Coder Q&A with Pat Macc: Collapse of an Endograft

by | Jul 10, 2019 | Education, ICD-10, Patricia Maccariella-Hafey, Q&A | 0 comments

Patricia Maccariella-Hafey, RHIA, CDIP, CCS, CCS-P, CIRCC has over 35 years expertise in the areas of ICD-9-CM, CPT, DRG/APC validation Professional Fee E&M coding, Interventional Radiology, and Facility E&M coding. Patricia is currently Director of Education a healthcare consulting firm specializing in coding compliance review, education and contract coding services.

Pat Maccariella‑Hafey
RHIA, CDIP, CCS, CCS‑P, CIRCC

Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador

What is the proper complication code in this case?

Question:

I am not sure what code to assign for the collapse of an endograft. Currently I have assigned T82.898A, Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter. Is there a better code to use?

Here is the documentation:

Patient has a complex congenital history and has underwent several procedures, most recently, he underwent transcatheter pulmonary valve replacement with a 29 mm Sapien 3 valve, following pulmonary artery angioplasty with a 20, followed by a 22 mm True balloon including placement of a 2nd pulmonic stent (4010 Palmaz mounted on a 22 BIB) inside of a 28 mm x 90 cm Navion Medtronic endograft (extending the entire length of the RV to PA conduit, with hope of also eliminating his known multiple PA to Ao fistulas) on 4/2019. Following this procedure, there was concern for hyperdynamic RVOT causing increase movement and partial collapse of the distal aspect of the endograft. He was uptitrated on beta blockade with hopes of medical management of this issue, however he returned with worsening symptoms and had evidence of complete collapse of the distal cell of the endograft which had folded over such that it was causing a fixed RVOT obstruction, with gradient >100 mmHg by echo, associated with very poor clinical response with worsening right sided heart failure and volume overload necessitating urgent hospitalization and mechanical correction of the obstruction.

After multiple multidisciplinary discussions between the adult congenital, heart failure and structural teams, a decision was made to proceed with stenting the collapsed part of the endograft to relieve the obstruction.

Stenting of the endograft was carried out.

# Pulmonary Valve Stenosis s/p TPVR (04/2019) with acute stent fracture s/p Stent Placement 5/28

– Underwent structural procedure with 2 stents placed in the RVOT without complications

“There was NO gradient across the Sapien 3 valve

The gradient across the inflow portion of the endograft (which was the targeted area of obstruction/collapsed graft which we stented) decreased from >55 mmHg to 15 mmHg

(note that the initial gradient was obtained after the obstruction had been crossed with a steerable guide catheter which was propping open the collapsed part of the endograft at the inflow, hence was likely an underestimate of the true gradient across the inflow which was >100 mmHg by echo)”

Answer:

This would be considered a “mechanical” complication of the stent graft since the MD states it is a fracture of the endograft and it is folded over on itself. I would change T82.898A TO T82.598A for Other mechanical complication of other cardiac and vascular devices and implants, initial encounter. I did not use “displacement” because the surgeon did not state that the graft was displaced, only that it collapsed upon itself causing obstruction.

Per the AHA ICD 10 Handbook, Chapter 33: Complications of Surgery and Medical Care: “Complications of this type are classified first according to whether they are mechanical or nonmechanical in nature. A mechanical complication is one that results from a failure of the device, implant, or graft, such as breakdown, displacement, leakage, or other malfunction. These are classified by the type of mechanical complication and the type of device involved.” See also Coding Clinic for ICD-10-CM/PCS, First Quarter 2019: Page 26 ​​

INDEX:

Complication, vascular; device or implant; mechanical; obstruction specified device NEC mechanical

breakdown T82.519

specified device NEC T82.518

displacement T82.529

specified device NEC T82.528

leakage T82.539

specified device NEC T82.538

malposition T82.529

specified device NEC T82.528

obstruction T82.599

specified device NEC T82.598

T82.59- Other mechanical complication of other cardiac and vascular devices and implants

Obstruction (mechanical) of other cardiac and vascular devices and implants
Perforation of other cardiac and vascular devices and implants
Protrusion of other cardiac and vascular devices and implants

We know that every case is unique. The above post is simply our opinion based on the information we have received. We encourage readers to research subsequent official guidance in the areas associated with this topic as they can change rapidly.

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