ICD-10-PCS: Orbital vs. Rotational Atherectomy

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

Is an orbital atherectomy the same as a rotational atherectomy? This question came to me earlier this week and has required some research. And, the answer is: They are not the same. Let’s look at the orbital atherectomy first.

Orbital atherectomy is performed on calcified plaque lesions using the Diamondback360 catheter from Cardiovascular Systems, Inc. This tool uses an orbiting diamond-covered crown on a special delivery wire that is driven by a pneumatic drive console. The crown orbits within the vessel and literally sands off the calcified lesion until the microscopic calcified particles are removed and flow out into the blood stream. The faster it orbits, the larger the opening that is created in the lumen of the vessel. Once open, the vessel can be dilated with a regular balloon angioplasty and stent procedure to hold the vessel open. The orbital atherectomy technology has been around since 2007 when it was introduced for peripheral vessels of the groin and legs. The technology later evolved to work in the smaller coronary arteries and in 2015, it was assigned a unique code in the New Technology section of ICD-10-PCS, in the X2C table for Extirpation of coronary arteries. This same technology, when used in the peripheral arteries, is not coded to the New Technology Section. Non-coronary orbital atherectomy would be coded as Extirpation in the Medical and Surgical section.

Rotational atherectomy is an older technology. A common tool for this procedure is a Rotablator from Boston Scientific. While this tool is also used on calcified lesions, it doesn’t have an orbiting crown. This catheter has a diamond-covered nose that is shaped like a bullet. This tool grinds its way through the center of the vessel and can only make a passage as large as the size of the head of the device. This can require several catheter changes to larger sizes to create the largest possible lumen. Rotational atherectomies are coded as Extirpation in the Medical and Surgical section, regardless of the artery where the procedure is performed.

It’s important to note that both of these types of atherectomy do not remove the calcified material from the body with the catheter. However, either procedure would be coded as Extirpation because the root operation’s definition just states that the foreign material is removed from the body part. Complete removal from the body is not required. Both catheters grind the calcified material into small particles that can be removed from the blood stream by the normal filtration process.

Learn more about the orbital atherectomy procedure at:

Learn more about the rotation atherectomy procedure at:

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About the Author

Lynn Kuehn is president of Kuehn Consulting, LLC, in Waukesha, Wisconsin, a consulting firm specializing in ICD-10-PCS coding for the inpatient setting. 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 ICD-10-PCS: An Applied Approach and Procedural Coding and Reimbursement for Physician Services. Together with her co-Author Theresa Jorwic, Lynn received the Triumph Literary Legacy Award from AHIMA for ICD-10-PCS: An Applied Approach. Called the “go-to” resource for learning and mastering ICD-10-PCS, ICD-10-PCS: An Applied Approach provides step-by-step instructions and exercises at all levels, and is used throughout Kuehn’s ICD-10-PCS courses authored for Libman Education.

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