Q: What is the ICD-10-PCS approach for burr hole drainage of a cerebral hematoma?
A: Burr hole drainage of a cerebral hematoma is coded using the Percutaneous approach in ICD-10-PCS. Although the procedure involves creating a small opening in the skull with a burr hole, the brain itself is not surgically exposed.
In ICD-10-PCS, the approach is determined by whether the site of the procedure is fully exposed, rather than simply whether an incision is made. During burr hole drainage, the surgeon creates a small opening through the skull to access and drain the hematoma, but the operative site is not opened widely enough to expose the brain. Because the procedure is performed through a limited opening without full exposure of the site, it meets the definition of a percutaneous approach rather than an open approach.
Q: Can placement of Duragen be coded when it is used to repair an accidental puncture or laceration of the dura?
A: Placement of Duragen is typically considered integral to closure of the operative site and is not coded separately when used as part of routine surgical closure. However, if Duragen is used to repair an accidental puncture or laceration of the dura, the purpose of the material changes from routine closure to repair of a defect. In this situation, the procedure may be coded as Supplement of the dura mater. As with many coding decisions, the key factor is the intent of the material placement—routine closure is integral, while repair of a dural defect may be separately reportable.
Q: How is a laparoscopically assisted placement of a ventriculoperitoneal (VP) shunt coded? Does the laparoscopic assistance change the approach value on the bypass code?
A: Laparoscopic assistance does not change the approach value for the bypass procedure when coding placement of a VP shunt. The bypass code is assigned based on the approach used for the shunt placement itself. However, the laparoscopic portion of the procedure is still reportable. A separate code for Inspection of the peritoneal cavity is assigned to capture the laparoscopic evaluation performed during the procedure.
Meet the Presenter: Kristi Pollard, RHIT, CCS, CPC, CIRCC
Kristi is the Director of Coding Quality & Education with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.
