Boari Bladder Flap

This edition of In the kNOW will be presenting information on a procedure highlighted in the April 2026 ICD-10-PCS updates—the Boari bladder flap. This surgical technique is used in the reconstruction of the ureter when a segment of the ureter has been damaged, removed, or is otherwise unable to function properly. Ureteral injuries may occur due to trauma, disease, or complications from prior surgical procedures. The Boari bladder flap is generally used when the ureteral segment requiring reconstruction is long or there is not enough mobility of the ureteral segment to perform a primary repair.

During a Boari bladder flap procedure, a portion of the bladder wall is surgically mobilized and shaped into a flap that can be extended upward to bridge the gap between the bladder and the remaining healthy portion of the ureter. This technique allows the surgeon to restore urinary flow from the kidney to the bladder without the need for more complex grafting procedures.

Source: https://operativereview.com/ureter-injury/

From a coding perspective, the April 2026 ICD-10-PCS update introduced a new table specifically designed to capture reconstruction of the ureter, which includes procedures such as the Boari bladder flap. The addition of this table allows coders to more accurately represent these reconstructive procedures that were previously more difficult to classify within existing PCS tables.

Notice that the new PCS table is in the Medical and Surgical section, in the urinary body system, and addresses a Transfer procedure. Coding professionals will recall that the root operation Transfer is defined as “moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part”, which is exactly what is being done with the Boari flap. A segment of bladder is peeled back and used to form the ureteral reconstruction. 

As procedural techniques continue to evolve, coding systems must adapt to ensure accurate representation of these surgical approaches. Being aware of new tables and code options related to reconstructive urologic procedures will help coding professionals correctly capture the services performed.

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.

Endovascular Repair of the Thoracic Aorta

This edition of “Spotlight on CPT” focuses on endovascular repair of the thoracic aorta, an area that has seen important clarification and restructuring in the 2026 CPT code set.

Endovascular repair of the thoracic aorta involves the delivery, positioning, and deployment of an endograft to treat aneurysms or other pathologic conditions of the thoracic aorta. The thoracic aorta includes the ascending aorta, aortic arch, and descending thoracic aorta down to the origin of the celiac artery. In these procedures, terms such as endograft, stent graft, endovascular graft, and endoprosthesis all refer to a covered stent used to reinforce the vessel wall and restore normal blood flow.

Coding for thoracic aortic repair depends largely on the anatomic relationship of the graft placement to the left subclavian artery. The CPT codes describe whether the procedure involves coverage of the left subclavian artery, avoidance of that vessel, or use of a branched graft system designed to maintain perfusion to the artery.

The 2026 CPT code set includes the following codes for these procedures:

33880 – Endovascular repair of the thoracic aorta with deployment of an aorto-iliac tube endograft that covers the left subclavian artery, including associated extensions placed proximally in the arch or ascending aorta and distally to the celiac artery.

33881 – Endovascular repair of the thoracic aorta with deployment of an aorto-iliac tube endograft that does not cover the left subclavian artery, including extensions from the level of the left subclavian artery to the celiac artery.

33882 – Endovascular repair using a branched multipiece endograft system that includes a fenestration for the left subclavian artery with associated stent graft placement.

In some cases, additional procedures may be required following the initial repair. These delayed services have their own CPT codes.

33883 – Delayed placement of proximal extension prosthesis(es) after thoracic aortic repair that does not involve coverage of the left subclavian artery.

33886 – Delayed placement of distal extension prosthesis(es) from the level of the left subclavian artery to the celiac artery following endovascular repair of the descending thoracic aorta.

It is important to note that code 33884 has been deleted, further refining the reporting structure for these procedures.

As with many endovascular procedures, multiple notes precede these codes in the CPT manual. Coding professionals should carefully review these notes, as they define included services such as catheterization, imaging guidance, and radiologic supervision and interpretation, which are typically bundled into the primary procedure code.

Understanding the anatomy involved and whether the repair involves coverage, preservation, or reconstruction of the left subclavian artery is essential for correct code assignment.

Now, light has been shed on endovascular repair of the thoracic aorta in CPT 2026.

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.

Springtime Slip-Ups

by Dianna Foley, RHIA, CHPS, CCS, CDIP

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

Spring has arrived and the Klutz family is thrilled to be outdoors again after a long winter. Flowers are blooming, the weather is warming up, and the children are eager to enjoy all the activities that come with the season. Of course, as we’ve come to expect any outdoor activities that the Klutz children participate in are likely to end with at least a few mishaps. Let’s see what befalls them this spring.

Little Dana was helping her mother plant flowers in the backyard garden. While digging in the soil with a small hand shovel, she accidentally jabbed the shovel into her left palm causing a small puncture wound. Luckily, Mrs. Klutz had a first aid kit nearby and quickly cleaned and bandaged the wound.

Raymond was flying a kite at the park during a breezy spring afternoon. While running backward to get the kite airborne, he tripped over a tree root and fell, landing on his right knee. A bruise quickly developed, but after a few minutes of rest he was back to watching the kite soar.

Peter decided to climb the family’s apple tree in the back yard to see if any blossoms were forming. While reaching out on a branch for a better look, he slipped and fell from the tree, landing on his left wrist. After a visit to urgent care, it was confirmed that Peter had a sprained wrist.

Janine volunteered to mow the lawn for the first time that season. While pushing the mower across the yard, a small stone was kicked up from beneath the mower and struck her on the right shin, leaving a painful contusion.

Egon was determined to wash the family car as part of his spring chores. As he stepped on the wet driveway while rinsing the car, he slipped and fell, landing on his tailbone. Although sore, Egon was relieved to learn that nothing was broken.

Thankfully, none of the Klutz children suffered major injuries this spring—though their parents suspect it’s only a matter of time before the next adventure results in another visit to the clinic!

Click HERE for the answers.

 

Intracochlear Administration of DB-OTO

Today, In the kNOW will be looking at an exciting emerging therapy highlighted in the April 2026 ICD-10-PCS updates—intracochlear administration of DB-OTO. This investigational treatment is a form of gene therapy designed to treat congenital hearing loss caused by mutations in the OTOF gene. The OTOF gene is responsible for producing otoferlin, a protein necessary for transmitting sound signals from the inner ear to the brain. When this gene is mutated, patients can experience profound hearing loss from birth.

The procedure involves delivering the DB-OTO therapy directly into the cochlea using an infusion catheter. The medication is administered locally to target the inner ear structures responsible for hearing. By introducing a functional copy of the gene, the therapy aims to restore the cellular mechanisms required for proper sound transmission.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2400521

The first code to be assigned will come from the New Technology section for the temporary insertion of the infusion catheter. X9H(D,E, or F)01B would be the assigned codes. The body part values of D (right inner ear), E (left inner ear) or F (bilateral inner ear) would be selected as appropriate. Another New Technology code will be assigned for the DB-OTO component with code XW0E33B. The body part value E is for ear(s) so if the procedure is performed bilaterally, coding professionals should only assign one code.

From a coding perspective, an additional procedure code is assigned when the round window membrane is augmented with locally harvested tissue such as fascia, bone, or muscle during the procedure. This additional step supports the repair of the round window as it is perforated in order for the infusion catheter to reach the cochlea. From the Supplement table in Ear, Nose, Sinus-Medical and Surgical (body system and section)-09U, use body parts D or E for inner ear, right or left to capture the round window repair and to fully represent the services performed.

As gene therapies continue to advance, coding professionals will increasingly encounter procedures like DB-OTO administration that reflect cutting-edge treatment approaches. Understanding both the clinical purpose and the associated procedural components will be key to ensuring accurate code assignment and complete documentation. 

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.