Seton insertion is a treatment for anal/perineal fistulas and in this edition of “In the kNOW”, we look at Coding Clinic advice for how this procedure should be coded.
First, let’s look at what a seton is and why it is used. Setons are generally a thread-like material used in fistula repair procedures in order to keep the passageway open. This permits drainage to occur and healing can occur from the inside of the fistula outward. As healing takes place, the seton can be downsized or removed.
Source: https://www.wirralsurgeon.co.uk/procedures/fistula-surgery.html
Nonabsorbable material is used for setons. This could include nylon or silk sutures, elastic bands, or even wires. The thickness of the seton can vary from thin to thick as each case requires.
A first quarter Coding Clinic from 2024 shared how seton placement performed without a fistulectomy should be coded. Again, since the seton is functioning as a drain, the ICD-10-PCS root operation is Drainage (taking or letting out fluids and/or gases from a body part) (operation character 9). The approach would be via natural or artificial opening (approach character 7) and the device character would be 0 for drainage device. The full ICD-10-PCS code would be 0D9Q70Z.
It is important to recognize that a Coding Clinic from first quarter 2015 provided guidance on coding for a seton when it is performed in conjunction with a fistulectomy. In the example provided, Coding Clinic stated that the definitive procedure was the fistulectomy with the seton placement was considered integral to the procedure since it is being used to facilitate healing. 0JBB0ZZ should be assigned for the open excision of perineal subcutaneous tissue and fascia.
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.
