Ask the Expert

This month’s selection:
A patient was admitted from an outside source with a portion of a catheter that was retained in the right ventricle of the heart. A catheter was inserted via the groin and maneuvered into the ventricle with a snare attached, and the foreign body was safely removed. I have been unable to find a suitable code for this procedure.

Pinkie M. Scott, RHIT
Coding Manager, HIS Department
Provena Saint Joseph Medical Center
Joliet, Ill.

Response:
Jonathan MacKenzie, CCS, internal quality assurance coordinator for Precyse Solutions, referred to Faye Brown’s ICD-9 Coding Handbook With Answers to help answer this question. According to this resource, the coder is expected to locate the code via the alphabetic index and then verify the code number in the tabular list. Significant discrepancies are an alert that a different term may be needed to index; however, Faye Brown also advises that “it may be necessary for coders to review the title for the chapter, section, and category in order to be sure the correct code has been identified.”

ICD-9 indexes “Removal — foreign body — heart” to 37.11; however, on reviewing the title for the chapter, section, and category as instructed, this code does not fully capture the circumstances since these codes are intended to capture a procedure involving an incision into the heart rather than the removal via snare described in the question. This brings us to the proper sections of the code book, though, and clearly we need to select a code from 37.x, “Other operations on heart and pericardium” as this appears to be the most appropriate selection of available codes. Reviewing each level brings us to 37.9, “Other operations on heart and pericardium,” and further review of the code options under this section leads us to 37.99, “Other” as the most probable option, as the other codes in this area reference specific different procedures, and this appears the most appropriate code to report a procedure of this nature which has no individual indexing.

On review of Coding Clinic guidelines, it is found that they dealt with a similar question in the first quarter 1989 edition in answer to a query regarding the removal of a detached inferior vena cava filter. Coding Clinic’s instructions were to code 37.99 for removal via a percutaneous transluminal approach if the filter has migrated into the atrium of the heart. Therefore, on the basis of the similar instructions found in the 1989 Coding Clinic and on the review of possible codes found after utilizing the alphabetic and numeric portions of the index, it is advised that the coder report 37.99 as the most appropriate code for this procedure.