Question

Common bile duct lithotripsy by extracorporeal shock wave

Root:

Fragmentation Code:

Rationale:  

Answer 1

ROOT: Fragmentation, (Breaking solid matter into pieces within a body part) .
Fragmentation code: 0FF98ZZ

Rationale :In ICD-9-CM, indexing lithotripsy directs the coder to 51.49, Incision of other bile ducts for relief of obstruction. This code does not identify the use of the scope to accomplish the procedure. Indexing ERCP directs the coder to 51.10, Endoscopic retrograde cholangiopancreatography (ERCP).

There is an excludes note for this range of codes excluding endoscopic procedures classified to other code ranges. Another indexing option is removal, subterm calculus, subterm bile duct, and subterm endoscopic–code 51.88, which is the correct code for this procedure.

In ICD-10-PCS, the indexing can also be challenging for this procedure. Indexing ERCP directs the coder to the root operation Fluoroscopy, which is the radiologic portion of the ERCP procedure. Indexing of lithotripsy directs the coder to the root operation Fragmentation and the body part duct, common bile can be found in the index. The coder is directed to table 0FF. After identification of the correct body part, the approach character is critical for accurate code assignment.

ERCP is performed with a scope entering through the mouth to the biliary system via the duodenum, so the approach value is Via Natural or Artificial Opening Endoscopic. The correct procedure code is 0FF98ZZ, endoscopic fragmentation of common bile duct stone.