The correct codes for our example are: 0BC68ZZ- Extirpation of Matter from Right Lower Lobe Bronchus, Via Natural or Artificial Opening Endoscopic 0BCB8ZZ- Extirpation of Matter from Left Lower Lobe Bronchus, Via Natural or Artificial Opening Endoscopic
The body part value is bronchus, as stated in the coding tip. The specific bronchus lobe that the mucoid casts or mucus plugs are removed from is coded. Since there is no selection in ICD-10-PCS for “bilateral bronchus,” the coder must code the specific bronchus lobe in which mucus plugs or mucoid casts are removed.
We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used? This is a great question. I have previously sent out a HIA Coding Tip on this very subject.
The Refresh With YES: PCS Bronchoscopy Coding Learning Path teaches learners how to apply ICD-10-PCS coding for bronchoscopy techniques. Learners will discuss the upper and lower respiratory system, as well as the codes and guidelines for common root operations applicable to bronchoscopies, including extraction, excision, drainage, and extirpation.
A bronchoscopy was performed due to abnormal radiologic findings in the lung field. The right middle lobe bronchus was occluded by a large mucus plug. Mucomyst was administered locally and the mucus plug was washed and suctioned.
Example: If a patient has bronchoscopy with BAL for biopsy from the right middle lobe the appropriate PCS code is 0B9D8ZX—Drainage of right middle lung lobe, via natural or artificial opening endoscopic, diagnostic, is appropriate.
Mucus plugging is classified as a foreign body as it is foreign to the respiratory tract. Please note that in Sixth edition the external cause code for mucus plugging would be W80. 8 Other specified object.
Extirpationuse of Mucomyst and by suctioning during bronchoscopy. As stated in the coding tip above, the root operation is “Extirpation” which is “taking or cutting out solid matter from a body part.” These mucus plugs or mucoid/bronchial casts are considered solid matter.
What is a mucus plug? As the name implies, mucus that accumulates in the lungs can plug up, or reduce airflow in, the larger or smaller airways. In the smallest airways, mucus plugs lead to collapsed air sacs, or alveoli. If enough alveoli are blocked, a person's oxygen levels will be negatively impacted over time.
DrainageBronchoalveolar Lavage (BAL): Bronchoalveolar lavage is also called a liquid biopsy and is a diagnostic procedure performed via a bronchoscope and it involves washing out tissue of the lung and airways to obtain a small sampling of tissue. BAL is coded to root operation “Drainage” because it involves removing fluid.
ICD-10 Code for Other diseases of bronchus, not elsewhere classified- J98. 09- Codify by AAPC.
Removal of secretions, blood, mucus plugs, or growths (polyps) to clear airways. Control of bleeding in the bronchi. Removing foreign objects or other blockages.
There are 2 types of bronchoscope: flexible and rigid. Both types come in different widths. A rigid bronchoscope is a straight tube....The flexible bronchoscope may be used to:Place a breathing tube in the airway to help give oxygen.Suction out secretions.Take tissue samples (biopsy)Put medicine into the lungs.
Answer: Initial therapeutic bronchoscopy is the first procedure during any hospitalization and is reported with CPT code 31645. A subsequent therapeutic bronchoscopy, later the same day or another day, but during the same hospitalization, is defined as subsequent and is reported with CPT code 31646.
What Is the Treatment for Mucus Plug in the Lungs?Bronchodilators to open airways.Expectorants to loosen phlegm. Guaifenesin (Robitussin and Mucinex)Decongestants to reduce mucus production.Mucolytics to thin lung secretions. N-acetylcysteine. Carbocysteine.
The so-called mucus plugging is not an unusual phenomenon in clinical medicine and the treatment usually requires bronchoscopic intervention [1]. Management of mucus plugs involves proper hydration, bronchodilation, and mucolytic agents.
Mucus in the lungs is known as phlegm or sputum. It is a common symptom in chronic lung diseases such as COPD (including chronic bronchitis and emphysema), cystic fibrosis, bronchiectasis, NTM lung disease or asthma.
Dizziness and GiddinessCode R42 is the diagnosis code used for Dizziness and Giddiness. It is a disorder characterized by a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo).
ICD-10-CM Diagnosis Code O47 O47.
Other specified complications of labor and delivery The 2022 edition of ICD-10-CM O75. 89 became effective on October 1, 2021. This is the American ICD-10-CM version of O75.
ICD-10 code O75. 82 for Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section is a medical classification as listed by WHO under the range - Pregnancy, childbirth and the puerperium .
The bronchoscopy is coded in addition to the thoracoscopic lobectomy based on the following PCS coding guideline, B3.11c:
Assign J470 for bronchiectasis. It is unlikely this patient would have been taken to surgery with current pneumonia and more likely that the physician is indicating a history of recurrent pneumonia. We recommend a review of the entire record to determine pneumonia status and/or query the physician before final coding of the pneumonia diagnosis.
OBCC is removal of matter (whatever tissue or pus or …) from the lung, not from the right upper lobe mainstem bronchus. That’s what’s done for remoqal of mucous plugs. It’s not lung that has stuff removed – it’s bronchus. The docs frequently leave that word out., You can’t remove stuff from lung without perforating (intentionally) the wall of the bronchus. Inspissated mucous is in the bronchus or trachea – not the lung. And suctioning of liquid out of wherever is drainage. If it’s solid matter, that would be extirpation.
Paul… when you get a minute, check ICD-10 0B968ZZ. This code looks like it counts.
For interest sake, drainage of lung means that there is a cyst or abscess of the lung which might be approached through open surgery or thoracoscope or percutaneous or through a bronchoscope for drainage of this collection. It has nothing to do with stuff that blocks up the bronchial tree at all.
There is a lot of confusion on these messages regarding procedures that drive to a Surgical MS-DRG….a bronch w/ ‘only’ washing will not, if coded properly, generate a surgical DRG. A bronch w/ a true ‘transbronchial Bx of lung tissue’ will drive to a surgical case.
Inspection of a body part (s) performed in order to achieve the objective of a procedure is not coded separately.
Non-excisional debridement will not drive to surgical DRG, but true surgical debridement is a valid O.R. procedure.
In my practice, Bronchoscopy ‘almost never’ impacts the DRG unless actual lung tissue is biopsied – washings and so forth do not impact DRG. Paul Evans, RHIA, CCS, CCS-P, CCDS.
Historically they have billed Z11.3 (encounter for screening for predominately sexual mode of transmission) for gonorrhea, chlamydia, and syphilis. However, I noticed that chlamydia is actually called out under Z11.8 (encounter for screening for other infectious and parasitic diseases .) Z11.3 specifically excludes HIV and HPV but doesn't have anything regarding chlamydia.
A resection is the removal of an entire organ or structure or the follow-up removal of a residual part of an organ or structure. If only part of an organ or structure is removed, that is an excision.