Author: Linda Kobayashi, BA, RHIT, CCS
Editor: Andrea Wong, BS
Including today, there are only 10 more day to go for ICD-10 implementation! Though some of you have had formal or academic training in ICD-10, and have been following our tidbits, the bulk of learning for ICD-10 will happen through application in the workplace. If you’ve taken this new code set seriously and have done your best to prepare for the big change, you should be in fairly good shape. Andrea and I hope our tidbits have contributed to your understanding of ICD-10. 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 as well as the Measurement and Monitoring section. This week’s lesson focuses on the Extracorporeal Assistance and Performance section.
This week’s coding problem:
The patient is suffering from chronic renal failure secondary to hypertension and receives renal dialysis treatments three times per week on an outpatient basis. Today he comes in for his regular renal dialysis treatment.
112.0 = Hypertensive chronic kidney disease with stage V chronic kidney disease or end stage renal disease, unspecified
N18.6 = End stage renal disease
Z99.2 = Dependence on renal dialysis
5A1D60Z = Hemodialysis
To locate I12.0: Disease Index > Hypertension, hypertensive > kidney > with > stage V chronic kidney disease (CKD) or end stage renal disease (ESRD) > I12.0
To locate N18.6: Tabular of Diseases > The instructional note under code I12.0 states, “Use additional code to identify the stage of chronic kidney disease (N18.5, N18.6.)”
To locate Z99.2: Disease Index > Dependence > on > renal dialysis (hemodialysis, peritoneal) > Z99.2
- ICD-10-CM Guideline I.C.9.a.2., Hypertensive Chronic Kidney Disease:
- Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present.
- Unlike hypertension with heart disease, ICD-10-CM presumes a cause-and-effect relationship and classifies chronic kidney disease with hypertension as hypertensive chronic kidney disease.
- The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease.
- Some good news for ICD-10-CM hypertensive renal failure: (1) Hypertensive renal failure has a limited number of ICD-10-CM codes – only nine codes for primary hypertension, which makes the task of coding hypertension relatively simple (2) The new code set drops the previous reference to “benign” and “malignant” hypertension. Physicians are well aware that hypertension is never truly “benign,” and the removal of this antiquated term is a welcome improvement in the lexicon of diseases.
To locate 5A1D60Z: PCS Index > Performance > Urinary > Multiple filtration > 5A1D60Z > Locate table 5A1 and go across the row to verify that the code listed in the Index is correct:
Monitoring of Cardiac Electrical Activity, Ambulatory, External Approach
- Root Operation: A type of performance.
- Duration: Single versus multiple: Single is a one-time episode whereas multiple indicates that this ”series” patient is seen on a regular basis.
- Filtration: A process for removing waste and excess water from the blood and is used primarily as an artificial replacement for lost kidney function in people with kidney failure. Dialysis may be used for those with an acute disturbance in kidney function, ªacute kidney injury” (previously acute renal failure) or progressive but chronically worsening kidney function—a state known as chronic kidney disease stage 5 (previously chronic renal failure or end-stage renal disease.)
- Function: This character is indicated by a (slashed) zero. The function is to cleanse the blood through a process referred to as filtration.
- The structure of the codes in the Extracorporeal Assistance and Performance section are not quite the same as those in the Measurement and Monitoring section; i.e., character 5, Duration, replaces Approach; character 6, Function, replaces Function/Device.
- Definition of Root Operation: Completely taking over a physiological function by extracorporeal means.
- The third character is identified by the value ‘1’.
- Note: Performance and Assistance are two variations of the same kinds of procedures, varying only in the degree of control exercised over the physiological function. ‘Assistance’ takes over only a portion of a physiological function (e.g. intra-aortic balloon pump, hyperbaric oxygen treatment).
- Other examples of Performance:
– Controlled and intermittent mechanical ventilation
– Cardiopulmonary bypass
– Continuous cardiac pacing
Directions for Locating the Codes by Going Directly to the Tables
Chronic Kidney Disease with Renal Dialysis
1. Step 1: Locate the correct section in your PCS coding book. If you don’t know which section is correct, simply flip through the various sections in your book until you find Extracorporeal Assistance and Performance (EAP). The first character value is always 5.
2. Step 2: Determine the correct Body System. Stay in the EAP section. The first 3 characters for all procedure codes are listed immediately above the rows. They include the section, EAP; the Body System, Physiological Systems; and the Root Operation, Performance, for a partial code of 5A1, with 4 characters to go.
3. Step 3: Determine the root operation. The root operations are listed alphabetically. Go through all the tables that start with 5A, looking for the root operation, EAP, with a character value of 1. We know have 5A1.
4. Step 4: Determine the Body System, You know it is the urinary system because the procedure is renal dialysis, with a character value of D. We now have 5A1D.
5. Step 5: Determine the Duration. In our scenario you know that renal dialysis for this patient is ongoing. Your choices are single or multiple, so it should be easy to assign the character value of 6 for multiple sessions because it was stated that the patient has had a series of encounters, at least 3 times per week. We now have 5A1D6.
6. Step 6: The function of renal dialysis is to cleanse the blood, by filtration, so you should now have characters 5A1D60.
7. Step 7: There is no qualifier, so assign the placeholder of Z. Z is to ICD-10-PCS what X is to ICD-10-CM, 5A1D60Z.