Until the April 2024 ICD-10-PCS code updates, there was no way to identify hand-assisted laparoscopic procedures specifically. This edition of “In the kNOW” explores the change that the April code update has brought us for coding this unique procedure.
Qualifier “G” has been added to very specific root operation “Excision” and “Resection” tables in ICD-10-PCS. This new qualifier specifies that the procedure was done with hand-assistance. So, what is hand-assistance? This is a variation on a laparoscopic procedure where one of the incisions is extended to be about 6-8 cm. in length. This allows placement of a device, often called a gel port or hand port, through which the surgeon can insert his hand to assist with the procedure. This may be deemed necessary in order to remove a specimen or to facilitate laparoscopy for patient that may have risk factors such as high BMI where it may be necessary to convert to an open procedure, or when there is the presence of bulky disease.
Coding professionals can look for documentation of HAL, hand-assisted, use of a gel port, and a larger sized incision or extension of an incision to identify hand-assisted laparoscopic procedures.
This update created 25 new procedure codes in ICD-10-PCS. They can be found in the following tables:
Resection
07T Resection of Lymphatic and Hemic Systems (spleen)
0DT Resection of Gastrointestinal System (right or left large intestine, appendix, transverse, descending, or sigmoid colon)
0FT Resection of Hepatobiliary System and Pancreas (liver, right or left lobe of liver, gallbladder, or pancreas)
0TT Resection of Urinary System (right, left, or bilateral kidney(s))
Excision
0DB Excision of Gastrointestinal System (right or left large intestine, appendix, transverse, descending, or sigmoid colon)
0FB Excision of Hepatobiliary System and Pancreas (liver, right or left lobe of liver, or pancreas)
Notice, that there is no ability to code a hand-assisted laparoscopic excision of the gallbladder, only resection. The same is true for the spleen or kidney(s), you cannot code for excision of these organs with hand-assistance.
Now you are In the kNOW!!
About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP, is an HIM professional with over 25 years of experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA, along with being an AHIMA-approved ICD-10-CM/PCS trainer. Dianna has held many positions in HIM and is now an independent coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna is an AHIMA-published author and has volunteered with AHIMA on projects including certification item writing, certification exam development, coding rapid design, and most recently has served on AHIMA’s nominating committee. She is a presenter on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
