A Step in the Right Direction?

Plantar fasciitis. Plantar fascial fibromatosis. Two conditions involving the plantar fascia that sound similar but do not represent the same disease process. Beginning October 1, 2026, the FY2027 ICD-10-CM code updates will separate the conditions more clearly and provide laterality-specific code choices. In this segment of “In the kNOW”, we’ll review what is changing and why the exact diagnosis matters.

Let’s begin with the anatomy. The plantar fascia is a thick band of tissue that runs along the bottom of the foot and supports the arch. Plantar fasciitis occurs when this tissue becomes irritated or degenerative, commonly producing heel pain that is often worse with the first steps in the morning or after a period of rest. Plantar fascial fibromatosis is different. It is a benign fibroblastic disorder that produces firm nodules or thickening within the plantar fascia and is also known as Ledderhose disease.

Through September 30, 2026, plantar fasciitis is listed as an inclusion term under M72.2, Plantar fascial fibromatosis. That placement can make the conditions appear interchangeable, but they are clinically different. With the FY2027 update, the inclusion term “Plantar fasciitis” is deleted from M72.2 and a new category, M67.A, is added specifically for plantar fasciitis.

The new plantar fasciitis code structure includes the following:

• M67.A01 Plantar fasciitis, right foot
• M67.A02 Plantar fasciitis, left foot
• M67.A09 Plantar fasciitis, unspecified foot

The M67.A0 subcategory identifies plantar fasciitis of the foot, but code assignment must continue to the laterality-specific code. When the medical record identifies the right or left foot, the unspecified code should not be selected simply because the final diagnosis statement does not repeat the side. Coding professionals should review the complete record and follow applicable documentation and coding requirements.

Plantar fascial fibromatosis remains classified under M72.2, but the category is also expanded to capture laterality. Ledderhose disease is added as an inclusion term, reinforcing that the fibromatosis codes identify the nodular fibroblastic condition rather than plantar fasciitis. The new code choices are: 

• M72.20 Plantar fascial fibromatosis, unspecified foot
• M72.21 Plantar fascial fibromatosis, right foot
• M72.22 Plantar fascial fibromatosis, left foot

The code change places greater importance on two pieces of documentation: the specific diagnosis and the affected foot. Heel pain alone should not be coded as plantar fasciitis without a provider diagnosis, and a plantar nodule should not automatically be coded as plantar fascial fibromatosis. When the documentation uses the terms inconsistently or does not clearly identify the condition, a query may be needed rather than selecting a code based only on symptoms or imaging findings.

To apply the change, review this scenario. A patient is evaluated for sharp right heel pain that is most severe after getting out of bed. The physician’s final diagnosis is right plantar fasciitis. For an encounter on or after October 1, 2026, the proper code assignment is M67.A01, Plantar fasciitis, right foot. M72.21 would not be appropriate because the physician did not diagnose plantar fascial fibromatosis.

Now consider a second patient with a firm nodule along the medial plantar fascia of the left foot. Following evaluation, the physician documents plantar fascial fibromatosis, also referred to as Ledderhose disease. The proper code assignment is M72.22, Plantar fascial fibromatosis, left foot. Even though both patients have a condition involving the plantar fascia, the code pathways are no longer the same.

Two additional points. First, the Excludes1 note under M72.8 is revised to direct plantar fasciitis to M67.A0-, supporting the separation of the two conditions. Second, the FY2027 codes apply to applicable encounters and inpatient discharges occurring on or after October 1, 2026. Services provided before that date must be coded using the code set in effect for the applicable date.

The revised structure gives coding professionals greater specificity, but accurate assignment will depend on documentation that clearly distinguishes plantar fasciitis from plantar fascial fibromatosis and identifies laterality.

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

You Don’t Have to Figure It Out Alone: Connect Through OHIMA Collaborate Communities

In health information management, we’re constantly learning, adapting, and solving new challenges. But you don’t have to figure it all out on your own.

Sometimes the best resource isn’t a manual, a webinar, or a Google search—it’s another HI professional who has been there before.

That’s the idea behind OHIMA Collaborate Communities: creating opportunities for OHIMA members to connect with peers, share experiences, exchange ideas, and learn from one another - all for FREE as an OHIMA member benefit!

Find Your HI Community

Collaborate Communities bring together OHIMA members with shared interests and areas of expertise. They provide a space to ask questions, discuss challenges, share resources, and discover how other professionals are approaching the work.

Currently, OHIMA offers two Collaborate Communities:

⮞ Pediatric Coding Collaborative
Connect with fellow professionals who work in pediatric coding to discuss challenges, share knowledge, and learn from one another’s experiences.

⮞ Release of Information Collaborative
Exchange ideas and best practices with professionals working in Release of Information and connect with others who understand the unique challenges of this area.

Whether you’re looking for a fresh perspective on a tricky situation or simply want to connect with others who understand what you do, these communities provide a place to start.

Your Peers Are Your Best Resource

Every organization does things a little differently. That’s what makes peer-to-peer collaboration so valuable.

You may have a process that works particularly well for your team. Another professional may have found a solution to a challenge you’re currently facing. Someone else may have a resource or perspective that gives you an entirely new way of looking at a problem.

That’s the power of collaboration.

By participating in an OHIMA Collaborate Community, you can:

• Connect with HI professionals across Ohio.
• Share your experiences, knowledge, and resources.
• Learn how others are approaching common challenges.
• Ask questions and get perspectives from your peers.
• Discover best practices you can bring back to your organization.
• Build your professional network beyond your own workplace.

And you don’t have to be a seasoned expert to participate. Sometimes simply asking a question can start a conversation that benefits an entire community.

Make Your Voice Part of the Conversation

OHIMA is more than an association—it’s a community of professionals who share a passion for health information management.

Collaborate Communities are one more way to make that community stronger.

So, if you’ve ever thought, “I wonder how other HI professionals are handling this…” this is your opportunity to find out.

Join the conversation. Share what you know. Learn from what others know. And help make Ohio’s HI community stronger—together.

Ready to Collaborate?

Visit the OHIMA Collaborate Communities page to learn more about the communities available and get connected.

Explore Collaborate Communities →

Your next great idea—or your next great connection—could be just a conversation away.

 

Maternal Terminology

This installment of “Spotlight on CPT” is being presented in a new format. As you may be aware, the AMA overhauled the Maternity section of the CPT manual with the changes becoming effective on January 1, 2027. In preparation for that major transition, the next several “Spotlight on CPT” blogs will focus on these upcoming changes.

In order to gain the most from those blogs, it will be important to have an understanding of maternity terminology. To help with that, the link below will take you to a 25-word word search puzzle focusing on maternal terms. As you search for the words, if you run across one that is unfamiliar to you, do a quick on-line search to determine its meaning.

Or, if crossword puzzles are more to your liking, then there is another link that will take you to a 25-word crossword puzzle. Either way, by the time you have completed the fun (hopefully) puzzle(s), you will be refreshed on maternal terminology and ready for the blitz of CPT changes coming in January.

Now, get ready to shed your own light on maternal terminology.

Maternity Care Coding Word Search

Word Search Answer Key

Maternity Care Coding Crossword Puzzle

Crossword Answer Key

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

August Agonies

by Dianna Foley, RHIA, CHPS, CCS, CDIP

Test your ICD-10-CM injury and external cause knowledge by coding the scenarios below. 

August arrived with heat, humidity, and one last burst of summer activities before school started. Naturally, the Klutz children tried to squeeze in as much chaos as possible.

Little Dana spent the afternoon at the county fair petting every animal she could find. By the next day, she had developed fever, abdominal cramping, and diarrhea. After a visit to the pediatrician, she was diagnosed with salmonella enteritis, likely related to contact with the animals or something she sampled at the fair.

Peter decided that flip-flops were appropriate footwear for a bike ride. They were not. He wasn’t out of the driveway before his foot slipped off the pedal, and he sustained a deep abrasion to the top of his right foot when the pedal came around and struck his foot.

Egon took on the job of mowing the lawn at his family’s house after football practice. He became dizzy, weak, and nauseated in the late summer heat and was treated for heat exhaustion.

Raymond was helping clean out the family’s garage when he accidentally sprayed insect pesticide into his left eye. His parents flushed the eye immediately, and urgent care diagnosed chemical conjunctivitis.

Janine joined friends for a late-summer hike in the nearby forest and came home with an itchy, expanding rash on her leg after brushing through tall grass. The provider diagnosed allergic contact dermatitis due to poison ivy.

Mr. and Mrs. Klutz decided August might be the perfect month to invest in bubble wrap.

Click HERE for the answers.

 

Location, Location, Location!

Interstitial. Cesarean scar. Cervical. Cornual. Four ectopic pregnancy locations that will have their own coding pathways when the FY 2027 ICD-10-CM code updates take effect on October 1, 2026. The terms may sound similar, and at times they are used inconsistently in the medical record, but the new codes make the exact site of the ectopic pregnancy an important part of code assignment. In this segment of “In the kNOW”, we’ll review what is changing and the documentation coding professionals will need.

Let’s begin with the basic concept. An ectopic pregnancy occurs when a fertilized egg implants in an abnormal location that cannot support the pregnancy. Although many ectopic pregnancies are tubal, implantation can occur in other locations. The 2027 code update recognizes several of these locations more specifically and provides separate code choices based on whether an intrauterine pregnancy is also present.

Currently, cervical pregnancy and cornual pregnancy are included under O00.8, Other ectopic pregnancy. Effective October 1, those inclusion terms are deleted from O00.8 because separate categories are being created. Interstitial ectopic pregnancy will be further classified under O00.1, Tubal pregnancy, while cesarean scar, cervical, and cornual ectopic pregnancies receive their own subcategories.

The new code structure includes the following: 

• O00.12 Interstitial ectopic pregnancy without intrauterine pregnancy:
  O00.121 right
  O00.122 left
  O00.129 unspecified

• O00.13 Interstitial ectopic pregnancy with intrauterine pregnancy:
  O00.131 right
  O00.132 left
  O00.139 unspecified

• O00.3 Cesarean scar ectopic pregnancy:
  O00.31 without intrauterine pregnancy
  O00.32 with intrauterine pregnancy

• O00.4 Cervical ectopic pregnancy:
  O00.41 without intrauterine pregnancy
  O00.42 with intrauterine pregnancy

• O00.51 Cornual ectopic pregnancy without intrauterine pregnancy:
  O00.511 right
  O00.512 left
  O00.519 unspecified

• O00.51 Cornual ectopic pregnancy with intrauterine pregnancy: 
  O00.521 right
  O00.522 left
  O00.529 unspecified

The expanded choices mean the documentation must do more than state “ectopic pregnancy.” Coding professionals should look for the exact location, whether the condition is right-sided or left-sided when laterality is built into the code, and whether an intrauterine pregnancy is also present. The presence or absence of an intrauterine pregnancy changes the code assignment in each of the new code families.

It is also important not to assume that interstitial and cornual mean the same thing. The FY2027 classification provides different code paths for these diagnoses. If both terms appear in the record or the documentation is unclear, the coding professional should not select a code based on personal interpretation. The provider should be queried so that the final diagnosis identifies the specific condition.

To apply the change, review this scenario. A patient at eight weeks’ gestation presents with pelvic pain. The emergency department note documents a suspected right “cornual/interstitial” ectopic pregnancy. The ultrasound report describes a right interstitial pregnancy, while the operative report uses the term cornual pregnancy. No intrauterine pregnancy is identified. Because the new code set treats interstitial and cornual ectopic pregnancy as separate diagnoses, the coding professional should query the provider rather than choose between the two terms. The provider clarifies that the final diagnosis is a right interstitial ectopic pregnancy without an intrauterine pregnancy. The proper code assignment is O00.121. If the provider had clarified a right cornual ectopic pregnancy, the correct code would be O00.511.

Two additional points. First, the FY 2027 codes apply to patient encounters and discharges occurring on or after October 1, 2026. Encounters before that date must be coded using the code set in effect on the date of service or discharge. Second, several of the new entries, such as O00.12, O00.13, and O00.5, are subcategories rather than complete reportable codes. Coding professionals must continue through the Tabular List and assign the code to the highest level of specificity supported by the documentation.

Organizations should make sure encoder updates, coding references, clinical documentation education, and internal audit tools are ready before October 1. These changes provide more precise reporting, but the accuracy of the final code will still depend on clear provider documentation of location, laterality, and the presence or absence of an intrauterine pregnancy. 

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

Percutaneous Coronary Intervention (PCI) Code Updates

This month’s “Spotlight on CPT” highlights recently updated percutaneous coronary intervention (PCI) procedural codes in the 2026 CPT code set.

PCI procedures are minimally invasive cardiovascular interventions used to restore blood flow in coronary arteries that have become narrowed or blocked due to coronary artery disease. These procedures may involve angioplasty, stent placement, atherectomy, or combinations of these techniques to reopen the affected vessel and improve myocardial perfusion.

For 2026, several codes in the coronary therapeutic services section were deleted and reorganized to better align with current clinical practice. Codes 92921, 92925, 92929, 92934, 92938, and 92944 were removed as part of this restructuring. 

 

Coronary Angioplasty and Atherectomy

 

Two foundational codes remain for reporting certain PCI procedures:

92920 – Percutaneous transluminal coronary angioplasty involving a single major coronary artery or branch.

92924 – Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed, involving a single major coronary artery or branch.

These codes describe procedures in which plaque is either compressed with a balloon (angioplasty) or physically removed using specialized devices (atherectomy). 

 

Coronary Stent Placement

 

When intracoronary stents are deployed, different codes apply depending on the number and location of treated lesions.

92928 – Placement of intracoronary stent(s), including angioplasty when performed, for one lesion involving one or more coronary segments.

92930 – Placement of stents for two or more distinct coronary lesions, including situations involving bifurcation lesions where treatment is required in both the main artery and a side branch. 

 

Combination Procedures

 

Some procedures require a combination of techniques to achieve optimal revascularization.

92933 – Coronary atherectomy combined with intracoronary stent placement, including angioplasty when performed, for a single coronary artery or branch.

92937 – Percutaneous transluminal revascularization performed through a coronary artery bypass graft, which may involve any combination of stent placement, atherectomy, or angioplasty, including distal protection when used. 

 

Treatment of Acute and Chronic Occlusions

 

Certain PCI procedures specifically address complete coronary artery blockages.

92941 – Percutaneous transluminal revascularization of acute total or subtotal occlusion during acute myocardial infarction, including techniques such as stenting, angioplasty, atherectomy, or aspiration thrombectomy when performed.

92943 – Revascularization of a chronic total occlusion (CTO) using an antegrade approach.

92945 – Revascularization of a chronic total occlusion using combined antegrade and retrograde approaches.

These codes recognize the increased complexity and specialized techniques often required to treat total coronary occlusions. 

 

Additional Coronary Intervention Code

 

The 2026 CPT update also introduces an add-on code for mechanical clot removal:

+92973 – Percutaneous transluminal coronary mechanical aspiration thrombectomy.

This add-on code is used when mechanical thrombectomy is performed in conjunction with another PCI procedure. 

 

Final Thoughts

 

The updates to the PCI coding structure reflect the continued evolution of interventional cardiology techniques. By refining the code set and removing outdated codes, CPT 2026 provides clearer guidance for reporting modern coronary revascularization procedures.

Coding professionals should carefully review the notes preceding the coronary therapeutic services codes, as these notes clarify included services and help ensure accurate reporting.

Now, light has been shed on percutaneous coronary intervention procedures in CPT 2026.

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

Parkinson’s Disease vs. Parkinsonism

In the kNOW is covering an ICD-10-CM Index update related to Parkinson’s disease and Parkinsonism highlighted in the April 2026 coding updates. While these terms are often used interchangeably in everyday conversation, they represent different clinical concepts that coding professionals must understand in order to assign the correct diagnosis code. 

Parkinsonism is an umbrella term used to describe a group of neurological conditions that produce symptoms affecting movement, such as tremors, rigidity, and slowed movement. Conditions that fall under Parkinsonism include drug-induced Parkinsonism, progressive supranuclear palsy, multiple system atrophy, dementia with Lewy bodies, vascular Parkinsonism, and corticobasal degeneration.

Parkinson’s disease, on the other hand, is a specific neurodegenerative disorder that progresses slowly over time. In addition to movement-related symptoms, individuals with Parkinson’s disease may also experience cognitive changes, depression, and other non-motor symptoms as the condition advances.

The April 2026 update revised the ICD-10-CM Index to help clarify this distinction. The index entry for Parkinson’s disease, syndrome, or tremor was deleted and replaced with guidance directing users to Parkinsonism or to Disease, Parkinson’s as appropriate.

Alphabetic Index Entry
Parkinsonism (idiopathic) (primary) G20.C
- due to
- - drugs NEC G21.19
- - - neuroleptic G21.11
- - Parkinson's disease -see Disease, Parkinson's
Parkinson's disease -see Disease, Parkinson's
Parkinson's syndrome or tremor -see Parkinsonism

This change reinforces the importance of carefully reviewing provider documentation to determine whether the diagnosis reflects Parkinson’s disease itself or another condition categorized under Parkinsonism.

Understanding these distinctions ensures accurate code assignment and supports more precise clinical data reporting.

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

OHIMA Board President Welcome FY2026-27

Dear OHIMA Members,
 

Welcome to the 2026–2027 OHIMA service year. It is truly an honor to begin this journey with you, our OHIMA members. Your dedication, energy, and commitment are the heart of this association, and I am grateful for the many ways you continue to strengthen our profession and support one another across Ohio.
 

OHIMA’s strength has always come from its people—members who believe deeply in the value of health information and in the difference our profession makes every day. As we look ahead, we have an exciting opportunity to build on that foundation with purpose, optimism, and a shared commitment to Educate, Advocate, and Engage. Some of the important initiatives and opportunities ahead include

• OHIMA 2027 Annual Meeting & Trade Show – HI Heroes Unite!
• OHIMA VIP Modules – Fall, Spring, and Summer semesters
• Virtual Summer Meeting & Coding Seminar
• Continued work in our Educate, Advocate, and Engage pillars

I hope each of you will feel encouraged to stay connected, share your ideas, ask questions, and take part in the programs and opportunities OHIMA offers throughout the year. Your voice matters. Your experience matters. And when we come together as a community, we create momentum that moves both our association and our profession forward. I am inspired by the talent, passion, and resilience represented across our membership, and I believe this year holds tremendous promise for all that we can accomplish together.
 

Thank you for being part of OHIMA and for bringing your knowledge, leadership, and commitment to this community. I look forward to a meaningful and inspiring 2026–2027 service year as we learn, grow, and lead together.
 

Warm regards,

Lisa Schofield, RHIA

OHIMA Board President, 2026–2027
President@ohima.org

Endovascular Revascularization of the Lower Extremities

Today, “Spotlight on CPT” focuses on endovascular revascularization procedures for lower extremity arterial occlusive disease, an area that experienced significant restructuring in the 2026 CPT code set.

Peripheral arterial disease (PAD) occurs when plaque buildup causes narrowing (stenosis) or blockage (occlusion) of the arteries supplying blood to the lower extremities. Endovascular procedures such as angioplasty, stent placement, atherectomy, or intravascular lithotripsy are commonly performed to restore blood flow and relieve symptoms such as claudication or critical limb ischemia.

In the 2026 CPT update, the previous code range 37220–37235 was deleted and replaced with a new coding structure 37254–37299. These changes introduced a more comprehensive system for reporting lower extremity revascularization procedures and include 46 new codes designed to better capture the complexity of these interventions.

Vascular Territory Concept

A key concept in the new coding framework is the use of vascular territories. A vascular territory represents a group of anatomically related arteries. This structure simplifies coding by allowing coders to report a single primary intervention code per territory, with additional add-on codes when multiple vessels within that territory are treated.

The four vascular territories are:

• Iliac territory
• Femoral and popliteal territory
• Tibial and peroneal territory
• Inframalleolar territory

Each territory contains specific arteries and coding rules that determine how many primary and add-on codes may be reported.

Lesion Complexity

The new code structure also differentiates between straightforward and complex lesions.

• Straightforward lesions generally represent stenosis, where the vessel is narrowed but not completely blocked.
• Complex lesions typically represent occlusions, where the artery is completely blocked and may require more advanced intervention.

This distinction is important because the CPT codes specify whether the treatment was performed on a straightforward or complex lesion, which directly impacts code selection.

Procedures Included in the Codes

The CPT codes for lower extremity revascularization include all maneuvers necessary to complete the intervention. These bundled services include:

• Vascular access and catheterization
• Imaging guidance and radiological supervision
• Lesion crossing and device placement
• Embolic protection when used
• Vessel closure following the procedure

Because these services are included in the procedure codes, they are not reported separately.

Additional Coding Considerations

When multiple vessels within the same vascular territory are treated, add-on codes may be reported for each additional vessel with a distinct lesion. However, lesions that span multiple vessels and are treated with a single therapy are coded with one treatment code only.

If separate lesions occur in different vascular territories and require separate interventions, multiple primary codes may be reported—one for each affected territory.

Careful review of the procedural documentation and anatomical location of the treated vessels is essential when assigning codes within this new framework.

Final Thoughts

The new coding structure for lower extremity revascularization procedures represents a significant change for coding professionals. By organizing codes around vascular territories and lesion complexity, CPT 2026 provides a more accurate way to report these increasingly sophisticated endovascular procedures.

Understanding the territory-based coding system and the distinction between straightforward and complex lesions will be key for accurate reporting of these procedures.

Now, light has been shed on lower extremity endovascular revascularization in CPT 2026.

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

Boari Bladder Flap

This edition of In the kNOW will be presenting information on a procedure highlighted in the April 2026 ICD-10-PCS updates—the Boari bladder flap. This surgical technique is used in the reconstruction of the ureter when a segment of the ureter has been damaged, removed, or is otherwise unable to function properly. Ureteral injuries may occur due to trauma, disease, or complications from prior surgical procedures. The Boari bladder flap is generally used when the ureteral segment requiring reconstruction is long or there is not enough mobility of the ureteral segment to perform a primary repair.

During a Boari bladder flap procedure, a portion of the bladder wall is surgically mobilized and shaped into a flap that can be extended upward to bridge the gap between the bladder and the remaining healthy portion of the ureter. This technique allows the surgeon to restore urinary flow from the kidney to the bladder without the need for more complex grafting procedures.

Source: https://operativereview.com/ureter-injury/

From a coding perspective, the April 2026 ICD-10-PCS update introduced a new table specifically designed to capture reconstruction of the ureter, which includes procedures such as the Boari bladder flap. The addition of this table allows coders to more accurately represent these reconstructive procedures that were previously more difficult to classify within existing PCS tables.

Notice that the new PCS table is in the Medical and Surgical section, in the urinary body system, and addresses a Transfer procedure. Coding professionals will recall that the root operation Transfer is defined as “moving, without taking out, all or a portion of a body part to another location to take over the function of all or a portion of a body part”, which is exactly what is being done with the Boari flap. A segment of bladder is peeled back and used to form the ureteral reconstruction. 

As procedural techniques continue to evolve, coding systems must adapt to ensure accurate representation of these surgical approaches. Being aware of new tables and code options related to reconstructive urologic procedures will help coding professionals correctly capture the services performed.

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.