Need some help. The physician did an EGD due to GI bleed, there was a single arteriovenous malformation noted in the gastric body. Two hemoclips were placed on the AVM. The physician did not identify the artery or the vein involved. How would you code this??
I believe that the intent would be to occlude the AVM, so I started down that path and got 04LY_CZ - occlusion of lower artery w extra luminal device (need approach) and 06LY_CZ - occlusion of lower vein w extra luminal device (need approach).
My problem with those codes are that the only options for approach are open, percutaneous, or percutaneous endoscopic. No option for via natural or artificial opening endoscopic.
The other code I was looking at, but I don't think it meets the intent and I can't code the device...was 0DQ68ZZ - Repair Stomach, Via natural or Artificial Opening Endoscopic.
I did send this to coding clinic...but would appreciate the benefit of all of the brain power AHIMA represents.
I researched a bit about gastric AVMs and from what I found, they intervene in the arterial portion. You could query to determine definitively if they did the procedure on the artery or vein or both.
I looked in the index under clipping, aneurysm and it directs you to see Restriction using extraluminal device. There is an entry for restriction- gastric - 04V2.
Then you can complete the code: 04V24CZ- Restriction of gastric artery, extraluminal device, percutaneous endoscopic approach.
For the vein: 06V2...
Hope this helps!
------------------------------Jodi Kingley, CCSInpatient CoderPrinceton HealthCare System
------------------------------Kathy CompletaCoding and Documentation Educator------------------------------
Hi everyone. I agree with Kathy. I code restriction of an artery in the gastric area percutaneously, endoscopically with extraluminal device as 04V24CZ. They are restricting the lumen, not completely occluding it (from what I read). The notes in my codebook say, "Definition: Partially closing an orifice or the lumen of a tubular body part and,. Explanation: The orifice can be a natural or an artificially created orifice". This is according to the AMA ICD10 pcs book for 2016.
------------------------------Jodi Kingley, CCSInpatient CoderPrinceton HealthCare SystemOriginal Message:Sent: 12-02-2015 08:12From: Kathy CompletaSubject: PCS - hemoclipping of AVM in the stomach
Sorry Jodi, I meant to use your name.
Wouldn't this be similar to the scenario in Coding Clinic 4Q 2014 p 20? In this one a bleeding duodenal ulcer was treated with multiple clips applied to the vessels. The advice was to code to root operation Repair. Rationale was: Most of the body’s organs and tissues are vascular, and they bleed when cut or eroded. Repair of a cut or eroded body part is coded to the body part repaired, rather than to a vascular system body part.
We did end up coding it to Repair following that Coding Clinic, because it allowed us to name the body part and choose the correct approach. I still think that the intent was occlusion - and with that code we could use extraluminal device, but not identify where it was located other than lower artery.
The reason I was questioning the repair following the coding clinic you mentioned is that in the example it is for an ulcer where the tissue was "eroded" - I don't believe that is the case with the AVM.
I did send this question to coding clinic for clarification.
Thank you all for your input. I will let you know what Coding Clinic says.
I am having an issue with this procedure right now, did CC ever reply to you? I am just really struggling with coding this as a repair during a colonsocopy and sending it to a major OR procedure DRG.
Unfortunately I have not received a response from Coding Clinic yet.
Thank you Kathy for your response.
This is my scenario:
Postop DX: five ascending colon AVMs status post submucosal injection, argon plasma coagulation and hemoclip placement. Cecal polyp status post APC ablation.
We wrote to AHIMA Code-Check regarding APC cautery of an AVM of the duodenum. For the clipping, I wrote to Coding Clinic a few months back and no response as of yet.
Question Response:The recommended code assignment for APC cautery, AVM of the duodenum is:0D598ZZ Destruction of Duodenum, Via Natural or Artificial Opening EndoscopicRationale for recommended code assignment:The character 3 root operation and character 4 body part are assigned based on the procedure documenation specified as:• APC cautery (char 3 root operation) was used to obliterate the AVM without further induction of bleeding• In the second duodenum (character 4 body part) near the papilla was an AVM that was bleeding,Destruction—Root operation 5Definition: Physical eradication of all or a portion of a body part by the direct use of energy, force or a destructive agentReference:FY2016 ICD-10-PCS Reference Manual. page 43Thanks,The AHIMA Code-Check™ Response TeamAHIMA | American Health Information Management Association233 N. Michigan Avenue, 21st Floor | Chicago, IL 60601-5809AHIMA: Health Information You Can Trust™ahima.orgThe information provided by Code-CheckTM is solely for general guidance on coding. Accordingly, information from Code-CheckTM is provided with the understanding that Code-CheckTM is not engaged in rendering official coding advice or services; nor is AHIMA the official source for coding advice. AHIMA strongly recommends contacting the official sources for coding advice: AHA Coding Clinic® (ICD-9-CM, ICD-10-CM, ICD-10-PCS, and HCPCS) and CPT® Assistant (CPT) for definitive answers to your questions. Reliance on information provided by AHIMA is solely at your own risk.Disclaimer for uploaded information: AHIMA is not a HIPAA Business Associate to its CheckPoint Code-Check™ users and does not require individually identifiable protected health information (PHI) in order to respond to customer coding questions. Before uploading information, ensure that all PHI has been redacted or de-identified in accordance with 45 C.F.R. 164.514(b)(2). Your failure to do so may be deemed a breach of unsecured PHI. Note that AHIMA may destroy, but cannot guarantee the destruction of, information containing PHI that was intentionally or negligently uploaded.