Question

A patient who had a mastectomy on the right side now presents for an open reconstruction procedure involving a pedicle flap of the deep inferior epigastric artery perforator to the mastectomy site. The root operation is and the PCS code is .

Answer 1

Ans. PCS Code : 0HRV077 :- Replacement of bilateral breast using deep inferior epigastric artery perforator flap, open approach, for the bilateral DIEP flap reconstruction.

Rationale:

The harvesting of the DIEP flap is not coded separately as this information would not add value to the coded data. In this case, the “Replacement” code fully specifies the fact than an autograft was harvested, with the qualifier value describing deep inferior epigastric perforator flap.

Shortly after the Coding Clinic was published, an article by Lynn Kuehn “ICD-10-PCS: The Rules Matter!” was published by Libman Education and discussed the confusion created by the codes recommended in the Third Quarter Coding Clinic. The focus of her discussion was on the importance of adhering to the hierarchy of coding guidance and that the root operation Replacement includes removing, physically eradicating or rendering nonfunctional the native body part being replaced.

These two divergent recommendations result in a discrepancy in the codes reported for cases where Resection of the breast occurs prior to Replacement of the breast in the same operative episode. I anticipate there will be forthcoming discussion of this controversy in the Coding Clinic as well as other sources so careful documentation and monitoring of this issue is recommended.

Consistency is a vital characteristic of data quality therefore coding professionals must immediately adopt and follow a guideline to ensure the codes reported in this scenario are consistent throughout the entire organization. Failure to research and adopt an official internal facility guideline will most certainly result in some cases being reported with a code for resection of the breast and others without the resection code.