified the first 3 characters.
- After identifying the 4th character, H, the Body Part for the Right Common Carotid Artery you, have only 3 characters left to assign. At no time do you have to assign 7 characters because the tables ALWAYS give you the first 3 character values and sometimes the Index gives you the 4th character value as well. So far we have the character values 03CH.
- It isn’t always easy to determine the Approach although in our scenario it’s easy. We know from the diagnostic statement that the Approach was Open. Now we are up to 5 characters, 03CH0.
- Because no device was left in place postoperatively, the character value is Z. We now have 6 character values, 03CH0Z.
- The 7th and last character value is the Qualifier. Since there is no Qualifier, the character value is Z, placeholder, for a code of 03CH0ZZ