Blog by Julia Palmer and Sue Belley
The results are in for the first scenario in the ICD-10 coding contest! We had a great response this first round, and we’re back this week with the correct answer to the scenario and some analysis of the answer and the most common errors we found in participants’ responses.
Patient presented to ambulatory surgery suite for a suspension microlaryngoscopy with shave excision of recurrent papillomatosis of the postcricoid area. Review an excerpt from the operative report and assign the ICD-10-PCS code for this procedure.
. . . The Dedo laryngoscope was inserted via the oral cavity and the patient was suspended from the Mayo stand. The shaver was then brought up onto the field and was used to begin removing the papillomatosis from the postcricoid region. The lesion was aggressively debulked.
Congratulations to all who got it right! If you missed this one, keep trying. Practice makes perfect! And be careful with your typing. The first character in this code is a zero and not the letter O. We had several submissions with this easy-to-make mistake. There are no codes in PCS that begin with the letter O. All codes in PCS begin with either 0-9 or B-H.
Let’s break down the code in comparison to the operative report. First, a shave excision of the papillomatosis of the postcricoid area via laryngoscopy is classified to the Medical Surgical section of PCS, character zero, and the Mouth and Throat body system, character C.
The third character identifies the root operation of Excision, character B. Excision is defined as cutting out or off, without replacement, a portion of a body part. A shaver was used to remove the papillomatosis from the postcricoid area.
Some contestants selected root operation Extirpation or Destruction. The shave excision is not an Extirpation because solid matter was not taken or cut out. If we read the explanation for this root operation (located at the back of the PCS book), we see that solid matter may be an abnormal byproduct of a biological function, such as a thrombus or calculus, or it may be a foreign body, such as a bullet or piece of glass.
Nor is this procedure Destruction because it didn’t involves the use of energy, force, or a destructive agent, such as that used in fulguration, cautery, laser, or application of a chemical.
The Body Part character appeared to cause the most trouble for contestants. You’ve probably heard that PCS coding requires a bit more anatomy knowledge. Well, this is an example. The postcricoid area is part of the hypopharynx, not the larynx. If you knew this, kudos! There is no Body Part for hypopharynx in the OCB table. However, if you use the Body Part key found at the back of the PCS book, you will see that we are instructed to use the Pharynx Body Part, character M, for hypopharynx.
The next character captures the operative Approach which was through the mouth using a laryngoscope. This equates to character 8, Via Natural or Artificial Opening Endoscopic. An additional code for Inspection is not assigned because the use of the scope is captured in the Approach character. Also note the ICD-10-PCS Official Guidelines for Coding and Reporting, B3.11a: Inspection of a body part(s) performed in order to achieve the objective of a procedure is not coded separately.
There is only one choice for the 6th character: Z, No Device.
The final character also caused a bit of trouble for some. It’s Z, No Qualifier. Some selected X, Diagnostic. Although the tissue excised was probably sent to pathology as most tissue specimens usually are, we don’t consider this a diagnostic procedure, as would be the case for a biopsy. Also note that the physician stated in the operative report that the diagnosis was “recurrent” papillomatosis.
Thanks for your submissions! The next coding contest scenario will be posted on Monday, July 15th. Keep polishing your ICD-10 coding skills, sign up to be notified when the next contest scenario goes live, and we’ll look forward to receiving your next submissions!
Julia Palmer is a Project Manager with the Consulting Services business of 3M Health Information Systems.
Sue Belley is a Project Manager and Senior Consultant with the Consulting Services business of 3M Health Information Systems.