Coding Tidbits Written By: Linda Kobayashi
Edited and Posted By: Andrea Wong
We’re on countdown for ICD-10. Check out this week’s tidbit and learn how to code embolization of a uterine artery.
Problem for this week:
The patient was diagnosed with intramural leiomyoma (fibroids) of the uterus. She underwent a pelvic exam and a hysteroscopy with biopsies as an outpatient. Based on the results, she was admitted to the acute care setting for percutaneous embolization of the right uterine artery, using coils. In addition to the fibroids, she has also been experiencing post-menopausal bleeding.
- D25.1 = Intramural leiomyoma of uterus
- N95.0 = Postmenopausal bleeding
- 04LE3DT = Occlusion of right uterine artery with intraluminal device, percutaneous approach
To Locate D25.0: Disease Index > Leiomyoma > uterus > intramural
To Locate N95.0: Disease Index > Bleeding > Post-menopausal
To Locate 04LE3DT: PCS Index > Embolization > see Occlusion > Artery > There is no listing in the Index for uterine artery or internal iliac artery. This is a good example of when you must use the tables to code this problem correctly. Once you locate the correct table, code the procedure:
Occlusion of Right Uterine Artery with Intraluminal Device, Percutaneous Approach
- Occlusion: Completely closing an orifice or the lumen of a tubular body part.
- Body System: The diaphragm is the dividing line between upper and lower arteries.
- Body Part: Where did the internal iliac artery come from? The uterine artery usually arises from the anterior division of the internal iliac artery. It travels to the uterus crossing the ureter anteriorly, reaching the uterus by traveling in the cardinal ligament. The cardinal ligament is a major ligament of the uterus. It is located at the base of the broad ligament of the uterus.
- Embolization uterine/internal iliac artery (UAE): This relatively new treatment is an alternative to open surgery for fibroids. Embolization is a technique that blocks the blood flow to the fibroid(s), causing them to shrink and die. This also often decreases menstrual bleeding and symptoms of pain, pressure, urinary frequency or constipation. In other words, embolization is a therapeutic introduction of a substance into a vessel in order to occlude it.
- Device: The coils are an embolic agent that helps block blood flow. The coils are considered to be an intraluminal device. Devices that remain in the patient post-operatively must be coded.
- Qualifier: Qualifiers contain unique values for individual procedures. For example, the qualifier can be used to identify the destination site in a bypass. In our example the qualifier indicates the type of artery (uterine) as well as laterality.
Directions for Locating the Codes by Going Directly to the Tables
Embolization of Right Uterine Artery
- 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 target organ is a uterine artery. You also know that the diaphragm divides upper and lower arteries. Since it is a lower artery (any arteries below the diaphragm), you should go to the Lower Arteries section. Lower arteries are assigned the character value of 4. We now have the 1st 2 characters, 04.
- Step 3: Determined the root operation. The root operations are listed alphabetically. Go through all the tables that start with 04, looking for the root operation, Occlusion (L). This is a fairly easy step because all you have to do to find “Occlusion” is to scan through all the tables starting with 04. We now have 04L.
- Step 4: Determine the body part. This one is a bit tricky. The body part is the uterine artery but the 04L table doesn’t list it. How do you know that you should assign the internal iliac artery as the correct body part? You don’t necessarily know, so if you don’t, pull out that anatomy book. We now have the characters 04LE.
- Step 5: The approach, as stated in our diagnostic statement, is percutaneous. So far we have characters 04LE3.
- Step 6: Determine if there is a device left in place. Yes, the coils are a type of embolic agent. Any device that remains in the patient post-operatively should be coded. We now have characters 04LE3D.
- Step 7: Determine the qualifier, the right uterine artery, T. We now have our code, 04LE3DT.