AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2014 Issue 3; Ask the Editor
Selective Excision of Paratracheal Lymph Nodes
A patient diagnosed with right lung cancer and chronic obstructive pulmonary disease underwent flexible fiberoptic bronchoscopy, video-assisted thoracoscopic right lobectomy and removal of lymph nodes from the right paratracheal stations 2, 4R, 7, 9, and 10R. What is the correct ICD-10-PCS code assignment for the removal of the lymph nodes from the right paratracheal stations 2, 4R, 7, 9, and 10R? ...
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Article Overview
This article addresses how to think about ICD-10-PCS coding for selective removal of paratracheal lymph nodes in the setting of lung cancer surgery. It is aimed at coders and clinical documentation reviewers working with thoracic procedures and highlights the type of documentation features that distinguish selective node removal from broader lymph node removal. The article centers on procedural coding concepts rather than clinical treatment guidance.
Why This Topic Matters
Accurate procedure coding depends on recognizing the scope of lymph node removal documented in the operative note, especially when thoracic surgery includes multiple anatomic stations. This topic is relevant to inpatient coders, CDI specialists, and auditors who review surgical documentation for ICD-10-PCS assignment.
What You Will Learn
- How selective lymph node removal is discussed in ICD-10-PCS coding context
- What types of thoracic surgical documentation are relevant to lymph node coding
- Why the distinction between different extents of node removal matters for procedure coding
- How operative wording can affect coding interpretation in lymph node cases
Who Should Read This
- Inpatient coders
- Clinical documentation integrity specialists
- Coding auditors
- Thoracic surgery coding staff
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