Coding Clinic, Fourth Quarter 2017, pages 104-105, advised the assignment of code 02H73DZ, Insertion of intraluminal device into left atrium, percutaneous approach, for transcatheter insertion of the Watchman device. Since the Watchman device was used to occlude the left atrial appendage, shouldn’t the correct code be 02L73DK, Occlusion of left atrial appendage with intraluminal device, percutaneous approach, instead?
It is correct that a successful insertion of a Watchman device into the left atrial appendage would be assigned code 02L73DK, Occlusion of left atrial appendage with intraluminal device, percutaneous approach.
However, in the case published in Coding Clinic, Fourth Quarter 2017, pages 104-105, the device was removed prior to the completion of the procedure when it was ultimately found to be inadequate. As such, the root operation Occlusion is not appropriate since the definition of the root operation was not accomplished. In the published case, both the Insertion code 02H73DZ and the Removal code 02PA3DZ are assigned.
Please refer to the 2019 revisions of the ICD-10-PCS Official Guidelines for Coding and Reporting, on page 76 of this issue. Guideline B6.1.a. has been revised to indicate “If a device that is intended to remain after the procedure is completed requires removal before the end of the operative episode in which it was inserted (for example, the device size is inadequate or a complication occurs), both the insertion and removal of the device should be coded.”