This page addresses follow-up questions and additional information pertinent to our webinar
Foundations of Congenital Cardiac Cath Coding: Diagnostic Coding for Pediatric Cardiac Cath.

** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q: So, how would I code the hypoxemia when it is associated with Fontan circulation?
A: Your first-listed diagnosis is going to be the Fontan circulation code, followed by the code for the associated condition, which is the hypoxemia in this case. So, code I27.848 for other Fontan associated condition, followed by code R09.02 for hypoxemia.

Q: When a transplant patient presents for a routine endomyocardial biopsy for rejection surveillance and no rejection is found, the encounter is reported with the aftercare code Z48.21, is that correct?
Now, if the pathology report confirms active rejection, how does the coding change? Would I still report the aftercare code Z48.21 and simply add T86.21 after it, or does the confirmed complication change which code is first-listed?
A: When a transplant patient presents for a scheduled endomyocardial biopsy purely to monitor for rejection, and nothing active is found, that encounter is captured with the aftercare code, Z48.21, Encounter for aftercare following heart transplant. Once rejection is confirmed, you would code T86.21, Heart transplant rejection, and the aftercare code no longer applies.

Q: A patient comes in for pacemaker generator replacement because the battery has reached end of life. Is this a scenario of the device complication?
A: No, a generator replacement due to end of battery life represents a routine device management, not a complication. In this scenario, the first-listed code is Z45.010, Encounter for checking and testing of cardiac pacemaker pulse generator.

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