Download FY 2017 ICD-10-PCS Code Updates Webinar 2

FY 2017 ICD-10-PCS
Code Updates
Webinar 2
Presented by: Kay Piper, RHIA, CDIP, CCS
Inpatient Coding Educator, St. Louis Network
Agenda
•
•
•
•
•
ICD-10-PCS Table Changes
ICD-10-PCS Root Operation Changes
Coding Examples
Key Definitions
Video Examples
Heart and Great Vessels
• Table 021
– Coronary Arteries
• The term “Site” has been changed to “Artery”
– New Device
• (8) Zooplastic Tissue
– New Qualifiers
• (S) Pulmonary Vein, Right
• (T) Pulmonary Vein, Left
• (U) Pulmonary Vein, Confluence
3
Heart and Great Vessels
4
Table 021
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
1 – Bypass: Altering the route of passage of the contents of a tubular body part
Body Part
Approach
Device
Qualifier
0 – Coronary Artery, One
Artery
1 – Coronary Artery, Two
Arteries
2 – Coronary Artery,
Three Arteries
3 – Coronary Artery, Four
or More Arteries
0 – Open
8 – Zooplastic Tissue
9 – Autologous Venous
Tissue
A – Autologous Arterial
Tissue
J – Synthetic Substitute
K – Nonautologous
Tissue Substitute
3 – Coronary Artery
8 – Internal Mammary,
Right
9 – Internal Mammary, Left
C – Thoracic Artery
F – Abdominal Aorta
W - Aorta
0 – Coronary Artery, One
Artery
1 – Coronary Artery, Two
Arteries
2 – Coronary Artery,
Three Arteries
3 – Coronary Artery, Four
or More Arteries
0 – Open
Z – No Device
3 – Coronary Artery
8 – Internal Mammary,
Right
9 – Internal Mammary, Left
C – Thoracic Artery
F – Abdominal Aorta
5
Table 021 (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
1 – Bypass: Altering the route of passage of the contents of a tubular body part
Body Part
Approach
Device
Qualifier
0 – Coronary Artery, One
Artery
1 – Coronary Artery, Two
Arteries
2 – Coronary Artery,
Three Arteries
3 – Coronary Artery, Four
or More Arteries
3 - Percutaneous
4 – Intraluminal Device,
Drug-eluting
D – Intraluminal Device
4 – Coronary Vein
0 – Coronary Artery, One
Artery
1 – Coronary Artery, Two
Arteries
2 – Coronary Artery,
Three Arteries
3 – Coronary Artery, Four
or More Arteries
4 – Percutaneous
Endoscopic
4 – Intraluminal Device,
Drug-eluting
D – Intraluminal Device
4 – Coronary Vein
6
Table 021 (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
1 – Bypass: Altering the route of passage of the contents of a tubular body part
Body Part
Approach
Device
Qualifier
0 – Coronary Artery, One
Artery
1 – Coronary Artery, Two
Arteries
2 – Coronary Artery,
Three Arteries
3 – Coronary Artery, Four
or More Arteries
4 – Percutaneous
Endoscopic
8 – Zooplastic Tissue
9 – Autologous Venous
Tissue
A – Autologous Arterial
Tissue
J – Synthetic Substitute
K – Nonautologous
Tissue Substitute
3 – Coronary Artery
8 – Internal Mammary,
Right
9 – Internal Mammary, Left
C – Thoracic Artery
F – Abdominal Aorta
W - Aorta
0 – Coronary Artery, One
Artery
1 – Coronary Artery, Two
Arteries
2 – Coronary Artery,
Three Arteries
3 – Coronary Artery, Four
or More Arteries
4 – Percutaneous
Endoscopic
Z – No Device
3 – Coronary Artery
8 – Internal Mammary,
Right
9 – Internal Mammary, Left
C – Thoracic Artery
F – Abdominal Aorta
7
Table 021 (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
1 – Bypass: Altering the route of passage of the contents of a tubular body part
Body Part
Approach
Device
Qualifier
6 – Atrium, Right
0 – Open
4 – Percutaneous
Endoscopic
8 – Zooplastic Tissue
9 – Autologous Venous
Tissue
A – Autologous Arterial
Tissue
J – Synthetic Substitute
K – Nonautologous
Tissue Substitute
P – Pulmonary Trunk
Q – Pulmonary Artery, Right
R – Pulmonary Artery, Left
8
Table 021 (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
1 – Bypass: Altering the route of passage of the contents of a tubular body part
Body Part
Approach
Device
Qualifier
7 – Atrium, Left
V – Superior Vena
Cava
0 – Open
4 – Percutaneous
Endoscopic
8 – Zooplastic Tissue
9 – Autologous Venous
Tissue
A – Autologous Arterial
Tissue
J – Synthetic Substitute
K – Nonautologous
Tissue Substitute
Z – No Device
P – Pulmonary Trunk
Q – Pulmonary Artery, Right
R – Pulmonary Artery, Left
S – Pulmonary Vein, Right
T – Pulmonary Vein, Left
U – Pulmonary Vein,
Confluence
9
Total Anomalous Pulmonary Venous
Return (TAPVR)
Total anomalous pulmonary venous return (TAPVR) is a
type of congenital heart disease in which the four
pulmonary veins that normally take oxygenated blood
from the lungs to the left side of the heart do not attach
normally to the left atrium. Instead, they attach to other
vascular structures that prevent oxygenated blood from
reaching the left side of the heart and subsequent pumping
of oxygenated blood to the systemic circulation. Initial
stabilization of the affected neonate may involve creation
or enlargement of an atrial septal defect (ASD) to allow
oxygenated blood to flow to the left side of the heart.
10
TAPVR
• The most common anatomic variants of
TAPVR are as follows:
–
–
–
–
Supracardiac
Infracardiac
Cardiac
Mixed
11
Table 021 (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
1 – Bypass: Altering the route of passage of the contents of a tubular body part
Body Part
Approach
Device
Qualifier
K – Ventricle, Right
L – Ventricle, Left
0 – Open
4 – Percutaneous
Endoscopic
8 – Zooplastic Tissue
9 – Autologous Venous
Tissue
A – Autologous Arterial
Tissue
J – Synthetic Substitute
K – Nonautologous
Tissue Substitute
P – Pulmonary Trunk
Q – Pulmonary Artery, Right
R – Pulmonary Artery, Left
12
Table 021 (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
1 – Bypass: Altering the route of passage of the contents of a tubular body part
Body Part
Approach
Device
Qualifier
P – Pulmonary Trunk
Q – Pulmonary Artery,
Right
R – Pulmonary Artery,
Left
0 – Open
4 – Percutaneous
Endoscopic
8 – Zooplastic Tissue
9 – Autologous Venous
Tissue
A – Autologous Arterial
Tissue
J – Synthetic Substitute
K – Nonautologous
Tissue Substitute
A – Innominate Artery
B – Subclavian
D – Carotid
13
C & M Meeting Discussion
The Modified Blalock-Taussig Shunt involves creation of a
“bypass” from the innominate artery to the pulmonary artery
with a synthetic type of tissue substitute. In this procedure, the
surgeon reroutes the blood flow by placing a graft (usually
Gore-Tex) from the innominate or subclavian artery to the
pulmonary trunk or the right or left pulmonary artery; there
are two anastomoses to place the graft –one proximally at
either the innominate or subclavian artery and the distal one
at the pulmonary trunk or the right or left pulmonary artery.
The purpose of the procedure is to create a systemic-topulmonary shunt as a palliative surgery for patients with
cyanotic heart defects such as TOF (Tetralogy of Fallot),
tricuspid or pulmonary atresia, etc.
14
Table 021 (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
1 – Bypass: Altering the route of passage of the contents of a tubular body part
Body Part
Approach
Device
Qualifier
W – Thoracic Aorta,
Descending
X – Thoracic Aorta,
Ascending/Arch
0 – Open
4 – Percutaneous
Endoscopic
8 – Zooplastic Tissue
9 – Autologous Venous
Tissue
A – Autologous Arterial
Tissue
J – Synthetic Substitute
K – Nonautologous
Tissue Substitute
Z – No Device
B – Subclavian
D – Carotid
P – Pulmonary Trunk
Q – Pulmonary Artery, Right
R – Pulmonary Artery, Left
15
Aorta
16
Ascending and Descending Aorta
Also added to the following root operations:
•
•
•
•
•
•
Destruction (025)
Dilation (027)
Excision (02B)
Extirpation (02C)
Insertion (02H)
Release (02N)
•
•
•
•
•
Repair (02Q)
Replacement (02R)
Reposition (02S)
Supplement (02U)
Restriction (02V)
17
Root Operation: Creation
FY 2016
FY 2017
Creation
Creation
Definition: Making a new genital
structure that does not take over the
function of a body part
Definition: Putting in or on biological or
synthetic material to form a new body
part that to the extent possible
replicates the anatomic structure or
function of an absent body part
Explanation: Used only for sex change
operations
Explanation: Used for gender
reassignment surgery and corrective
procedures in individuals with congenital
anomalies
Includes/Examples: Creation of vagina in Includes/Examples: Creation of vagina in
a male, creation of penis in a female
a male, creation of right and left
atrioventricular valve from common
atrioventricular valve
18
Root Operation: Creation
Creation is no longer just
used to reflect the making
of a new genital structure
(gender re-assignment), it
has been modified to reflect:
“Putting in or on biological
or synthetic material to form
a new body part” . In the
Heart and Great Vessels it is
now used for the creation of
heart valves: Aortic, Mitral
and Tricuspid
19
Table 024 – New Table
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
4 – Creation: Putting in or on biological or synthetic material to form a new body
part that to the extent possible replicates the anatomic structure or function of
an absent body part
Body Part
Approach
Device
Qualifier
F – Aortic Valve
0 – Open
7 – Autologous Tissue
Substitute
8 – Zooplastic Tissue
J – Synthetic Substitute
K – Nonautologous
Tissue Substitute
J – Truncal Valve
G – Mitral Valve
J – Tricuspid Valve
0 – Open
7 – Autologous Tissue
Substitute
8 – Zooplastic Tissue
J – Synthetic Substitute
K – Nonautologous
Tissue Substitute
2 – Common Atrioventricular
Valve
20
Activity: Heart Valve Replacement
Watch the following video showing an
animation of a heart valve replacement
surgery
Heart Valve Replacement
21
Coding Example
3-day-old infant born with
truncus arteriosus presents for
repair. The pulmonary artery
bifurcation is separated from
the arterial trunk. The trunk is
closed, forming the aorta. The
truncal valve was in good
working order and was
therefore used to create the
aortic valve. The ventricular
septal defect is closed. GoreTex conduit from right ventricle
to pulmonary bifurcation was
placed.
Code the creation of the aortic
valve.
22
Coding Example Answer
024F07J - Creation of Aortic Valve using Truncal Valve,
Open Approach
Section
0
Medical and Surgical
Body System
2
Heart and Great Vessels
Operation
4
Creation: Putting in or on biological or synthetic
materials to form a new body part that to the extent
possible replicates the anatomic structure or
function of an absent body part.
Body Part
F
Aortic Valve
Approach
0
Open
Device
7
Autologous Tissue Substitute
Qualifier
J
Truncal Valve
23
Table 025
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
5 – Destruction: Physical eradication of all or a portion of a body part by the direct
use of energy, force, or a destructive agent
Body Part
Approach
Device
Qualifier
4 – Coronary Vein
5 – Atrial Septum
6 – Atrium, Right
8 – Conduction Mechanism
9 – Chordae Tendineae
D – Papillary Muscle
F – Aortic Valve
G – Mitral Valve
H – Pulmonary Valve
J – Tricuspid Valve
K – Ventricle, Right
L – Ventricle, Left
M – Ventricular Septum
N – Pericardium
P – Pulmonary Trunk
Q – Pulmonary Artery, Right
R – Pulmonary Artery, Left
S – Pulmonary Vein, Right
T – Pulmonary Vein, Left
V – Superior Vena Cava
0 – Open
3 - Percutaneous
4 – Percutaneous
Endoscopic
Z – No Device
Z – No Qualifier
W – Thoracic Aorta, Descending
X – Thoracic Aorta, Ascending/Arch
24
Table 027
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
7 – Dilation: Expanding an orifice or the lumen of a tubular body part
Body Part
Approach
Device
Qualifier
0 – Coronary Artery, One
Artery
1 – Coronary Artery, Two
Arteries
2 – Coronary Artery,
Three Arteries
3 – Coronary Artery, Four
or More Arteries
0 – Open
3 – Percutaneous
4 – Percutaneous
Endoscopic
4 – Intraluminal Device, Drugeluting
5 – Intraluminal Device, Drugeluting, Two
6 – Intraluminal Device, Drugeluting, Three
7 – Intraluminal Device, Drugeluting, Four or More
D – Intraluminal Device
E – Intraluminal Device, Two
F – Intraluminal Device, Three
G – Intraluminal Device, Four
or More
T – Intraluminal Device,
Radioactive
Z – No Device
6 – Bifurcation
Z – No Qualifier
25
Table 027 (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
7 – Dilation: Expanding an orifice or the lumen of a tubular body part
Body Part
Approach
Device
Qualifier
F – Aortic Valve
G – Mitral Valve
H – Pulmonary Valve
J – Tricuspid Valve
K – Ventricle, Right
P – Pulmonary Trunk
Q – Pulmonary Artery,
Right
S – Pulmonary Vein, Right
T – Pulmonary Vein, Left
V – Superior Vena Cava
W – Thoracic Aorta,
Descending
X – Thoracic Aorta,
Ascending/Arch
0 – Open
3 – Percutaneous
4 – Percutaneous
Endoscopic
4 – Intraluminal Device, Drugeluting
D – Intraluminal Device
Z – No Device
Z – No Qualifier
26
Coding Example
PROCEDURE:
Successful stenting of the proximal LAD using two 3.5 x 18 mm
Resolute drug-eluting stent with excellent results.
DESCRIPTION OF PROCEDURE:
The patient is a very pleasant 71-year-old gentleman who
underwent cardiac catheterization because of symptoms of
reflux disease and an abnormal stress test. He had evidence
for severe disease of the proximal LAD. He did have disease of a
small branch of the ramus intermedius vessel. The stent in the
circumflex system is patent. No significant RCA disease was
appreciated. LV function was 50% to 60%.
27
Coding Example (cont)
He was given Angiomax per protocol. A 6-French JL4 guiding
catheter was placed in the ostium of the left main. The lesion
was crossed with a BMW wire. He was given Angiomax per
protocol prior to wiring the vessel. Primary stenting was done
using a 3.5 x 18 mm Resolute drug-eluting stent deployed at 14
atmospheres with excellent results. A second drug eluting stent
was deployed. The patient tolerated the procedure well.
CONCLUSION:
1. Successful stenting of the proximal LAD, placing a 3.5 x 18
mm Resolute drug-eluting stent with excellent results.
2. Angio-Seal was used to close the catheterization site.
Please assign the correct code for stent.
28
Coding Example Answer
027035Z – Dilatation of Coronary Artery with Drugeluting Device, Two, Percutaneous Approach
Section
0
Medical and Surgical
Body System
2
Heart and Great Vessels
Operation
7
Dilation: Expanding an orifice or the lumen of a
tubular body part
Body Part
0
Coronary Artery, One Artery
Approach
3
Percutaneous
Device
5
Intraluminal Device, Drug-eluting, Two
Qualifier
Z
No Qualifier
29
Table 02B
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
B – Excision: Cutting out or off, without replacement, a portion of a body part
Body Part
Approach
Device
Qualifier
4 – Coronary Vein
5 – Atrial Septum
6 – Atrium, Right
8 – Conduction Mechanism
9 – Chordae Tendineae
D – Papillary Muscle
F – Aortic Valve
G – Mitral Valve
H – Pulmonary Valve
J – Tricuspid Valve
K – Ventricle, Right
L – Ventricle, Left
M – Ventricular Septum
N – Pericardium
P – Pulmonary Trunk
Q – Pulmonary Artery, Right
R – Pulmonary Artery, Left
S – Pulmonary Vein, Right
T – Pulmonary Vein, Left
V – Superior Vena Cava
0 – Open
3 - Percutaneous
4 – Percutaneous
Endoscopic
Z – No Device
X – Diagnostic
Z – No Qualifier
W – Thoracic Aorta, Descending
X – Thoracic Aorta, Ascending/Arch
30
Table 02C
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
C – Extirpation: Taking or cutting out solid matter from a body part
Body Part
Approach
Device
Qualifier
0 – Coronary Artery, One
Artery
1 – Coronary Artery, Two
Arteries
2 – Coronary Artery,
Three Arteries
3 – Coronary Artery, Four
or More Arteries
0 – Open
3 – Percutaneous
4 – Percutaneous
Endoscopic
Z – No Device
6 – Bifurcation
Z – No Qualifier
•Qualifier 6 – Bifurcation
•03C Table
•04C Table
31
Table 02C (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
C – Extirpation: Taking or cutting out solid matter from a body part
Body Part
Approach
Device
Qualifier
4 – Coronary Vein
5 – Atrial Septum
6 – Atrium, Right
7 – Atrium, Left
8 – Conduction Mechanism
9 – Chordae Tendineae
D – Papillary Muscle
F – Aortic Valve
G – Mitral Valve
H – Pulmonary Valve
J – Tricuspid Valve
K – Ventricle, Right
L – Ventricle, Left
M – Ventricular Septum
N – Pericardium
P – Pulmonary Trunk
Q – Pulmonary Artery, Right
R – Pulmonary Artery, Left
S – Pulmonary Vein, Right
T – Pulmonary Vein, Left
V – Superior Vena Cava
0 – Open
3 - Percutaneous
4 – Percutaneous
Endoscopic
Z – No Device
Z – No Qualifier
W – Thoracic Aorta, Descending
X – Thoracic Aorta, Ascending/Arch
32
Table 02H
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
H – Insertion: Putting in a nonbiological appliance that monitors, assists, performs,
or prevents a physiological function but does not physically take the place of a
body part
Body Part
Approach
Device
Qualifier
4 – Coronary Vein
6 – Atrium, Right
7 – Atrium, Left
K – Ventricle, Right
L – Ventricle, Left
0 – Open
3 – Percutaneous
4 – Percutaneous
Endoscopic
0 – Monitoring Device,
Pressure Sensor
2 – Monitoring Device
3 – Infusion Device
J – Cardiac Lead,
Pacemaker
K – Cardiac Lead,
Defibrillator
M – Cardiac Lead
N – Intracardiac
Pacemaker
Z – No Qualifier
33
Table 02H (cont)
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
H – Insertion: Putting in a nonbiological appliance that monitors, assists, performs,
or prevents a physiological function but does not physically take the place of a
body part
Body Part
Approach
Device
Qualifier
P – Pulmonary Trunk
Q – Pulmonary Artery,
Right
R – Pulmonary Artery,
Left
S – Pulmonary Vein,
Right
T – Pulmonary Vein, Left
W – Thoracic Aorta,
Descending
X – Thoracic Aorta,
Ascending/Arch
0 – Open
3 - Percutaneous
4 – Percutaneous
Endoscopic
0 – Monitoring Device,
Pressure Sensor
2 – Monitoring Device
3 – Infusion Device
D – Intraluminal Device
Z – No Qualifier
34
Coding Example
An 80 yr. old female admitted for an ischemic stroke,
developed atrial fibrillation. Medication was administered,
but the patient continued in atrial fibrillation.
Cardiologists recommended an
intracardial pacemaker insertion
which was carried out by
inserting the pacemaker
endoscopically into the right
atrium.
Assign a code for the pacemaker
insertion.
35
Coding Example Answer
02H64NZ – Insertion of Intracardiac Pacemaker in the
Right Atrium, Percutaneous Endoscopic Approach
Section
0
Medical and Surgical
Body System
2
Heart and Great Vessels
Operation
H
Insertion: Putting in a biological appliance that monitors,
assists, performs or prevents a physiological function but
does not physically take the place of a body part
Body Part
6
Atrium, Right
Approach
4
Percutaneous Endoscopic
Device
N
Intra-cardiac Pacemaker
Qualifier
Z
No Qualifier
36
Table 02L
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
L – Occlusion: Completely closing an orifice or the lumen of a tubular body part
body part
Body Part
Approach
Device
Qualifier
H – Pulmonary Valve
S – Pulmonary Vein,
Right
T – Pulmonary Vein, Left
V – Superior Vena Cava
0 – Open
3 - Percutaneous
4 – Percutaneous
Endoscopic
C – Extraluminal Device
D – Intraluminal Device
Z – No Device
Z – No Qualifier
37
Rastelli Example
Images from HeartBabyHome.com
38
Table 02N
Section
Body System
Operation
0 – Medical and Surgical
2 – Heart and Great Vessels
N – Release: Freeing a body part from an abnormal physical constraint by cutting
or by the use of force
Body Part
Approach
Device
Qualifier
4 – Coronary Vein
5 – Atrial Septum
6 – Atrium, Right
7 – Atrium, Left
8 – Conduction Mechanism
9 – Chordae Tendineae
D – Papillary Muscle
F – Aortic Valve
G – Mitral Valve
H – Pulmonary Valve
J – Tricuspid Valve
K – Ventricle, Right
L – Ventricle, Left
M – Ventricular Septum
N – Pericardium
P – Pulmonary Trunk
Q – Pulmonary Artery, Right
R – Pulmonary Artery, Left
S – Pulmonary Vein, Right
T – Pulmonary Vein, Left
V – Superior Vena Cava
0 – Open
3 - Percutaneous
4 – Percutaneous
Endoscopic
Z – No Device
Z – No Qualifier
W – Thoracic Aorta, Descending
X – Thoracic Aorta, Ascending/Arch
39
Thank you for
joining us for FY
2017 ICD-10-PCS
Code Updates
Webinar 2!!