Physicians please weigh in-Laterality of Hiatal Hernia Repair in ICD-10

cmorellcmorell
in CDI Talk Archive
The topic of laterality of hiatal hernia repair is a subject we are currently addressing.
I searched and found a thread on CDI talk from 9/16/15 in which someone posted:
I spoke to general surgeons today and they have never classified a hiatal hernia as left/right they both suggested it as midline which defaulted to the bilateral?

Usually these procedures are outpatient and therefore this doesn't come up very often. Coding asked for our help to educate the surgeon on an inpatient case for an open query. They queried for laterality, right, left, midline for the hiatal hernia repair. They wanted to know which side of the diagphragm was the hernia repair done"?

I spoke to the surgeon. She said "there is no such thing". There is one hiatus. It is a hole. Just as if you were going into an umbilicus-right, left or midline (bilateral) approach?
She agreed forthis specific account to document on a query but would not be putting it in her OP notes going forward and looking like a laughing stock to her colleagues.

I shared the info with another physician and he agreed with the surgeon and said in this case it appears someone wasn't paying attention when creating ICD-10 pathways. I am now campaigning to have midline as the default.

Wondering if others are coming across this issue-those are the choices in the 3M Encoder.

Thanks,
Charlie Morell

Comments

  • Unknown
    edited March 2016
    Hiatal hernia is K44 with numbers for with or without gangrene or obstruction. There is no right or left to be coded. Leave the docs alone with hiatal hernia. Congenital diaphragmatic hernias (Morgagni or Bochdalek Q79.0) can be right or left but there is no ICD-10 code for right or left with these either. Who is telling you to get laterality for diaphragmatic hernias? There is no bilateral in ICD-10 either.

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)
  • cmorellcmorell
    edited March 2016
    Thank you for weighing in Dr. Gold.
    The problem arises with assignment of the ICD-10 procedure code for repair of hiatal hernia. E.g. with use of the 3M Encoder
    The procedure code begins with:
    0BQ then the

    Body part is either 2. Diaphragm (e.g. hiatal, parasternal)
    or 5. Paraesophageal

    Either choice leads to options of left, right or bilateral (e.g. midline)

    the bilateral choice results in both codes
    0BQS4ZZ Repair left diaphragm, percutaneous endoscopic approach
    0BQR4ZZ Repair right diaphragm, percutaneous endoscopic approach

    A coding clinic reference comes up:

    Laparoscopic Nissen fundoplication and diaphragmatic hernia repair
    Coding Clinic, Third Quarter ICD-10 2014 Page: 28 Effective with discharges: September 15, 2014

    Related Information

    Question:

    A 57-year-old female presented with a symptomatic midline diaphragm (paraesophageal) hernia and intractable gastroesophageal reflux. She underwent laparoscopic diaphragmatic hernia repair and Nissen fundoplication. During surgery, the hernia sac was separated from the diaphragm and the redundant sac was excised. The fundus of the stomach was brought around the esophagus and a loose Nissen fundoplication was performed. What are the correct ICD-10-PCS codes for laparoscopic paraesophageal hernia repair with Nissen fundoplication?

    Answer:

    When the diaphragmatic hernia is described as midline, assign codes for both right and left diaphragm repair, otherwise code to the side that was operated on. Assign the following ICD-10-PCS codes:


    0DV44ZZ
    Restriction of esophagogastric junction, percutaneous endoscopic approach (Nissen fundoplication)



    0BQR4ZZ

    Repair right diaphragm, percutaneous endoscopic approach (laparoscopic right diaphragm hernia repair)


    0BQS4ZZ

    Repair left diaphragm, percutaneous endoscopic approach (laparoscopic left diaphragm hernia repair)


    Our surgeons are saying for repair of a hiatal hernia there is no right side, left side or midline of the diaphragm. The hiatus is a single hole. They would prefer the default to be midline.

    This is not so different than the greater/lesser saphenous vein choice recently resolved with default to upper/greater.

    Hoping the coding clinic folks will make this a default too.

    Thanks,
    Charlie Morell
  • Unknown
    edited March 2016
    This could be interesting. The procedure is RELLY repair of stomach - restoring it to its normal anatomic structure and function - and the diaphragm may or may not be repaired at all. If you go at it this way, and I'm sure someone will chime in, we have 0DQ64ZZ unless a device is used. In inguinal and femoral hernias, the body wall is fixed (right or left) and in diaphragmatic hernias, the right or left is fixed. But sliding hiatal hernias may have a cinching up of the crus or not. There is no hole in the diaphragm to repair. Interesting!

    Robert S. Gold, MD
    CEO, DCBA, Inc
    4611 Brierwood Place
    Atlanta, GA 30360
    (770) 216-9691 (Office)
    (404) 580-0204 (Cell)

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