Coding Tidbits Written By: Linda Kobayashi
Edited and Posted By: Andrea Wong
For the past few weeks we have given you coding problems that require assignment of both diagnoses and procedures. With respect to the breakdown of diagnostic codes, a new feature, we will only do that for the PDx. This week you will be given a problem to solve from Perinatal Conditions, Chapter 16. Also, directions for locating the codes by using the tables only applies to the principal procedure and it will always be the last item discussed.
Problem for this week: A one-day-old 2,200-gram female infant was born prematurely at 34 weeks gestation. She was transferred from another hospital for evaluation of a congenital diaphragmatic hernia. Just before transfer, intubation was necessitated by some respiratory distress. The ventilator support was continued for 3 days. When she was stabilized, the diaphragmatic hernia was repaired via an abdominal approach, and the hernia sac was excised.
- Q79.0: Congenital diaphragmatic hernia
- P07.18: Other low birth weight newborn, 2000-2499 grams
- P07.37: Other preterm newborn, gestational age 34 completed weeks
- P22.9: Respiratory distress of newborn, unspecified
- 0WQF0ZZ: Repair abdominal wall, open approach
- 5A1945Z: Respiratory ventilation, 24-96 consecutive hours
Breakdown of PDx, Congenital Diaphragmatic Hernia:
- Q79 = Congenital malformations of musculoskeletal system, not elsewhere classified
- Q79.0 = Congenital diaphragmatic hernia
To locate Q79.0: Disease Index > Hernia > diaphragm, diaphragmatic > congenital > Q79.0 >
verify in Tabular.
To Locate P07.18: Disease Index > Low > birthweight > with weight of > 2000-2499 grams > P07.18 > Verify in Tabular.
To Locate P07.37: Disease Index > Preterm > newborn > gestational age > 34 completed weeks > P07.37 > Verify in Tabular.
To Locate P22.9: Disease Index > Distress > respiratory > newborn > P22.9 > Verify in
- No code from category Z38 (liveborn infants) is assigned. The patient wasn’t born in this hospital; rather, she was transferred from another hospital when she was one day old. Codes from category 38 is to be used for the initial birth record only.
- If you located gestational age (weeks), from the main term, Pregnancy, and then to the sub-term “weeks of gestation,” you would be directed to a code from catetgory Z3A, which is only to be used on the maternal records only. Code Z3A are not to be coded with codes on the liveborn infant record.
- When both birth weight and gestational age are available, both should be coded with birth weight sequenced before gestational age.
- Preterm consists of 28 weeks or more but less than 37 completed weeks (196 completed days but less than 259 completed days) of gestation.
To Locate 0WQF0ZZ: PCS Index > Herniorrhaphy > see Repair > Anatomical Regions > General > 0WQ > Locate table 0WQ and go across the row to finish building the code:
Repair Abdominal Wall, Open Approach
- Repair is defined as “Restoring, to the extent possible, a body part to its normal anatomic structure and function.”
- General Anatomical Regions, 2nd character, includes the general body cavities (spaces that contain organs and other structures.) Included in the general regions are the larger surface areas of the body such as the chest wall, abdominal wall, and upper and lower back.
- One of the larger surface areas of the body is the abdominal wall. Using an open approach, the surgeon was able to access the diaphragmatic hernia, after which the hernia was excised.
- You may be questioning why Device, the 6th character wasn’t coded. If there is a device, the device character is always specified and indicates the device placed during the procedure.
- Intubation is not coded because it was performed at the other hospital.
To Locate 5A1945Z: PCS Index > Performance > Respiratory > 24-96 Consecutive hours > 5A1945Z
Respiratory Ventilation, 24-96 hours
- We were tempted to go to the main term Ventilation but then I remembered that it is faster and easier to go directly to the root operation, Performance.
- Performance is defined as “Completely taking over a physiological function by extracorporeal means.”
- The root operation is Performance because the machine has taken over the patient’s cardiac function during the procedure.
- Note that the 5th character, Approach and Device (Med/Surg section), have been replaced by Duration and Function in the Extracorporeal Assistance and Performance section, respectively.
- This was an easy one to code because the Index gives you the answer.
- There are 31 Body Systems under Physiological Systems such as Respiratory, Circulatory, GI System Skin and Breast, et al. The Extracorporeal Assistance and Performance section is included here.
Directions for Locating the Codes by Going Directly to the Tables
Herniorrhaphy of Abdominal wall
- Step #1 is to locate the correct section in your PCS coding book. The majority of procedures are in the Med/Surg section. The first character in the Med/Surg section is always 0.
- Step 2: Determine the correct Body System – General Anatomical Regions. Since you are dealing with Anatomical Regions and since you know that the abdominal wall is part of Anatomical Regions, it should be easy to determine the body system. Thus far, we have identified the first two characters, 0W.
- Step 3: Determine the root operation. You know you have to be in a table that starts with 0W. From this point I would look for the root operation, Repair, by scanning through the tables. The root operations are listed alphabetically, so it shouldn’t be hard to find the correct one. We now have the first three characters, 0WQ, which puts us in the correct table. The first 3 character values are always listed for you at the top of the table. It gives the section, Med/Surg; the body system, Anatomical Regions, General; the root operation, Repair.
- Step 4: Identify the Body Part to determine the 4th character value. The Body Part, Abdominal Wall, should relate to the root operation, Repair, because it was the diaphragmatic hernia that was repaired. We now have 4 character values 0WQF.
- Step 5: Determine the Approach. No guesswork regarding the approach, as our diagnostic statement clearly states that the procedure was done via an abdominal approach, which is an open approach. We should now have 5 characters, 0WQF0.
- Step 6: Determine whether or not a device was left in the patient postoperatively. No device was left in place, so assign Z, the placeholder, as the character value. We should now have 6 characters, 0WQF0Z.
- Step 7: There is no qualifier, so we should now have our code, 0WQF0ZZ. Z functions as a placeholder in ICD-10-PCS. In other words, Z is to PCS what X is to ICD-10-CM.