We have spent the last two weeks focusing on procedures in the Administration section. We’ll continue on the same topic this week. I haven’t yet mentioned that cast application, cervical traction, and cystometrograms are also considered Administrative procedures.
Coding problems for this week:
- Percutaneous irrigation of ankle joint.
- Administration of a hepatitis B vaccine, IM.
- Peritoneal dialysis via indwelling catheter.
Problem #1, Percutaneous irrigation of ankle joint.
To Locate: PCS Index > Irrigation > Irrigating Substance > 3E1U38Z > Locate table 3E1 and go across the row to validate that the code listed in the Index is correct:
Irrigation of Joints Using Irrigating Substance, Percutaneous Approach
- Root Operation: Irrigation is defined as “Putting in or on a cleansing liquid substance.” Some examples include Peritoneal dialysis via indwelling catheter, percutaneous irrigation of knee joint, and gastric lavage.
- Approach: A puncture is made to access the knee joint, so the obvious answer is Percutaneous. Making it even easier is the fact that table 3E1 only lists one approach, Percutaneous.
- Qualifier: You have two choices in table 3E1 for the Qualifier, either Diagnostic or No Qualifier. I opted for the latter because there is no indication that this procedure was done for biopsy purposes. It was done to clean the area out.
Problem #2, Administration of a hepatitis B vaccine, IM.
To Locate: PCS Index > Introduction of substance in or on > Muscle > Vaccine > 3E0234
Introduction of Serum, Toxoid and Vaccine into Muscle, Percutaneous Approach
- You got a break with this one because the Index gave you the whole code. However, you should still verify it by going to the appropriate row in the tables section.
- The approach value for intradermal, subcutaneous, and intramuscular Introduction (ie, Injections) is always Percutaneous.
Problem #3, Peritoneal dialysis via indwelling catheter.
To Locate: PCS Index > Irrigation > Peritoneal Cavity > Dialysate > 3E1M39Z > Locate table 3E1 and then go across the row to validate that the code listed in the Index is correct:
Irrigation of Peritoneal Cavity Using Dialysate, Percutaneous Approach
- I always advise you to go to the Root Operation when you start your Index search. However, there’s usually more than one way to skin a cat. If you refer to the main term Dialysis and the sub-term Peritoneal, it also gives you the same code, 3E1M39Z. Not every procedure is listed in the Index. When this happens, what are you going to do? You’ll need to go directly to the tables. This is why its important to develop a comfort level with the tables. So here we go:
- Locate the Administration section in the PCS-10 coding book.
- Locate the Root Operation, Irrigation (every table lists the Root Operation alphabetically.)
- You should now be in the correct table, 3E1.
- Continue across the row to assign the remaining 4 character values.
- Irrigation is defined as “Putting in or on a cleaning substance.” Dialysis is a process for removing waste (diffusion) and excess water (ultrafiltration) from the blood and is used primarily as an artificial replacement for lost kidney function in people with renal failure. In other words, dialysis cleans the blood by removing the waste products such as urea and creatinine.
- Approaches involving catheterization are coded to Percutaneous.