Coding Tidbits Written By: Linda Kobayashi
Edited and Posted By: Andrea Wong
Less than a month to go! Are you ready for ICD-10? Take heart in knowing that we’re pretty much in the same boat; the new code set levels the playing field. If you’ve been following our Tidbits, you know that we are addressing sections of the PCS coding book other than Med/Surg. For the past few weeks we have addressed the Placement and Administration sections. This week’s lesson focuses on the Measuring and Monitoring section.
This week’s coding problem:
The patient has an irregular heart rhythm that comes and goes. This is known as paroxysmal atrial fibrillation. Based on these symptoms, his physician orders a Holter Monitoring System. The monitoring device is attached to the patient with orders to come back in 3 days for the results. The results over the testing period did not change. Final diagnosis: Paroxysmal atrial fibrillation.
I48.0 = Paroxysmal atrial fibrillation
4A12X45 = Monitoring of cardiac electrical activity, ambulatory, external approach
To locate I48.0: Disease Index > Fibrillation > atrial or auricular > paroxysmal
- The structure of the codes in the Measurement and Monitoring section are the same as those in the Med/Surg with one exception: Character #6, Function, replaces Devices.
- What is the difference between measurement and monitoring? Repeated readings over a period of time are considered MONITORING, while a single reading is considered MEASUREMENT.
- Detection of atrial fibrillation may be more difficult in people who do not have it all the time, where the irregular heart rhythm comes and goes by itself- this is known as paroxysmal atrial fibrillation. If the patient has paroxysmal atrial fibrillation then it may be necessary to have the ECG tracing recorded for 24 hours or longer, as is the case in our scenario.
To locate 4A12X45: PCS Index > Monitoring > Cardiac > Electrical Activity > Ambulatory > 4A12X45 > Locate table to verify character selection.
Alternate location of 4A12X45: PCS Index > Holter Monitoring > 4A12X45 > Locate table to verify character selection.
Monitoring of Cardiac Electrical Activity, Ambulatory, External Approach
- Physiological Systems: There are only 2 valid character values for the 2nd character, Body System, for M&M procedures: Physiological Systems (A) and Physiological Devices (B), such as a pacemaker or defibrillator.
- If the patient has paroxysmal atrial fibrillation then it may be necessary to have the ECG tracing recorded for 24 hours or longer (sometimes for 7 or 14 days).
- This test, referred to as aHolter monitor, is a battery-operated portable device that measures and tape records your heart’s activity (ECG) continuously for 24 to 48 hours or longer depending on the type of monitoring The device is the size of a small camera. It has wires with silver dollar-sized electrodes that attach to your skin. The patient does not need to stay in the hospital for this test and can carry on with most of his/her usual daily activities. The patient must keep a diary of activities and symptoms (if any) that are experienced (palpitations, dizzy spells or chest pains etc) while wearing the monitor.
- Body Region: The 4th character specifies the Body System that is being monitored. The structure of the codes in the M&M section are the same as those in the Med/Surg with one exception: Character # 6, Function, replaces Devices.
- Approach: The approach is external. You know this because the electrodes are attached to the skin of the chest.
- Function: The Holter monitor measures the electrical activity of the heart.
- Qualifier: The patient is ambulatory during the monitoring period.
Directions for Locating the Codes by Going Directly to the Tables
- Step #1 is to locate the correct section in your PCS coding book. If you don’t know which section is the correct one, simply flip through the various sections in your PCS coding book until you find Measurement and Monitoring (M&M). The first character value is always 4.
- Step 2: Determine the correct Body System. Stay in the M&M section. The first 3 characters for all procedure codes are listed immediately above the rows. They include the section, M&M; the Physiological System for cardiac; and the Root Operation, Monitoring, for a partial code of 4A1, with 4 characters to go.
- Step 3: Determine the root operation. The root operations are listed alphabetically. Go through all the tables that start with 4A, looking for the root operation, Monitoring, with a character value of 1. We already know we have 4A1.
- Step 4: Determine the Body System, You know it is the cardiac’s electrical activity that is being monitored by the Holter monitor, with a value of 2.
- Step 5: Determine the approach. The approach is external because the electrodes are placed outside of the body, on the surface of the skin of the chest. The value for the approach for External is (X.) So far we have 4A12X.
- Step 6: Determine the function of the device. You know that the function is to record the heart’s electrical activity with a value of 4. We now have 4A12X4.
- Step 7: Determine the qualifier. In our scenario you know that the qualifier is 5, ambulatory. You know that the patient can be ambulatory during the testing period, so we assign the 5 for a code of 4A12X45.