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AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2016 Issue 1; Ask the Editor

Biliary Obstruction due to Hepatocellular Malignancy

A 69-year-old patient with nonresectable hepatocellular carcinoma (HCC), status post radioembolization, presented with two weeks of progressive hyperbilirubinemia. He underwent endoscopic retrograde cholangiopancreatography, which revealed biliary obstruction from HCC progression. The provider performed biliary sphincterotomy and insertion of biliary stent into the common bile duct. There is confusion as to whether it is appropriate to sequence the carcinoma as the principal diagnosis, since it is the underlying cause of the obstruction, or whether the obstruction is sequenced as the principal diagnosis, since it was the reason for the admission, and no treatment was directed to the carcinoma. What is the correct sequencing of the biliary obstruction and the hepatocellular carcinoma for this encounter?  ...

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