The topic of discussion in this edition of “In the kNOW” will be annuloplasty. This procedure is used to treat heart valves that are leaky. To accomplish this, surgeons perform procedures that will reshape, reinforce, or tighten the annulus or ring that surrounds a heart valve.
With the April 2024 Index update to ICD-10-PCS, a new root operation has been added to annuloplasty. Now, in addition to supplement and repair, restriction can be used as an annuloplasty root operation. The ICD-10-PCS Index now looks like this:
Annuloplasty
see Repair, Heart and Great Vessels 02Q
see Supplement, Heart and Great Vessels 02U
see Restriction, Heart and Great Vessels 02V
Annuloplasty procedures may be performed on any of the heart valves: mitral, aortic, pulmonary, or tricuspid.
Let’s consider each of these types of annuloplasty by first examining a supplement procedure. During this annuloplasty procedure, a surgeon places a synthetic ring, either O or C-shaped, around the valve’s base. This will tighten the loose opening and prevent regurgitation. Supplement would be the correct root operation for this procedure as its definition is “Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part”.
Here is an illustration of a ring annuloplasty.
Source: https://www.templehealth.org/services/treatments/mitral-valve-repair-replacement
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The correct coding for this procedure if it was done with an open approach on the mitral valve would be 02UG0JZ – Supplement mitral valve, synthetic substitute, open approach. It is also possible that a percutaneous or percutaneous endoscopic approach could be used depending on the valve treated.
Next, a surgeon could simply repair the leaflet. Repair would be the correct root operation for this since its definition is “Restoring, to the extent possible, a body part to its normal anatomic structure and function”. Again, an open mitral valve repair would be coded as 02QG0ZZ – Repair mitral valve, open approach.
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Source: https://www.templehealth.org/services/treatments/mitral-valve-repair-replacement
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The newest addition to coding annuloplasty is with the root operation Restriction. The definition of this root operation is “Partially closing an orifice or the lumen of a tubular body part”. In this procedure, the surgeon sews the leaflets together in the center of the valve to prevent prolapse from occurring. However, the side edges are kept open in order to maintain blood flow. If an open approach was used to restrict the mitral valve, the correct code would be 02VG0ZZ – Restriction, mitral valve, open approach.
Source: https://www.templehealth.org/services/treatments/mitral-valve-repair-replacement
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.
