Knowledge Base Article

Dilemma:

Why can’t the Root Operation, ‘Destruction’ be used when cauterization is performed in the nose to stop bleeding instead of ‘Control’? For instance, a patient was admitted for surgery due to multiple failed attempts to stop epistaxis.  The surgeon saw no active bleeding; but did see some suspicious sites so he cauterized the right turbinate and the nasal septum. 

Also, using ‘Destruction’ grouped the case to an ENT DRG (see table) which appears to be an appropriate clinical representation of the admission.  However, using ‘Control’ grouped the case to Extensive OR Procedure Unrelated to Principal Diagnosis. 

FY 2017 ICD-10-PCS Coding Guideline:

• Control
  Stopping, or attempting to stop, postprocedural or other acute bleeding. If an attempt to stop postprocedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.

Solution:

The Root Operation, ‘Control’ was broadened to include these types of cases, so regardless of the method, the coding reflects the main objective of these types of procedures, which is to control bleeding.

The above procedure grouping is a DRG shift that has been reported to CMS and should be corrected in the next October 1st update. 

Resource:  Rhonda Butler, Clinical Research Manager for 3M Health Information Systems

FY 2017 ICD-10-PCS Coding Guidelines