A quarterly publication of the Central Office on ICD-10-CM/PCS

1 A quarterly publication of the Central Office on ICD-10-CM/PCS . Volume 5 Second Quarter Number 2 2018. In This Issue Osteoporosis and Fracture Intra-Aortic Balloon Pump 3 (Traumatic versus Pathologic) 12. Pacing Lead Attached to Automatic Ask the Editor Implantable Cardioverter Arthroscopic Drainage of Knee Defibrillator 19. and Nonexcisional Debridement 17 Prelaminated Free Flap Graft Using Carotid Artery Stenosis and AlloDerm 20 Transient Ischemic Attack 9 Prescribed Opioids for Pain Cocaine Use and Pregnancy 10 Management 11. Degenerative Changes of Bilateral Posterior Capsular Opacity 14. Hips 15 Recreational Marijuana Use 11. Degenerative Changes of Cervical Sessile Serrated Polyp 14. Spine 14 Takotsubo Syndrome with Diabetes with Arthropathy 6 Hypertension 9. Diabetes with Peripheral Transverse Rectus Abdominis Angiopathy 7 Myocutaneous (TRAM) Delay 18.

2 Discogenic Degenerative Changes 15 Traumatic Subdural Hygroma 13. Encephalopathy due to Urinary Urinary Tract Infection During Tract Infection 22 Delivery Episode 20. Exchange of Tibial Polyethylene Urinary Tract Infection and Component with Stabilizing Hydronephrosis with Obstruction Insert (Tibial Tray) 16 due to Ureteral Calculus 21. Excision of Synovial Cyst 22. High Transverse Cesarean Section 17 Clarifications Kennedy Terminal Ulcer 21 Coronary Artery Bifurcation 24. Newborn Disturbance of Sodium Encephalopathy due to Other Balance 6 Conditions 24. Non-Traumatic Subdural Hygroma 13 Third and Fourth Degree Observation for Suspected Burn Obstetric Lacerations 25. Injury 7. Observation for Suspected Injury Correction Following Motor Vehicle Dismembered Pyeloplasty 27. Accident 8. Coding advice or code assignments contained in this issue effective with discharges June 6, 2018.

3 Coding Clinic for Editorial Advisory Board Lee R. Morisy, , FACS. Representative, Amer. College ICD 10 CM/PCS Donna Ganzer, Chairman Published quarterly by the of Surgeons, Memphis, TN. President, Ganzer Network American Hospital Association Corporation, Great Neck, NY Janice R. Noller, RHIA, Central Office on CDIP, CCS. ICD-10-CM/PCS . Sue Bowman, MJ, RHIA, Inpatient Coding Educator 155 N. Wacker Drive Chicago, IL 60606. CCS, FAHIMA University of Utah Health Senior Director, Coding Salt Lake City, UT. ISSN 0742-9800 Policy and Compliance, American Health Information Bernard Pfeifer, Management Association, Representative for American Coding Clinic for Chicago, IL Medical Assn., Harwich, MA. ICD-10-CM/PCS . Online subscription information Donna Pickett, RHIA, MPH. Lisa O. Daughtry, BA, RHIT, can be found at www.

4 Chief, Classifications and CCS, CDIP. Public Health Data Standards, Coding Educator, Wake Med Click Help Center then Centers for Disease Control &. Health and Hospitals, subscriptions for more Prevention, Hyattsville, MD. Raleigh, NC. information. Evan Pollack, , FACP. Mady Hue, RHIA Representative for American Executive Editor Office of Hospital Policy, College of Physicians, Bryn Nelly Leon-Chisen, RHIA. Centers for Medicare & Mawr, PA. Director, Central Office on Medicaid Services, ICD-10-CM/PCS Heather Segerstrom, RHIA, Baltimore, MD. CCS. Editorial Staff, AHA Central Jeffrey F. Linzer, , FAAP Supervisor of Coding, Health Office on ICD-10-CM/PCS Representative, American Information Mgmt, Advocate Karen Ayala, RHIT Academy of Pediatrics, BroMenn Med Ctr, Advocate Coding Specialist Atlanta, GA Eureka Hospital, Normal, IL.

5 Denene Harper, RHIA Subscriptions? Questions? Problems? Senior Coding Consultant Call 312-422-3366. Diane Komar, RHIT Individual answers within AHA Coding Clinic are available for repro- Coding Consultant duction by hospitals and health systems for the purpose of respond- ing to payor audit requests. The answer needs to be reproduced in Susan Latham, RHIT its entirety, and not edited or altered in any way. Payors, consultants, Coding Consultant and other for-profit, commercial entities may only use AHA Coding Clinic content as an internal reference and for audit purposes. AHA. Anita Rapier, RHIT, CCS Coding Clinic content may not be utilized for commercial, for-profit Managing Editor purposes and may not be re-sold, repackaged or distributed without the consent of the American Hospital Association Central Office .

6 The Senior Coding Consultant Content may not be compiled, shared, or distributed in a way that circumvents the need for an individual or entity to access, purchase, Cherrsse Ruffin, RHIT or obtain a license to utilize Coding Clinic content. The use of user- Coding Consultant names and passwords should be limited to the purchaser and/or user and not shared with other individuals or entities to circumvent the Kathy White, RHIA purchase of an individual license. For more information on obtaining Coding Consultant a license to utilize Coding Clinic beyond what is listed above, please contact Tim Carlson GretchenYoung-Charles, RHIA. Senior Coding Consultant Coding Clinic is the official publication for ICD-10-CM/PCS coding guidelines and advice as designated by the four cooperating parties. Halima Zayyad-Matarieh, The cooperating parties listed below have final approval of the cod- ing advice provided in this publication : American Hospital Associa- RHIA, Coding Consultant tion, American Health Information Management Association, Centers for Medicare & Medicaid Services (formerly HCFA), National Center Medical Advisors, Centers for Health Statistics for Medicare & Medicaid 2018 by the American Hospital Association.

7 All rights reserved. Re- Services production or use of this publication in any form or in any information storage or retrieval system is forbidden without express permission of Songhai Barclift, , FACOG. the publisher. For permission to reprint material from this publication , Karen Nakano, please write to the Central Office on ICD-10-CM/PCS , American Hos- pital Association, 155 N. Wacker Drive, Suite 400, Chicago, IL 60606. Intra-Aortic Balloon Pump The Central Office on ICD-10-CM/PCS has received numerous requests regarding the reporting of an intra-aortic balloon pump (IABP). The following information regarding an IABP, along with some coding examples, is being provided to help clarify the coding issues. An intra-aortic balloon pump (IABP) provides circulatory support by helping the heart pump blood.

8 Specifically, it is a polyethylene balloon mounted on a catheter that is generally inserted into the descending aorta through the femoral artery. The other end of the catheter attaches to a computer console containing a pump that inflates the balloon. The balloon at the end of the catheter inflates and deflates with the rhythm of the heart, helping the heart to pump blood into the body. At the start of diastole, the balloon inflates augmenting coronary perfusion. At the beginning of systole, the balloon deflates and blood is ejected from the left ventricle increasing cardiac output. These actions decrease the workload on the heart and allow the heart to pump more blood. The IABP is driven by a balloon pump console and can be programmed to produce rates as high as 140 beats per minute. IABP therapy was first used for surgical patients but is now being used with interventional cardiology procedures and medical therapy.

9 Some indications for IABP therapy include failure to wean from cardiopulmonary bypass, cardiogenic shock, heart failure, acute heart attack, and support during some cardiology procedures such as angioplasty and stent placement. An IABP may be used pre-, intra-, or postoperatively to support the patient for a few hours up to several days. As specifically indicated on page 10 of the First Quarter 2017 issue of Coding Clinic, the advice for coding external heart assist devices does not apply to the placement or removal of intra-aortic balloon pumps. Therefore, it is not appropriate to report an IABP with the device value external heart assist device. Additionally, from a coding perspective, the IABP is not classified as a device, nor coded as a device in ICD-10-PCS. Since an IABP is not considered a device under ICD-10-PCS, it would also not be appropriate to report the root operations insertion and/or removal for the placement or removal of the intra-aortic balloon pump.

10 The use of an IABP is appropriately coded using the root operation Assistance.. Coding Clinic Second Quarter 2018 3. Question: The patient was admitted as an inpatient for percutaneous coronary intervention (PCI). An intra- aortic balloon pump (IABP) was placed for support, and it was removed at the end of the procedure. Is it appropriate to report the intraoperative use of the IABP? Answer: Typically, auxiliary procedures done solely to support the performance of a surgical procedure are not coded separately. However, cardiopulmonary bypass and IABP are exceptions. When a surgical procedure is performed using IABP, code separately with the root operation Assistance. Assign the following ICD-10-PCS code: 5A02210 Assistance with cardiac output using balloon pump, continuous, for the intraoperative use of IABP support This advice supersedes information previously published in Coding Clinic Third Quarter 2013, pages 18-19.