“In the kNOW” for this month will be looking at ICD-10-PCS coding for an associating liver partition and portal vein ligation for staged hepatectomy procedure (ALPPS). This is a two-stage procedure used in the treatment of liver cancer.
This procedure focuses on the regenerative property of the liver which is the only organ that regenerates. The goal is to separate healthy liver tissue from that containing the cancer, and giving the future liver remnant (FLR) the opportunity to enlarge. This is necessary so that the remaining portion of the liver is sufficient to perform the liver functions and prevent post-hepatic failure. Once the hypertrophy of the FLR occurs after a week or two, then the diseased part of the liver is removed.
Let’s examine how this procedure is performed and coded.
First, the portal vein is ligated which cuts the blood supply. During this initial procedure, a division of the liver tissue (in this case the right lobe) is also done. When that division is combined with the portal vein ligation, it spurs the regeneration of the liver.
If the above-described procedure was performed with an open approach, the correct coding would be:
06L80ZZ Occlusion of portal vein, open approach
0F810ZZ Division of right lobe liver, open approach
In the second stage of the procedure, once it’s been determined that there has been sufficient hypertrophy of the liver remnant, the diseased portion of the liver is removed, again an open approach.
0FT20ZZ Resection of left lobe liver, open approach
Coding professionals should take note that the 4th Quarter Coding Clinic from 2021 addressed an ALPPS procedure during which a cholecystectomy was also performed. Coding Clinic informs us that the cholecystectomy may be coded unless it was removed as part of the excision or resection of the right lobe of the liver. In that circumstance, coding of the cholecystectomy would not be done.
Now you are In the kNOW!!
About the Author
She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.