AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2018 Issue 2; Ask the Editor
Transverse Rectus Abdominis Myocutaneous (TRAM) Delay
A woman, who had undergone bilateral mastectomy and radiation therapy, was admitted for transverse rectus abdominis myocutaneous (TRAM) delay procedure. At surgery, incisions were made over the inferior aspect of the rectus muscle bilaterally and the rectus muscle was retracted medially. The vascular pedicle, comprising the inferior epigastric artery and vein, were identified and doubly ligated with surgical clips on the right as well as the left. According to studies, ligation of the deep epigastric vessels before TRAM flap reconstruction (TRAM delay) may improve blood circulation to the TRAM, and can decrease the rate of flap ischemia. What is the code assignment for this procedure? ...
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Article Overview
This premium article explains a TRAM delay procedure in the context of post-mastectomy breast reconstruction and reviews the related ICD-10-PCS coding considerations. It is intended for coders and revenue cycle staff who need to understand the procedural concept, the anatomic context, and the code assignment referenced in the article.
Why This Topic Matters
TRAM delay procedures are part of reconstructive surgical planning, and accurate coding depends on understanding the operative anatomy and the procedure’s relationship to later flap reconstruction. This article helps readers recognize the relevant ICD-10-PCS code assignment discussed for the vascular ligation component of the procedure.
What You Will Learn
- What a TRAM delay procedure is in the reconstructive surgery setting
- The anatomic structures involved in the operative description
- How the article frames the ICD-10-PCS coding issue for the procedure
- The relationship between vascular ligation and later flap reconstruction planning
Who Should Read This
- Medical coders
- Coding auditors
- Revenue cycle staff
- Hospital coding teams
- Surgical documentation specialists
Codes Discussed
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