What happens in ICD-10-PCS stays in ICD-10-PCS: Understanding the device value, part 3 of 3

In part 2 we talked about the Mississippi Mud rule, an informal notion about how the device works in PCS that can get you mired in confusion when it comes to root op Revision. Now we’re ready to talk about another rule making the rounds of the infosphere, which I will call “the Spumoni rule of how not to understand the device value.” It is the flip side of the Mississippi Mud rule. Where the Mississippi Mud rule wants to insist that once a device, always a device, the Spumoni rule says that once not a device, never a device. It goes something like this: if the original root operation at the site had a device value of No Device, then the root operation Revision can never be coded for a subsequent procedure at that site.

I know, before it was “always,” now it’s “never.” I told you this rule was the flip side. So what is the deal with the Spumoni rule? You are way ahead of me here--what we talked about in the first part of this blogatribe exposes the pale underbelly of the Spumoni rule. Like so: there are two uses of device value Z No Device. In some root operations, device value Z No Device is used because it adds no information of value to the code. It may even be actionable as coder harassment, to have to schlepp a device value and put it into the code in such cases. Why? Because it is inherent in the root operation that a device (in PCS terms) is always used to perform that root operation, and there is only one PCS device value available, so it would always be the same value everywhere for all codes that use that root operation. (This is an explanation, not a rule, so “always” is permissible.) In part 1, I called this use of device value Z the Rocky Road flavor of device value Z, and the examples I gave you were the root operations Transfer and Transplantation.

Example time—let’s think of a scenario in which the root op Revision would in fact be the best choice for coding a subsequent procedure, when the original procedure was coded to Transfer.

Here’s one:

A female patient has a mastectomy followed by a pedicle TRAM flap for breast reconstruction done. Six weeks later, she reports pain at the site of the TRAM flap and discomfort moving her arm. The patient undergoes another procedure where the flap is reopened, and found to be malpositioned causing tension on the axillary side. The flap is adjusted and resutured to relieve the tension on the axillary side of the flap.

This may rarely occur, but the point is, it is not impossible. If this procedure report comes to you to code, you should feel free to code root op Revision if that is the best choice.

Your turn—come up with an example in which the root op Revision would in fact be the best choice for coding a subsequent procedure, when the original procedure was coded to Transplantation.

Rhonda Butler is a clinical research manager with 3M Health Information Systems.