Coder Q&A with Pat Macc: Mucoid Casts and Mucus Plugs
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
This is a great question. I have previously sent out a HIA Coding Tip on this very subject. It can be located and read here: https://www.hiacode.com/education/codingtips/bronchoscopy-removal-mucus-plugs-foreign-body/
Mucus plugs occur within the bronchus. They are formed when mucus accumulates in the lungs and can plug up or reduce the airflow in small or large airways. They can lead to collapsed alveoli (air sacs) and that is why the physician removes them. The patient may have chest pain or shortness of breath because of them. Usually they are washed or suctioned away and sometimes Mucomyst is used locally to help remove the mucus plug.
Mucoid casts are large, thick, tenacious mucus “molds or impressions” of the inner lining of the bronchial tubes. They can appear as large gelatinous looking or rigid “casts.” They can occur as a result of infection, allergic inflammation, or reaction to a presence of a foreign body or chemicals. They can be coughed up, however, if they remain in the bronchial tubes, they can cause shortness of breath, chest pain and hypoxemia. These are removed similar to mucus plugs, by washing them away, by
use of Mucomyst and by suctioning during bronchoscopy.
As stated in the coding tip above, the root operation is “Extirpation” which is “taking or cutting out solid matter from a body part.” These mucus plugs or mucoid/bronchial casts are considered solid matter. The body part value is bronchus, as stated in the coding tip. The specific bronchus lobe that the mucoid casts or mucus plugs are removed from is coded. Since there is no selection in ICD-10-PCS for “bilateral bronchus,” the coder must code the specific bronchus lobe in which mucus plugs or mucoid casts are removed. If there is any question as to where they are being removed, best practice is to query the physician.
AHA Coding Clinic for ICD-10-CM/PCS, Third Quarter 2017: Page 14
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.
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?
In Part 7, we focused on identifying any instrumentation that may be used during a spinal fusion. In Part 8, we are going to focus on identifying if a discectomy is performed and if this is an excision or a resection of the disc.
In Part 6, we focused on identifying the type of bone graft product used for the spinal fusion. In Part 7, we are going to focus on identifying any instrumentation or device used.
In Part 5, we focused on identifying the approach being used for the spinal fusion. In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion.
In Part 4, we focused on determining the spinal column being fused. In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).
This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
In Part 3, we focused on determining the level of the fusion(s) and how to determine the number of vertebrae fused. In Part 4, we are going to focus on identifying which column is being fused (anterior, posterior or both).
Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
In Part 1, we learned the diagnoses associated with the need for spinal fusions, and in Part 2 the need to identify if the fusion is an initial or refusion of the vertebrae. In Part 3, we are going to focus on determining the level(s) of fusion, as well as the number of vertebrae fused.
In Part 2, we are going to look at the differences between initial fusion and a refusion. In ICD-9, there were specific codes to show if the fusion was an initial fusion, or if it was a refusion. In ICD-10-PCS, initial fusions and refusion procedures are coded to the same root operation “fusion.”
This is Part 1 of a 14 part series focusing on education for spinal fusions. Spinal fusion coding is a tough job for coders. There are so many diseases/disorders that result in the need for spinal fusion, and even more choices in reporting the ICD-10-PCS codes.
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We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Valerie Abney, CDIP, RHIT, CCS, about the steps she takes to find her routine.
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