HCGTV: Webinar - Body Parts, Devices, and Qualifiers, Oh My! ICD-10-PCS Coding for Coronary Bypass

The speaker welcomes the audience to the webinar on ICD-10 PCS coding for coronary bypass and introduces Christy Pollard, the lead developer and experienced teacher who will be presenting. The speaker humorously mentions a shared trait with Christy, being a Colorado native who has never skied, and praises Christy's engaging and informative presentations. Christy confirms her readiness to present on coronary artery bypass graft coating for ICD-10-PCS, noting it as a follow-up to a previous CPT presentation.

Christy begins with a brief overview of the anatomy related to CABG coding, emphasizing the importance of understanding the procedural process. She discusses ICD-10 PCS guideline A11, which highlights the coder's responsibility to translate medical records into PCS codes, and the expectation that physicians won't use the same terminology as coders. The focus is on coronary artery bypass, where the root operation is 'bypass', and the discussion revolves around the 0211 table, which is crucial for code assignment.

The presentation delves into the anatomy of the coronary arteries, explaining the blood flow from the aorta to the coronary arteries. Christy describes the right coronary artery (RCA) and the left main coronary artery (LMCA), which branches into the circumflex and the left anterior descending (LAD) arteries. She emphasizes the significance of the LAD for blood supply to the left ventricle, highlighting the dangers of blockages leading to myocardial infarction. The discussion includes the identification of various branches of the coronary arteries and the importance of understanding these for accurate coding.

Christy discusses different types of coronary artery bypass procedures, including aortocoronary bypass with free grafts and mammary artery bypass using in-situ or pedicle grafts. She explains the coding implications of each, including the body part and qualifier values. The presentation also covers the harvesting of graft materials, with a focus on the saphenous vein and the radial artery, and the coding for excision when applicable. Christy clarifies that in-situ grafts, such as the internal mammary artery (IMA), are not considered devices and thus have no device qualifier in the code.

The webinar continues with a discussion on the coding implications of different graft types, including autologous venous and arterial tissues, and synthetic substances. Christy addresses the use of the internal thoracic artery as a newer term for the internal mammary artery and its implications for coding. She also introduces the concept of sequential or 'jump' grafts, where a single graft segment is used to bypass multiple areas of blockage, and how this affects the body part character count for the number of coronary arteries bypassed.

Christy discusses various sites for graft harvesting, including the saphenous vein, radial artery, and mammary arteries, and the root operation for graft harvesting when it involves a free graft. She mentions the DuraGraft technology, a new procedure to prevent future graft failure, and its coding under the XY0 table. Christy also touches on the coding for cardiopulmonary bypass (CPB), distinguishing it from coronary artery bypass grafting and emphasizing its role in taking over cardiac and respiratory functions during heart surgery.

The presentation addresses the coding for redo coronary artery bypasses, referencing a Coding Clinic article that provides guidance on whether to code it as a new bypass or as a revision depending on the procedure's intent. Christy differentiates between mobilizing an artery for bypass and releasing a constricted coronary artery, explaining the coding implications of each. She also clarifies that coronary endarterectomy, when done in preparation for CABG, is not coded separately as it is considered integral to the bypass procedure.

Christy presents case studies to illustrate the application of coding principles discussed earlier in the presentation. She walks through the operative reports, highlighting key phrases and terms that impact code assignment. The case studies cover multiple bypass grafts using different types of graft materials, such as the left internal mammary artery (LIMA), radial artery, and saphenous vein grafts. Christy emphasizes the importance of identifying the number of grafts, the type of graft material, and the approach used for harvesting in determining the correct codes.

Christy concludes the presentation by listing the references used and mentions that a follow-up FAQ video will be posted to address questions from the webinar. She encourages attendees to submit questions through the chat window or via email and reminds them of the next webinar on CPT coding for vascular access devices.