Coding, Classification and Reimbursement

PCS Code for repair of glenoid labrum ligament - clarification

  • 1.  PCS Code for repair of glenoid labrum ligament - clarification

    Posted 8 days ago
    Hello,
    I was wondering if someone can clarify the following scenario? I'm using it as an example in my PCS class. This scenario was taken from the ICD-10-CM/PCS AHIMA workshop in 2015.

    "The patient presents for surgical repair of a rotator cuff tear of the left shoulder and undergoes arthroscopic investigation and repair of the glenoid labrum ligament."

    Ii is coded in the workbook as 0MQ24ZZ. This code breaks down to bursa and ligaments, repair, shoulder ligament, percutaneous endo., no device, no character.  This makes complete sense to me.

    However if you look in Appendix D on page 1481 in the 2018 coding manual, the glenoid labrum ligament is found under "shoulder joint" not "shoulder bursa ligament".  It is listed this way in the 2019 manual as well.  Using that logic, the code would be 0RQK4ZZ.

    Any insight or clarification is GREATLY appreciated!!

    Andréa


    ------------------------------
    Andréa Siekierski,RHIA, CCS, CCS-P, CPC, CRC
    Assistant Professor
    Waubonsee Community Collge
    ------------------------------


  • 2.  RE: PCS Code for repair of glenoid labrum ligament - clarification

    Posted 8 days ago

    Code 0MQ24ZZ (Repair, shoulder bursa and ligament) does appear to be the logical code for the capsulorraphy (glenoid labrum ligament repair).

    However, my take on this is to code to the body part "shoulder joint" and not "shoulder bursa and ligament."   My rationale is that the Body Part Key table specifically states the shoulder joint includes the glenoid labrum ligament.  You can see that under the body part "Shoulder bursa and ligament," it identifies all other shoulder ligaments. So, to me the body part key is making that distinction between shoulder bursa/ligament and shoulder joint.

    For what it's worth, the encoder's coding path leads me to the shoulder joint.

    I hope I'm making sense.

     



    ------------------------------
    Cristina Co
    Facility Outpatient Coder
    ------------------------------



  • 3.  RE: PCS Code for repair of glenoid labrum ligament - clarification

    Posted 7 days ago
    Hi,

    The Body Part key entry for Glenoid Ligament was changed for FY2016. So if you are using answers from 2015 it would not be correct based on current coding instructions.  I am not sure of the reasoning for the change other than guessing that since they have the labrum in parenthesis and it is located in the joint itself.

    Glenoid Addendum

    ------------------------------
    Chrystel Barron, RHIA, CCS, CCS-P, CHTS-TR, CICA
    Coding Education Instructor
    Cleveland Clinic Health System
    ------------------------------



  • 4.  RE: PCS Code for repair of glenoid labrum ligament - clarification

    Posted 7 days ago
    Thank you both for the assistance!!!  It's so helpful to get insight from "the field".

    ------------------------------
    Andréa Siekierski,RHIA, CCS, CCS-P, CPC, CRC
    Assistant Professor
    Waubonsee Community Collge
    ------------------------------



  • 5.  RE: PCS Code for repair of glenoid labrum ligament - clarification

    Posted 7 days ago
    There is a Coding Clinic that addresses this, 3Q 2013 pg 20-21 which advises that "the glenoid labrum is a triangular fibrocartilaginous structure that serves to deepen the glenoid.  Because the glenoid was also referred to as the glenoid ligament, it is currently classified as a shoulder ligament in the I10 PCS body part key. The CMS is reviewing this issue. In the interim, coders should be guided by the official body part definitions." So, apparently the Body Part Key has been corrected since this publication and is now is correctly referring to shoulder joint. There is also a PCS Guideline for this.

    Tendons, ligaments, bursae and fascia near a joint

    B4.5
    Procedures performed on tendons, ligaments, bursae and fascia supporting a joint are coded to the body part in the respective body system that is the focus of the procedure. Procedures performed on joint structures themselves are coded to the body part in the joint body systems.
    Examples: Repair of the anterior cruciate ligament of the knee is coded to the knee bursa and ligament body part in the bursae and ligaments body system.
    Knee arthroscopy with shaving of articular cartilage is coded to the knee joint body part in the Lower Joints body system.



    ------------------------------
    Karen Neal
    Coding Quality Auditor
    Conifer Health Solutions
    ------------------------------