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ICD-10 coding challenge: Epistaxis
CHALLENGE QUESTION
Epistaxis, or nasal bleeding, is a common occurrence and has been reported in up to 60 percent of the population. In many instances it is minor or self-limiting and persons do not seek medical treatment. In other cases, bleeding can be severe, can adversely impact the patient’s blood pressure, and require emergency intervention.
Treatments of epistaxis can include:
- topical vasoconstriction
- chemical cautery (e.g., silver nitrate)
- electrocautery
- anterior of posterior nasal packing (nasal tampon or gauze impregnated with petroleum jelly)
- use of a balloon system (including a modified Foley catheter)
- arterial ligation or embolization
According to the 2017 ICD-10-PCS Official Guidelines for Coding and Reporting, what root operation would be used for each of the epistaxis treatments listed above?
ANSWER
The root operation for all of the epistaxis treatments listed is Control. Effective October 1, 2017, the definition of root operation Control has changed. Note: there is only one difference between the 2016 and 2017 definitions below (in italics):
2016
Stopping, or attempting to stop, postprocedural bleeding.” If an attempt to stop postprocedural bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.
2017
Control
Stopping, or attempting to stop, postprocedural or other acute bleeding. If an attempt to stop postprocedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.
According to the 2017 definition, none of the treatments listed would otherwise code to Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection; therefore, Control is the correct root operation. And, since the root operation of Control is not an option in the Ear, Nose and Sinus body system, the procedures are coded to the General Anatomical Regions body system and Respiratory Tract body part as seen below:
Sue Belley is a project manager with the consulting services business of 3M Health Information Systems.
6 thoughts on “ICD-10 coding challenge: Epistaxis”
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Sue Belley, RHIA
Clinical content development manager, consulting services and outsource services
Susan Belley, M.Ed., RHIA, CPHQ, is the manager of clinical content development and the manager of outsource services within the consulting services business of 3M Health Information Systems. She is…
I think I understand, but why wouldn’t cautery be coded to destruction and packing coded to packing (in the placement section)?
Thanks for the comment!
The root operation of destruction would not be assigned in this case because it is not one of the definitive operations listed in the definition of Control (i.e., Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection). The same goes for the root operation of Packing. The root operation Control is assigned unless the procedure performed to stop the hemorrhage is one of the aforementioned.
Clarification
Would you assign Control of bleeding on an inpatient account when the physician has used Afrin spray for epistaxis? Does this meet the UHDDS criteria to be coded as a procedure?
The Uniform Hospital Discharge Data Set (UHDDS), as published in the Federal Register Volume 50, Number 147, July 31, 1985, includes data items for reporting procedures. The definitions included can be used to determine which codes should be reported. Item 12 of UHDDS states that all significant procedures are to be reported and defines a significant procedure as one that is:
1. surgical in nature, or
2. carries a procedural risk, or
3. carries an anesthetic risk, or
4. requires specialized training.
If we’re able to code Afrin Spray as Control of bleeding, would you please share your references to support this? Thanks
Thanks for the question Monique! If you are a 3M HIS customer, you can call 3M Nosology (https://www.3m.com/3M/en_US/health-information-systems-us/support/) for an answer. If you are not a customer, please submit your question to Coding Clinic (https://www.codingclinicadvisor.com/).
When rhino rocket is used in ER for Epistaxis wouldn’t we use packing for root operator instead of control?
Thanks for the question Olga! If you are a 3M HIS customer, you can call 3M Nosology (https://www.3m.com/3M/en_US/health-information-systems-us/support/) for an answer. If you are not a customer, please submit your question to Coding Clinic (https://www.codingclinicadvisor.com/).