Errata Basic ICD-9-CM Coding, 2006 Edition AC200505K Last minute updates in the coding of percutaneous transluminal coronary angioplasty (chapter 10 of book) and encounters for chemotherapy (chapter 23 of book) were received after the 2006 edition of Basic ICD-9- CM Coding was in production. Revised information is presented in bold-face type. Please make note of these changes in your book and answer key. Chapter 10 Changes: Percutaneous Transluminal Coronary Angioplasty Percutaneous transluminal coronary angioplasty (PTCA) is used to relieve obstruction of coronary arteries. PTCA is performed to widen a narrowed area of a coronary artery by employing a balloon-tipped catheter. The catheter is passed to the obstructed area, and the balloon is inflated one or more times to exert pressure on the narrowed area. A thrombolytic agent may be infused into the heart. Recent revisions have been made to the coding of PTCA and coronary stent insertions. At one time, angioplasty and stents were focused on treating single, short coronary obstructions. More extensive lesions were treated with coronary artery bypass grafts. Now, with advances in the devices used, it is possible to insert stents in several different vessels during the same operative episode. It is also possible to insert multiple adjoining or overlapping stents. Under the category heading, 36, Operations on vessels of heart, three code also notes are included: Code also any injection or infusion of platelet inhibitor (99.20) Code also any injection or infusion of thrombolytic agent (99.10) Code also cardiopulmonary bypass, if performed [extracorporeal circulation][heart-lung machine] (39.61) The percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy is identified with procedure code 00.66. It may also be referred to as a balloon angioplasty of a coronary artery. Beneath procedure code 00.66 are directional notes to code also : Injection or infusion of thrombolytic agent (99.10) Insertion of coronary artery stent(s)(36.06-36.07) Intracoronary artery thrombolytic infusion (36.04) Number of vascular stents inserted (00.45-00.48) Number of vessels treated (00.40-00.43) Note: PTCA with atherectomy involving different coronary arteries should be coded individually on the basis of the procedure performed. EXAMPLE: PTCA of left anterior descending artery with insertion of single drug-eluting stent: 00.66, 36.07, 00.40, 00.45 EXAMPLE: PTCA of left anterior descending artery and circumflex vessels with insertion of three non-drugeluting stents: 00.66, 36.06, 00.41, 00.47
A point to remember: Percutaneous transluminal angioplasty may also be performed on other arteries, such as renal, femoral, femoropopliteal, and vertebral. Code 39.50, Angioplasty or atherectomy of noncoronary vessel, is available for classifying angioplasty of these vessels. Insertion of stents into noncoronary vessels is reported with code 39.90, Insertion of non-drug-eluting peripheral vessel stent(s). You also code the number of vascular stents inserted (00.45 00.48) and the number of vessels treated (00.40 00.43). Code 36.06 is used for the insertion of a non-drug-eluting coronary artery stent(s), while 36.07 is used for the insertion of a drug-eluting coronary artery stent(s).
Chapter 23 Changes: Factors Influencing Health Status and Contact with Health Services (V01 V84) When a person with a resolving disease or injury or one with a chronic, long-term condition requiring continuous care encounters the healthcare system for specific aftercare of that disease or injury (for example, dialysis for renal disease, chemotherapy for malignancy, or cast change). A diagnosis or symptoms code should be used whenever a current, acute diagnosis is being treated or a sign or symptom is being studied. EXAMPLE: Patient is admitted for chemotherapy for acute lymphocytic leukemia: V58.11, Encounter for chemotherapy; 204.00, Acute lymphocytic leukemia; 99.25, Chemotherapy Category V58, Encounter for Other and Unspecified Procedures and Aftercare Category V58 includes codes for admissions or encounters for radiotherapy, chemotherapy, immunotherapy, attention to surgical dressings and sutures, other aftercare following surgery, and long-term (current) drug use, therapeutic drug monitoring, and so forth. Aftercare codes are not used if treatment is directed at a current, acute disease or injury. The diagnosis code is used for these patients. Exceptions to this rule are code V58.0, Radiotherapy, and V58.11, Antineoplastic Chemotherapy. These codes are always listed first, followed by the malignancy diagnosis code, when the patient s encounter is solely to receive radiation therapy or chemotherapy. Either code can be listed first if the patient is receiving both therapies during the same visit. EXAMPLE: Admission for chemotherapy for patient with metastasis to bone; patient has history of breast carcinoma with mastectomy performed eight years ago: V58.11, Encounter for chemotherapy; 198.5, Secondary neoplasm of the bone; V10.3, Personal history of malignant neoplasm of breast; 99.25, Injection or infusion of cancer chemotherapeutic substance Categories V73 V82, Special Screening Examinations On page 294, the final sentence of the second full paragraph reads, If a condition is established during the screening, the code for the condition should be reported rather than the screening code. This is incorrect. This sentence should read, Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis. This correction is in accordance with Coding Clinic 4 th quarter 2001, page 55, which supersedes Coding Clinic 4 th quarter 1996, page 53. First-Listed V Codes/Categories/Subcategories: V20 Health supervision of infant or child V22.0 Supervision of normal first pregnancy V22.1 Supervision of other normal pregnancy V24 Postpartum care and examination V29 Observation and evaluation of newborns for suspected condition not found (Exception: A code from V30 V39 may be sequenced before the V29 if it is in the newborn record.) V30 V39 Liveborn infants according to type of birth V46.12 Encounter for respirator dependence during power failure V56.0 Extracorporeal dialysis V58.0 Radiotherapy
V58.11 Chemotherapy (Note: V58.0 and V58.11 can be used together on a record with either being sequenced first when a patient receives both radiation therapy and chemotherapy during the same visit.)
Answer Key Changes: Exercise 5.2 7. V58.11 Admission, for, (or Encounter, for) chemotherapy, 162.3 Neoplasm, lung, upper lobe, malignant, primary M8042/3 Carcinoma, oat cell, primary site 198.5 Neoplasm, bone, malignant, secondary M8042.6 Carcinoma, oat cell, secondary site Review Exercise: Chapter 5 15. V58.11 Admission, for, (or Encounter, for) chemotherapy, 191.9 Glioblastoma, giant cell, unspecified site M9441/3 Glioblastoma, giant cell 17. V58.11 Admission, for, (or Encounter, for) chemotherapy, 204.00 Leukemia, lymphocytic, acute Fifth digit 0 = without mention of remission M9821/3 Leukemia, lympocytic acute Exercise 10.6 5. 00.66 Angioplasty, coronary, percutaneous transluminal 00.40 Procedure on single vessel Note at Angioplasty codes instructs to assign code for number of vessels treated 99.10 Injection, thrombolytic agent Review Exercise: Chapter 10 10. 410.11 Infarct, infarction, myocardial, anterior wall Fifth digit 1 = initial episode 00.66 Angioplasty, coronary, percutaneous transluminal 00.41 Procedure on two vessels Note at Angioplasty codes instructs to assign code for number of vessels treated 99.10 Injection, thrombolytic agent Review Exercise: Chapter 10 14. 444.81 Occlusion, iliac artery 39.50 Angioplasty, percutaneous, iliac Code also any insertion of noncoronary stent(s) or stent graft(s) Code also any number of vascular stents inserted (00.45-00.48) Code also any number of vessels treated (00.40-00.43) 00.55 Insertion, stent, non-coronary vessel (with angioplasty 39.50) drug eluting Code also any number of vascular stents inserted (00.45-00.48) Code also any number of vessels treated (00.40-00.43) 00.45 Insertion of one vascular stent 00.40 Procedure on single vessel
Exercise 23.2 4. V58.11 Admission, for, (or Encounter, for) chemotherapy, Chemotherapy, encounter (for) 201.90 Lymphoma, Hodgkin s Hodgkin s, lymphoma Fifth digit 0 = unspecified site Review Exercise: Chapter 23 15. V58.11 Admission, for, (or Encounter, for) chemotherapy, 174.2 Neoplasm, breast, upper inner quadrant, malignant, primary Coding Self Test 10. V56.0 Admission, dialysis, renal Dialysis, renal 585.5 Disease, kidney, chronic, stage V (Delete second listed 585 Failure, renal, chronic) 39.95 Hemodialysis Coding Self Test 46. V58.11 Admission, for, (or Encounter, for) chemotherapy, 183.0 Neoplasm, ovary, malignant, primary M8010/3 Carcinoma, primary 196.6 Neoplasm, lymph, gland, intrapelvic, malignant, secondary M8010/6 Carcinoma, metastatic 99.25 Chemotherapy