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ICD-10-PCS: Let’s Solve the Coronary Artery Bifurcation Issue

by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA

First things first. A bifurcation is like a fork in the road. Webster says that a bifurcation is “the point or area at which something divides into two branches or parts or the point at which bifurcating occurs.” Here are two examples as shown in the drawings.

Bifurcated lesion example 1 is a lesion that starts in the left coronary artery (LCA) and extends into both branches of the LCA, called the circumflex artery and the left anterior descending artery.

Bifurcated lesion example 2 is a lesion that starts in the right coronary artery (RCA) and extends further down the RCA but also into a side branch called the right marginal artery.

In coding angioplasty of coronary arteries, it seems like we don’t really need to know the names and locations of these arteries, but we do need to identify a lesion that’s found at the bifurcation. That brings me to the second thing we need to know to solve this puzzle. We need to know how the typical coronary arteries’ branches take place:

  • Right coronary artery, which branches into:
    • Right marginal
    • Right posterior descending
  • Left coronary artery, which branches into:
    • Left anterior descending, which branches into:
      • The diagonal and septal arteries
    • Circumflex, which branches into:
      • The obtuse marginal, posterior descending and posterolateral arteries

When coding angioplasty of lesions at the bifurcation, the body part value is the number of arteries treated and the qualifier value will be 6, Bifurcation. If stents are left in place after the Dilation procedure, we code all of the stents used to treat the lesion at the bifurcation.

For example, if the lesion in Example 1 was treated with 2 bare metal stents, the code would be:

02723E6 – Dilation, 3 Coronary Arteries (Left coronary artery, circumflex artery, and left anterior descending) at the Bifurcation with 2 Intraluminal Devices, Percutaneous Approach

In the lesion in Example 2 was treated with 2 drug-eluting stents, the code would be:

0271356 – Dilation, 2 Coronary Arteries (Right coronary artery and right marginal artery) at the Bifurcation with 2 Drug-eluting Intraluminal Devices, Percutaneous Approach

The qualifier of Bifurcation identifies that the lesion is at the point where the bifurcation takes place into two vessels. It would be wonderful if the cardiologist always told us it was a bifurcation but documentation isn’t always perfect. (Don’t forget to check the angiography report for additional details.) You can assign the qualifier of Bifurcation when the situation is described without stating the word, based on ICD-10-PCS Guideline A11 that allows coding professionals to interpret documentation without requiring exact terminology to be documented. For additional information, check out Coding Clinic for ICD-10-CM/PCS, 2nd Quarter, 2018, page 24 for another example of coding lesions at a coronary artery bifurcation.

Vascular Roadmap Flash Cards for ICD-10-PCS
Save time and code with confidence with the Libman Education Vascular Roadmap Flash Cards for ICD-10-PCS! Developed by nationally recognized ICD-10-PCS coding expert Lynn Kuehn, these cards help you to identify the body part, where the vessel ‘starts’ and where it ‘goes,’ and what is continuous. Learn more here.

To view the introductory video for the Vascular Roadmap Flashcards, click the page’s “Video” tab.

About the Author

Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
Lynn Kuehn is president of Kuehn Consulting, LLC, a consulting firm specializing in coding for all settings and physician practice management issues. Lynn is a nationally recognized trainer on ICD-10-PCS and other HIM-related topics. Lynn served on the AHIMA Board of Directors and authored several of AHIMA’s most popular books including Procedural Coding and Reimbursement for Physician Services, CCS-P Exam Preparation, and ICD-10-PCS: An Applied Approach.

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