4/16/2014 ICD-10 Coding Roundtable May 9, 2014 A N N E M . PAV L I K , R H I T AHIMA-APPROVE D ICD-10-CM/PCS TRAINER E D U C AT I O N C O N S U LTA N T T R A I N I N G A N D E D U C AT I O N D I V I S I O N © 2014 Amphion Medical Solutions Before we start… © 2014 Amphion Medical Solutions 2 Before we start… Are you trained in ICD-10-CM, ICD-10-PCS or both? Perhaps neither? © 2014 Amphion Medical Solutions 3 1 4/16/2014 Before we start… © 2014 Amphion Medical Solutions 4 ICD-10 Coding Roundtable Objectives Overview identified “documentation challenges” for coding in ICD -10 Overview “Virtual” Coding Roundtable © 2014 Amphion Medical Solutions 5 ICD-10 Coding Roundtable Topics for Discussion I69 (OCG and Excludes1 Note) Character 7: Qualifier X (Diagnostic) Excision versus Resection: Colon Removal Lymph Node versus Lymphatic Chain © 2014 Amphion Medical Solutions 6 2 4/16/2014 ICD-10 Coding Roundtable Handouts PP Slides ICD-10-CM Official Guidelines for Coding and Reporting 2014 ICD-10-PCS Official Guidelines for Coding and Reporting 2014 Operative Notes (Case Examples) © 2014 Amphion Medical Solutions 7 ICD-10 Coding Roundtable Weblinks 2014 ICD-10-CM Code Tables & Index http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-CM-and-GEMs.html ICD-10-CM Official Guidelines for Coding and Reporting 2014 http://www.cdc.gov/nchs/data/icd/icd10cm_guidelines_2014.pdf 2014 ICD-10-PCS Code Tables & Index 2014 Official ICD-10-PCS Coding Guidelines http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html 2014 ICD-10-PCS Reference Manual http://www.cms.gov/Medicare/Coding/ICD10/2014-ICD-10-PCS.html © 2014 Amphion Medical Solutions 8 Category I69 Chapter 9.Diseases of the circulatory system (I00-I99) I00-I02 I05-I09 I10-I15 I20-I25 I26-I28 I30-I52 I60-I69 I70-I79 I80-I89 I95-I99 Acute rheumatic fever Chronic rheumatic heart diseases Hypertensive diseases Ischemic heart diseases Pulmonary heart disease and diseases of pulmonary circulation Other forms of heart disease Cerebrovascular diseases Diseases of arteries, arterioles and capillaries Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified Other and unspecified disorders of the circulatory system © 2014 Amphion Medical Solutions 9 3 4/16/2014 Category I69 Chapter 9.Diseases of the circulatory system (I00-I99) I69 Sequelae of cerebrovascular disease Note: Category I69 is to be used to indicate conditions in I60-I67 as the cause of sequelae. The 'sequelae' include conditions specified as such or as residuals which may occur at any time after the onset of the causal condition Excludes1: personal history of cerebral infarction without residual deficit (Z86.73) personal history of prolonged reversible ischemic neurologic deficit (PRIND) (Z86.73) © 2014 Amphion Medical Solutions 10 Category I69 Chapter 9.Diseases of the circulatory system (I00-I99) I60 Nontraumatic subarachnoid hemorrhage I61 Nontraumatic intracerebral hemorrhage I62 Other and unspecified nontraumatic intracranial hemorrhage I63 Cerebral infarction I65 Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction I66 Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction I67 Other cerebrovascular diseases © 2014 Amphion Medical Solutions 11 Category I69 Section I.B. General Coding Guidelines (pg 14) 10. Sequela (Late Effects) A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can be used. The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous injury. Coding of sequela generally requires two codes sequenced in the following order: The condition or nature of the sequela is sequenced first. The sequela code is sequenced second. © 2014 Amphion Medical Solutions 12 4 4/16/2014 Category I69 ICD-10-CM Official Guidelines for Coding & Reporting 2014 Section I.C. Chapter-Specific Coding Guidelines (pg 44) 9. Chapter 9: Diseases of the Circulatory System (I00-I99) d. Sequelae of Cerebrovascular Disease 1) Category I69, Sequelae of Cerebrovascular disease Category I69 is used to indicate conditions classifiable to categories I60-I67 as the causes of sequela (neurologic deficits), themselves classified elsewhere. These “late effects” include neurologic deficits that persist after initial onset of conditions classifiable to categories I60-I67. The neurologic deficits caused by cerebrovascular disease may be present from the onset or may arise at any time after the onset of the condition classifiable to categories I60-I67. © 2014 Amphion Medical Solutions 13 Category I69 ICD-10-CM Official Guidelines for Coding & Reporting 2014 Section I.C. Chapter-Specific Coding Guidelines (pg 44) 9. Chapter 9: Diseases of the Circulatory System (I00-I99) d. Sequelae of Cerebrovascular Disease 2) Codes from category I69 with codes from I60-I67 Codes from category I69 may be assigned on a health care record with codes from I60-I67, if the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease. © 2014 Amphion Medical Solutions 14 Category I69 Chapter 9.Diseases of the circulatory system (I00-I99) I60 Nontraumatic subarachnoid hemorrhage Excludes1: sequelae of subarachnoid hemorrhage (I69.0-) I61 Nontraumatic intracerebral hemorrhage Excludes1: sequelae of intracerebral hemorrhage (I69.1-) I62 Other and unspecified nontraumatic intracranial hemorrhage Excludes1: sequelae of intracranial hemorrhage (I69.2) I63 Cerebral infarction Excludes1: sequelae of cerebral infarction (I69.3-) I67 Other cerebrovascular diseases Excludes1: sequelae of the listed conditions (I69.8) © 2014 Amphion Medical Solutions 15 5 4/16/2014 Category I69 ICD-10-CM Official Guidelines for Coding & Reporting 2014 Section I.A. Conventions for the ICD-10-CM (pg 10) 12. Excludes Notes The ICD-10-CM has two types of excludes notes. Each type of note has a different definition for use but they are all similar in that they indicate that codes excluded from each other are independent of each other. a. Excludes1 A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. © 2014 Amphion Medical Solutions 16 Category I69 Chapter 9.Diseases of the circulatory system (I00-I99) I60 Nontraumatic subarachnoid hemorrhage Excludes1: sequelae of subarachnoid hemorrhage (I69.0-) Cannot assign a code from category I69.0- & a code from category I60 © 2014 Amphion Medical Solutions 17 Category I69 Chapter 9.Diseases of the circulatory system (I00-I99) I60 Nontraumatic subarachnoid hemorrhage Excludes1: sequelae of subarachnoid hemorrhage (I69.0-) I61 Nontraumatic intracerebral hemorrhage Excludes1: sequelae of intracerebral hemorrhage (I69.1-) I62 Other and unspecified nontraumatic intracranial hemorrhage Excludes1: sequelae of intracranial hemorrhage (I69.2) I63 Cerebral infarction Excludes1: sequelae of cerebral infarction (I69.3-) I67 Other cerebrovascular diseases Excludes1: sequelae of the listed conditions (I69.8) © 2014 Amphion Medical Solutions 18 6 4/16/2014 Category I69 Chapter 9.Diseases of the circulatory system (I00-I99) Hemiplegia following cerebrovascular disease I69.G81 Hemipleia and Hemiparesis Note: This category is to be used only when hemiplegia (complete)(incomplete) is reported without further specification, or is stated to be old or longstanding but of unspecified cause. The category is also for use in multiple coding to identify these types of hemiplegia resulting from any cause. Excludes1: congenital cerebral palsy (G80.-) hemiplegia and hemiparesis due to sequela of cerebrovascular disease (I69.05-, I69.15-, I69.25-, I69.35-, I69.85-, I69.95-) © 2014 Amphion Medical Solutions 19 Category I69 Chapter 9.Diseases of the circulatory system (I00-I99) *CC I69.059 Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting unspecified side *CC I69.159 Hemiplga following nontraumatic intcrbl hemor affecting unspecified side *CC I69.259 Hemiplga following oth nontraumatic intcrn hemor affecting unspecified side *CC I69.359 Hemiplegia and hemiparesis following cerebral infarction affecting unspecified side *CC I69.859 Hemiplegia and hemiparesis following other cerebrovascular disease affecting unspecified side *Complication/Comorbidity © 2014 Amphion Medical Solutions 20 Category I69 MS-DRG Grouping Grouper Flag Nontraumatic subarachnoid hemorrhage, unspecified I69.059 hemorrhage affecting unspecified side 065 Intracranial hemorrhage or cerebral infarction w CC or tPA in 24 hrs 066 Intracranial hemorrhage or cerebral infarction w /o CC /MCC 1 Diseases and Disorders of the Nervous System Grouper Flag CC ICD-10-CM Code Description Excludes1 Note prevents us following from reporting! Hemiplegia and hemiparesis nontraumatic subarachnoid CC DRG: DRG: MDC: ICD-10-CM Code I60.9 ICD-9-CM Code ICD-9-CM Code Description 430 Subarachnoid Hemorrhage 438.20 Hemiplegia Affecting Unspecified Side © 2014 Amphion Medical Solutions 21 7 4/16/2014 Category I69 Case Discussion I69 (OCG, Excludes1 Note, MS-DRG) © 2014 Amphion Medical Solutions 22 Qualifier X (Diagnostic) Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part Approach Device Qualifier 7 Characters in a PCS Code (1-9; A-H, J-N, and P-Z) Each character has its own unique meaning © 2014 Amphion Medical Solutions 23 Qualifier X (Diagnostic) Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part Approach Device Qualifier 3rd character indicates the root operation which is the objective of the procedure 31 root operations in the Medical and Surgical section © 2014 Amphion Medical Solutions 24 8 4/16/2014 Qualifier X (Diagnostic) Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part Approach Device Qualifier 7th character indicates the qualifier Defines an additional attribute of the performed procedure No specific guidelines © 2014 Amphion Medical Solutions 25 Qualifier X (Diagnostic) 2014 ICD-10-PCS Reference Manual (pg 20) The seventh character defines a qualifier for the code. A qualifier specifies an additional attribute of the procedure, if applicable. Examples of qualifiers include Diagnostic and Stereotactic. Qualifier choices vary depending on the previous values selected. © 2014 Amphion Medical Solutions 26 Qualifier X (Diagnostic) ICD-10-PCS Official Guidelines for Coding & Reporting 2014 Section B. Medical and Surgical Section Guidelines (pg 6) Biopsy procedures B3.4a Biopsy procedures are coded using the root operations Excision, Extraction, or Drainage and the qualifier Diagnostic. The qualifier Diagnostic is used only for biopsies. Examples: Fine needle aspiration biopsy of lung is coded to the root operation Drainage with the qualifier Diagnostic. Biopsy of bone marrow is coded to the root operation Extraction with the qualifier Diagnostic. Lymph node sampling for biopsy is coded to the root operation Excision with the qualifier Diagnostic. © 2014 Amphion Medical Solutions 27 9 4/16/2014 Qualifier X (Diagnostic) ICD-10-PCS Official Guidelines for Coding & Reporting 2014 Section B. Medical and Surgical Section Guidelines (pg 3) Conventions A11 Many of the terms used to construct PCS codes are defined within the system. It is the coder’s responsibility to determine what the documentation in the medical record equates to in the PCS definitions. The physician is not expected to use the terms used in PCS code descriptions, nor is the coder required to query the physician when the correlation between the documentation and the defined PCS terms is clear. © 2014 Amphion Medical Solutions 28 Qualifier X (Diagnostic) ICD-10-PCS Official Guidelines for Coding & Reporting 2014 Section B. Medical and Surgical Section Guidelines (pg 3) Conventions A11 (continued) Example: When the physician documents “partial resection” the coder can independently correlate “partial resection” to the root operation Excision without querying the physician for clarification. © 2014 Amphion Medical Solutions 29 Qualifier X (Diagnostic) 2014 ICD-10-PCS Reference Manual (pg 44-45) Extraction - Root operation D Definition: Pulling or stripping out or off all or a portion of a body part by the use of force Explanation: The qualifier Diagnostic is used to identify extraction procedures that are biopsies Examples: Dilation and curettage, vein stripping © 2014 Amphion Medical Solutions 30 10 4/16/2014 Qualifier X (Diagnostic) 2014 ICD-10-PCS Reference Manual (pg 44-45) Extraction - Root operation D Extraction is coded when the method employed to take out the body part is pulling or stripping. Minor cutting, such as that used in vein stripping procedures, is included in Extraction if the objective of the procedure is nevertheless met by pulling or stripping. As with all applicable ICD-10-PCS codes, cutting used to reach the procedure site is specified in the approach value. © 2014 Amphion Medical Solutions 31 Qualifier X (Diagnostic) 2014 ICD-10-PCS Reference Manual (pg 44-45) Extraction - Root operation D Example: Suction dilation & curettage ...after induction of general anesthesia the patient was placed in the dorsal lithotomy position and appropriately prepped and draped. Successive dilators were placed until the cervix was adequate for insertion of the suction cannula. Suction cannula was placed and suction curettage performed with no residual endometrial lining. The tissue was sent to pathology to rule out endometrial cancer... © 2014 Amphion Medical Solutions 32 Qualifier X (Diagnostic) Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Medical & Surgical Body System Female Reproductive Root Operation Extraction Body Part Endometrium Device No Device Qualifier Diagnostic 0 U D B Approach Via Natural/ Artifical Opening 7 Z X The tissue was sent to pathology to rule out endometrial cancer... © 2014 Amphion Medical Solutions 33 11 4/16/2014 Qualifier X (Diagnostic) 2014 AHIMA Coder Training Manual Extraction - Root operation D Example: Dilation & curettage The patient undergoes a D&C with documentation indicating that the endocmetrial cavity was curetted for tissue sampling. © 2014 Amphion Medical Solutions 34 Qualifier X (Diagnostic) AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2014 (p92) If a lesion is removed for therapeutic purposes & sent to the laboratory for examination, even though the term “biopsy” may be used in describing the procedure, a biopsy code is not assigned. Surgical specimens are routinely sent to the pathology laboratory for examination (study); In this instance, the procedure is not a biopsy and assigning a biopsy code (qualifier X for diagnostic) is inappropriate. © 2014 Amphion Medical Solutions 35 Qualifier X (Diagnostic) 2014 AHIMA Coder Training Manual Drainage - Root operation 9 Example: Arthrocentesis of Right Knee The patient is evaluated for septic arthritis of the right knee and an arthrocentesis is performed. © 2014 Amphion Medical Solutions 36 12 4/16/2014 Qualifier X (Diagnostic) 2014 AHIMA Coder Training Manual Excision - Root operation D Example: Partial Mastectomy, UOQ, right breast Pre and Postop Dx: Localized area of extensive fibrocystic mastitis Procedure: A wedge excision of the upper outer quadrant of the right breast was performed. The specimen was sent to the lab for histological frozen section which revealed a benign fibrocystic mastitis without any evidence of malignancy. What’s our Qualifier? Z = No Qualifier or X = Diagnostic? © 2014 Amphion Medical Solutions 37 Qualifier X (Diagnostic) Case Example Excision - Root operation D Example: Fractional D&C Pre and Postop Dx: Dysfunctional Uterine Bleeding Procedure: Sharp curetting of the entire cavity was again performed until a gritty texture was noted. Endometrial curettings were submitted to Pathology. What’s our Qualifier? Z = No Qualifier or X = Diagnostic? © 2014 Amphion Medical Solutions 38 Qualifier X (Diagnostic) Case Example Excision - Root operation D Example: Fractional D&C Pre and Postop Dx: Dysfunctional Uterine Bleeding , rule out … Procedure: Sharp curetting of the entire cavity was again performed until a gritty texture was noted. Endometrial curettings were submitted to Pathology. What’s our Qualifier? Z = No Qualifier or X = Diagnostic? © 2014 Amphion Medical Solutions 39 13 4/16/2014 Qualifier X (Diagnostic) Case #1 PROCEDURE: Bone marrow aspirate and biopsy PROCEDURE SUMMARY: … the Jamshidi needle was advanced into the bone cavity. A bone marrow biopsy was obtained without any complications. What’s our Qualifier? Z = No Qualifier or X = Diagnostic? © 2014 Amphion Medical Solutions 40 Qualifier X (Diagnostic) Case #2 PROCEDURE: Bilateral excision of bilateral breast lumps PROCEDURE SUMMARY: The right breast was performed first by injecting a local anesthetic in the infraareolar area and a curvilinear incision was made at the areolar border. Dissection was taken down posterior to the nipple and, with careful dissection towards the upper outer quadrant, a clump of tissue was removed. © 2014 Amphion Medical Solutions 41 Qualifier X (Diagnostic) Case #2 PROCEDURE: Bilateral excision of bilateral breast lumps PROCEDURE SUMMARY: Attention was then turned to a left breast lump which was more retroareolar and lateral. Local anesthetic was injected in the infraareolar border and a curvilinear incision was made in the areolar margin. Dissection was taken down the retroareolar position, scraping the lump off the dermis posteriorly. Dissection was taken down around the lump with traction retraction and sharp dissection. This was taken laterally until all of the mass was completely removed in 1 piece. What’s our Qualifier? Z = No Qualifier or X = Diagnostic? © 2014 Amphion Medical Solutions 42 14 4/16/2014 Qualifier X (Diagnostic) Case #3 PROCEDURE: Colonoscopy with snare polypectomy. POSTOPERATIVE DIAGNOSIS: A total of 3 polyps in the rectosigmoid region all measuring between 4 and 8 mm removed with hot snare recovered for histopathology. PROCEDURE SUMMARY: A total of 3 polyps were found in the rectosigmoid region measuring between 4 and 8 mm, all had fairly narrow-based attachment and each was removed with a hot snare and recovered for histopathology. © 2014 Amphion Medical Solutions 43 Qualifier X (Diagnostic) Case #3 PROCEDURE: Colonoscopy with biopsy POSTOPERATIVE DIAGNOSIS: Large spreading multinodular carpet-like polyp versus mass at hepatic flexure, multiple biopsies obtained. PROCEDURE SUMMARY: There was an additional, quite large polyp at the hepatic flexure. …. This was too big to endoscopically remove. Multiple biopsies were taken for histopathology. What’s our Qualifier? Z = No Qualifier or X = Diagnostic? © 2014 Amphion Medical Solutions 44 Qualifier X (Diagnostic) Case Discussion Character 7: Qualifier X (Diagnostic) © 2014 Amphion Medical Solutions 45 15 4/16/2014 Excision vs Resection Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section Body System Root Operation Body Part Approach Device Qualifier 3rd character indicates the root operation which is the objective of the procedure 31 root operations in the Medical and Surgical section © 2014 Amphion Medical Solutions 46 Excision vs Resection 2014 ICD-10-PCS Reference Manual (pg 44-45) Excision Definition: Cutting out or off, without replacement, a portion of a body part Explanation: The qualifier Diagnostic is used to identify excision procedures that are biopsies Examples: Partial nephrectomy, liver biopsy Resection Definition: Cutting out or off, without replacement, all of a body part Explanation: N/A Examples: Total nephrectomy, total lobectomy of lung © 2014 Amphion Medical Solutions 47 Excision vs Resection ICD-10-PCS Official Guidelines for Coding & Reporting 2014 Section B. Medical and Surgical Section Guidelines (pg 7) Excision vs. Resection B3.8 PCS contains specific body parts for anatomical subdivisions of a body part, such as lobes of the lungs or liver and regions of the intestine. Resection of the specific body part is coded whenever all of the body part is cut out or off, rather than coding Excision of a less specific body part. Example: Left upper lung lobectomy is coded to Resection of Upper Lung Lobe, Left rather than Excision of Lung, Left. © 2014 Amphion Medical Solutions 48 16 4/16/2014 Excision vs Resection Lobes of Lung 1. 2. 3. 4. 5. Left Upper Lobe (LUL) Left Lower Lobe (LLL) Right Upper Lobe (RUL) Right Middle Lobe (RML) Right Lower Lobe (RLL) Removal of entire lobe of lung: Root Operation = Resection (Cutting out or off, without replacement, all of a body part) © 2014 Amphion Medical Solutions 49 Excision vs Resection ICD-10-PCS Official Guidelines for Coding & Reporting 2014 Section B. Medical and Surgical Section Guidelines (pg 6) Multiple Procedures B3.2 During the same operative episode, multiple procedures are coded if: a. The same root operation is performed on different body parts as defined by distinct values of the body part character. Example: Diagnostic excision of liver and pancreas are coded separately. © 2014 Amphion Medical Solutions 50 Excision vs Resection ICD-10-PCS Official Guidelines for Coding & Reporting 2014 Section B. Medical and Surgical Section Guidelines (pg 6) Multiple Procedures B3.2 During the same operative episode, multiple procedures are coded if: b. The same root operation is repeated at different body sites that are included in the same body part value. Example: Excision of the sartorius muscle and excision of the gracilis muscle are both included in the upper leg muscle body part value, and multiple procedures are coded. © 2014 Amphion Medical Solutions 51 17 4/16/2014 Excision vs Resection Index Entries: Excision intestine large 0DBE left 0DBG right 0DBT small 0DB8 Resection intestine large 0DTE left 0DTG right 0DTF small 0DT8 © 2014 Amphion Medical Solutions 52 Excision vs Resection © 2014 Amphion Medical Solutions Excision vs Resection © 2014 Amphion Medical Solutions 18 4/16/2014 Excision vs Resection © 2014 Amphion Medical Solutions Excision vs Resection 2014 ICD-10-PCS Reference Manual (pg 39-40) Example: Right hemicolectomy ...a vertical midline incision was used to enter the abdominal cavity. There was noted to be a mass in the region of the cecum. The mass was easily mobilized and it was felt that a right hemicolectomy was indicated. The right colon was mobilized by incising the white line of Toldt and reflecting colon medially. The loose tissue was taken down bluntly with a hand and adhesions were taken down sharply. © 2014 Amphion Medical Solutions 56 Excision vs Resection 2014 ICD-10-PCS Reference Manual (pg 39-40) Example: Right hemicolectomy The colon was mobilized to the left end up to the level of the hepatic flexure. The mesentery was incised sharply with a knife and down to the level of the root of the mesentery. The mesentery of the right colon and the distal ileum was then taken down between Kellys and tied with #2-0 silk, down to the level of the takeoff vessels. After removing the right colon specimen off the field, a primary anastomosis was planned... . © 2014 Amphion Medical Solutions 57 19 4/16/2014 Excision vs Resection Right Colon Left Colon Canadian Cancer Society, Surgery for colon cancer. 15, April 2104 < http://www.cancer.ca/en/cancer-information/cancer-type/colorectal/treatment/surgery/surgery-for-colon-cancer/?region=on> © 2014 Amphion Medical Solutions Excision vs Resection Character 1 Character 2 Character 3 Character 4 Character 5 Character 6 Character 7 Section (Medical & Surgical) Body System (Gastrointestinal) Root Operation (Resection) Body Part (Lg Intestine, Right) Approach (Open) Device (No Device) Qualifier (No Qualifier) 0 D T F 0 Z Z © 2014 Amphion Medical Solutions 59 Excision vs Resection Case #4 PROCEDURE: Right hemicolectomy PROCEDURE SUMMARY: … entire ileocecal region up to the transverse colon was mobilized into the field. A window was made 5 inches from the ileocecal valve and a GIA-75 was fired across the ileum. A second GIA device was fired across the proximal transverse colon, © 2014 Amphion Medical Solutions 60 20 4/16/2014 Excision vs Resection Case #5 PROCEDURE: Low anterior colon resection PROCEDURE SUMMARY: … a GIA was fired right across the descending colon and sigmoid colon junction and then with peons within the mesentery were placed all the way down to the rectosigmoid junction where a TA55 balloon Roticulator was fired. The specimen was cut with #10 blade Bard-Parker and sent it to Pathology. © 2014 Amphion Medical Solutions 61 Excision vs Resection Right Colon Left Colon Canadian Cancer Society, Surgery for colon cancer. 15, April 2104 < http://www.cancer.ca/en/cancer-information/cancer-type/colorectal/treatment/surgery/surgery-for-colon-cancer/?region=on> © 2014 Amphion Medical Solutions Excision vs Resection Case Discussion Excision versus Resection: Colon Removal Lymph Node versus Lymphatic Chain © 2014 Amphion Medical Solutions 63 21 4/16/2014 Lymph Node vs Lymphatic Chain 2014 ICD-10-PCS Reference Manual (pg 39) Coding note: Lymph nodes When an entire lymph node chain is cut out, the appropriate root operation is Resection. When a lymph node(s) is cut out, the root operation is Excision. © 2014 Amphion Medical Solutions 64 Lymph Node vs Lymphatic Chain http://www.paradoja7.com/lymph-node-system/ © 2014 Amphion Medical Solutions Lymph Node vs Lymphatic Chain Major Lymph Node Chains of Head SEER Training Modules, Major Lymph Node Chains of Head. U. S. National Institutes of Health, National Cancer Institute. 24, March 2014<http://training.seer.cancer.gov/head-neck/anatomy/lymph-node.html> © 2014 Amphion Medical Solutions 22 4/16/2014 Lymph Node vs Lymphatic Chain Lymph Nodes of Breast & Arm Axillary Lymph Nodes 2. Apical axillary 3. Lateral (surface) axillary 4. Lateral (surface) axillary 5. Central axillary 6. Brachial axillary 7. Interpectoral 8. Paramammary 9. Parasternal (internal mammary) SEER Training Modules, Lymph Nodes of Breast & Arm. U. S. National Institutes of Health, National Cancer Institute. 10, April 2014<http://training.seer.cancer.gov/lymphoma/anatomy/chains/lymph-upper.html> © 2014 Amphion Medical Solutions Lymph Node vs Lymphatic Chain Canadian Cancer Society, Anatomy and physiology of the breast. 15, April 2104 <http://www.cancer.ca/en/cancer-information/cancer-type/breast/anatomy-and-physiology/?region=on#ixzz2yQMbbhtJ> © 2014 Amphion Medical Solutions Lymph Node vs Lymphatic Chain © 2014 Amphion Medical Solutions 23 4/16/2014 Lymph Node vs Lymphatic Chain © 2014 Amphion Medical Solutions Lymph Node vs Lymphatic Chain Case #6 PROCEDURE: Left axillary lymph node excisional biopsy PROCEDURE SUMMARY: … I was able to easily palpate the lymph node and grasp it with a figure-of-eight 2-0 silk suture and by sharp dissection, was carried to hemoclip all attached structures. The lymph node was excised in its entirety. © 2014 Amphion Medical Solutions 71 Lymph Node vs Lymphatic Chain Case #7 PROCEDURE: Bilateral Mastectomies with Axillary Node Dissection PROCEDURE SUMMARY: … Then, 4 mL of Lymphazurin blue dye was injected in the subareolar area for lymphatic mapping. … The axillary space was entered. Blue lymphatics and blue lymph nodes were identified. There were three that contained blue dye. One was firm and palpable. These were all sent as sentinel lymph nodes and were negative by touch prep. No additional palpable nodes were noted. © 2014 Amphion Medical Solutions 72 24 4/16/2014 Lymph Node vs Lymphatic Chain Case #8 PROCEDURE: Left modified radical mastectomy PROCEDURE SUMMARY: … then the axillary contents were dissected out. Left axillary vein and artery were identified and preserved. The patient had several clinically palpable lymph nodes, they were removed with the axillary dissection. Care was taken to avoid injury to any of the above mentioned neurovascular structures. © 2014 Amphion Medical Solutions 73 Lymph Node vs Lymphatic Chain Case Discussion Excision versus Resection: Colon Resections Lymph Node versus Lymphatic Chain © 2014 Amphion Medical Solutions 74 Coding Clinic for ICD-10 Effective January 1, 2014, the AHA Central Office will no longer accept questions on ICD-9-CM. AHA began publishing answers on ICD-10-CM/PCS questions in Coding Clinic 4th Qtr 2012. Online process now available; however if you’ve already mailed or faxed a question do not resubmit it online as this will create a duplicate in the system and significantly delay the processing of the original question. Response time for submitted questions is dependent on the complexity of the question. © 2014 Amphion Medical Solutions 75 25 4/16/2014 Coding Clinic for ICD-10 How ICD-10-CM Questions are Addressed http://www.ahacentraloffice.org/ Submit a Question http://www.codingclinicadvisor.com/ (also provides link to FAQ – Do’s & Don’ts for submitting ?s) Frequently Asked Questions http://www.codingclinicadvisor.com/Faq.aspx © 2014 Amphion Medical Solutions 76 ICD-10 Coding Roundtable Questions?? Questions [email protected] © 2014 Amphion Medical Solutions 77 WHIMA Coding Roundtable for ICD-10 The WHIMA I-10 Task Force is offering participation in a WHIMA Virtual Coding Roundtable beginning with the Fall WHIMA meeting. © 2014 Amphion Medical Solutions 78 26 4/16/2014 WHIMA Coding Roundtable for ICD-10 Future Sessions Following the Fall WHIMA meeting the coding roundtable will be conducted remotely every other month Questions submitted prior to next roundtable will be addressed Questions should be accompanied by chart documentation with all PHI removed Questions not pertaining to the current roundtable’s agenda will be addressed at the next roundtable Registration fee is $50 per site per roundtable session © 2014 Amphion Medical Solutions 79 ICD-10 Coding Roundtable Thank you for the opportunity to speak with you today © 2014 Amphion Medical Solutions 27
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