AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2017 Issue 3; Ask the Editor
Augmentation Cystoplasty with Indiana Pouch and Continent Urinary Diversion
A patient with a history of prostate cancer and total urinary incontinence underwent an augmentation cystoplasty with Indiana pouch and continent urinary diversion. During the procedure, a midline incision was made from the umbilicus to the pubis. The bladder was mobilized and opened. Both ureteral orifices were initially cannulated with catheters, which were exchanged with urinary diversion stents. The bladder neck incision was extended and the bladder neck was circumscribed. The colon was divided and a segment of the terminal ileum was isolated. The right colon was opened and these edges were sewn together. A portion of the pouch was then sewn to the bladder. The bladder was closed. A catheter was brought through the closure, and the ureteral stents were removed through the suture line. A catheterizing segment of the pouch was brought through a circular incision in the right mid abdomen and the pouch was secured to the undersurface of the abdominal wall. What is the appropriate ICD-10-PCS code for creation of the Indiana pouch when the bladder is directly connected to the colonic pouch instead of using the ureter as the conduit? ...
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Article Overview
This article reviews a surgical urinary reconstruction case involving bladder augmentation, creation of a continent diversion, and related operative steps. It is aimed at coders and CDI professionals who need to understand the procedure context and the coding approach for inpatient operative reporting. The discussion is focused on identifying the appropriate ICD-10-PCS code for the case and on the anatomy and procedural elements involved.
Why This Topic Matters
Complex urinary diversion cases often combine multiple reconstructive steps, making accurate inpatient procedure reporting important for facility coding, data quality, and record review.
What You Will Learn
- How a complex urinary reconstruction case is described in operative terms
- What procedural elements are part of a bladder augmentation and continent diversion case
- How the case context relates to ICD-10-PCS procedure assignment
- How anatomy and operative steps inform inpatient coding review
Who Should Read This
- Hospital inpatient coders
- Coding educators
- Clinical documentation integrity specialists
- Revenue cycle professionals
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