1/12/ Exercise Epidural injection of steroid (anti-inflammatory) for pain

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1 Errata for ICD-10-CM and ICD-10-PCS Coding Handbook 2018 without Answers Narrative changes appear in bold italicized text; deletions show as strikethrough text. 1/12/18 Page Number Current Text Revision 102 For example, a procedure to control bleeding from duodenal ulcers by using clips on vessels in the duodenum is coded to Repair of the duodenum rather than to a vascular system body part. In a similar example, control of epistaxis with sutures placed to surround a small ruptured arterial bleeding vessel of the external right naris is coded to 09QKXZZ, Repair nose, external approach. For example, a procedure to control bleeding from duodenal ulcers by using clips on vessels in the duodenum is coded to Repair Control of the duodenum rather than to a vascular system body part. In a similar example, control of epistaxis with sutures placed to surround a small ruptured arterial bleeding vessel of the external right naris is coded to 09QKXZZ, Repair nose, external approach. 0W3Q7ZZ, Control bleeding in respiratory tract, via natural or artificial opening. 157 When the patient makes a return visit to learn the result of the serology test, code Z71.7, Human immunodeficiency virus [HIV] counseling, should be assigned as the reason for the encounter when the test result is negative, inconclusive (R75), or positive. 210 For example, if a patient is admitted for a spinal fusion to treat lumbar spinal stenosis, assign code M48.06, Spinal stenosis, lumbar region, as the principal diagnosis. When the patient makes a return visit to learn the result of the serology test, code Z71.7, Human immunodeficiency virus [HIV] counseling, should be assigned as the reason for the encounter when the test result is negative, or inconclusive (R75)., or positive. For example, if a patient is admitted for a spinal fusion to treat lumbar spinal stenosis with neurogenic claudication, assign code M48.062, Spinal stenosis, lumbar region with neurogenic claudication, as the principal diagnosis. 212 Exercise Epidural injection of steroid (anti-inflammatory) for pain 246 Examples of appropriate coding include the following: K25.5 Chronic gastric ulcer with perforation K26.3 Acute duodenal ulcer K25.6 Gastric ulcer with hemorrhage and perforation Exercise Spinal Eepidural space injection of steroid (anti-inflammatory) for pain Examples of appropriate coding include the following: K25.5 Chronic or unspecified gastric ulcer with perforation K26.3 Acute duodenal ulcer without hemorrhage or perforation

2 266 A fifth character is assigned for duration, which distinguishes between a single (continuous) encounter and multiple (separate) encounters. For example, multiple hemodialysis encounters are coded to 5A1D60Z, Performance of urinary filtration, multiple. K25.6 Chronic or unspecified Ggastric ulcer with hemorrhage and perforation A fifth character is assigned for the duration of the dialysis session., which distinguishes between a single (continuous) encounter and multiple (separate) encounters Options are: intermittent, less than 6 hours per day; prolonged intermittent, 6-18 hours per day; or continuous, greater than 18 hours per day. For example, multiple hemodialysis encounters are administered for 4 hours per day is coded to 5A1D60Z 5A1D70Z, Performance of urinary filtration, multiple intermittent, less than 6 hours per day. 267 When dialysis is performed during the same episode of care, procedure code 5A1D00Z (single encounter) or 5A1D60Z (multiple encounter) is assigned to specify that the dialysis was actually performed during the encounter. 267 Z N Z A1D00Z Patient with chronic kidney disease, stage 5, on chronic dialysis, admitted for cleansing of hemodialysis catheter, single hemodialysis performed Intermittent hemodialysis is the conventional hemodialysis usually performed for end stage renal disease 3 times per week for about 4 hours per session. Intermittent hemodialysis may also be performed for acute kidney injury and may be somewhat lengthier or more frequent. The other two forms of hemodialysis can be referred to as Renal Replacement Therapy (RRT). These forms are directed only at acute kidney injury/acute renal failure and are typically delivered to critically ill patients in intensive care. They are a gentler type of dialysis with lower blood pump speeds and lower dialysate flow rates. When dialysis is performed during the same episode of care, procedure code 5A1D00Z (single encounter) or 5A1D60Z (multiple encounter) 5A1D70Z (intermittent), 5A1D80Z (prolonged intermittent), or 5A1D90Z (continuous) is assigned to specify that the dialysis was actually performed during the encounter. Z N Z A1D00Z 5A1D70Z Patient with chronic kidney disease, stage 5, on chronic dialysis, admitted for cleansing of hemodialysis catheter, single hemodialysis for 5 hours performed

3 275 For example, for a subtotal laparoscopic hysterectomy, code 0UT94ZZ, Resection of uterus, percutaneous endoscopic approach, is assigned 275 A total hysterectomy removes the whole uterus and cervix. This procedure requires two separate codes, one for the complete removal of the uterus and another for the complete removal of the cervix, because uterus and cervix have distinct body part values. This requirement is supported by the ICD-10-PCS guideline for multiple procedures B3.2c, which states that multiple procedures during the same operative episode are coded if [t]he same root operation is performed on different body parts as defined by distinct values of the body part character. For example, a total laparoscopic hysterectomy is coded as 0UT94ZZ, Resection of uterus, percutaneous endoscopic approach, along with 0UTC4ZZ, Resection of cervix, percutaneous endoscopic approach. 290 When coding for debridement of areas other than skin, excisional debridement is coded to the root operation Excision (for excisional debridement) or Extraction (for nonexcisional debridement) of the specific body part. 303 In addition, character 4 (body part) identifies the specific joint components resurfaced (total resurfacing involves both the acetabular and femoral components; partial involves femoral surface or acetabular surface only), as follows: 0SUR0BZ + 0SUA0BZ Resurfacing right hip, total, acetabulum and femoral 347 For subsequent encounters when there are retained products of conception following either a spontaneous abortion or an elective termination of pregnancy, assign the appropriate code from category O03, Spontaneous abortion, or code O07.4, Failed attempted termination of pregnancy without complication, and Z33.2, For example, for a subtotal supracervical laparoscopic hysterectomy, code 0UT94ZZ 0UT94ZL, Resection of uterus, supracervical, percutaneous endoscopic approach, is assigned. A total hysterectomy removes the whole uterus and cervix. This procedure requires two separate codes, one for the complete removal of the uterus and another for the complete removal of the cervix, because uterus and cervix have distinct body part values. This requirement is supported by the ICD-10-PCS guideline for multiple procedures B3.2c, which states that multiple procedures during the same operative episode are coded if [t]he same root operation is performed on different body parts as defined by distinct values of the body part character. Based on guidance from the Index, only one ICD-10-PCS code describing resection of the uterus is required for a total hysterectomy. For example, a total laparoscopic hysterectomy is coded as 0UT94ZZ, Resection of uterus, percutaneous endoscopic approach, along with 0UTC4ZZ, Resection of cervix, percutaneous endoscopic approach. When coding for debridement of areas other than skin, excisional debridement is coded to the root operation Excision (for excisional debridement) or Extraction (for nonexcisional debridement) of the specific body part. In addition, character 4 (body part) identifies the specific joint components resurfaced (total resurfacing involves both the acetabular and femoral components; partial involves femoral surface or acetabular surface only), as follows: 0SUR0BZ + 0SUA0BZ 0SU90BZ Resurfacing right hip, total, acetabulum and femoral For subsequent encounters when there are retained products of conception following either a spontaneous abortion or an elective termination of pregnancy without complications, assign the appropriate code from category O03.4, Incomplete Sspontaneous abortion

4 Encounter for elective termination of pregnancy. This advice applies even when the patient was discharged previously with a discharge diagnosis of complete abortion. 386 An additional code is used to identify hypertension (I10 I15) when present. 431 Assign code 02HA3RS, Insertion of biventricular short term heart assist system into heart, per cutaneous approach, to identify the insertion of a biventricular external heart assist device... without complication, or code O07.4, Failed attempted termination of pregnancy without complication, and Z33.2, Encounter for elective termination of pregnancy. This advice applies even when the patient was discharged previously with a discharge diagnosis of complete abortion. If the patient has a specific complication associated with the spontaneous abortion or elective termination of pregnancy in addition to retained products of conception, assign the appropriate complication in category O03 or O07 instead of code O03.4 or O07.4. An additional code is used to identify hypertension (I10 I15I16) when present. Assign code 02HA3RS, Insertion of biventricular short term external heart assist system into heart, percutaneous approach, to identify the insertion of a biventricular external heart assist device Codes I21.0- through I21.3- identify type 1 transmural infarctions; code I21.4- identifies type 1 subendocardial infarctions Assign the appropriate code for the radiation provided using a code from the Radiation Therapy Section, root operation "Beam radiation," modality "electrons," and selecting the "intraoperative" value for character 7, qualifier. Burns and corrosions of the same local site at the three-character category level (T20 T28) but of different degrees (depth) are classified to the subcategory identifying the highest degree recorded in the diagnosis. 536 A patient with end-stage kidney disease due to a congenital anomaly of the urinary tract status post deceased-donor right renal transplantation was admitted with delayed graft function and persistent severe hyperkalemia, which required hemodialysis.... Assign code 5A1D00Z, Codes I21.0- through I21.3- [delete hyphen] identify type 1 transmural infarctions; code I21.4- [delete hyphen] identifies type 1 subendocardial infarctions... Assign the appropriate code for the radiation provided using a code from the Radiation Therapy Section, root operation modality "Beam radiation," modality qualifier "electrons," and selecting the "intraoperative" value for character 7, qualifier. Burns and corrosions of the same local site at the three-character category level (T20 T285) but of different degrees (depth) are classified to the subcategory identifying the highest degree recorded in the diagnosis. A patient with end-stage kidney disease due to a congenital anomaly of the urinary tract status post deceased donor right renal transplantation was admitted with delayed graft function and persistent severe hyperkalemia, which required intermittent hemodialysis of less than 6

5 633 Performance of urinary filtration, single, for the hemodialysis She received good pain relief with IV pain medication and an epidural steroid injection.... hours per day.... Assign code 5A1D00Z 5A1D70Z, Performance of urinary filtration, single intermittent, less than 6 hours per day, for the hemodialysis She received good pain relief with IV pain medication and an epidural spinal space steroid injection....