This “In the kNOW”
article will explore ICD-10-PCS guideline B4.1c which was revised for the second year
in a row. The revisions align with Coding
Clinic guidance issued last year.
ICD-10-PCS
guideline B4.1c was revised with the FY 2023 update to state:
“If
a single vascular procedure is performed on a continuous section of an arterial
or venous body part, code the body part value corresponding to the
anatomically most proximal (closest to the heart) portion of the arterial or
venous body part.
Example: A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the femoral artery is coded to the external iliac body part. A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the external iliac artery is also coded to the external iliac artery body part.”
Example: A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the femoral artery is coded to the external iliac body part. A procedure performed on a continuous section of artery from the femoral artery to the external iliac artery with the point of entry at the external iliac artery is also coded to the external iliac artery body part.”
The bolded
phrases above are the revisions for FY 2023.
The guideline now is quite clear that it is pertaining only to vascular
body parts which was initially explained in a First Quarter 2022 Coding
Clinic. Additionally, the guideline
is applicable when a procedure involves continuous sections of vascular
body parts. If lesions are in different
vessels and are not continuous, coding professionals will assign codes for each
body part treated. Let’s look at some
scenarios to see how this will be applied in practice.
When coding
endarterectomies, if 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 and is
illustrated in the picture below.
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 noncontiguous lesions were found in both
the common and internal carotid arteries and both were treated by extirpation,
then two procedure codes would be assigned, one for each artery (body part). See picture below.
Here is an
example of a vascular procedure in the leg.
In the popliteal artery on the right, a 90% stenotic area of about 1.5
cm. found just above the kneecap was treated with balloon angioplasty. Another area of stenosis was identified in
the anterior tibial artery just above the tibioperoneal trunk. This vessel also was treated with
angioplasty. Because two different areas
of stenosis were treated, codes should be assigned for both body parts, the
popliteal and the anterior tibial arteries with codes 047M3ZZ and 047P3ZZ.
Another
example combines both guidelines. Access
at the right femoral artery demonstrated significant stenosis of the distal
right femoral artery with extension into the proximal popliteal artery. Angioplasty of the femoral artery was
performed using the 4-mm balloon and then attention was shifted to the
popliteal artery stenosis. The same balloon was used to angioplasty this
stenosis. A guidewire was then passed
through the rest of the popliteal vessel. An additional stenotic area in the
distal peroneal artery was noted and angioplasty was performed there as
well. Final images indicated improved
run-off. Here the initial code will be
for the femoral artery angioplasty even though there was extension into the
popliteal since the femoral artery is closest to the heart. Then, a second code will be needed to
capture the angioplasty that took place in the peroneal artery since it was a
separate lesion. The appropriate codes
to be assigned would be 047K3ZZ and 047T3ZZ.
Now you are In the kNOW!!
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About the Author
Dianna Foley, RHIA, CCS, CHPS, CDIP is
OHIMA's Education Coordinator. Dianna has been an HIM
professional for over 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She previously 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 and holds RHIA, CHPS, CDIP and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and is a presenter on coding topics at the national, state, and regional levels. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
