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CCHIS March Newsletter discussing the coding of Intracranial Angioplasty with stent in both ICD-9 PCS and ICD-10 PCS.

CCHIS March Newsletter discussing the coding of Intracranial Angioplasty with stent in both ICD-9 PCS and ICD-10 PCS.

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  • 1. Your arteries carry life-sustaining oxygen and nutrients along with blood cells and platelets throughout the body. On occasion plaque buildup forms in these arteries. Plaque is a substance made up of cholesterol, fatty deposits, calcium and other materials in the body. To rid the artery of the plaque an angioplasty which may include stent placement is sometimes required. This means a balloon with a stent wrapped around it is inflated to push the plaque back against the artery wall. In ICD-9 PCS adjunct codes describing the number of stents inserted and the number of vessels treated are needed to capture the complete procedure. The adjunct codes are documented in addition to the primary angioplasty code for coding accuracy. In ICD-10 PCS the rules are just the opposite. Every ICD-10 PCS code is a complete code which does not require an additional code. In other words, adjunct codes are not used. A separate ICD-10 PCS code must be used for each vessel treated and for each type of stent (drug-eluting, non-drug eluting or radioactive). ANGIOPLASTY RULES WHAT TO EXPECT 1 Angioplasty Rules 2 Coding Scenario 3 ICD-10 PCS Angioplasty Structures 4 Requests for Coding Topics “Every ICD-10 PCS code is a complete code which does not require an additional code.” MARCH 2014 Volume 1 Issue 3 By Cynthia Brown, MBA, RHIT, CCS www.cyntcodinghealthinformationservices.com CCHIS, P.O. Box 3019, Decatur, GA 30031 404-992-8984 http://www.cyntcodinghealthinformationservices.com Cynthia@cyntcodinghealthinformationservices.com [phone] CODING YESTERDAY’S NOMENCLATURE TODAY® Coding Intracranial Angioplasty in ICD-9 CM & ICD-10 CM CODING NEWSLETTER FOR HEALTHCARE CODING PROFESSIONALS
  • 2. Page 2 Coding Yesterday’s Nomenclature Today 72-year-old man with an unruptured aneurysm in the right middle cerebral artery and total occlusion of the left vertebral artery is referred for endovascular treatment of this high-grade (93% diameter, 4-5 mm length) eccentric stenosis. The patient underwent cerebral angioplasty and stenting (CAS) under local anesthesia. A 6F guiding catheter with 0.064-inch inner diameter was selectively placed via a femoral arterial route into the right vertebral artery. Low-molecular-weight dextran (1000 mL per day) was started 1 hour before CAS and continued until the next day. Heparin (10,000 U) was administered intravenously to avoid thrombus formation during the procedure, and isosorbide dinitrate (2.5 mg) was injected into the right vertebral artery through a guiding catheter to prevent balloon catheter-induced vasospasm. A 0.014-inch guidewire was navigated across the stenosis. The very flexible balloon catheter with a 2.5-mm diameter and 20-mm length was guided over the wire and then inflated twice at 6 atm for 60 seconds to predilate the lesion. The balloon catheter was replaced by the balloon-expandable coronary stent (gfx) with a 3.0-mm diameter and 12-mm length with the 0.014-inch 300-cm exchange guidewire. The stent was deployed at 9 atm for 15 seconds. The lesion was sufficiently dilated very easily and the stenosis was reduced from 93% to 0%. No complications occurred during or after the procedure, which was finished within 60 minutes. ONLY PROCEDURE CODES WILL BE CODED IN THIS CASE. ICD-9 PCS: 00.62; 00.65; 00.40; 00.45 ICD-10 PCS: 037G3DZ In ICD-9, 00.62 represents the angioplasty of intracranial vessel (intracranial portion of vertebral artery) which can be found in the alphabetical index by going to the terms “angioplasty, intracranial.” The coder is further instructed in the Tabular List to code also any percutaneous intracranial stent insertion (00.65, Percutaneous Insertion of Intracranial Vascular Stent(s)); the number of vessels treated (00.40, Procedure on Singe Vessel); and the number of stents inserted (00.45, Insertion of One Vascular Stent). In ICD-10, there is one code which will capture the complete procedure, 037G3DZ. It can be found by going to the PCS Tables: Medical & Surgical (0); Upper Arteries (3); Dilation (7) and then Intracranial Artery (G) (Vertebral Artery is Intracranial in this case); Percutaneous (3); Intraluminal Device (D); No Qualifier (Z). www.cyntcodinghealthinformationservices.com Balloon angioplasty with stenting for intracranial vertebral atherosclerotic stenosis. “72-year-old man with an unruptured aneurysm in the RT middle cerebra artery & total occlusion of LT vertebral artery.” Coding Scenario
  • 3. Coding Yesterday’s Nomenclature Today Coding Yesterday’s Nomenclature Today Coding Health Information Services ® CORONARY ANGIOPLASTY •Approach: Open, Percutaneous, Percutaneous Endoscopic •Device: Intraulumina Device (Non and drug eluting, radioactive), No Device •Qualifier: Bifurcation, No Qualifier PRECEREBRAL ANGIOPLASTY •Approach: Open, Percutaneous, Percutaneous Endoscopic •Device: Intraluminal (Non and Drug Eluting), No Device •Qualifier: No Qualfier CEREBRAL ANGIOPLASTY •Approach: Open, Percutaneous, Percutaneous Endoscopic •Device: Intraluminal (Non and Drug Eluting), No Device •Qualifier: No Qualifier NONCORONA RY VESSEL ANGIOPLASTY •Approach, Open, Percutaneous, Percutaneous Endoscopic •Device: Intraluminal (Non and Drug Eluting), No Device •Qualifier: No Qualifier AHIMA approved ICD-10 CM/PCS Trainer ICD-10 PCS STRUCTURE OF ANGIOPLASTIES “All Things Coding”® “Accurate and complete coding is a must in today’s economically challenged healthcare environment.”
  • 4. Page 4 Coding Yesterday’s Nomenclature Today CCHIS Professional Affiliates AHIMA GHIMA AHIMA approved ICD-10 CM/PCS Trainer EDWOSB/WOSB VOSB SCORE Atlanta CyntCoding Health Information Services P.O. BOX 3019 Decatur, GA 30031 Phone: 404-992-8984 E-Fax: 678-805-4919 E-mail: cyntcoder@cyntcodinghealthinformationservices.com Requests for Coding Topics E-mail your coding topics using the format below to: cyntcoder@cyntcodinghealthinformationservices.com CCHIS NEWSLETTER TERMS AND CONDITIONS OF USE All content provided in this “CCHIS Newsletter” is for informational purposes only. The owner of this newsletter makes no representations as to the accuracy or completeness of any information in this newsletter or found by following any link in this newsletter. The owner of http://cyntcodinghealthinformationservices.com will not be liable for any errors or omissions in information nor for the availability of this information. The owner will not be liable for any losses, injuries, or damages from the display or use of this information. The terms and conditions are subject to change at any time with or without notice. CODING YESTERDAY’S NOMENCLATURE TODAY® www.cyntcodinghealthinformationservices.com