Knowledge Base Article

For the I-10 Corner this week, we’re discussing a few of the procedural coding guidelines for Cardiac Bypass Procedures, including a few examples.

Remember: The letters I and O and not used in PCS since they are easily confused with numbers one (1) and zero (0).

ICD-10-PCS Coding Guidelines

Coronary Bypass Procedures

B3.6b. Coronary arteries are classified by number of distinct sites treated, rather than number of coronary arteries or anatomic name of a coronary artery (e.g., left anterior descending). Coronary artery bypass procedures are coded differently than other bypass procedures as described in guideline B3.6a. Rather than identifying the body part bypassed from, the body part identifies the number of coronary artery sites bypassed to, and the qualifier specifies the vessel bypassed from.

Example: Aortocoronary artery bypass of one site on the left anterior descending coronary artery and one site on the obtuse marginal coronary artery is classified in the body part axis of classification as two coronary artery sites and the qualifier specifies the ‘aorta’ as the body part bypassed from.

B3.6c. If multiple coronary artery sites are bypassed, a separate procedure is coded for each coronary artery site that uses a different device and/or qualifier.

Example: Aortocoronary artery bypass and internal mammary coronary artery bypass are coded separately.

Coronary Excision for Graft

B3.9. If an autograft is obtained from a different body part in order to complete the objective of the procedure, a separate procedure is coded.

Example: Coronary bypass with excision of saphenous vein graft; excision of saphenous vein is coded separately.

Coding Example: CABG of LAD using left internal mammary artery, open; off pump (02100Z9). Root Operation: Bypass, Coronary Artery, One Site, (0210), Open (0), No Device (z), Internal Mammary, Left (9).

                Note: The Internal Mammary Artery = No Device. It is not considered graft material.

Coding Example: Open coronary artery bypass graft of three coronary arteries using left autologous greater saphenous vein (021209w). Root Operation: Bypass, Coronary Artery, Three Sites (0212), Open, (0), Autologous Venous Tissue (9), Aorta (w).

Note: For Coronary Bypass, the Body Part identifies the number of coronary artery sites bypassed to-- which is the Aorta.

Coronary Body Parts

B4.4 The coronary arteries are classified as a single body part that is further specified by number of sites treated and not by name or number or arteries. Separate body part values are used to specify the number of sites treated when the same procedure is performed on multiple sites in the coronary arteries.

Example: Angioplasty of two distinct sites in the left anterior descending coronary artery with placement of two stents is coded as Dilation of Coronary Arteries, Two Sites, with Intraluminal Device.

Example: Angioplasty of two distinct sites in the left anterior descending coronary artery, one with stent placed and one without, is coded separately as Dilation of Coronary Artery, One Site, with Intraluminal Device, and Dilation of Coronary Artery, One Site, with no device.

Coding Example: PTCA of two coronary arteries: RCA with stent (intraluminal device) (02703DZ) and LAD without stent (02703ZZ). Root Operation: Dilation, Artery, Coronary, One Site (0270)—one with an intraluminal device and one without.

Note: Coronary arteries are counted as single body parts. It doesn’t matter how many arteries were treated. The main distinguishing factor is the number of sites treated.

MMP hopes this article was beneficial in helping you become more familiar with cardiac bypass procedures in ICD-10-PCS.