WA Clinical Coding Advisory Group: Coding …

1 Queries discussed by WA Clinical Coding Advisory group Meeting on 20th August 2014. Attendees: Meeting held by e-mail feedback. Query no. Query Description Decision 1 Gastric band removal Recommendation: When no complication is documented as the reason for removal of a gastric band, coders should first seek clarification from the clinician regarding a diagnosis. If clarification is not possible, assign Adjustment and What code is assigned for management of other implanted devices, for removal of gastric band, with no complications documented as the reason for gastric band removal when no removal, following the pathway: complication is documented as the reason for removal? Management - implanted device -- specified Decision: Assign Adjustment and management of other implanted devices for removal of gastric band when there are no documented complications as the reason for removal and clarification from the clinician regarding a diagnosis is not possible.

2 [WA Clinical Coding Advisory group Decision Date: 20/08/2014]. th 2 Gastric band port resiting Recommendation: The CCWA 6 Ed. decision gives the following advice: Previous CCWA decision for Q: What codes should be assigned for port resiting of gastric band. Discharge summary states: "weight loss . gastric band port resiting (Jan port resiting" (pt had previous gastric banding). Operation record states: "weight loss port resiting port th 2010, 6 Ed.) has been mobilized capsule excised and port resited on ext. oblique under local anaesthetic.. th updated to reflect 8 Edition codes. D: The port is usually inserted distal to the navel area and acts as the access point for injecting saline which travels (via a tube) to the silicone gastric band. The saline volume can be increased/decreased to inflate/deflate No complications are the gastric band to the desired level. The most likely scenario is that due to the weight loss, the port is visibly documented as the reason for protruding and thus patient preferred for it to be relocated.

3 Other common reasons for relocation are port infection, port resiting. pain or displacement. As there is no particular complication documented in your case, we advise assignment of Adjustment and management of other specific device and 14215-00 [889] Revision of gastric band. Replacement of implanted reservoir of gastric band is included in 14215-00. 1. continued Query no. Query Description Decision th Fifth digits were added to Adjustment and management of other implanted devices in 7 Ed., making this code th invalid at the 4 digit level. Adjustment and management of other implanted devices is the code assigned for th gastric band port resiting, with no documented complications in 8 Ed. th With a major update to block [889] Procedures for obesity in 8 Ed., code 14215-00 [889] Revision of gastric band was th deleted. The 8 Ed. code for gastric band port resiting is 31441-00 [889] Revision of gastric band reservoir. Decision: The previous CCWA decision has been retired.

4 For gastric band port resiting, with no documented complications as the reason for resiting, assign Adjustment and management of other implanted devices and 31441-00 [889] Revision of gastric band reservoir. [WA Clinical Coding Advisory group Decision Date: 20/08/2014]. 3 Repair tegmen tympani Recommendation: The tegmen tympani is part of the temporal bone, separating the middle ear (tympanic) cavity from defect and PORP the cranial cavity. It extends posteriorly to form the roof of the mastoid antrum. Left untreated, a tegmen tympani defect repositioning can result in a direct communication between the middle ear/mastoid cavity and the cranial cavity; or a meningocele. How do you code transmastoid There are no specific ACHI codes for repair of tegmen tympani defect or repositioning of Partial Ossicular Replacement repair of tegmen tympani Prosthesis (PORP). defect and repositioning of PORP? For repair of tegmen tympani defect, assign 90116-00 [328] Other procedures on mastoid or temporal bone, following the index pathway: A cholesterol granuloma arising from the mastoid Procedure antrum has extended into the - temporal bone NEC.

5 Middle ear cavity creating a defect in the tegmen tympani For repositioning of PORP, assign 90115-00 [320] Other procedures on ossicles of ear, following the index pathway: and displacing the PORP. (Partial Ossicular Replacement Procedure Prosthesis) from a previous - ear ossicular chain reconstruction - - ossicles NEC. (OCR). The 3x2 mm tegmen tympani Decision: This query has been forwarded to the ACCD for guidance. In the interim, assign 90116-00 [328] Other defect is reconstructed with procedures on mastoid or temporal bone and 90115-00 [320] Other procedures on ossicles of ear, for the conchal cartilage. The procedures: repair of tegmen tympani defect and repositioning of Partial Ossicular Replacement Prosthesis displaced PORP is (PORP), respectively. repositioned onto stapes. [WA Clinical Coding Advisory group Decision Date: 20/08/2014]. 2. continued Query no. Query Description Decision 4 Bilateral ureteric stent Recommendation: Bilateral insertion of ureteric stents is coded according to the instructions in the Bilateral Procedures insertion section of ACS 0020 Bilateral/multiple procedures.

6 This procedure meets the definition of a bilateral procedure, it involves the same organ/structure on different sides of the body at the same operative episode. It is coded as per the How do you apply ACS 0020 third point under Bilateral Procedures (Procedures with no code option for bilateral): Where no single code is provided for Bilateral/multiple procedures the bilateral procedure, assign the code twice.. when Coding bilateral insertion of ureteric stents? Some examples listed under the Multiple Procedures section, point 2, may confuse coders when applying ACS. 0020 to the Coding of bilateral ureteric stent insertion: Is the procedure coded once or twice? For embolisation involving multiple vessels ( left and right uterine arteries), coders are instructed to assign one procedure code. However, embolisation of left and right uterine arteries meets the definition of a bilateral procedure according to the definition under Bilateral Procedures.

7 This raises the question of whether this particular example is appropriately listed under Multiple Procedures. These other examples listed under Multiple Procedures, point 2, may meet the definition of a bilateral procedure as well: laparoscopic aspiration of ovarian cysts; and intranasal removal of polyps from maxillary antrum . Furthermore, the terminology non-bilateral site is used in point 4, but not in point 2, which seems inconsistent. Given these over-lapping examples and inconsistent use of terminology, it is not entirely clear which section of ACS 0020 the coder should be following to code bilateral ureteric stent insertion: Bilateral Procedures or Multiple Procedures? There should be clear distinction between Bilateral and Multiple Procedures, enabling the coder to easily decide which section of ACS 0020 to follow. Coding Matters, September 2002, Volume 9 (2) (pg. 16) instructs: if an endoscopic bilateral ureteric stent is performed this would be coded twice as there is no available bilateral' procedure code.

8 Decision: This query has been forwarded to the ACCD for clarification on the intended interpretation of ACS 0020. Bilateral/multiple procedures. In the interim, assign the relevant procedure code for insertion of ureteric stents twice, when stents are inserted into the left and right ureter at the same operative episode. [WA Clinical Coding Advisory group Decision Date: 20/08/2014]. 3.