Route Operation - Repair or Destruction

bbogda@morrishospital.orgbbogda@morrishospital.org
in Clinical & Coding
We have been getting differing advice on whether to code treatment of an angiodysplastic lesion or Dieulafoy lesion as a repair or destruction when the lesion is treated w APC and hemoclip.  The advice from one source says to code both the "Destruction" of the lesion as the objective is to cauterize/destroy the abnormal lesion;  and "Repair"  for placement of the hemoclip to control possible/future bleeding - returning it to normal structure and function.  They further state that both can be coded referencing the ICD-10-PCS Official Guideline (Multiple procedures B3.2) that state multiple root operations with distinct objectives procedures performed on the same body part are coded separately.  
Another adviser states that the objective is the same - to control the bleeding.  Our coders are uncomfortable coding the "Repair" as it is a much larger DRG and was an invalid OR procedure in I-9. 
How are you assigning these procedures?

Comments

  • bbogda@morrishospital.orgbbogda@morrishospital.org
    bbogda@morrishospital.org said:
    We have been getting differing advice on whether to code treatment of an angiodysplastic lesion or Dieulafoy lesion as a repair or destruction when the lesion is treated w APC and hemoclip.  The advice from one source says to code both the "Destruction" of the lesion as the objective is to cauterize/destroy the abnormal lesion;  and "Repair"  for placement of the hemoclip to control possible/future bleeding - returning it to normal structure and function.  They further state that both can be coded referencing the ICD-10-PCS Official Guideline (Multiple procedures B3.2) that state multiple root operations with distinct objectives procedures performed on the same body part are coded separately.  
    Another adviser states that the objective is the same - to control the bleeding.  Our coders are uncomfortable coding the "Repair" as it is a much larger DRG and was an invalid OR procedure in I-9. 
    How are you assigning these procedures?

    Just putting this question out there again, hoping to get feedback.  We continue to have discussions on whether treatment of AVM with cautery and clip goes to route operation of Repair or Destroy.  Any thoughts?  (What if just cautery, what if just clip?)
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