Are these really procedures now?

lconaway@altoonaregional.org

Hi everyone. I am in need of some coding help. Previously, we all know that a pt having a Bronch done with "BAL", didn't change the DRG assignment but now there are several procedures in which they not only pull the DRG to a surgical one, the financial impact is major. Is this correct? We have a pt who is here with sepsis with multiple MCC's but our coders have used the arterial line insertion as an OR which makes nearly 30,000 dollars difference in reimbursement. For an arterial line? Really? From a clinical standpoint, this seems hard to grasp. Similar procedures that are now pulling the DRG include:
Bronchial levage – 0B9D8ZX
GI clips – 0DQ68ZZ
Removal of feeding tube – 0DP68UZ
Arterial line - 03HY32Z

Any advise? Just want to make sure these are the correct ICD-10 codes so we don't have to give back hundreds of thousands next year!

LeeAnn Conaway, RN, CCRN, CCDS
UPMC Altoona CDI Coordinator

laura.bohls@prairielakes.com

Our coders would code an art line as 4a133b1

Laura Bohls, RN
Clinical Documentation Specialist
605-882-5454

lconaway@altoonaregional.org

Hi Laura, Thanks for your input. Our coders use that code also but tell us the other code needs added to reflect the actual insertion of the arterial line? Just doesn’t seem right. : /
Has anyone seen any coding clinic advice?

LeeAnn

laura.bohls@prairielakes.com

I don't have specific coding clinics, but in discussing with the coders it falls along with the same as say an IV. You don't code the insertion of the IV you code the purpose of the IV (infusion). The purpose of the art line is monitoring. Our coders say they wouldn't code the insertion since that is not the purpose of the art line.

Laura Bohls, RN
Clinical Documentation Specialist
605-882-5454

lconaway@altoonaregional.org

I have copied our coders on this discussion and our lead coder just wrote me and said....



I have sent the question to Coding Clinic – they seem to agree that it is a grey area and have forwarded the question to their Editorial Review Board. One of the challenges is that we have a PCS coding guideline that states that an insertion code needs to be included with the monitoring code if a device is used. And “monitoring” is not a procedure that we code alone. (not on our list of non-operative procedure codes)



Jeff - we do code the insertion of a PICC but interestingly enough, it doesn't count as an operative procedure. There is a coding clinic that gives advice on PICC lines.



Peripherally inserted central catheter placement


Coding Clinic, Third Quarter 2013 Page: 18 Effective with discharges: September 10, 2013

Question:

What is the correct ICD-10-PCS code for the placement of a peripherally inserted central catheter (PICC line)?

Answer:

The correct coding of venous catheters depends on the end placement of the catheter, meaning the site where the device ended up. For example, assign the following ICD-10-PCS code for a PICC line where the infusion catheter is initially placed in the right internal jugular and then threaded into the superior vena cava:

02HV33Z, Insertion of infusion device into superior vena cava, percutaneous approach

In this example, the peripherally inserted central catheter ended up in the superior vena cava (endplacement).





I will keep everyone posted as to the response.



LeeAnn

paxneros

We wrote into Nosolgy for advice on A Lines. We were told to use 4A133B1 for the monitoring done via Arterial Cath.  And not to use a code for the insertion of a device. We were told to code conservatively when reporting lines. There are several coding pathways which are under evaluation.

Same with GI clippings ~in the past they were reported as "control of Bleed or Hemorrhage". The root operation term used now is "Repair" of the anotomical site.  That isnt so much a pathway diversion but "old habits die hardest."

We cant use the "same ICD9 coding language" as previously done.

mulled2

Our ICD 10 advisor says they are currently OR procedures and have been sent to CMS for review. Im sure they will reverse it. She has taken it to the highest powers to be and they say code it for now

sautter.elizabeth@mayo.edu

Our Coders use 04HK33Z for the ART line, and it is not reimbursable.

rhondawest619@hotmail.com

Hi Jeff,

Coding Clinic 4th qtr 2015 has a section on Vascular Access Devices. They use code 02HV33Z for PICC placements.

Sincerely,

Rhonda West-Haynes, MHA,BSN,RHIA,CCDS,CCS
Manager Clinical Documentation Specialists
Chester County Hospital

katysuegood@gmail.com

LeeAnn,

You reference a coding guideline stating that an insertion code must be assigned with a monitoring code? Where is this located? I haven’t found it. I admit to being less familiar than I should be with the new guidelines….

Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

lconaway@altoonaregional.org

Hi Katy. I’ll ask our coders. They wrote me that in response to my question to them. I’ll let you know her response.

LeeAnn

katysuegood@gmail.com

Thanks LeeAnn ☺

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404