Coding Tidbits Written By: Linda Kobayashi
Edited and Posted By: Andrea Wong
Problem for this week:
A 55-year-old man was diagnosed with coronary artery disease of 3 coronary arteries. He undergoes coronary artery bypass surgery (CABG) using 3 saphenous vein grafts to the aorta, with cardiopulmonary bypass.
- I25.10 = Atherosclerotic heart disease of native coronary artery without angina pectoris
- 021209W = Bypass coronary artery, 3 sites from aorta with autologous venous tissue, open approach
- 5A1221Z = Performance of cardiac output, continuous
- I25.10: Index > Arteriosclerosis, arteriosclerotic > coronary (artery)
To Locate 021209W: Px index > Bypass > Artery > Coronary > 3 sites > 0212 > go to table 021 and go across the row to assign the remaining characters:
Bypass coronary artery, 3 sites from aorta with autologous venous tissue, open approach Comments:
- Bypass is defined in ICD-10-PCS as “Altering the route of passage of the contents of a tubular body part.”
- Guideline B3.6b: Coronary arteries are classified by the number of distinct sites treated, rather than the number of coronary arteries or anatomical name of a coronary artery involved (eg, left anterior descending). Coronary artery bypass procedures are coded differently from other bypass procedures: The body part identifies the # of coronary arteries sites bypassed to, and the qualifier specifies the vessel bypassed from.
- In our example, aortocoronary artery bypass of 3 sites is classified in the body part axis of classification as a value of 2, for 3 coronary artery sites, and the qualifier specifies the aorta as the body part bypassed from with the value of W. Think of it as the number of coronary arteries with bypass grafts from the aorta to the coronary arteries.
- The saphenous vein is removed from the patients own leg and one end of the saphenous vein graft is sewn to the largest artery in the body (aorta) and the other end is sewn past the obstruction into the coronary artery.
To Locate 5A1221Z: Px index > Performance > Cardiac > Continuous Output > 5A1221Z: locate table 5A1 and verify that the code is correct:
Performance of cardiac output, continuous
- Values for 5A1221Z: This section, Extracorporeal Assistance and Performance, covers such procedures as cardiopulmonary bypass procedures, ventilator management, hyperbaric wound therapy and hemodialysis. The root operation, Performance, means completely taking over a physiological function by extracorporeal means. Duration, the 5th character value, describes whether the procedure was performed on a single occasion or multiple occasions. The 6th character value, Function, refers to cardiac output during the procedure.
- A&P: Cardiopulmonary bypass is a technique that mechanically circulates and oxygenates blood from the body while bypassing the heart and lungs.
Directions for Locating the Codes by Going Directly to the Tables
CABG with autologous venous tissue, 3 sites, open approach
- Step 1: 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 3 of the coronary arteries underwent a bypass, 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 02 looking for the root operation, Bypass (1). This is a fairly easy step because all you have to do to find “Bypass” is to scan through all the 02 tables alphabetically. So far we have values 021.
- Step 4: Code selection is based on the number of coronary artery sites treated using the 4thcharacter, body part value to indicate coronary artery at one site, two sites, etc. 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. We now have the characters 0212.
- Step 5: The approach for performing a CABG is open. So far we have 02120.
- Step 6: Determine if there is a device left in place. As you well know, this procedure involves 3 saphenous vein grafts to the aorta. The saphenous vein is an autologous venous tissue graft because it is taken from the patient’s own leg. So now we have our code 021209.
- Step 7: Determine if there is a qualifier. The qualifier indicates the location of where the bypass is originating from which, medically speaking, is from the Aorta (W) to the coronary arteries. The code is now complete as 021209W.