by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
The question of the day is – What makes a valve replacement a rapid deployment technique valve replacement in the New Technology section of ICD-10-PCS? These days, there are multiple options. Is this a transcatheter aortic valve replacement by another name? Is this a certain way to perform an open valve replacement?
There are three aortic valve options from which providers and patients can choose. Here they are, along with some important coding details:
Stented tissue valve – An example is the Sapien zooplastic valve, mounted on a stent, used in the TAVR (transcatheter aortic valve) procedure or the TA-TAVR (a TAVR done transapically through the bottom of the heart). These are percutaneous procedures done through catheters, coded in the 02R table.
Stentless tissue valve – An example is the Mosaic valve with zooplastic tissue mounted on a synthetic ring (not a stent). It is placed using the open approach and the synthetic ring is sewn inside the valve annulus with multiple hand-sewn sutures. This also includes mechanical and human valve replacements, coded in the 02R table.
Sutureless valve – An example is the Perceval sutureless valve with zooplastic tissue on a spring-like wire frame (not a stent). It is placed either through a mini-sternotomy or a mini-thoracotomy but still the open approach, coded in the X2R table in the New Technology section. The Perceval valve is considered the rapid deployment technique because no suturing is required. Another example is the Intuity Elite valve that is placed using an open approach, with the valve mounted a delivery frame and only requiring three sutures.
The ICD-10-PCS Device Key is the real key here. The Perceval and Intuity Elite valve entries direct the coder to Zooplastic Tissue, Rapid Deployment Technique in New Technology, meaning the X2R table. All other valves direct the coder to a specific device type in Heart and Great Vessels, the 02R table. It comes down to how the valve is deployed, not the approach value or what the leaflets are made of, that determines which table is used for coding.
All of this is covered in the ICD-10-PCS: Cardiac Procedure Coding course — one of the many courses in the Libman Education e-Learning Library: ICD-10-PCS. The library provides unlimited access for a full year to my current catalog of ICD-10-PCS training with more to come. Please consider this helpful resource so that you’re not faced with this kind of question in the future.
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