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

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
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P.O. BOX 3019
Decatur, GA 30031
Phone:
404-992-8984
E-Fax:
678-805-4919
E-mail:
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Requests for Coding Topics
E-mail your coding topics using the format below to:
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