This segment of “In the kNOW” will explore ICD-10-PCS guideline B4.1c revision and recent clarification by Coding Clinic.
ICD-10-PCS guideline B4.1c was revised with the October 2021 update to state “If a procedure is performed on a continuous section of a tubular body part, code the body part value corresponding to the anatomically most proximal (closest to the heart) portion of the tubular body part.” This has caused confusion and concern among coding professionals. The confusion stems from wondering if this guideline is applicable to all tubular body parts, say gastrointestinal as well as vascular. The concern is coming from how this might skew data involving procedures such as endarterectomies. Let’s look at each of these in turn.
First, Coding Clinic has noted in their First Quarter 2022 update that additional clarification will be provided for this guideline. Notably, the terms “vascular”, “arterial/venous”, and “single” will be added for clarity. For now, they explain that tubular part is referring to vasculature. Coding professionals should interpret this to mean arteries and veins, but not other tubular organs such as those found in the gastrointestinal tract (i.e., esophagus, stomach).
Next, questions raised concerns over coding procedures such as endarterectomies. Clarification was provided that when a single lesion is addressed that spans multiple body parts, for example a plaque that extends from the common carotid into the internal carotid, then the common carotid body part would be assigned as it is the vessel closest to the heart. This is the type of scenario to which this guideline is intended to be applied. However, if separate lesions were found in separate vessels and were treated, then apply the multiple procedure guideline (B3.2a) which states “During the same operative episode, multiple procedures are coded if the same root operation is performed on different body parts as defined by distinct values of the body part character.” This means that if lesions were found in both the common and internal carotid arteries and both were treated by extirpation, then two procedures codes would be assigned, one for each artery (body part).
Hopefully, having this guideline clarified by Coding Clinic will make coding for vascular procedures a little less confusing.
Now you are In the kNOW!!
About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP is
OHIMA's Coding Education Coordinator. Dianna has been an HIM
professional for 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. 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.
