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Coronary Artery Bypass Procedures (CABG) in ICD-10-PCS:

Compliance date for the ICD-10 implementation is not a flexible deadline and HHS has no plans to extend the compliance date, so after 5010 the next to be successfully implemented is ICD-10-CM and ICD-10-PCS.
With so many changes coming our way, ICD-10 Coders Academy brings to you unique aspects in ICD-10 of various coding scenarios and procedures in every edition of our e-newsletter ICD-10 Insight. In this edition of ICD-10 Insight, we will learn how CABG is coded in ICD-10-PCS.
Coronary artery bypass procedures are one of the many procedure codes that will become more specific in ICD-10 in terms of the materials used for creating the bypass conduit, approach to the procedure, as well as the source or origin of blood to the coronaries.
The fact that ICD-10-PCS is more specific in terms of gathering accurate information and more uniform over the different axes of classification. This may be observed clearly by having a look upon the CABG codes in ICD-9-CM. ICD-9 Volume 3 contains only nine codes in subcategory 36.1 Bypass anastomosis for heart revascularization, to code CABG procedures. From the nine codes in ICD-9 Volume 3 in subcategory 36.1, the first 4 codes describes the procedure in terms of the number of coronary arteries bypassed, the other codes specify the source of blood flow created towards coronary and one code is for unspecified circumstances. This makes the classification inconsistent at the 4th digit axis. Moreover, there is no scope in ICD-9 Volume 3 to capture information about the source or nature of the conduit that is created for revascularization as well as the approach adapted to perform the procedure.
In contrast to that, the ICD-10-PCS contains in all 248 codes for CABG procedures with in-depth information about the number of coronary artery sites bypass performed, along with the information about the approach adapted to perform the procedure, and the material used to create the conduit (autologous, non-autologous, synthetic graft, etc.). In addition, the PCS codes also provide the information about the source to the bypass in every code.
Table 021 in ICD-10-PCS provides the 4th to 7th character values to construct a code for any coronary artery bypass procedure performed in today's practice of medicine. In having a glimpse of the table, it looks like a complex grid but once a coder understands these characters and the values associated with them at different axes of the code, it gives a sense of pleasure and satisfaction that how great a code in such a specific detail will be.

The characters 4th to 7th of table 021:
  • The 4th character identifies the number of destination coronary arteries a bypass procedure is performed
  • The 5th character identifies any one of the three approaches (open, percutaneous, or percutaneous endoscopic, adapted for performing the procedure)
  • The 6th character in this table identifies the different materials may be used to create the bypass (autologous vein or autologous artery, nonautologous tissue, synthetic substitute, etc.)
  • The 7th character in the table enables a coder to construct a code as per the source of the blood flow to the myocardium through the bypass conduit made by the surgeon
The fixed 7 character coding system with each character of the code describing a definite aspect of the details of a procedure with its own attributed value, along the axis of a code made ICD-10-PCS as more acceptable over ICD-9 Volume 3.
The following are some examples of PCS codes for coronary artery bypass procedures with complete code definitions:
021009W - Bypass Coronary Artery, One Site to Aorta with Autologous Venous Tissue, Open Approach
02110AF - Bypass Coronary Artery, Two Sites to Abdominal Artery with Autologous Arterial Tissue, Open Approach
0210344 - Bypass Coronary Artery, One Site to Coronary Vein with Drug-eluting Intraluminal Device, Percutaneous Approach
Tips for CABG procedures coding in ICD-10-PCS:
  • Read and understand the medical record carefully
  • Decide the number of coronary artery sites bypass is performed
  • Carefully understand the approach
  • Check the procedure details for the harvesting of artery or vein from the patient's body or else, a nonautologous or synthetic material is used
  • Capture the correct information about the source of blood flow in the bypass
  • Sometimes a direct bypass without a graft may also be created between a coronary artery and another vessel, in such case the device value "Z" no device should be assigned
  • Be careful while constructing the PCS code in the table. Since a code may be constructed by moving in a single row collecting appropriate character values, but not by moving in the table by picking characters from different rows.
Note: Obtaining autologous vein graft or an artery graft from the patient's body during the coronary bypass procedure should also be coded additionally
It is evident that a claim with this much of specific detailed information about a procedure will in future enable a payer to develop appropriate reimbursement methodologies, may improve insurance policies in terms of coverage of services, enable faster claim processing, reduce the denial or pending claim issues and appeals processes, more accurate data outcome for research and development as well as other statistics once the ICD-10 will be implemented.
It is also a known fact that accurate data has always enabled medicine to understand diseases processes their magnitude and impact in reality over human population along with a better analysis of the valid procedures with acceptable results over the others. Since the time now demands a quick shift to the new and more advanced and accurate coding system, year 2012 is the most appropriate time to begin with the learning of ICD-10, with a plan for successful implementation by October 1, 2013.

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