Health Information Management

Q&A: Coding versus clinical conventions

CDI Strategies, May 12, 2016

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Q: When I try to code ileostomy take down of the small bowel resection and end-to-end anastomosis I get to code 0DBB4ZZ. Is this not a repair of the ileum and coded to 0DQB3ZZ? Coding Clinic notes the prior code not the latter, but repair means restore to previous function.
 
A: Coding Clinic states:
“The ileostomy takedown is coded as ‘Excision’ because part of the ileum is removed, and the anastomosis is considered inherent to the surgery and not coded separately. The ICD-10-PCS Official Guidelines for Coding and Reporting state ‘Procedural steps necessary to reach the operative site and close the operative site, including anastomosis of a tubular body part, are also not coded separately.’ Assign the following ICD-10-PCS codes: 0DBB0ZZ Excision of ileum, open approach (for the ileostomy takedown); 0WQF0ZZ Repair abdominal wall, open approach (for parastomal hernia repair and stoma closure.)
 
The definition of repair is “repairing to the extent possible, a body part to its normal anatomic structure and function.” I agree that the takedown does seem to fit the definition of a repair but, per the Coding Clinic it is coded to the root operation of excision.
 
The ICD-10 code set was designed to assist with standardization of healthcare data for use with reimbursement and statistical analysis which can be applied to quality measures, research, and demographic analysis. If we each choose to use these codes as we interpret them versus how the Cooperating Parties direct us to, the data would be useless.
 
There are times that the coding instructions do not appear to make sense or clinically support the situation but we are required by law to apply these rules consistently. We must do our best to follow the instructions as provided and the instruction regarding how to code a colostomy takedown within the Coding Clinic is very clear—as being an excision versus a repair.
 
We can, however, challenge this logic by submitting a Coding Clinic question to its editorial advisory board for further clarification. Questions can be submitted at http://www.codingclinicadvisor.com/.  You receive a reply usually within a few weeks.
 
And, Coding Clinic advice does change over time, as new concerns are brought to life. The most recent instruction will “trump” any previous advice and any conflicting advice given in preceding years will become null. But until changes are provided we must follow the instruction given. This can be frustrating but we must work to support the integrity of the code set.

Editor’s Note:
Laurie L. Prescott, RN, MSN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, and CDI Education Director at HCPro in Danvers, Massachusetts, answered this question, a portion of which is included in the May/June edition of the CDI Journal. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit www.hcprobootcamps.com/courses/10040/overview



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