ICD-10 Transition tips and tools

Inpatient Diagnosis and Procedure Coding: Carotid Stenosis

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Below are two inpatient procedures, and the ICD-10-CM diagnosis and procedure codes that would be assigned for them when the new system takes effect.  Also included are the ICD-9-CM system codes that be assigned currently.

Procedure 1

Date of Service: 02/21/2010 1030

Preoperative Diagnosis: Carotid stenosis

Postoperative Diagnosis: Carotid stenosis

Procedure: Right carotid endarterectomy

Anesthesia: General endotracheal anesthesia

Indications for Procedure: The patient is an 82-year-old male with a history of carotid stenosis. The patient underwent a left carotid endarterectomy a few weeks ago and now he is here for critical stenosis of his right internal carotid artery.

Procedure: After explaining the risks and benefits of the procedure and obtaining informed consent, the patient was taken to the operating room and placed supine on the operating table. After placement of monitoring lines and induction of general endotracheal anesthesia, the neck and upper chest were prepped with Betadine and draped in a sterile fashion. An oblique incision was made along the anterior border of the sternocleidomastoid on the right side. The incision was carried through the skin, platysma and deep cervical fascia. Then the patient was systemically heparinized with 8,000 units of intravenous heparin. The carotid sheath was entered, and the common carotid artery was identified. This was dissected to the bifurcation, and the internal and external carotid arteries were dissected freely. Then testing clamping with the common carotid artery, and after a stable EEG, the internal and external carotid arteries were also clamped. An arteriotomy was made in the common carotid artery, and this was brought into the internal carotid artery. A standard endarterectomy was performed, taking care to remove all debris from the artery. The artery was irrigated thoroughly with heparinized saline. The vagus, the ansa, and the hypoglossal nerves were visualized and were preserved. The arteriotomy was closed with 6-0 Prolene in running fashion. Flow was re-established. Hemostasis was obtained, and the incision was closed with 2 layers of 2-0 Vicryl. The skin was closed with subcuticular 3-0 Vicryl. The patient tolerated the procedure well. Estimated blood loss was 100 ml. The needle, sponge, and instrument counts were correct.

Diagnosis Code Assignments
ICD-9-CM Diagnosis Code: 433.10 -- occlusion stenosis carotid artery without cerebral infarction

ICD-10-CM Diagnosis Code:  I65.21

Alphabetic Index: Stenosis, artery, cerebral (see occlusion, artery, cerebral)

Alphabetic Index: Occlusion, artery, carotid I65.2-

Tabular Index: Occlusion, artery, carotid, right I65.21

Procedure Code Assignments
ICD-9-CM Procedure Code: 38.12 -- carotid endarterectomy and 00.40 procedure on single vessel

ICD-10-CM Procedure Code: 03BK0ZZ

In the ICD-10 system, each digit of the code indicates a specific identifier. For the above code, digits are interpreted as follows.

(0) Section: Medical surgical

(3) Body System: Upper arteries

(B) Root Operation: Excision (cutting out or off, without replacement, a portion of a body part). A standard endarterectomy was performed, taking care to remove all debris from the artery.

(K) Body Part: Internal carotid artery, right. Right internal carotid artery.

(0) Approach: Open. Oblique incision was made along the anterior border of the sternocleidomastoid on the right side.

(Z) Device: Not applicable

(Z) Qualifier: Not applicable

Procedure 2
Date of Service: 02/22/2010 2035

Preoperative Diagnosis: Carotid stenosis and thrombosis of the right carotid artery, status post right carotid endarterectomy

Postoperative Diagnosis: Carotid stenosis and thrombosis of the right carotid artery, status post right carotid endarterectomy

Operation: Exploration of right carotid, bring back under GA, removal of thrombus, and patch angioplasty

Anesthesia: General endotracheal

Indications for Procedure: Patient is an 81-year-old male who underwent a right carotid endarterectomy that was uneventful. The patient was noted to have iatrogenic CVA left sided with hemiplegia approximately 7 hours after the surgery. CT angiogram confirmed possible occlusion of the right carotid artery.

Procedure: The patient was emergently brought to the operating room and on the operating table. After placement of monitoring lines and induction of general endotracheal anesthesia, the patient was then systemically heparinized. The neck and upper chest were prepped with Betadine and draped in a sterile fashion. Then the incision was opened. The incision was carried through the skin and subcutaneous tissue to the deep fascia. The carotid artery was identified. The patient was then heparinized with an additional 5,000 units of intravenous heparin, and the carotid artery was left undisturbed at this point and interrogation with Doppler ultrasound revealed flow in both the common and the internal carotid artery. Now, the carotid suture line was then opened, again, not clamping the artery at this point. Thrombus was extracted, taking care to not allow any embolization of the thrombus. The distal extraction of the thrombus was performed first, and there was good backflow from the internal carotid artery. At this point, the right internal carotid artery was clamped and then the proximal common carotid artery was explored and the thrombus was removed. There was good brisk antegrade flow. At this point, a bovine pericardial patch was used to close the carotid incision with 6-0 Prolene. Once this was completed, flow was re-established. Hemostasis was obtained, and a 10-French Jackson-Pratt drain was inserted through a separate stab incision. The incision was then closed with 2 layers of 2-0 Vicryl. The skin was closed with subcuticular 3-0 Vicryl. The patient tolerated the procedure well. Estimated blood loss was 100 mL. The needle, sponge, and instrument counts were correct.

Diagnosis Code Assignments
ICD-9-CM Diagnosis Code: 997.02 -- iatrogenic CVA

ICD-10-CM Diagnosis Code: I97.821

Alphabetic Index: Complications, postoperative (see complications, circulatory system)

Alphabetic Index: Complications, circulatory system, postprocedural I97.89

Tabular Index:

I97.8    Other intraoperative and postprocedural complications and disorders of the circulatory system, not elsewhere classified. (Use additional code, if applicable, to further specify the disorder.)

I97.82 Postprocedural cerebrovascular infarction (validate in tabular correct code descriptor for diagnosis: incorrect I97.89, correct I97.821)

I97.821 Postprocedural cerebrovascular infarction during other surgery


ICD-9-CM Diagnosis Code:
434.01 -- cerebral thrombus with cerebral infarction

ICD-10-CM Diagnosis Code: I63.031

Alphabetic Index: Infarction, cerebral, due to, thrombus, pre-cerebral artery, I63.0-

Tabular Index: Cerebral infarction due to thrombosis of precerebral arteries I63.0

Tabular Index: Cerebral infarction due to thrombosis of right carotid artery I63.031


ICD-9-CM Diagnosis Code:
342.90 -- unspecified hemiplegia hemiparesis nondominant side

ICD-10-CM Diagnosis Code: I69.354

Alphabetic Index: Hemiplegia following cerebral infarction I69.35-

Tabular Index: Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side I69.354.

ICD-10-CM (2011 version) Official Guidelines for Coding and Reporting: Disease-specific guidelines, Chapter 6, Diseases of Nervous System and Sense Organs, a) Dominant/Non-dominant Side. If the affected side is documented, but not specified as dominant or non-dominant, and the classification system does not indicate the default, code selection is as follows: If the left side is affected, the default is non-dominant. If the right side is affected (or for ambidextrous patients), the default is dominant.


ICD-9-CM Procedure Code:
38.02 -- incision vessel head/neck

ICD-10-PCS Procedure Code: 03CK0ZZ

In the ICD-10 system, each digit of the code indicates a specific identifier. For the above code, digits are interpreted as follows.

 (0) Section: Medical Surgical

(3) Body System: Upper Arteries

(C) Root Operation: Extirpation (taking or cutting out solid matter from a body part). Thrombus was extracted, taking care to not allow any embolization of the thrombus.

(K) Body Part: Internal Carotid Artery, Right. Right internal carotid artery.

(0) Approach: Open. The incision was carried through the skin and subcutaneous tissue to the deep fascia...

(Z) Device: Not applicable

(Z) Qualifier: Not applicable


ICD-9-CM Procedure Code:
39.56 -- repair blood vessel with tissue patch graft)

ICD-10-CM Procedure Code: 03RK0KZ

(0) Section: Medical Surgical

(3) Body System: Upper Arteries

(R) Root Operation: Replacement (putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part). A bovine pericardial patch was used.

(K) Body Part: Internal Carotid Artery, Right. Right internal carotid artery.

(0) Approach: Open. The incision was carried through the skin and subcutaneous tissue to the deep fascia...

(K) Device: Non-autologous tissue substitute. A bovine pericardial patch was used to close the carotid incision.

(Z) Qualifier: Not applicable

Carol Spencer is a senior healthcare consultant with Medical Learning Inc. (MedLearn), St. Paul, MN.


ICD 10 Transition tips and tools Archives
 

I am trying to determine the CPT code for the interpretation of an EEG during a carotid endarerectomy. Many thanks

Alice Gross,  Office Manater,  Abington Neurological Associates, LtdJuly 24, 2013
Willow Grove, PA



I am preparing for graduation from a St. Louis Community College. I will be graduating this coming Saturday and I must say that ICD-10 is all the way different from ICD-9. It looks really interesting and I can't wait to learn it but first I have to get really used to ICD-9 but I don't think ICD-10 will be a problem.

Tamra RobinsonMay 19, 2011
Saint Louis, MO



Wouldn't procedure #1 also be extirpation rather than excision?

Brian May 18, 2011




     

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