1Q 2020

PCS Coding Clinics Breakdown

This Deck Contains Confidential Information: Do Not Duplicate or Distribute Without Permission
 Detoxification and pharmacotherapy
• Code HZ2ZZZ, Detoxification services for substance abuse treatment, includes
detoxification services to help the patient stabilize. Detoxification includes the active
management of withdrawal symptoms.

• Pharmacotherapy (HZ9_ZZZ), involves replacing the substance of abuse over a longer

period to wean the patient (e.g., methadone maintenance for heroin dependence), which
is different from prescribing Ativan or other drugs to offset symptoms of alcohol
withdrawal, such as delirium tremens or pending delirium tremens.

2 – Confidential: Do Not Duplicate or Distribute Without Permission

 Intraventricular vascular malformation excision
• In an intraventricular vascular malformation excision, the body part depends on the type
of malformation documented.

Example:

• If the surgeon confirms that the lesion is a DVA (developmental venous anomaly), only the
excision of intracranial vein code is reported.

• 05BL0ZZ Excision of intracranial vein, open approach

3 – Confidential: Do Not Duplicate or Distribute Without Permission

4 – Confidential: Do Not
Duplicate or Distribute
 Pulmonary artery unifocalization
• Collateral arteries – fetal vessels that normally close down, but which these patients rely
on as the only open path from the heart to the lungs (pulmonary atresia).

• In unifocalization, the misdirected blood vessels are rerouted into a single vessel (or into
the pulmonary artery if it is present), which is then attached to the right ventricle of the
heart through a conduit.

5 – Confidential: Do Not Duplicate or Distribute Without Permission

 Pulmonary artery unifocalization
• “Nonduplicate MAPCAs to the left and right lung were taken off the descending aorta
and unifocalized together with the native pulmonary arteries (PAs). These required
extensive patching with PhotoFix (bovine) pericardium.”

• 02UP08Z Supplement pulmonary trunk with zooplastic tissue, open approach, for
pulmonary artery plasty using PhotoFix (bovine) pericardium to form a single pulmonary
artery trunk conduit for the distal anastomosis with the Gore-Tex ®.

• “A right ventriculotomy was performed, and an 8 mm Gore-Tex ® conduit was sewn into
the unifocalized PAs distally and the right ventricular outflow tract proximally.”

• 021K0JP Bypass right ventricle to pulmonary trunk with synthetic substitute, open
approach, for the Gore-Tex ® portion of the bypass conduit

6 – Confidential: Do Not Duplicate or Distribute Without Permission

7
8
 Elephant trunk repair of aortic dissection
• “After median sternotomy, the ascending aorta was divided and trimmed down to the
sinotubular junction. A Hemishield Dacron graft was fashioned end-toend to the aorta at
the junction.”

• “The ascending aorta was further abbreviated to allow hemiarch resection. A Gore-Tex ®
fixed elephant trunk endoprosthesis was then passed into the open arch, under direct
vision. The endograft was deployed and secured to the edge of the hemiarch incision on
the lesser curvature.”

• “A hole was developed in the endograft for the left subclavian artery. Through this, a
Gore Viabahn covered endograft was passed into the left subclavian artery and remained
in the lumen.”

9 – Confidential: Do Not Duplicate or Distribute Without Permission

 Elephant trunk repair of aortic dissection
• 02RX0JZ Replacement of thoracic aorta, ascending/arch with synthetic substitute, open
approach, for the replacement of a portion of the ascending aorta with Dacron

• 02VW0DZ Restriction of thoracic aorta, descending with intraluminal device, open

approach, for the endoprosthesis placed in the descending portion of the thoracic aorta;
and

• 03H40DZ Insertion of intraluminal device into left subclavian artery, open approach, for
the endograft extension placed in the left subclavian

10 – Confidential: Do Not Duplicate or Distribute Without Permission

11
12
 Delayed reconstruction following mastectomy using gracilis
musculocutaneous free flap

13 – Confidential: Do Not Duplicate or Distribute Without Permission

14 – Confidential: Do Not
Duplicate or Distribute
15 – Confidential: Do Not
Duplicate or Distribute
 Delayed reconstruction following mastectomy using gracilis
musculocutaneous free flap
• 0HRU07Z Replacement of left breast with autologous tissue substitute, open approach;
and

• 0KBR0ZZ Excision of left upper leg muscle, open approach, for the left breast delayed
reconstruction using vertical upper gracilis musculocutaneous free flap.

16 – Confidential: Do Not Duplicate or Distribute Without Permission

 Free flap microvascular breast reconstruction
• S/P mastectomy w/ abdominal superficial inferior epigastric artery (SIEA) flap
reconstruction.

• Postoperatively a change in the color of the flap with decreased signals was noted and
the patient was taken back to the operating room. There was no blood flow from the
internal mammary vein so it was decided to utilize the external jugular vein instead.

17 – Confidential: Do Not Duplicate or Distribute Without Permission

 Free flap microvascular breast reconstruction
• “A neck incision was made exposing the external jugular vein. A saphenous vein graft
was harvested for additional length. A subcutaneous tunnel was created from the left
neck to the chest and the vein graft was passed through the tunnel. The proximal
saphenous vein graft was anastomosed to the left external jugular vein (EJV) and the
distal saphenous vein graft was anastomosed to the superficial inferior epigastric vein
(SIEV).”

• 051Q49Y Bypass left external jugular vein to upper vein with autologous venous tissue,
percutaneous endoscopic approach, for the left external jugular to superficial inferior
epigastric vein bypass via saphenous vein graft; and

• 06BQ0ZZ Excision of left saphenous vein, open approach, for the harvesting of the graft.

18 – Confidential: Do Not Duplicate or Distribute Without Permission

 Repair of sternal dehiscence using Sternal Talon® device
• “The sternum was debrided with a saw and pectoralis flaps were advanced but left
connected to the chest wall. Sternal Talon® plates were placed across the sternum
beginning at ribs 3-6. Each plate was anchored with screws lateral to the sternum. The
sternum and manubrium were reapproximated at the midline with the titanium plates
and screws. The pectoralis muscles were sutured together at the fascia level over the
plates. The fascia and chest wall were then reapproximated.”

• 0PH000Z Insertion of rigid plate internal fixation device into sternum, open approach,
for the repair of the sternum with insertion of the Sternal Talon® device.

• The objective of the procedure is to insert the device to hold the sternum closed.

19 – Confidential: Do Not Duplicate or Distribute Without Permission

20 – Confidential: Do Not
Duplicate or Distribute
 Polarity Skin TE (TM) application
• The patient had previously undergone placement of autograft and homograft due to full
thickness burns and is now admitted for failure of the previously placed autograft and
homograft.

• “During surgery, the affected areas were excised and debrided, a new homograft was
placed, and full thickness skin was harvested for anticipated Polarity Skin TETM grafting.
During this admission, the patient also underwent removal of the homograft,
debridement of the affected areas and placement of full thickness Polarity Skin TETM
graft.”

21 – Confidential: Do Not Duplicate or Distribute Without Permission

 How is SkinTE used?
• Medical providers take a small, full-thickness skin sample from the patient (autologous)
and returns it to PolarityTE in the provided parcel.

• PolarityTE manufactures SkinTE.

• SkinTE is contained within a syringe and is returned to provider in all-inclusive

Deployment Box as soon as same day, and typically within 48-72 hours based on
providers’ requests.

• Provider applies SkinTE to patient’s wound/defect, covers with dressings and cares for
wound/defect similar to standard of care for skin grafts

22 – Confidential: Do Not Duplicate or Distribute Without Permission

23 – Confidential: Do Not
Duplicate or Distribute
 Polarity Skin TE (TM) application
• Assign the appropriate code for the full thickness autologous tissue substitute, with the
root operation "Replacement," for the placement of the full thickness Polarity Skin TETM
graft.

• The excision of failed autograft and homograft, followed by replacement with full
thickness Skin TE TM graft, support the root operation "Replacement" - Putting in or on
biological or synthetic material that physically takes the place and/or function of all or a
portion of a body part.

24
 Repair of buried penis
• “The patient underwent escutcheonectomy. At surgery, the penis was degloved to the
suspensory ligament. Escutcheonectomy was performed with removal of excess
suprapubic skin, fat and tissue. Split-thickness skin graft was excised from the right
upper thigh. The graft was used to cover the penis where it had been degloved.”

• 0JB80ZZ Excision of abdomen subcutaneous tissue and fascia, open approach, for the
escutcheonectomy

• 0VUS07Z Supplement penis with autologous tissue substitute, open approach, for the
skin graft to the penis; and

• 0HBHXZZ Excision of right upper leg skin, external approach, for the split thickness skin
graft harvest from the right thigh.

• If the scrotal fat pad is also excised, it can be coded separately in table 0VB, Excision,
male reproductive system.

25 – Confidential: Do Not Duplicate or Distribute Without Permission

26 – Confidential: Do Not
Duplicate or Distribute
 Ablation convergent procedure
• A patient with afib presents for a redo ablation procedure. A hybrid ablation convergent
procedure was done, in which the cardiologist performed a catheter-based ablation in
the electrophysiology (EP) laboratory, and the cardiothoracic surgeon performed an
ablation via a thoracoscopic (subxiphoid) approach.

27
 Ablation convergent procedure
• 02584ZZ Destruction of conduction mechanism, percutaneous endoscopic approach, for
the ablation using the thoracoscopic (subxiphoid) approach, and

• 02583ZZ Destruction of conduction mechanism, percutaneous approach, for the ablation

performed using a catheter-based approach.

• Do not assign a separate code for the EAM (electroanatomic mapping). The EAM was done
to assist in the performance of the ablation procedure and is not a separate diagnostic
mapping.

28 – Confidential: Do Not Duplicate or Distribute Without Permission

 Spinal fusion without use of bone graft
• “Through a right thoracotomy approach, a right anterior spinal fusion was performed
with placement of screws into the vertebral body and seating of a rod cord at T5-T11.
Significant correction of the scoliosis curve was obtained across the thoracic levels. The
patient was repositioned for exposure of the left side to complete left anterior spinal
fusion at T11-L4. Screws were placed into the vertebral body and a rod cord was secured
across the levels with significant correction of the scoliosis and derotation of the lumbar
segments.”

29 – Confidential: Do Not Duplicate or Distribute Without Permission

30 – Confidential: Do Not
Duplicate or Distribute
31
 Spinal fusion without use of bone graft
• In ICD-10-PCS, this procedure is not classified as a fusion, but rather as an anterior
vertebral tethering procedure. Reposition is the appropriate root operation.

• 0PS404Z Reposition thoracic vertebra with internal fixation device, open approach; and

• 0QS004Z Reposition lumbar vertebra with internal fixation device, open approach, for
this case.

32 – Confidential: Do Not Duplicate or Distribute Without Permission

Thank you!