Question

Please do not go to a website and copy and paste a bunch of stuff that does not answer the question. *ICD 10 PCS*

1. Research and discuss the guidelines that apply to the coding of CABGs, Pacemaker insertions, and also to the Coding of a Debridement.

Answer 1

Guidelines that applies to CABGs:

1. Cardiac or cardiovascular surgery focuses on the heart and great vessels. Coronary artery bypass grafting (CABG) is the most common cardiac surgery operation performed worldwide for the patients affected by coronary artery disease. This procedure improves the blood flow to the heart. A cardiac or cardiovascular surgeon could treat heart failure, atrial fibrillation, blockages in the heart valve, leaking heart valve, and abnormal enlargement or aneurysms of the large arteries in the chest. Documentation of any such procedures for medical claims can be done with the help of an experienced medical coding company.

2. When documenting CABG, medical coders need to know that coronary arteries are classified by the number of distinct sites treated rather than the number of coronary arteries or the anatomic name of the artery, such as left anterior descending. They should also be knowledgeable in the devices used for the bypass; laterality; specific site; and approach for any autologous grafts harvested from another body site for the bypass conduits, and if the patient was placed on a pump or not.

3. Components of a procedure specified in the root operation definition and explanation, procedural steps necessary to reach the operative site and close the operative site, including anastomosis of a tubular body part, are not coded separately. For instance, resection of a joint as part of a joint replacement procedure is included in the root operation definition of replacement and is not coded separately. Also, laparotomy performed to reach the site of an open liver biopsy is not coded separately.

4. If the intended procedure is discontinued before root operation or not completed, code the procedure to the root operation performed. If a procedure is discontinued before any other root operation is performed, code the root operation inspection of the body part or anatomical region inspected. In case a planned aortic valve replacement procedure is discontinued after the initial thoracotomy and before any incision is made in the heart muscle, when the patient becomes hemodynamically unstable, it is coded as an open Inspection of the mediastinum.

5. To code bypass procedure, knowledge regarding the blood flow is important. The coding is done by identifying the body part bypassed “from” and the body part bypassed “to”. The fourth character body part specifies the body part bypassed from, and the qualifier specifies the body part bypassed to. For example, in case of bypasses from the femoral artery to the popliteal artery, femoral artery is the body part and popliteal artery is the qualifier.

Guidelines applies to Pacemaker insertions:

To manage the patient’s sick sinus syndrome, a permanent dual chamber pacemaker with atrial and ventricular leads was implanted. An incision was made into the left chest wall with the dual chamber pacemaker being placed in the subcutaneous pocket. Next, a small incision was made into the skin and the leads were percutaneously passed into the right ventricle and right atrium.

The ICD-10-PCS code assignment for this case example is:

•            0JH606Z, Insertion of pacemaker generator

•            02H63JZ, Insertion of device in atrium

•            02HK3JZ, Insertion of device in ventricle

It is important to note that the pacemaker generator is placed in the subcutaneous tissue of the chest. The correct body system is subcutaneous tissue and fascia. A common error occurs when using the Alphabetic Index, under Insertion, Chest Wall. This index entry directs the coder to table OWH8, which may appear to be correct until character 6, device. On this table, there is no device character to identify the dual chamber pacemaker. When using the tables in ICD-10-PCS, if a code seems “almost right,” review the table to ensure the row of the table, or even the table itself is correct.

Debridement and its guidelines:

Debridement is a procedure for treating a wound in the skin. It involves thoroughly cleaning the wound and removing all hyperkeratotic (thickened skin or callus), infected, and nonviable (necrotic or dead) tissue, foreign debris, and residual material from dressings. Debridement can be accomplished either surgically or through alternate methods such as use of special dressings and gels.

Guidelines that applies to Debridement:

The American Hospital Association has published extensive guidelines in Coding Clinic that outline the appropriate assignment of the debridement codes. The 1988 fourth quarter Coding Clinic revised the code for debridement of wound, infection, or burn to differentiate excisional and non-excisional procedures related to treatment of devitalized tissue.

Excisional debridement, was defined as the “surgical removal or cutting away of devitalized tissue, necrosis, or slough,” which could be performed in the operating room, emergency room, or at the patient’s bedside.

Non-excisional debridement, was defined as the “non-operative brushing, irrigating, scrubbing, or washing away of devitalized tissue, necrosis, or slough,” including snipping of tissue followed by Hubbard tank therapy.

The second quarter 2000 Coding Clinic noted that an excisional debridement could be coded when performed by a nurse, therapist, physician assistant, or physician. (This advice superseded previously published advice.)

The first quarter 2004 Coding Clinic further defined excisional debridement to involve cutting outside or beyond the wound margin in removing devitalized tissue. Documentation should clearly indicate that the procedure involves cutting outside or beyond the wound margin.