8 Practice questions ICD-10-PCS for PCI, atherectomy, angioplasty, umbilical vein catheter placement and contrast selection in angiography.

This comprehensive document provides answers to various coding scenarios and includes detailed descriptions of each use case, along with the corresponding ICD-10-PCS procedure codes and ICD-10-CM diagnostic codes. The scenarios cover topics such as use case categories, appropriate procedure code selection for specific medical procedures, determination of contrast media type, coding for specific diagnoses, and more. The document aims to enhance understanding and accuracy in medical coding practices.

1. What is the description of Use Case 8 category? a) PDX D63.0 for anemia (should not be PDX) b) Actual LOS > DRGs GMLOS and no CCs/MCCs c) Expired patients d) Selected DRGs Answer: b) Actual LOS > DRGs GMLOS and no CCs/MCCs Rationale: The description of Use Case 8 category is "Actual LOS > DRGs GMLOS and no CCs/MCCs." This category refers to patients whose actual length of stay (LOS) exceeds the Geometric Mean Length of Stay (GMLOS) for the assigned Diagnosis-Related Group (DRG) and have no complications or major complications or comorbidities (CCs/MCCs) documented. 2. What is the description of Use Case 55 category? a) PDX D63.0 for anemia (should not be PDX) b) Actual LOS > DRGs GMLOS and no CCs/MCCs c) Expired patients d) Selected DRGs Answer: c) Expired patients Rationale: The description of Use Case 55 category is "Expired patients." This category pertains to patients who have passed away during their hospital stay. 3. What is the description of Use Case 31 category? a) PDX D63.0 for anemia (should not be PDX) b) Actual LOS > DRGs GMLOS and no CCs/MCCs c) Expired patients d) Selected DRGs Answer: d) Selected DRGs Rationale: The description of Use Case 31 category is "Selected DRGs." This category refers to cases where specific DRGs have been selected for analysis. 4. A newborn infant with extreme prematurity had an umbilical vein catheter inserted for venous access to administer fluids and medications. Follow-up imaging confirms that the catheter tip is in the inferior vena cava. What is the appropriate code for placement of an umbilical vein catheter? a) 06H033T b) 06H023T c) 06H013T d) 06H003T Answer: a) 06H033T Rationale: The appropriate code for the placement of an umbilical vein catheter with the catheter tip in the inferior vena cava is 06H033T.

In 2023, the ICD-10-PCS procedure code 06H033T represents the following procedure: - Root Operation: Insertion - Body Part: Infusion Device - Approach: Percutaneous - Device: Via Umbilical Vein - Qualifier: Into Inferior Vena Cava To build this code, you would follow the structure of ICD-10-PCS codes, which consists of seven characters. Here's a breakdown of each character and its meaning: 1. Section: The first character represents the section of the ICD-10-PCS classification. In this case, "0" indicates the Medical and Surgical section. 2. Body System: The second character identifies the general anatomical region or body system involved. In this case, "6" represents the Cardiovascular system. 3. Root Operation: The third character represents the root operation or the objective of the procedure. Here, "H" indicates "Insertion." 4. Body Part: The fourth character specifies the specific body part or anatomical site involved in the procedure. In this case, "0" represents the Infusion Device. 5. Approach: The fifth character indicates the approach or method used to reach the target site. Here, "3" signifies "Percutaneous." 6. Device: The sixth character identifies any specific device used during the procedure. In this case, "3" signifies "Via Umbilical Vein." 7. Qualifier: The seventh character provides additional details or qualifiers for the procedure. Here, "T" represents "Into Inferior Vena Cava." By combining these characters, the code 06H033T describes the insertion of an infusion device via the umbilical vein into the inferior vena cava using a percutaneous approach. It's important to note that the ICD-10-PCS codes are subject to updates and revisions, so always refer to the latest coding guidelines and updates to ensure accurate coding.

5. When a diagnostic percutaneous left heart catheterization is performed, along with right and left coronary arteriography and left ventriculogram using nonionic iso-osmolar contrast, such as Visipaque, how is the coder to determine the type of contrast used to perform the angiography? a) High osmolar b) Low osmolar c) Other d) None of the above Answer: c) Other Rationale: In this scenario, the coder needs to select "Other" as the type of contrast used for the angiography since it is specified as nonionic iso-osmolar contrast like Visipaque, which doesn't fall under the categories of high osmolar or low osmolar contrast. Here are some additional details about the different types of contrast media:

• High osmolar contrast media are the oldest type of contrast media. They are made up of large molecules that can cause a lot of fluid to shift out of the blood vessels and into the surrounding tissues. This can lead to side effects such as pain, nausea, and vomiting.
• Low osmolar contrast media are made up of smaller molecules that don't cause as much fluid to shift out of the blood vessels. This makes them less likely to cause side effects.
• Nonionic iso-osmolar contrast media are the newest type of contrast media. They are made up of the smallest molecules and are the least likely to cause side effects.

Visipaque is a nonionic iso-osmolar contrast media, so it falls into the "Other" category.

6. A ten-month-old was admitted to the hospital due to dyspnea. CT scan of the head, neck, and chest showed hairpin turns and twists in the aortic arch, carotid and pulmonary arteries. Cardiac catheterization showed severe lengthening, narrowing, and twisting of all of the child's major arteries and severe hypoplasia, or underdevelopment, of the aorta. The geneticist consultant diagnosed arterial tortuosity syndrome (ATS). What is the appropriate ICD-10-CM diagnosis code for ATS? a) Q87.82 b) Q87.89 c) Q87.9 d) Q87.0 Answer: a) Q87.82 Rationale: The appropriate ICD-10-CM diagnosis code for arterial tortuosity syndrome (ATS) is Q87.82, which specifically represents arterial tortuosity.

Arterial tortuosity syndrome is a rare congenital disorder characterized by the abnormal twisting and elongation of the major arteries in the body. The disorder can affect any artery, but it most commonly affects the aorta, carotid arteries, and pulmonary arteries. The twisting and elongation of the arteries can cause a variety of symptoms, including dyspnea, chest pain, and heart failure. The disorder is often diagnosed in childhood, but it can also be diagnosed in adulthood. There is no cure for arterial tortuosity syndrome, but treatment can help to manage the symptoms. Treatment options may include medication, surgery, or lifestyle changes.

7. A 65-year-old male with severe calf claudication developed an ulcer on the right foot and was admitted to the hospital for a percutaneous interventional procedure. The patient is a smoker with diabetes mellitus, hypertension, and dyslipidemia. Diagnostic angiography confirmed complete occlusion of the right superficial femoral artery, and he underwent balloon angioplasty with stent placement using a drug-coated balloon. Postprocedural imaging showed that blood flow had been restored. What is the appropriate ICD-10-PCS code for angioplasty of the femoral artery using a drug-coated balloon with stent placement? a) 047K3D1 b) 047C3D1 c) 047J3D1 d) 047H3D1 Answer: a) 047K3D1 0 - Medical and Surgical Section 4 - Lower Arteries Body System 7 - Dilation Approach K - Femoral Artery, Right 3 - Bifurcation D - Drug-eluting Intraluminal Device 1 - Drug-Coated Balloon Qualifier

Rationale: The root operation for the PCS code 047K3D1 is "Dilation." Here's how you can build the PCS code 047K3D1: 0 - Medical and Surgical Section: The procedure falls under the Medical and Surgical section of the ICD-10-PCS code system. 4 - Lower Arteries Body System: Select the body system that corresponds to the arteries being treated, which in this case is the "Lower Arteries" (Lower Arteries body system is specified in the scenario). 7 - Dilation Approach: Choose the approach that describes how the procedure is performed. In this case, the approach is "Dilation" (balloon angioplasty). K - Femoral Artery, Right: Select the specific body part involved in the procedure. In this case, it is the "Femoral Artery, Right" (specified in the scenario). 3 - Bifurcation: Specify the specific site or location within the body part where the procedure is performed. In this case, it is the "Bifurcation" of the right femoral artery (specified in the scenario). D - Drug-eluting Intraluminal Device: Indicate any device used during the procedure. In this case, it is a "Drug-eluting Intraluminal Device" (drug-coated balloon). 1 - Drug-Coated Balloon Qualifier: Provide any additional qualifiers or specific details about the procedure. In this case, it signifies the use of a "Drug-Coated Balloon." So, the PCS code 047K3D1 represents a procedure where angioplasty is performed on the bifurcation of the right femoral artery using a drug-coated balloon. 8. A 70-year-old male with first and second-degree atrioventricular (AV) blocks as well as right bundle branch block presents for insertion of a leadless pacemaker. A leadless pacemaker was inserted via catheter under fluoroscopic guidance into the right ventricle. The ICD-10-PCS does not provide a value for a leadless pacemaker. How should this procedure be coded? a) 02GK3DZ b) 02GK3DZ c) 02FK3DZ d) 02EK3DZ Answer: a) 02GK3DZ

0 - Medical and Surgical Section 2 - Heart and Great Vessels Body System G - Right Ventricle K - Catheter Approach 3 - Insertion D - Leadless Pacemaker Z - No Qualifier Rationale: Since the ICD-10-PCS does not provide a specific value for a leadless pacemaker, the procedure should be coded using the appropriate root operation for "Insertion" (0), the body part value for the right ventricle (H), and the approach value for catheter (K), resulting in the code 02GK3DZ.

The PCS code 02GK3DZ can be broken down as follows: 0 - Medical and Surgical Section: The procedure falls under the Medical and Surgical section of the ICD-10-PCS code system. 2 - Heart and Great Vessels Body System: Select the body system that corresponds to the heart and great vessels, which is the "Heart and Great Vessels" (Heart and Great Vessels body system is specified in the scenario). G - Right Ventricle: Choose the specific body part involved in the procedure. In this case, it is the "Right Ventricle" (specified in the scenario). K - Catheter Approach: Select the approach that describes how the procedure is performed. In this case, it is the "Catheter" approach. 3 - Insertion: Specify the specific action performed on the body part. In this case, it is the "Insertion" of a leadless pacemaker. D - Leadless Pacemaker: Indicate any device used during the procedure. In this case, it is a "Leadless Pacemaker." Z - No Qualifier: No additional qualifiers or specific details are provided for this code.