ICD-10-PCS: Coding Scenario
ICD-10-PCS Coding Scenario
B3.1a Root Operation – General Guidelines:
In order to determine the appropriate root operation, the full definition of the root operation as contained in the PCS Tables must be applied.
Metastatic amelanotic melanoma
A previous staging CT of the chest, abdomen, and pelvis revealed a single 4 cm lobulated mass lesion in the left lower lobe of the lung, confirmed to be amelanotic melanoma on subsequent biopsy.
Thermal ablation of the lung tumor
Grounding pads were placed on the patient, two on each thigh. After conscious sedation with Midazolam and Fentanyl and local anesthesia with intradermal and subcutaneous 1% lidocaine injection, a tiny incision was made into the skin. Under CT fluoroscopic guidance, a 10 cm long expandable 15-gauge StarBurst XL RF electrode was advanced into the lung mass. CT scan showed superomedial position of the electrode within the mass. A treatment algorithm with staged deployment was applied with the lesion ablated for 20 min at maximum deployment and target temperature of 90°C. Intermittent CT fluoroscopy was performed during the ablation cycle, and the electrode position was readjusted appropriately. The electrode was partially withdrawn at the end of the cycle and repositioned for further ablation. Repositioning and repeat ablation was performed two times to produce a thermal lesion that incorporates the tumor and nonmalignant lung parenchyma to create 1 cm wide surgical margin around the mass. Upon completion of the ablations, the needle was heated on withdrawal to minimize the risk of track ablation. Follow-up serial chest radiographs were performed, as per standard post-lung biopsy protocol, and were negative for a pneumothorax. The patient tolerated the procedure well and was discharged to recovery in satisfactory condition.
ICD-10-PCS Procedure Code(s):
0B5J3ZZ Destruction of Left Lower Lung Lobe, Percutaneous Approach
Rationale for Procedure Code(s):
The Medical and Surgical section constitutes the vast majority of procedures reported in the inpatient setting and all procedure codes in this section have a first character value of ‘0’.
The general body system on which the procedure was performed is the Respiratory System represented by the second character value of ‘B’.
The term “Ablation” in the ICD-10-PCS index directs the coder to the root operation Destruction. Even if the index is not consulted, the objective of destroying the tumor by thermal energy coincides with that of the same root operation. The root operation Destruction is represented by the third character value of ‘5’.
Applying guideline B3.1a, the full definition of Destruction as contained in the PCS Tables is “Physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent.” In this scenario, the portion of the left lower lung lobe containing the tumor is destroyed.
The body part is the Left Lower Lung Lobe represented by the fourth character value of ‘J’.
The approach is Percutaneous as only a small incision is used to place the probe under CT guidance which is represented by the fifth character value of ‘3’.
No devices or qualifiers apply so the last sixth and seventh character values are ‘Z’ No Device and ‘Z’ No Qualifier.
Optum360 Coding Resource:
Coding from the Operative Report for ICD-10-CM and –PCS
(Optum360 item#: CHOP15)