AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2019 Quarter 4; ICD-10-PCS NEW/REVISED CODES
Intraoperative ECMO
The patient is a 75-year-old male with coronary artery disease, who is admitted for a non-ST elevation myocardial infarction. Coronary angiography reveals a heavily calcified 80% left main stenosis. Veno-Arterial (VA) ECMO was used for hemodynamic support during the percutaneous coronary intervention. Under fluoroscopic guidance, VA ECMO is instituted and the PCI of the left main lesion using a drug-eluting stent is undertaken. At the end of the procedure, VA ECMO is weaned, percutaneous femoral sheaths are removed, and the access sites are closed. Is it appropriate to assign intraoperative ECMO codes for procedures performed in the cardiac catheterization lab rather than the operating suite? How should the procedures be coded? ...
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Article Overview
This article reviews the coding of intraoperative extracorporeal membrane oxygenation (ECMO) in the context of ICD-10-PCS, with emphasis on how intraoperative support is distinguished from ongoing life support. It is aimed at medical coders, auditors, and reimbursement professionals who work with cardiology, cardiac catheterization, and transplant-related procedures. The article covers the relevant code table structure, duration/function qualifiers, and a clinical scenario involving temporary hemodynamic support during a procedure.
Why This Topic Matters
Correctly recognizing intraoperative ECMO affects procedure coding consistency for complex cases performed outside the operating room, including cardiac catheterization lab services and other high-acuity interventions.
Article Sections
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ICD-10-PCS table update
Introduces the relevant ICD-10-PCS table and notes the addition of a new duration value used to distinguish a type of ECMO support from other uses.
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Clinical context for intraoperative support
Describes general procedural settings where temporary extracorporeal support may be used, including major cardiac and thoracic interventions.
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Code table components
Presents the body system, duration, function, and qualifier elements associated with the ECMO-related table structure.
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Clinical scenario and coding question
Provides a patient case involving temporary circulatory support during an intervention and frames the coding issue related to where the procedure is performed.
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Coding clarification
Addresses whether the ECMO reporting concept applies in a catheterization lab setting and summarizes the general coding interpretation.
What You Will Learn
- How intraoperative ECMO is distinguished within ICD-10-PCS
- What procedural contexts are associated with temporary ECMO support
- How table elements relate to ECMO reporting
- Why the procedure setting may matter for coding review
Who Should Read This
- Medical coders
- Coding auditors
- Clinical documentation improvement specialists
- Revenue cycle professionals
- Cardiology coding staff
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