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Q:  How would you code for placement of a bone flap from craniotomy into the subcutaneous tissue for storage? Is that integral to the procedure or is there a separate code for it?
A:  Placement of the bone flap in the subcutaneous tissue for storage meets the root operation definition of Reposition (Moving to its normal location, or other suitable location, all or a portion of a body part). This is reported with code 0NS00ZZ, Reposition of skull, open approach.

Q:  For Case Study #1 in the presentation, why is the body part Brain rather than Cerebral Hemisphere? The documentation states that there was a right frontotemporal parietal decompressive craniectomy. Isn’t that the right cerebral hemisphere?
A:  The reference we used for this case study was Coding Clinic, Second Quarter 2016: Page 29, in which they advised coding a right frontotemporal parietal decompressive craniectomy to the body part Brain.

Q:  How is Duragen repair of the dura coded?
A:  When Duragen is used for routine repair of the dura mater during craniectomy, no code is assigned as it is integral to the operative closure. However, if a hole was inadvertently made in the dura during the procedure, requiring repair with Duragen, assign code 00U20KZ, Supplement dura mater with nonautologous tissue substitute, open approach. Duragen is a xenograft (animal tissue) composed of bovine dura mater or pericardium. (Source: Coding Clinic, Third Quarter 2014: Page 17).

Q:  How is laparoscopically assisted placement of a ventriculoperitoneal shunt coded?
A:  Assign codes 00163J6 (Bypass of cerebral ventricle to peritoneal cavity with synthetic substitute, percutaneous approach) and 0WJG4ZZ (Inspection of peritoneal cavity, percutaneous endoscopic approach) when a VP shunt is placed with laparoscopic assistance. Since the laparoscopy involves a different body part (peritoneal cavity) than the bypass procedure (cerebral ventricle), the procedure requires two codes. (Source: Coding Clinic, Second Quarter 2013: Page 36).

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Senior Consultant

Kristi is a senior consultant with more than 20 years of industry experience. She develops and delivers training on ICD-10-CM/PCS and CPT, both virtually and in classroom settings.
Kristi also performs DRG and APC audits and is known for her vast knowledge on coding vascular interventional radiology procedures. Kristi has an extensive background in coding education and consulting and is a national speakers on topics related to ICD-10 and CPT coding as well as code-based reimbursement.

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