AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2017 Issue 4; New/Revised ICD-10-PCS Procedure Codes
Fontan Completion Procedure
In code table 061, Lower Veins, Bypass, three qualifiers were added. QualifierP Pulmonary Trunk Q Pulmonary Artery, Right R Pulmonary Artery, Left The Fontan procedure is typically the final reconstructive procedure performed in pediatric patients with a single ventricle, for example, hypoplastic left heart syndrome, as well as other similar defects. The entire reconstruction usually requires three procedures. The first procedure is performed shortly after birth and consists of the Norwood procedure with modified Blalock-Taussig shunt or the Norwood-Sano procedure. Coding Clinic, First Quarter 2017, pages 19-20, addressed coding the Norwood procedure. Coding Clinic, Fourth Quarter 2016, pages 102-103...
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Article Overview
This premium article explains coding considerations for the Fontan completion procedure in pediatric congenital heart reconstruction, with reference to related staged procedures and a table update affecting ICD-10-PCS lower-vein bypass qualifiers. It is useful for coding professionals who work with congenital heart surgery, inpatient procedural coding, and ICD-10-PCS body-part selection. The article also references prior Coding Clinic guidance and a sample case that illustrates how the procedure is coded within the updated framework.
Why This Topic Matters
Fontan completion is a complex congenital heart operation, and small differences in anatomy and procedural approach can affect ICD-10-PCS code selection. This article matters because it clarifies how an update to a bypass table interacts with existing Coding Clinic guidance for a highly specialized pediatric cardiac surgery context.
Article Sections
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ICD-10-PCS table update
Introduces changes to a lower-vein bypass table and the newly added qualifiers relevant to congenital heart bypass coding.
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Staged Fontan reconstruction
Describes the overall staged surgical pathway used in single-ventricle congenital heart repair and places the Fontan completion procedure within that sequence.
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Fontan completion procedure details
Summarizes the anatomy and surgical reconstruction involved in the final stage of Fontan circulation, including the general flow pathway and use of graft-based connections.
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Fenestration and surgical considerations
Explains an additional surgical feature sometimes incorporated into the reconstruction and its general purpose within the procedure.
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Prior Coding Clinic guidance
References earlier Coding Clinic discussion related to coding this type of cardiac bypass procedure and the way the updated table affects body-part selection.
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Sample case and coding question
Presents a representative patient scenario and asks how the procedure should be coded under the described ICD-10-PCS framework.
What You Will Learn
- How the Fontan completion procedure fits into staged congenital heart repair
- What ICD-10-PCS table changes are relevant to lower-vein bypass coding
- How prior Coding Clinic references are connected to this procedure type
- What general features of a sample Fontan case are highlighted for coding review
Who Should Read This
- ICD-10-PCS coders
- Inpatient coding professionals
- Coding auditors
- Clinical documentation specialists
- Cardiovascular surgery coding staff
Codes Discussed
Code Ranges Discussed
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