Note: This is a clarifcation of a previous article. Click here to view the previous article.
Note: A clarification has been issued for this article. Click here to view the correction.
Coding Clinic, Second Quarter 2013, advised the assignment of codes that describe the destruction of the right and left pulmonary veins (025T3ZZ and 025S3ZZ), for catheter ablation around the pulmonary veins. We are requesting that the Coding Clinic Editorial Advisory Board revisit this advice. According to our electrophysiology study (EPS) physicians, the pulmonary veins are not being destroyed or eradicated. The intent of the surgery is to ablate the atrium. I understand that in ICD-10-PCS “peripulmonary vein” is coded to the body site; however the EPS physician stated that the pulmonary vein would never be destroyed. Could the EAB clarify this issue?
Upon further review, by the Editorial Advisory Board (EAB) for Coding Clinic, it has been determined that it is not appropriate to direct the coder to the pulmonary vein (codes 025T3ZZ and 025S3ZZ) for catheter ablation around the pulmonary veins. The operative report indicates that the target of the ablation procedure was the arrhythmogenic focus in the conduction pathway of the left atrium. EPS procedures involve the conduction mechanism by definition.
Anytime the term “peri” is documented, it is important for coders to review nearby anatomical structures to determine whether they more accurately describe the specific site or area of the procedure. In this case, it was the heart’s conduction pathway (mechanism).
The ICD-10-PCS guideline pertaining to “peri” (B4.1b) only applies when a more specific body part value is not available. Although the body part was described in the documentation as “peri-pulmonary veins,” the actual target of the ablation procedure was the arrhythmogenic focus in the conduction pathway and a specific body part exists for “conduction mechanism.” The “peri” guideline would apply when there is no body part value available in ICD-10-PCS. For the catheter ablation to treat atrial fibrillation, the correct ICD-10-PCS code assignment is as follows:
02583ZZ Destruction of conduction mechanism, percutaneous approach