FY 2024: MDC 6 - Digestive System - Surgical

Transcript

1. H I M | C O D I N G & C D I | H E A LT H I T | R E V C Y C L E Empowering Better Health e4health tackles healthcare’s data, quality and revenue challenges empowering your providers to focus on better care.
2. MDC 6 Diseases and disorders of the DIGESTIVE system SURGICAL
3. Objectives • Review MDC 6- Diseases and Disorders of the Digestive System with a focus on selected diagnoses and procedures • Learner will acquire a basic understanding of the diagnoses and procedures included in MDC-6 • Discuss Query opportunities in MDC-6 • Review coding clinics relevant to the chosen topics in each DRG
4. MDC 6-MS- DRGs (Surgical) • 326-327-328 Stomach, Esophageal and Duodenal Procedures with/without CC/MCC • 329-330-331 Major Small and Large Bowel Procedures with/without CC/MCC • 332-333-334 Rectal Resection with/without CC/MCC • 335-336-337 Peritoneal Adhesiolysis with/without CC/MCC • 338-339-340 Appendectomy with Complicated Principal Diagnosis with/without CC/MCC • 341-342-343 Appendectomy without Complicated Principal Diagnosis with/without CC/MCC • 344-345-346 Minor Small and Large Bowel Procedure with/without CC/MCC • 347-348-349 Anal and Stomal Procedures with/without CC/MCC • 350-351-352 Inguinal and Femoral Hernia Procedures with/without CC/MCC • 353-354-355 Hernia Procedures except Inguinal and Femoral with/without CC/MCC • 356-357-358 Other Digestive System OR Procedures with/without CC/MCC
5. ICD-10-PCS Review Coding guidelines, clinical criteria and query opportunities
6. Anatomy Review- Digestive system
7. Anatomy Review- Digestive system
8. Anatomy Review- Digestive system
9. Anatomy Review- Digestive system
10. EGD (esophagogastroduodenoscopy) • Can be done as an inspection • Root operation: Inspection • Can be done with biopsy • Root operation: Excision with ‘x’ as Qualifier • Can be done with removal of lesion/polyp • Root operation: Excision
11. Colonoscopy
12. Stomach, Esophageal & Duodenal Procedures • Creation of esophagogastric sphincteric competence, other procedures • Fundoplication, gastric cardioplasty, Nissen fundoplication • Root operation: Restriction • Excision of stomach via percutaneous endoscopic approach (diagnostic) • Includes percutaneous approach; Diagnostic, vertical • Excision or Destruction of lesion or tissue, pharynx and Division, tongue, palate, pharynx muscle • Repair of Zenker’s diverticulum • Root operation: Division, Excision or Repair • Gastrectomy, partial, with anastomosis to jejunum • Billroth II • Root operation: Bypass, Excision • Gastrectomy, partial, with anastomosis to duodenum • Billroth I, distal gastrectomy, gastro-pylorectomy • Review op report for total (Resection) or partial (Excision) removal of stomach
13. • Gastroenterostomy without gastrectomy • Gastro-duodenostomy, gastroenterostomy, percutaneous (endoscopic) gastrojejunostomy (PEGJ)- similar to PEG but tube in jejunum instead of stomach • Root operation: Bypass • Reposition stomach • Reduction of gastric volvulus • Root operation: Reposition • Pancreatico-duodenectomy, radical • Whipple procedure (excision of the pancreas, duodenum and adjacent tissues with multiple anastomoses) • Root operation: Bypass, Excision and/or Resection • Closely review op report for ALL partial or total structures removed; presence of LN biopsy; postoperative complications of leakage, or associated malnutrition STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES
14. • Shunt, venous, intra-abdominal • TIPS procedure (Bypass) • Proximal and distal portions of shunt locations must be documented. • Suture of laceration of esophagus • Repair of Mallory Weiss tear • Root operation: Repair • Review for acute blood loss anemia (ABLA) STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES
15. Esophageal Varices Treatment • Ligation of the esophageal vein, Root Operation: Occlusion • Endoscopic banding, Root Operation: Occlusion • Use “percutaneous endoscopic” as the approach • Endoscopic injection of a sclerosing agent, Root Operation: Introduction
16. • Anastomosis, intestinal • Both proximal and distal ends must be documented • Root operation: Bypass • Only assigned when a colostomy reversal doe not have trimming of intestinal edges • Closure of intestinal stoma • Closure or take down of colostomy • Root operation: Excision • Colectomy, total, intra-abdominal • Laparoscopic or open approach, assign additional code if ostomy created • Root operation: Resection Major Small & Large Bowel Procedures
17. Major Small & Large Bowel Procedures • Colostomy and ileostomy • Permanent and temporary • Root operation: Bypass • Clear description of portion of large intestine (ascending, descending, sigmoid, transverse) used must be documented • Excision, partial, of large intestine • Cecectomy, Enterocolectomy, Hartmann resection, Ileocolectomy, Resection of transverse colon, Sigmoidectomy • Root operation: Excision • Approach and specific location in intestine and all excised or resected portions must be documented
18. Major small and large bowel procedures • Repair of gastrointestinal organs • Colovaginal fistula, Cystocele, Other vaginoenteric fistula, Rectocele, Rectovaginal fistula • Root operation: Repair; Supplement if graft or prosthesis used in repair • Review record for documentation of all organs repaired and proper PDx assignment • Resection of intestine • All portions of small and large intestines • Root operation: Resection • Integral components per definition of root operation or necessary procedural steps to reach or close operation site are not coded separately • Suture of laceration • Small intestine except duodenum, large intestine • Root operation: Repair and/or Supplement • Careful review of operation report for clarification of etiology of laceration and its clinical significance is needed before this code can be assigned
19. Rectal Procedures • Excision or resection of rectum • Anterior resection of rectum with synchronous colostomy, complete proctectomy, partial proctectomy, rectal resection • Root operation: Excision or Resection • Colostomy done with rectal resection, assign additional code for colostomy • Root operation: Bypass • Resection of rectum, pull-through • Altemeier operation • Root operation: Excision or Resection • Review the operation note to confirm only portions of rectum/anus are resected
20. Peritoneal Adhesiolysis • Lysis of peritoneal adhesions • Adhesions of biliary tract, gallbladder, intestines, liver, mesentery, omentum, pancreas, peritoneum • Root operation: Release • Specific body part and approach must be identified • Code lysis of adhesions (LOA) when they are documented as extensive, requiring extra intraoperative time; they prevent access to the organ requiring surgery; or it is the only procedure performed • Do not code lysis of adhesions when they are only mentioned in the operation report with no intervention or do not prolong the procedure • Lysis of adhesions is frequently integral to the procedure
21. APPENDECTOMY • Complicated Principal Diagnosis • Acute appendicitis with/without abscess, with perforation, with generalized or localized peritonitis, rupture, or gangrene • Malignant neoplasm of appendix: Malignant carcinoid tumor of appendix • Uncomplicated Principal Diagnosis • Acute appendicitis without abscess, perforation, rupture, peritonitis, or gangrene • Procedures • Appendectomy • Root operation: Most often Resection; Open vs. laparoscopic approach • Drainage of appendix • Root operation: Drainage; Specify with/without drainage device
22. Minor Small & Large Bowel Procedures • Biopsy, open, of large intestine, rectum and small intestine • Root operation: Excision; Closed biopsy does not impact MS-DRG assignment • Reduction of volvulus • Reposition of duodenum, jejunum, ascending, transverse, descending, and sigmoid colon • Root operation: Reposition
23. Anal & Stomal Procedures • Excision, local, of lesion or tissue • Small intestine, ileum, jejunum, colon, large intestine, and rectum via laparoscopic, endoscopic, or percutaneous approach • Root operation: Excision • Operations on hemorrhoids • Destruction, excision, ligation • Root operation: Destruction, Excision or Occlusion depending on the goal of the procedure • Excision of Meckel's diverticulum • Laparoscopic or endoscopic • Revision of intestinal stoma • Based on intent, most often root operation is Repair. Sometimes: Release, Supplement, or Reposition
24. Inguinal & Femoral Hernia Procedures • Two different root operations • Based on intent of procedure • Root operation “Supplement” if graft or prosthesis used • Root operation “Repair” if without graft or prosthesis • Repair of femoral hernia • Open, laparoscopic and with/without graft; Report laterality • Root operation: Supplement or Repair • Repair of inguinal hernia • Open, laparoscopic and with/without graft; Report laterality • Root operation: Supplement or Repair • Hernia associated with adhesions and lysis performed→ MS-DRG 335-337 Peritoneal Adhesiolysis • Lysis of adhesions is higher in surgical hierarchy for MDC 6 due to addition of time and complexity to procedure
25. Other Hernia Procedures • Repair of other hernia of abdominal wall • Open or laparoscopic; Hernia type: Epigastric, hypogastric, incisional, Spigelian, umbilical, ventral • Root operation: Repair • Repair of other hernia of abdominal wall with graft or prosthesis • Open or laparoscopic with mesh or other graft of same hernias listed above • Root operation: Supplement • Remember! Hernia repair with LOA→ MS-DRG 335-337 Peritoneal Adhesiolysis • Other procedures • Repair of omentum, open, percutaneous, or percutaneous endoscopic approach • Reattachment of abdominal wall, open approach
26. Bariatric surgery • Adjustable Gastric Banding • Vertical Banded Gastroplasty • Open Gastric Bypass • Biliopancreatic Diversion
27. Feeding Tubes • Insertion of feeding tube into stomach or jejunum • Percutaneous Endoscopic Gastrostomy (PEG) tube • Insertion with the aid of a scope to determine best placement • Approach is percutaneous as the tube is not delivered via the scope
28. Other digestive system procedures • Biopsy, lymph node • Root operation: Excision or Drainage • Cholecystectomy, open • Open, total cholecystectomy • Root operation: Resection • Creation of cutaneoperitoneal fistula • Insertion of peritoneal dialysis catheter • Root operation: Bypass • Confirm documentation of ESRD
29. Other digestive system procedures • Debridement, excisional, of skin or subcutaneous tissue • Excision of skin AND subcutaneous tissue codes to body part subcutaneous tissue • Root operation: Excision • Confirm documentation of type, depth of debridement. Query if applicable. • Drainage of peritoneal cavity • With or without drainage device
30. Other digestive system procedures • Drainage of peritoneum • With or without drainage device via percutaneous endoscopic approach • Excision or destruction of peritoneal tissue • Mesentery, omentum complete or partial, peritoneum, presacral region, retroperitoneum • Root operation: Destruction, Excision or Resection • Careful review of operative report for what structures were removed for proper code assignment • Incision of abdominal wall • Incision and drainage of abdominal operative wound abscess • Root operation: Drainage or Excision • Insertion of intraluminal device into superior vena cava, percutaneous approach • Greenfield filter, vena cava umbrella, IVC filter • Root operation: Insertion • Procedure found in many MDCs, confirm PDx; Confirm device position is superior vena cava as inferior vena cava position does not impact MS-DRG
31. Other digestive system procedures • Laparotomy and laparoscopy • Exploratory laparotomy, peritoneoscopy • Root operation: Inspection • Assign if it’s the only procedure performed, i.e., suspected intrabdominal pathology but none found, only inspection of abdomen performed • Insertion of totally implantable vascular access device, subcutaneous tissue and fascia, open approach • Insertion into chest, abdomen, upper or lower arm or leg
32. Laser Interstitial Thermal Therapy (LITT) • Codes deleted from radiation therapy and added to Medical – Surgical section of ICD-10-PCS • Utilizes a laser fiber probe to deliver thermal energy for the targeted ablation of diseased tissue. New procedure to treat GI tumors • Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2022, Page 53 • Root operation destruction using LITT (Laser Interstitial Thermal Therapy) • Found in the different body systems where LITT is applied • LITT is the qualifier value This Photo by Unknown author is licensed under CC BY.
33. References • Anal fissure. Retrieved from https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424 on 11/23/22. • Anal fistula. Last reviewed 02/14/2019. Retrieved from https://my.clevelandclinic.org/health/diseases/14466-anal-fistula on 11/23/22 • Angiodysplasia StatPearls [Internet]. Maryam Aghighi; Mehran Taherian; Ashish Sharma. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK549777/ 11/11/22 • Anorectal Abscess. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/anorectal-abscess on 11/18/22 • Appendicitis. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/appendicitis 11/10/2022 • Bariatric Surgery Risks, Complications and Side Effects. Retrieved from https://www.upmc.com/Services/bariatrics/candidate/risks- and-complications on 11/23/22 • Birth Defects Surveillance Toolkit. November 19, 2020. Retrieved from https://www.cdc.gov/ncbddd/birthdefects/surveillancemanual/chapters/chapter-1/chapter1-4.html on 11/18/22 • Diverticulosis and Diverticulitis of the Colon. Retrieved from https://my.clevelandclinic.org/health/diseases/10352-diverticular- disease on 11/11/22 • Dumping Syndrome. Retrieved from https://www.mayoclinic.org/diseases-conditions/dumping-syndrome/symptoms-causes/syc- 20371915 11/17/22
34. References • Esophageal Diverticulum. Retrieved from https://my.clevelandclinic.org/health/diseases/16977-esophageal-diverticulum on 11/11/22 • Esophageal Spasms. Retrieved from https://my.clevelandclinic.org/health/diseases/15575-esophageal-spasms on 11/11/22 • Gastroparesis. Retrieved from https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc- 20355787 on 11/17/22 • Hemorrhoids. Retrieved from https://www.mayoclinic.org/diseases-conditions/hemorrhoids/symptoms-causes/syc-20360268 on 11/30/22 • Hernia. Last reviewed on 09/27/2018. Retrieved from https://my.clevelandclinic.org/health/diseases/15757-hernia on 11/30/2022 • Imperforate Anus. Retrieved from https://pediatricsurgery.wustl.edu/patient-care/congenital-and-pediatric- conditions/imperforate-anus/ on 11/22/22 • Intestinal Atresia and Stenosis. Reviewed By Katelyn Grube, MSN, APRN. Last Updated 10/2022. Retrieved 11/18/22 from https://www.cincinnatichildrens.org/health/i/obstructions • Intestinal ischemia. Retrieved from https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/symptoms- causes/syc-20373946 on 11/30/22 • Irritable Bowel Syndrome. Retrieved from https://www.mayoclinic.org/diseases-conditions/irritable-bowel- syndrome/symptoms-causes/syc-20360016 11/17/22
35. References • AHA ICD-10-CM and ICD-10-PCS Coding Handbook • ICD-10-PCS: An Applied Approach 2023 • Cengage: 3-2-1 CODE IT! • https://www.mayoclinic.org/diseases-conditions/esophageal-varices/symptoms-causes/syc-20351538. Retrieved 10/20/22 12:50PM • Mayo Clinic retrieved 11/9/22 from https://www.mayoclinic.org/diseases-conditions/peritonitis/symptoms-causes/syc-20376247 and https://www.mayoclinic.org/diseases-conditions/peritonitis/diagnosis-treatment/drc-20376250 • Pneumatosis Intestinalis. Jaehyuck Im; Fatima Anjum. Last Update: June 19, 2022. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK564381/ on 11/23/22 • Situs Inversus. Last reviewed 07/18/2022. Retrieved from https://my.clevelandclinic.org/health/diseases/23486-situs-inversus on 11/22/22 • What Is Cystic Fibrosis? Last updated on March 24, 2022. Retrieved from https://www.nhlbi.nih.gov/health/cystic-fibrosis on 11/23/22
36. Thank you! To learn more, please visit: e4.health