Coding Tidbits Written By: Linda Kobayashi
Edited and Posted By: Andrea Wong
Problem for this week:
The patient, a 70-year-old gentleman, saw his doctor complaining of chest pain. He has a history of coronary artery disease for which he has been on Nitroglycerine for several years. He also has a history of smoking 3 packs per day with no intention of quitting or cutting down. A heart catheterization done two days ago in the outpatient setting showed that there was atherosclerosis in his left anterior descending (LAD) coronary artery, native vessel. Due to his cardiac history along with his angina and smoking, he was admitted and underwent a PTCA of the LAD with insertion of a drug-eluting stent. To reach the targeted site, the procedure was done percutaneously.
- I25.119: Atherosclerotic heart disease of native coronary artery with unspecified
- F17.210 = Nicotine dependence, cigarettes, uncomplicated
- 027034Z: Dilation of coronary artery, one site with drug-eluting intraluminal
device, percutaneous approach
Breakdown of I25.119:
- I25 = Chronic ischemic heart disease
- I25.1 = Atherosclerotic heart disease of native coronary disease
- I25.11 = Atherosclerotic of native coronary artery with angina pectoris
- I25.119 = Atherosclerotic of native coronary artery with unspecified angina pectoris
To locate I25.119: Disease Index > Atherosclerosis (see also Arteriosclerosis) > coronary > artery > with angina pectoris > see Arteriosclerosis, coronary (artery) > native vessel > with > angina pectoris > I25.119.
Comments for I25.119:
- ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris. One of the subcategories for this code is I25.11, Atherosclerotic heart disease of native coronary artery with angina pectoris.
- When using this combination code it is not necessary to use an additional code for angina pectoris. A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis.
To locate F17.210: Disease Index > Dependence > drug > nicotine > cigarettes > F17.210
To Locate 027034Z: PCS Index > PTCA (percutaneous transluminal coronary angioplasty) > see Dilation, Heart and Great Vessels > 027 > Artery > Coronary > One Site > 0270 > Locate table 027 and go across the row to finish building the code as well as verify that the 4th character, “0” is correct:
Dilation of Coronary Artery, One Site with Drug-eluting Intraluminal Device, Percutaneous Approach
- The Index instructs us to see Dilation of Heart and Great Vessels, but there is no subterm under Dilation for Heart/Great Vessels, so what do you do? Stay with the main term, Dilation, and then look for the subterm, Coronary. From there, you should easily find the code in the code.
- Dilation: Expanding an orifice or the lumen of a tubular body part.
- PTCA is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle.
- Once the guidewires and catheters are in place, a balloon catheter is advanced to the blockage site. The balloon is inflated for a few seconds to compress the blockage site against the artery wall. Then the balloon is deflated and pulled out.
Directions for Locating the Codes by Going Directly to the Tables
PTCA of the LAD with Insertion of a Drug-Eluting Stent
- Step #1 is to locate the correct section in your PCS coding book. You know that surgery was performed, so the most logical selection is the Med/Surg section. The majority of procedures are located in the Med/Surg section. The first character in this section is always 0.
- Step 2: Determine the correct Body System. You know that the one of the coronary arteries underwent insertion of a drug-eluting stent, so it should be apparent that the Heart and Great Vessels should be assigned as the 2nd You should now have two characters, 02.
- Step 3: Determined the root operation. The root operations are listed alphabetically. Go through the all the tables that start with O2 looking for the root operation, Dilation (7). This is a fairly easy step because all you have to do to find “Dilation” is to scan through all the 02 tables alphabetically.
- Step 4: Code selection is based on the number of coronary artery sites treated using the 4th character, body part value to indicate coronary artery at one site, two sites….coronary arteries are classified by the number of distinct sites treated rather than the number of coronary arteries or the anatomic name of a coronary artery, as in our scenario – LAD. We now have the characters 0270.
- Step 5: The approach, as stated in our diagnostic statement, is percutaneous. So far we have 02703.
- Step 6: Determine is there is a device left in place. As you well know, it is a drug-eluting stent. So now we have our code 027034.
- Step 7: Determine if there is a qualifier. There is no qualifier, so the 7th character is Z. The code is now complete as 027034Z.