ICD-10 Transition tips and tools

Outpatient Surgical Coding Exercise: Ventral Hernia

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Below is an example of a common hernia procedure as well as the ICD-10-CM codes that should be assigned for this outpatient encounter.

Preoperative Diagnosis:         Ventral hernia

Postoperative Diagnosis:        Same

Procedure:                              Laparoscopic ventral hernia repair with mesh

Anesthesia:                              General

Procedure Description: The patient was taken to the operating room and underwent general anesthesia. A 5 millimeter optical trocar was placed in the right upper quadrant after anesthetizing the skin with Marcaine. Then under direct camera visualization a 10 millimeter port was placed in the right lower quadrant, and a 5 millimeter port was placed on the left side of the abdomen. 

The peritoneal fat was reduced from the hernia. A small stab incision was made overlying the skin and the hernia through which the endo close device was used to secure Vicryl sutures around the defect, after which time a Parietx mesh was introduced through the abdominal cavity, then secured into position using AbsorbaTack overlying the hernia.  Meticulous hemostasis was obtained. The fascial defect from the 10 millimeter port was closed using endo close device and large Vicryl sutures. Pneumoperitoneum was evacuated.  Skin was approximated using absorbable sutures. Dermabond was applied.  The patient tolerated the procedure well.

Codes Assigned
Listed below in the first table is a comparison of the ICD-9 diagnosis codes and the ICD-10 diagnosis codes. As you can see, the descriptors are similar.

ICD-9-CM Diagnosis Codes

ICD-10-CM Diagnosis Codes

553.20  Ventral hernia, unspecified

K43.90  Ventral hernia, unspecified, without obstruction or gangrene

 Note also that each digit of the ICD-10 diagnosis code is a specific identifier: K = Chapter 11-disease of digestive system; 40-46 = hernia; 43 = ventral; .90 = without obstruction or gangrene, unspecified.

However, now review the second table, which lists the ICD-9 procedure codes against the ICD-10 procedure codes, and you will see that their descriptors differ. Even though ICD-9-CM procedure codes would not be reported in the outpatient setting (per HIPAA guidelines), we are providing them below for illustrative purposes.

For respiratory, the ICD-10 Index for procedures instructs the coder to see the anatomical region, lower extremity. The ventral hernia is of the abdominal wall, and following the logic the coder would see the anatomical region, abdominal wall.

ICD-9-CM Procedure Codes

ICD-10-PCS

53.63 - Other laparoscopic repair of other hernia, of anterior abdominal wall with graft or prosthesis

OWQF4ZZ  Repair of abdominal wall by percutaneous endoscopic method

 

Like the ICD-10 diagnosis codes, each digit in the ICD-10-PCS column identifies a specific feature: O = medical surgical; W = anatomical region, general; Q = repair; F = abdominal wall; 4 = percutaneous endoscopic; Z= No device; and Z = no qualifier.

In addition, for the above outpatient case, you will need to assign the following CPT procedure codes.

49659 Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy

The following are the links to access the latest version of ICD-10-CM and ICD-10-PCS.

http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm and http://www.cms.hhs.gov/ICD10/01m_2009_ICD10PCS.asp#TopOfPage

Peggy Hapner is manager of the HIM consulting division at Medical Learning Inc. (MedLearn), St. Paul, MN.


ICD 10 Transition tips and tools Archives
 

Hi,

I am pursuing a career and Medical Billing and Coding. How does one becomes an excellent Medical Coder? What is the highest degree an individual can obtain as a Medical and Coding? Please do tell.

Regards,


Ginou

Ginou LissadeOctober 07, 2009
Elmont, NY




     

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