In Table 0F8, Division of Hepatobiliary System and Pancreas, all liver body part values have been added as shown below. The change will allow the reporting of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).
1 Liver, Right Lobe
2 Liver, Left Lobe
4 Percutaneous Endoscopic
|Z No Device||Z No Qualifier|
A patient presents for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) due to intrahepatic cholangiocellular carcinoma of the right liver lobe. The procedure is carried out in order to create hypertrophy in the small left lateral liver lobe. After achieving pneumoperitoneum robotic ports were placed. The robot was brought in and ports were docked for robotic assisted laparoscopic surgery. A cholecystectomy was performed. Then, the right portal vein was isolated and a Hem-o-lock clip was placed, completely occluding portal flow. Next, the hepatic parenchyma between segments 4 and 3 was divided using a scalpel. Segment 4 pedicle was identified, clipped and divided followed by stage 1 ALPPS procedures. Approximately 50% parenchyma dissection was performed. The liver splitting sites were then sprayed with FloSeal® for homeostasis. How should this procedure coded in ICD-10-PCS? Are the portal vein occlusion and cholecystectomy procedures coded separately?
Assign the following ICD-10-PCS codes:
0F824ZZ Division of left lobe liver, percutaneous endoscopic approach, for the ALPPS of the liver to create hypertrophy in the left lobe of the liver;
0FT44ZZ Resection of gallbladder, percutaneous endoscopic approach, for the cholecystectomy;
06L84CZ Occlusion of portal vein with extraluminal device, percutaneous endoscopic approach, for the portal vein occlusion using a clip; and
8E0W3CZ Robotic assisted procedure of trunk region, percutaneous approach, for the robotic assisted laparoscopy.
ALPPS is most accurately classified as a Division procedure. If the gallbladder had been removed as part of an excision or resection of the right lobe of the liver, the gallbladder resection would not be coded separately. However, in this case the right lobe of the liver was not excised or resected, so it is appropriate to code the gallbladder removal.