Coding problem for this week, 3/16/15: Destruction of left sigmoid lesion and bypass of left sigmoid colon via insertion of scope through the anus and then up to the targeted site. The Approach for both Destruction and Bypass are via Natural or Artificial Opening, Endoscopic.
Answer Key: 0D5N8ZZ; 0D1N8ZN
Guideline B3.2.c. – Multiple root operations with distinct objectives are performed on the same body part. For example, Destruction of sigmoid lesion and bypass of sigmoid colon are coded separately.
Problem, Part 1, Destruction of left sigmoid lesion:
To Locate: PCS Index > Destruction > Intestine > Large > Left > 0D5N > Locate table 0D5 and then go across the row to complete the code. Before we go on, I want to point out how important it is to validate the 4th character listed in the Index. In our scenario, the 4th character value is G. This is incorrect. Once you locate the table you will see that there is a more specific choice than the left large intestine: N for sigmoid colon. Then go across the row to finish building the code:
Destruction of Sigmoid colon, Via Natural or Artificial Opening Endoscopic
- Destruction: Physical eradication of all or a portion of a body part.
- None of the body part is physically taken out because it has been destroyed. There is nothing left to remove and therefore, nothing left to biopsy.
- When the site of the procedure is around or surrounding a body part, the procedure is coded to the body part named. We coded it to the sigmoid colon, which is the body part named.
- Coding sigmoid lesion destruction is a bit tricky. The Index doesn’t list destruction of a sigmoid lesion; it only gives us the sigmoid colon. If you’re using 3M and go to lesion destruction, it will also send you to destruction of sigmoid colon. This is a good example of when we have to rely on the diagnosis code to indicate that it is a lesion that was destroyed, not the entire sigmoid colon.
PROBLEM, PART 2: Bypass of left sigmoid colon.
To Locate: PCS Index > Bypass > Colon > Sigmoid > 0D1N > Locate table 0D1 and go across the row to finish building the code:
- Bypass: Altering the route or passage of the contents of a tubular body part.
- The only difference between the two codes is the root operation. We have multiple root operations, Destruction and Bypass for the same body part, the sigmoid colon.
Locating the Codes by Going Directly to the Tables
Directions for Destruction of Lesion of Sigmoid Colon
- Make sure you’re in the correct section. This shouldn’t be too much of an issue because the majority of the codes will be in the Medical/Surgical section.
- Determine which Body System you should be in. We are in the Gastrointestinal Body System. So far we have identified the 1st two characters, 0 (Med/Surg) and Body System (D).
- Then look for the Root Operation, 3rd character. The root operations are arranged alphabetically. We are looking for Destruction, character value 3. Now we are in the correct table, 0D5.
- After identifying the 4th character, N, the Body Part for the sigmoid colon, you only have 3 characters left to assign. So far we have the character values, 0D5N.
- It isn’t always easy to determine the approach, although it is in this instance because the problem states that the Approach is Via Natural or Artificial Opening, Endoscopic, 8.
- Now we’re up to 0D5N8 with 2 characters values left to go, the values for characters 6 and 7. Since no device was used or left in place postoperatively, the 6th character value is Z.
- We’re almost done – 0D5N8Z so far. There is no indication that a qualifier is needed, so bingo – we now have our code, 0D5N8ZZ.