Lesson

The circulatory system is comprised of the heart, great vessels, arteries, veins, and capillaries. Recall that arteries are the ones that carry blood away from the heart, and veins are the ones that return blood to the heart. This week, you will want to spend some time reviewing the anatomy of the circulatory systems. When coding procedures on the circulatory system, be aware that the root operation, bypass, is coded differently with the coronary arteries. The coronary arteries are not individually identified with body part values. The body part value identifies the number of coronary artery sites treated (from value 0 for one site to value 3 for four or more sites) and the qualifier specifies the vessel bypassed from (the origin of the bypass). The qualifiers for the remainder of the body parts within the circulatory system describe the body part bypassed. Refer to OGCR B3.6b and B4.4 for additional guidance. 

Also note that procedures commonly referred to as a hearth catheter are not coded in ICD-10-PCS. Recall that the root operation should be assigned based on the intent of the procedure; therefore, the procedure performed through the catheter is what you would code. There are only four approaches applicable to procedures performed on the circulatory system: open (0), percutaneous (3), percutaneous endoscopic (4), and external (X).

There are three body systems that represent procedures performed on the gastrointestinal (GI) system—mouth and throat (C), the GI system (D), and the hepatobiliary system (F). Each of these has its own set of tables in ICD-10-PCS. Again, your knowledge of anatomy is important in recognizing the structures of the digestive system and hepatobiliary system affecting code assignment. Some of the common root operations performed on these systems includes dilation, occlusion, restriction, transplantation, and bypass. For bypass procedures, the body part value identifies the body part bypassed from and the qualifier specifies the body part bypassed to.

Note: It may be appropriate to code multiple procedures during the same operative session if multiple root operations with distinct objectives are performed on the same body part. Refer to OGCR B3.2c.

Some of the hormone-secreting organs considered to be part of the endocrine system are classified in other body systems within ICD-10-PCS, such as the hypothalamus, which is included in the central nervous system body system; the pancreas, which is included in the hepatobiliary body system; the ovary, which is included in the female reproductive body system; and the testes, which are included in the male reproductive body system. Root operations not applicable to the endocrine system are transplantation and root operations that describe procedures on tubular body parts. There aren’t any qualifiers unique to the endocrine system, just the standard qualifiers of Diagnostic (X) and No Qualifier (Z).

All of the structures that you would expect to be part of the lymphatic system are included in this body system within ICD-10-PCS, with the exception of the tonsils, which are included in the mouth and throat body system. The body part value is the entire lymph node chain. Recall that resection is the appropriate root operation when all of a body part is cut out or off (the entire lymph node chain in this case). If only a single lymph node is removed, the appropriate root operation is excision (cutting out or off a portion of a body part). Qualifiers used for the lymphatic system include the source of transplanted tissue. Be sure to review the definitions describing the source of allogeneic, syngeneic, and zooplastic.

Spend time reviewing the anatomy of both the endocrine and lymphatic systems using the figures in the text. The second character values for these systems are the endocrine system (G) and the lymphatic and hemic systems (7). 

This section covers the body systems for the skin and breast (H), as well as the subcutaneous tissue and fascia (J). Review the anatomy of the integumentary system, including the layers of the skin, the portions of the breast, and parts of the nails. ICD-10-PCS makes a clear distinction between skin (epidermis and dermis) and subcutaneous tissue (layer below the dermis). There are many root operations performed on the integumentary system. Alteration is a common one applicable when cosmetic surgery is performed. Again, it is important to recognize the intent of the procedure. For example, the same procedure may be coded two separate ways depending on whether there is a medical reason versus cosmetic reason for performing the procedure. 

Some helpful tips for this section include the following.

• Make note of the guidelines pertaining to biopsy. When a biopsy is performed and a more definitive procedure is performed on the same body part, you would code both the biopsy and the definitive procedure. Reference OGCR B3.4.
• Review the unique circumstances involved in coding transfer and replacement skin graft procedures based on whether or not the nervous and blood supply is left intact or detached.
• Recognize the correct use of the body part value when a procedure is performed on the skin, subcutaneous tissue, or fascia overlying a joint.
• Review OGCR B3.5, which pertains to coding procedures performed on overlapping layers of skin, subcutaneous tissue, fascia, muscle, and bone.