Coding MAPCA Coil Embolization

A congenital collateral vessel. An embolization procedure. A body-part value that may not be immediately apparent. In this segment of “In the kNOW,” we examine the diagnosis and procedure coding for major aortopulmonary collateral arteries, commonly known as MAPCAs.

MAPCAs are abnormal congenital blood vessels that originate from the aorta or one of its first-order branches and connect with the pulmonary arteries. They frequently occur in patients with complex congenital heart disease, including pulmonary atresia and Tetralogy of Fallot.

Because a specific ICD-10-CM code does not identify MAPCAs by name, coders must determine which congenital malformation category best represents the condition.

Coding Clinic directs assignment of:

Q28.8 — Other specified congenital malformations of circulatory system

The diagnosis should not be coded as an acquired vascular disorder simply because the MAPCA is evaluated or treated later in the patient’s life. The vessel remains a congenital malformation.

Let’s now consider a patient with a history of multiple congenital heart conditions including; Tetralogy of Fallot, MAPCAs, pulmonary artery unifocalization, ventricular septal defect, pulmonary atresia, and placement of a right ventricle-to-pulmonary artery conduit.

During cardiac catheterization, angiography demonstrates collateral blood flow involving several vessels and the right lung. A microcatheter is advanced into an aortopulmonary collateral arising from the descending aorta. A microvascular plug and coils are deployed to occlude the collateral vessel. Follow-up angiography confirms that flow has been reduced to a minimal level.

Coding Clinic directs assignment of:

02LQ3DZ — Occlusion of right pulmonary artery with intraluminal device, percutaneous approach

Elements that support this code: 

• Root operation: Occlusion, because the objective is to completely close the collateral vessel.
• Body part: Right pulmonary artery, which adequately represents the treated site.
• Approach: Percutaneous, based on catheter access.
• Device: Intraluminal device, representing the coils and vascular plug left within the vessel.

Although the collateral originated from the descending aorta, the ICD-10-PCS body-part value is not selected solely from the vessel’s point of origin. For this case, the right pulmonary artery appropriately captures the procedural site.

The operative report should clearly identify: 

• The vessel being treated
• The origin and destination of the collateral
• The side involved
• The objective of the embolization
• The type of device deployed
• The catheter-based approach
• The post-embolization blood-flow findings

Coding professionals should not select the body-part value from the access vessel or assume that every embolization is coded to the vessel from which the collateral originates. Review the complete catheterization and angiography documentation to determine the actual treatment site and procedural objective.

Organizations should incorporate this guidance into congenital cardiac coding education, encoder notes, and procedure-audit tools. When the anatomy is complex, collaboration among the coder, clinical documentation integrity specialist, and physician may be necessary to ensure that the coded body part accurately represents the procedure. 

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

October Oddities

by Dianna Foley, RHIA, CHPS, CCS, CDIP

Test your ICD-10-CM injury and external cause knowledge by coding the scenarios below. 

October brought pumpkins, costumes, hayrides, and enough opportunities for the Klutz children to turn fall fun into coding practice.

Little Dana was helping carve pumpkins when she reached for a slippery seed and nicked her left thumb with a carving tool. The cut was small but required careful cleaning and a simple dressing.

Peter visited a haunted corn maze in his neighbor’s farm field and sprinted away from a teenager dressed as a scarecrow. He tripped over a corn stalk and sprained his right ankle.

Egon drank apple cider at a fall festival held at the local park. Eight hours later, he developed nausea, vomiting, and diarrhea. Several other festival-goers also became ill, and he was diagnosed with E. coli infectious gastroenteritis related to contaminated cider.

Raymond wore face paint as part of his Halloween costume and refused to wash it off before bed. By morning, his cheeks were red, itchy, and irritated. The provider diagnosed irritant contact dermatitis due to cosmetics.

Janine volunteered to help decorate the high school gym for the Fall Festival dance and decided the oversized spider web would look best stretched from one basketball hoop to the other. While standing on a folding chair to hook the web in place, she reached just a little too far, tipped sideways, and landed hard on her right elbow. At urgent care, she was diagnosed with a nondisplaced, coronoid process fracture of the upper end of the right ulna.

Mr. Klutz announced that next year’s costumes would involve helmets, gloves, and possibly medical-grade disinfectant.

 

Click HERE for the answers.

 

Labor Management Coding in the 2027 CPT Maternity Care Revisions

This edition of “Spotlight on CPT” focuses on labor management coding, one of the major areas of change in the 2027 CPT maternity care revisions.

Labor is the period during which the maternal body and fetus prepare for delivery and care is provided for any medical conditions or complications that may arise. Under the revised CPT structure, labor management is reported separately from antepartum care and delivery care.

Labor management will be reported for each calendar date and will be based on whether the service represents initial or subsequent day labor management. The codes also distinguish between straightforward and complex labor management.

Initial day labor management includes the E/M work associated with admission and is reported once per setting at the highest level of care provided on that calendar date. The initial day codes are:

59080 – Initial day labor management; straightforward, per day
59081 – Initial day labor management; complex, per day

Initial day labor management may be reported when labor services are first needed, induction begins, the physician or qualified health care professional has not previously managed labor services during the same facility admission or stay, the parturient is transferred to a new facility after labor services at another facility, or a provider from a different specialty or subspecialty assumes care for medically necessary escalation.

Subsequent day labor management is reported for each calendar date after the initial date when labor management continues and none of the criteria for initial day reporting is met. The subsequent day codes are:

59082 – Subsequent day labor management; straightforward, per day
59083 – Subsequent day labor management; complex, per day

Labor management includes services such as interim physical examinations, collection and interpretation of physiologic data, and induction or augmentation of labor. Physiologic data may include partograms, tocometric data, vital signs, and pulse oximetry. Induction or augmentation may involve mechanical cervical dilation or ripening, prostaglandins, oxytocin, or amniotomy. These services are not separately reportable when included in labor management.

Labor management requires a face-to-face encounter and is reported once per calendar date. Multiple visits by the same physician, qualified health care professional, or same group practice on the same date in the same setting are reported as a single labor management service. A continuous visit that spans two calendar dates may still be considered a single service when the physician or qualified health care professional remains continuously focused on the same parturient.

The distinction between straightforward and complex labor management is important. Straightforward labor management generally involves a singleton vertex presentation, routine maternal and fetal monitoring, normal labor progression or routine induction or augmentation, stable medical conditions not requiring active management during labor, and no previous cesarean delivery.

Complex labor management may involve more than one fetus, fetal monitoring that requires a change in management or physician intervention, prolonged labor, labor complications, severe maternal morbidity indicators, maternal medical conditions requiring management during labor, or a previous cesarean delivery. If labor management does not meet the definition of straightforward, the complex code should be considered.

Coding professionals should also remember that labor management is reported only once per day regardless of the number of fetuses. Duration alone does not determine complexity unless prolonged labor is diagnosed. When the patient’s condition changes during the same calendar date and labor management moves from straightforward to complex, only the complex code is reported for that date.

Now, light has been shed on labor management coding in the 2027 CPT maternity care revisions.

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

History Gets More Specific

Social. Medical. Surgical. Intersex. Unspecified. Detransition. Beginning October 1, 2026, the FY2027 ICD-10-CM code updates will provide separate Z codes to describe different types of personal history related to gender transition and sex reassignment. In this segment of “In the kNOW”, we’ll review each code and the documentation needed to assign it correctly.

The changes occur under Z87.890, Personal history of sex reassignment. The classification also adds “Personal history of gender transition” as an inclusion term. Although the parent code continues to use the phrase “sex reassignment,” the new child codes use more specific gender-transition terminology. Coding professionals should follow the terminology and instructions in the Tabular List while assigning the code that best reflects the provider’s documentation.

It is important to understand what a personal history code represents. These codes describe a transition-related event, treatment, or circumstance that occurred in the past. They do not automatically indicate that the patient currently has an active condition, is receiving current treatment, or identifies in any particular way. As with other history codes, the information should be reported when it is documented and relevant to the encounter.

The new code choices include the following:

• Z87.8901 Personal history of social gender transition
  This code identifies a documented history of social transition. Social transition may involve nonmedical changes in how a person presented or was recognized socially, such as a change in name, pronouns, clothing, or other social expression. The code does not describe hormone therapy or surgery.

• Z87.8902 Personal history of medical gender transition
  This code identifies a history of medical treatment associated with gender transition. The Tabular List specifically includes a personal history of pharmacological or hormonal gender transition. It should not be assigned solely because a medication appears on the medication list; the documentation should connect the treatment to the patient’s transition history.

• Z87.8903 Personal history of surgical gender transition
  This code identifies a history of surgery performed as part of gender transition. It does not identify the specific procedure or the patient’s current anatomy. Other codes may be needed when a prior procedure, acquired absence, or current postoperative condition is relevant to the encounter.

• Z87.8904 Personal history of intersex surgery
  This code identifies a documented history of surgery related to an intersex variation or differences in sex characteristics. It is separate from the surgical gender-transition code. Coding professionals should not infer this history from anatomy, a congenital condition, or a prior procedure when the relationship is not clearly documented.

• Z87.8909 Personal history of unspecified gender transition
  This code is used when a history of gender transition is documented but the record does not identify whether the transition was social, medical, surgical, or another specified type. The unspecified code should not be selected when the complete record supports one of the more specific options. Coding professionals should not assume a more specific type based on appearance, medication history, surgical scars, demographic information, or prior registration data.

• Z87.893 Personal history of gender detransition
  This code identifies a documented history of gender detransition, meaning that one or more aspects of a prior transition were discontinued or reversed. The Tabular List includes a “Code also” instruction for personal history of sex reassignment, Z87.890-. Therefore, when applicable and supported by the documentation, Z87.893 is assigned with the most specific Z87.890- code describing the prior transition history.

To apply the change, review this scenario. A patient presents for evaluation before an unrelated procedure. The history and physical documents prior hormonal gender transition and a later history of gender detransition. No transition-related treatment is currently being provided, but the history is relevant to medication reconciliation and clinical planning. For an encounter on or after October 1, 2026, the appropriate history codes are Z87.8902, Personal history of medical gender transition, and Z87.893, Personal history of gender detransition. Z87.8909 would not be appropriate because the medical nature of the prior transition is documented.

Two additional points. First, because specific child codes are being added under Z87.890, coding professionals must assign the complete code supported by the documentation rather than stopping at the parent category. Second, a history code should not replace coding for an active condition, current treatment, complication, status, or aftercare when one of those circumstances is the reason for the encounter. The complete record and the applicable coding guidelines must be reviewed.

The added specificity surrounding the new gender transition history codes can improve reporting, but only when documentation clearly identifies the type of history and coding professionals avoid making assumptions about a patient’s identity, treatment, or anatomy. 

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

Can Artificial Intelligence Make Healthcare Safer?

by Noor Janjua Zaidi, BSHIM, RHIA

Health Informatics looks at the promise—and the risks—of AI-supported clinical decisions

Imagine this: A digital tool notices that a patient may be at risk, flags a possible medication error, or helps a clinician make a more informed decision within the electronic health record (EHR). That is the promise of artificial intelligence in healthcare. But here is the question: Are healthcare organizations ready to use these tools safely and effectively? 

What does the research tell us?

A systematic review published in September 2026 examined 20 studies on healthcare professionals’ adoption of AI-based clinical decision support systems (AI-CDSS). The message was clear: successful adoption depends on more than the technology itself. Staff training, organizational support, and meaningful involvement of healthcare professionals in development and implementation of all matters. (Yushu et al.)

Waldock et al. (2026) reached a similarly cautious conclusion after reviewing 50 studies across 17 medical specialties. AI-based predictive systems showed moderate overall performance, but results varied across clinical settings. In other words, a tool that performs well in one environment may not work equally well in another.

Where could AI make a difference?

In my healthcare experience, accurate patient information, clear communication, and dependable EHR systems are necessary to safe care. From a health informatics perspective, AI could add value by helping teams:

• Reduce administrative burden and streamline clinical workflows
• Identify patient-safety concerns earlier
• Detect possible medication errors or high-risk patterns
• Support—not replace—professional clinical judgment
  
  

What could go wrong?

AI can introduce new risks when it relies on inaccurate data, generates too many alerts, or encourages users to depend too heavily on automated recommendations. Before integrating AI into routine care, organizations should ask: Is the data reliable? Are staff prepared? Who monitors the system after launch? How will problems be reported and corrected? 

Four priorities for safer AI

1. Protect data quality. AI recommendations are only as dependable as the information behind them.
2. Train and involve staff. The people using technology should help shape how it is designed and introduced.
3. Monitor performance continuously. Organizations must evaluate reliability across real clinical settings, not only during initial testing.
4. Keep people at the center. AI should strengthen clinical judgment, patient trust, and equitable outcomes—not to replace human expertise.

Your turn

If AI were introduced in your healthcare setting tomorrow, what would make you trust it—and what safeguards would you want in place? The real measure of success will not be technological efficiency alone. It will be whether AI makes care safer, earns patient trust, and supports fair healthcare outcomes. 

References

Waldock, W. J., Guni, A., Darzi, A., & Ashrafian, H. (2026). Performance of predictive AI-based clinical decision support systems across clinical domains: A systematic review and meta-analysis. PLOS Digital Health, 5(3), e0001310. https://doi.org/10.1371/journal.pdig.0001310

Factors influencing healthcare providers’ adoption of artificial intelligence-based clinical decision-support systems: a systematic review using the CFIR framework | Human Resources for Health | Springer Nature Link (2026). Human Resources for Health. https://doi.org/10.1186/s12960-026-01102-x

  

About the Author  

I am Noor Ul Ain Janjua Zaidi, RHIA, and I am currently pursuing a Master of Health Informatics at the University of Cincinnati. My background in Health Information Management and experience in healthcare have inspired a strong passion for using technology, data analytics, and artificial intelligence to improve patient safety, enhance healthcare quality, and support better clinical decision-making. I am also proud to be an active member of OHIMA, serving on the Nominating Committee and AI Task Force, where I enjoy contributing to professional initiatives and exploring the evolving role of artificial intelligence in health information management.