ICD-10 coding for angiography procedures

ICD-10-PCS codes provide so much more detail than their ICD-9 counterparts. This level of detail is great for statistics and research; however, sometimes, it’s not so great for coding professionals. The information needed to complete all seven characters of a PCS code can be difficult to find in some instances. One area I find particularly tricky is the type of contrast used during angiography procedures.

Options in the plain radiography, fluoroscopy and computerized tomography tables include:

0-High osmolar
1-Low osmolar
Y-Other contrast

The most commonly assigned codes from these tables in the inpatient hospital setting are for coronary angiography procedures (generally done as part of a heart catheterization). Details on the type of contrast medium can be difficult to locate in the documentation. The coder may have to review procedure logs rather than relying on physician documentation on the procedure note.

Once the coder locates the contrast documentation, the work really begins. The contrast name does not indicate if it is high osmolar, low osmolar or “other” contrast. Fortunately, there are resources to help with this identification. Clinical pharmacology references will include this information in the drug description/classification section.

Additionally, Coding Clinic has addressed one of the more common contrast mediums, Visipaque, in the Third Quarter of 2016, page 36, directing the coder to use character Y (other contrast) for Visipaque. Omnipaque and Isovue are two of the more common low osmolar contrast agents. High osmolar contrast agents are the least common of the available options.

If you are not able to locate the contrast information in the medical record, you may need to go to the servicing department to determine where this information is documented. If you’re lucky, your facility will only be utilizing one type of contrast, but without a conversation with the imaging department, the coding staff may never know.

Although the type of contrast does not directly impact reimbursement, it’s important for statistical and research purposes to report this information accurately. Once you know what agents your facility uses, coding accuracy and efficiency will improve.

Happy coding!
 

Teresa Seville, RHIT, CCS, is a development analyst with Solventum