Last week we stated that we would not continue our discussion of procedures in the Administrative section after 2/10/15. However, we are behind schedule so for this week only, we are going to do some more review of procedures coded to the Administrative section.
Problems for this week:
- Esophagogastroscopy with Botex injection into esophageal sphincter.
- Sclerotherapy of brachial plexus lesion, alcohol injection.
- 3E0T3TZ vs 0153
Problem #1, Esophagogastroscopy with Botox injection into esophageal sphincter.
To Locate: PCS Index > Introduction of substance in or on > Gastrointestinal tract > Upper > Destructive Agent > 3E0G > Locate table 3E0 and go across the row to finish building the code:
Introduction of Other Therapeutic Substance into Upper GI, via Natural or Artificial Opening Endoscopic
- When you have to scan several rows until you come to the correct row, first look for the 4th character value, ‘G’ under the appropriate Root Operation, Introduction. And don’t necessarily stop at the first row you come to that has the 4th character value you are looking for as it may not contain the remaining character values, 5 – 7 —- keep looking.
- Introduction is part of the new terminology for ICD-10-PCS. In ICD-9-CM, Introduction is referred to as Injection.
- When coding procedures in the Administration section, the approach is usually Percutaneous. In our scenario the scope is entered through a natural opening, hence a character value of 8 is assigned to account for the endoscope as well as to account for its insertion via a natural opening.
- The substance is Botox but ICD-10-PCS does not have a code for Botox, at last in this instance; hence, “Other Therapeutic Substance” is assigned; likewise for 7th character, C, “Other substance.” Some examples include anti-infectives, anti-neoplastics, etc.
- Botulinum toxin is a paralyzing agent with temporary effects; it does not sclerose or destroy the nerve.
Problem #2, Sclerotherapy of brachial plexus lesion, alcohol injection.
To Locate: PCS Index > Introduction of substance in or on > Nerve > Plexus > Destructive Agent > 3E0T3TZ > Locate table 3E0 and after locating the appropriate row, continue across the row to validate that the code given in the Index is correct.
Introduction of Destructive Agent into Peripheral Nerves and Plexi, Percutaneous Approach
- The brachial plexus is a network of nerves that originate in the neck region and branch off to form most of the other nerves that control movement and sensation in the upper limbs, including the shoulder, arm, forearm, and hand. The radial, median, and ulnar nerves originate in the brachial plexus.
- When you see “Introduction” or “Injection,” you know that a puncture was made, hence the approach is percutaneous.
- Just as our first problem didn’t have a code for Botox, ditto for this problem – there is no code for alcohol. However, we know that alcohol is used as a destructive agent to deaden nerves.