MDC6消化系統疾病類編碼注意事項 - nhi.gov.tw

1022. . .. .

Gastrointestinal system
duodenum
–Esophagogastroduodenoscopy [EGD] or upper GI endoscopy
Coding Handbood With Answers 2014,p248
0DJ08ZZ
4. . .. .
ICD-10-PCS Official Guidelines-1
• Components of a procedure specified in the root operation definition
and explanation are not coded separately. Procedural steps necessary to
reach the operative site and close the operative site, including
anastomosis of a tubular body part, are also not coded separately
•
•
• Laparotomy performed to reach the site of an open liver biopsy is not
coded separately.
• In a resection of sigmoid colon with anastomosis of descending colon to
rectum, the anastomosis is not coded separately.
5. . .. .
coded if:
• B3.2a
• The same root operation is performed on different body parts as
defined by distinct values of the body part character.

separately.
ICD-10-PCS Official Guidelines-3(1)
• B3.2b
• The same root operation is repeated at different body sites that are
included in the same in multiple body parts, and those body parts are
separate and distinct body parts classified to a single ICD-10-PCS body
part value. .(ICD-10-PCS Official Guidelines2016)
•
• Example: Excision of the sartorius muscle and excision of the gracilis
muscle are both included in the upper leg muscle body part value, and
multiple procedures are coded.
7. . .. .
ICD-10-PCS Official Guidelines-3(2)
• Multiple root operations with distinct objectives are performed on the
same body part.
•
• Example: Destruction of sigmoid lesion and bypass of sigmoid colon
are coded separately.
• (Destrution)(Bypass)
• B3.2d
• The intended root operation is attempted using one approach, but is
converted to a different approach.
•
cholecystectomy is coded as percutaneous endoscopic
Inspection and open Resection.
inspection)(Open resection)
• (Excision)(Extraction) (Drainage)(Diagnostic)
• Examples:
• Fine needle aspiration biopsy of lung is coded to the root operation
Drainage with the qualifier Diagnostic.
• Biopsy of bone marrow is coded to the root operation Extraction with
the qualifier Diagnostic.
• Lymph node sampling for biopsy is coded to the root operation
Excision with the qualifier Diagnostic. ICD-10-PCS Official Guidelines for Coding and Reporting 2016,p5
11. . .. .
• B3.4b
• If a diagnostic Excision, Extraction, or Drainage procedure (biopsy) is
followed by a more definitive procedure, such as Destruction, Excision or
Resection at the same procedure site, both the biopsy and the more definitive
treatment are coded.
the same procedure site, both the biopsy and the partial
mastectomy procedure are coded
• Bypass procedures are coded by identifying the body part bypassed
“from” and the body part bypassed “to.” The fourth character body
part specifies the body part bypassed from, and the qualifier specifies
the body part bypassed to.
• 4
• Example: Bypass from stomach to jejunum, stomach is the body
part and jejunum is the qualifier
• (Body part) (Qualifier)
13. . .. .
• B3.11a
• Inspection of a body part(s) performed in order to achieve the objective
of a procedure is not coded separately.
•
14. . .. .
• B3.11c
• When both an Inspection procedure and another procedure are performed on
the same body part during the same episode, if the Inspection procedure is
performed using a different approach than the other procedure, the Inspection
procedure is coded separately.
•
• Example: Endoscopic Inspection of the duodenum is coded separately when
open Excision of the duodenum is performed during the same procedural
episode.
15. . .. .
Esophagitis
• K22.11 Ulcer of esophagus with bleeding()
–Esophagitis with gastro-esophageal reflux disease (K21.0)
• K21.0 Reflux esophagitis ()
16. . .. .
Barrett's esophagus
dysplasia
dysplasia
– K22.719 Barrett's esophagus with dysplasia, unspecified
17. . .. .
Ulcers of the Stomach and Small Intestine_1
K25-K28

Anemia due to blood loss Anemia with UGI bleeding
–Peptic ulcerulcer site anemiagastric
ulcer with
Forrest classification
Acute hemorrhage
Signs of recent hemorrhage
–Forrest II c (Hematin on ulcer base)
Lesions without active bleeding
fibrin-covered ulcer base)

:

patch(Use autologous greater omentum)
I-10 CM
I-10 PCS
0DU907Z0DBS0ZZ
Supplement
*I-10 PCS0DU907Z
*Root operationSupplement
suture site Supplement”Repair with device” (Coding Clinic 2015,1Q,p28-29)
22. . .. .
Excision for graft
Excision for graft
–B3.9
• If an autograft is obtained from a different body part in order to
complete the objective of the procedure, a separate procedure is coded.
•
Gastrointestinal bleeding-1
Question
–The patient suffered lower Gastrointestinal bleeding and was
treated with endovascular embolization using microcoils to stop
the blood flow. The bleeding site was found in the proximal left
descending colon branch of the left colic artery. The main arterial
branch to this bleeding site was successfully embolized with
microcoils. What is the appropriate ICD-10-PCS procedure code?
–microcoils microcoilsICD-10-PCS
Coding Clinic 2014,1Q,p24
devices. The device key entry for “Embolization coils” advices
coders to use intraluminal device. Assign ICD-10-PCS code as
follows:
percutaneous approach
Gastrointestinal bleeding-3(1)
Question
esophagogastroduodenoscopy was carried out. Multiple clips
were applied to the vessels to control the multiple hemorrhaging
ulcers. Should”control” be assigned for the root operationWhat
is the appropriate ICD-10-PCS procedure code
– Root operation”control” ICD-10-PCS
Answer
–The root operation”control”is defined as only applicable for
procedures to correct postoperative bleeding, and so it does not apply
to this procedure. This procedure is a repair of the duodenum. Most of
the body’s organs and tissues are vascular, and they bleed when cut or
eroded. Repair of a cut or eroded body part is codes to the body part
repaired, rather than to a vascular system body part. In this case, the
duodenal ulcers are being repaired via an endoscopic approach, with
clips placed on vessels eroded by the ulcers.
ICD-10-PCS :0DQ98ZZ Repair duodenum, via natural
or artificial opening endoscopic

https://en.wikipedia.org/wiki/Endoclip
APC
Root operation
1944
Question
–Shallow gastric ulcer about 0.8 cm with oozing in the lesser
curvature side of the antrum s/p heat probe thermocoagulation
ICD-10-PCS 0W398ZZ 0D568ZZ
1944
(1:10000
1:100000) 3% 3.6% 7.1% 50% (fibrin sealant), thrombin
Root operation
Coding Clinic 2015,3Q,p24-25
I-10-PCS3E0G8GC

Hernias of the abdominal cavity-1
( ) ( )
http://www.jjmt.com.tw/hernia/intro.php
K40-K46
• recurrent
–Ventral Hernia(K43)
midline spigelian subxiphoidsupra-umbilicus) gangrene obstruction
36. . .. .
(Herniorrhaphy or hernia repair)
ICD-10-PCSmesh or graft
Root operationRepair
Root operationSupplement
-1
repair

–This 1 year-3-month-old girl was born at GA 36 weeks , productive
cough and dyspnea .Under the impression of hiatal hernia, she was
admitted for laparoscopic repair of hiatal hernia with patch

–Laparoscopic repair of hiatal hernia with Goretex patch 6 cm * 6 cm
used
I-10-CM
2014,3Q,p28
Hiatal hernia
gastroesophageal junction 4omentum
39. . .. .
Supplement
*Device Synthetic Substitute
-2(1)

I-10-CM
–K42.0 Hernia umbilical obstruction
-2(2) *I-10 PCS0WUF0JZ
*Device Synthetic Substitute
Dieulafoy Lesions
K63.81
43. . .. .
Crohn’s disease-1
()
44. . .. .
Crohn’s disease-2
Rectal bleeding K50.011 K50.111 K50.811 K50.911
Intestinal
obstruction
45. . .. .

Question
are used to identify Crohn’s diaease with intestinal abscess.
When presents with Crohn’s diaease of the small intestine with a
rectal abscess, would it be approprite to assign an additional
code for the rectal abscess?
AnswerK50.014+K61.1
–Yes, it is approprite to assign code K50.014, Crohn’s diaease of
the small intestine with abscess, along with code K61.1, Rectal
abecess, since the additional code provides information
regarding the specific site the abscess. Codes in category K50
describe intestinal abscess only. Coding Clinic 2012,4Q,p104
46. . .. .
Diverticulosis and Diverticulitis-1

http://connect.mayoclinic.org/hubcap/webinars/
Diverticulosis and Diverticulitis-2

• Diverticulosis and diverticulitis of duodenum
• K57.12 Diverticulitis of small intestine without perforation or
abscess without bleeding
Diverticulosis
Diverticulitis
5
50. . .. .
Fissure and Fistula of Anal-1
Fistula
–perianal abscess35
Fissure
51. . .. .
K 60
K60.1 (Chronic anal fissure)
K60.2 (Unspecified anal fissure)
K60.3 (Anal fistula)

–1.Perianal abscess
–2.Anal fistula
Fistulotomy
–In surgery, an anal fistulotomy was performed on the skin of
the perineum with drainage of the perianal abscess.
ICD-10-CM
Exludes 1
rectal regions with abscess or
cellulitis(K61.-)
Exclude1
–If two ICD-10-CM diagnoses are not related to each other,it is
permissible to report both codes despite the presence of an
Excludes1 note . Excludes1
Example
– I60-I69 (Cerebrovascular Diseases)
–Excludes 1 note • Codes range I60-I69 has an Excludes 1 note for traumatic intracranial
hemorrhage(S06.-) Codes in I60-I69 should not be used for a diagnosis
of for traumatic intracranial hemorrhage. However, if the patient has
both a current traumatic intracranial hemorrhage and sequela from a
previous stroke, then it would be appropriate to assign both a code
from S06 and I69.(S06+I69)
54. . .. .
Fistulotomy
Drainage of the perianal abscess
*I-10 PCS0D9QXZZ
*Root operationDrainage
Complications of Artificial Openings of the Digestive System-1
K94 T80~T88
″2″(infection)
Complications of Artificial Openings of the Digestive System-2

–4
58. . .. .

ICD-10-CM
enterostomy

*Device Feeding device
60. . .. .
Dilation of gastrojejunostomy anastomosis stricture-1
Question
completely occluded. A dilating balloon was able be through the
anastomosis. After the stricture was dilated, the scope was easily
passed into the afferent and efferent limbs of the jejunum
without difficulty. What is the correct body part for the dilation
of the gastrojejunostomy stricture?
61. . .. .
Dilation of gastrojejunostomy anastomosis stricture-2
Answer
anastomosi(stomach and jejunum were both dilated), codes are
assigned for each site.Assign the following ICD-10-PCS codes:
–0D768ZZ+0D7A8ZZ
Right Colectomy-1
–A 69-year-old patient, who was diagnosed with volvulus of the
right colon,underwent right colectomy. Would separate codes be
assigned for the resection of the cecum with appendix and
excision of the transverse colon? What is correct ICD-10-PCS
procedure code assignment for the right colectomy?
– ICD-10-PCS
Right Colectomy-2
–Although there is not universal agreement as to the anatomical
definition of the right colon, the surgeon documented,” resection
of the right,” in the operative report so it should be coded as
such. Do not separately code the excision of adjacent structures
that are an inherent part of the procedure to resect an entire
body part. Assign the ICD-10-PCS code as follows
ICD-10-PCS 0DTF0ZZ
involves removing • cecum
• part of the terminal ileum,
0DTF0ZZ
https://jarednoel.wordpress.com/tag/colectomy/
Right Colectomy-3
functional end-to-end anastomosis, is it appropriate to report an
additional code for the side-to-side anastomosis
0DTF0ZZ
Answer
–Do not assign a code for the side-to-side functional end-to-end
anastomosis. ICD-10-PCS Official Quidelines for Coding and
Reporting,Section B3.1b, clarifies that procedure steps necessary to
close the operative site, including anastomosis of tubular body pat,
are not coded separately. This quideline would apply regardless of
whether the procedure is an end-to-end or side-to-side anastomosis.
–Additionally, since there is a body part for right colon and entire
right colon was removed, the primary procedure is coded as
resection.
–ICD-10-PCS 0DTF0ZZ(Resection right large intestine)
Colostomy-1
Question
The above patient also had colostomy creation at the same time
that lower anterior resection of the rectum was performed.
Should the colostomy be coded?
Answer
Yes, creation of the colostomy should be separately coded. In this
case the sigmoid colon was bypassed to skin, and is appropirately
coded to the root operation “Bypass.”
Colostomy-2
–0D1N0Z4
https://www.google.com.tw/search?q=colostomy&biw
=911&bih=429&source=lnms&tbm=isch&sa=X&ved=
0ahUKEwjMvpG8zJrNAhULJJQKHYvMBGYQ_AUIB
Foreign body in esophagus-1
A child presents with a penny lodged() in the proximal
esophagus, and underwent endoscopy with foreign body removal.
During the inspection of the upper GI tract, no evidence of
external migration ()or inflammation was found. What is the
appropriate ICD-10-CM code assignment for a foreign body
lodged in the esophagus that does not cause injury, compression
of the trachea or respiratory obstruction
ICD-10-CM
Foreign body in esophagus-2
Answer • An esophageal foreign body is any object that does not belong in the
esophagus that becomes stuck there, and so it is classified as causing injury
in ICD-10-CM. Immediate treatment of an esophageal foreign body is
required, especially in cause of infant or child ingestion, due to potentially
serious complications, such as airway compromise, esophageal injury, and
digestive tract injury. If respiratory compromise is documented,assign code
T18.190-,Other foreign object in esophagus causing compression of
trachea. If there is no respiratory compromise or compression, assign code
T18.198-,Other foreign object in esophagus causing other injury.
• ICD-10-CM T18.190- T18.198-
Foreign esophagus tracheal compression specified type T18.190
71

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MDC6消化系統疾病類編碼 注意事項 - nhi.gov.tw

MDC6消化系統疾病類編碼注意事項 - nhi.gov.tw