Coding Cardiac Catheterization

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Coding Cardiac Catheterization
February 3, 2015
Vol. 5
What Is Cardiac Catheterization?
ICD-10-PCS Tabular
Cardiac catheterization is a medical procedure used to diagnose and treat
some heart conditions. A long, thin, flexible tube called a catheter is put
into a blood vessel in the arm, groin, or neck and threaded to the heart.
This portion of the catheterization is not the procedure; it is the
percutaneous approach to the heart and great vessels.
The physician may put a special type of dye in the catheter. The dye will
flow through the bloodstream to the heart. Then, the physician will take
images of the heart, usually of the left heart (Left Cardiac Catheterization),
but may be of the right heart, or of the left and right heart. This is coded
as:
• Measurement, Cardiac.
The dye will make the coronary arteries visible on the pictures. This test is
coronary angiography. This is coded as:
• Fluoroscopy, Artery, Coronary
• OR
• Plain Radiography, Artery, Coronary
Section
Body System
Operation
Body System
Character
2
Body
System
Character
3
Root
Operation
Character
4
Body
System
Character
5
Approach
Character
6
Function/
Device
ICD-10-PCS Code structure in the Imaging Section:
Character
3
Root Type
Character
4
Body Part
Character
5
Contrast
Character
6
Qualifer
Character
7
Qualifier
Imaging Section
“B” is the value that represents the Imaging Section as the first character
6 Right Heart
7 Left Heart
8 Bilateral
B2111ZZ
“A French left coronary artery catheter was introduced and selective
injections using iodixanol were made into the left coronary artery. A right
coronary artery catheter was introduced and selective injections using
iodixanol were made of right coronary artery.”
• First, the coder needs to know is iodixanol a:
High osmolar contrast?
• Low osmolar contrast?
• Other contrast?
• Second, the coder needs to know the number of arteries visualized
• Two, left coronary artery and right coronary artery
• Third, the coder needs to know the type of imaging done:
• Total fluoroscopy time: 7.5 minutes
•
ICD-10-PCS Index
Fluoroscopy
Artery
Coronary
Multiple B211
Laser, Intraoperative B211
Single B210
Laser, Intraoperative B210
Section
Body System
Type
B Imaging
2 Heart
1 Fluoroscopy: Single plane or bi-plane real time display of an image developed from the
capture of external ionizing radiation on a fluorescent screen. The image may also be
stored by either digital or analog means
Body Part
0
1
2
3
Coronary Artery, Single
Coronary Artery, Multiple
Coronary Artery Bypass Graft, Single
Coronary Artery Bypass Graft, Multiple
Contrast
0 High Osmolar
1 Low Osmolar
Y Other Constrast
Qualifier
Qualifier
Z None
Example Part 3: Left ventriculogram using iodixanol
Z None
B2151ZZ
ICD-10-PCS Index
Fluoroscopy
Heart
Left B215
Right B214
Right and Left B216
ICD-10-PCS Tabular
Example:
Procedure: Left heart catheterization, coronary angiography and left
ventriculogram
Description of Procedure: The right groin was prepped and draped in the
usual sterile fashion and locally anesthetized. The right femoral artery was
entered with 18 gauge needle and J guide wire was introduced into
descending aorta. A French left coronary artery catheter was introduced and
selective injections using iodixanol were made into the left coronary artery.
A right coronary artery catheter was introduced and selective injections
using iodixanol were made of right coronary artery. The right coronary artery
catheter was exchanged and the left heart catheterization was performed at
rest with pressures being measured. The left ventriculogram was performed
using iodixanol. Total fluoroscopy time: 7.5 minutes
Example Part 1: Left heart catheterization
4A023N7
ICD-10-PCS Index
Catheterization
see
see
see
see
see
N Sampling and Pressure
Qualifier
ICD-10-PCS Tabular
The Measurement and Monitoring section is section 4 of ICD-10-PCS and
includes codes procedures that determine the level of a physiological or
physical function. The first character in the Measurement and Monitoring
section is “4.”
Character
2
Body
System
0 Open
3 Percutaneous
Character
7
Qualifier
Measurement and Monitoring Section
Character
1
Section
Funtion/Device
Example Part 2: Coronary angiography
ICD-10-PCS Code structure in the Measurement and Monitoring Section:
Character
1
Section
Approach
2 Cardiac
What Is Cardiac Ventriculography?
Cardiac Ventriculography is a medical imaging test used to determine a
patient's cardiac function most often in the left ventricle, but may be of the
right ventricle, or of the left and right ventricle. Cardiac ventriculography
involves injecting contrast media into the heart's ventricle(s) to measure the
volume of blood pumped. This is coded as:
• Fluoroscopy, Heart
4 Measurement and Monitoring
A Physiological Systems
0 Measurement: Determining the level of a physiological or physical function at a point in
time
Dilation
Drainage
Irrigation
Insertion of device in Heart
Measurement, Cardiac 4A02
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Section
Body System
Type
B Imaging
2 Heart
1 Fluoroscopy: Single plane or bi-plane real time display of an image developed from the
capture of external ionizing radiation on a fluorescent screen. The image may also be
stored by either digital or analog means
Body Part
4
5
6
7
8
F
Heart, Right
Heart, Left
Heart, Right and Left
Internal Mammary Bypass Graft, Right
Internal Mammary Bypass Graft, Left
Bypass Graft, Other
Contrast
0 High Osmolar
1 Low Osmolar
Y Other Constrast
Qualifier
Z None
Qualifier
Z None
Final codes for this procedure:
• Left heart catheterization 4A023N7
• Coronary angiography B2111ZZ
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• Left ventriculogram using iodixanol B2151ZZ
Note: The coder must be guided by documentation in the medical record
of each individual case to make the correct code selections.
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The ICD-10 Fun Corner
Anthelio's ICD-10 Obstetrics MatchCode Game
Directions: Match the correct ICD-10-CM code next to the following:
Intrauterine pregnancy, 12 weeks
gestation, undelivered, with mild
hyperemesis gravidarum
Z37.61
Therapeutic abortion, complete,
with embolism
O86.12
Elective sterilization
O90.3
Gestational hypertension pregnancy,
third trimester, undelivered
Z30.2
Endometritis following delivery
O13.3
Outcome of delivery, triplets, one
stillborn
O04.7
Peripartum cardiomyopathy
O21.0
The answers are on the next page.
© 2015 Anthelio Healthcare Solutions Inc. Proprietary and confidential. All Rights Reserved.
www.antheliohealth.com
The ICD-10 Fun Corner
Anthelio's ICD-10 Obstetrics MatchCode Game Solution
Intrauterine pregnancy, 12 weeks
gestation, undelivered, with mild
hyperemesis gravidarum
O21.0
Therapeutic abortion, complete,
with embolism
O04.7
Elective sterilization
Z30.2
Gestational hypertension pregnancy,
third trimester, undelivered
O13.3
Endometritis following delivery
O86.12
Outcome of delivery, triplets, one
stillborn
Z37.61
Peripartum cardiomyopathy
O90.3
© 2015 Anthelio Healthcare Solutions Inc. Proprietary and confidential. All Rights Reserved.
www.antheliohealth.com