Cardiology Coding Alert

Question: We have a question regarding the seventh character on in-stent restenosis code T82.858-. Patient had in-stent re-stenosis of RC, 90 percent. PCI (stent) was done, reducing to 0 percent. I am using 92928-RC with dx code T82.858-. From looking at previous intervention reports for this patient, the stent was originally placed prior to September 2002. I have no access to reports earlier than that. At that time, the stent to proximal RC had 20-30 percent “area of narrowing,” and of course nothing was done at that time. In 2010, another stent was placed in the mid RC for 85 percent stenosis. Which seventh character should I use on T82.858-?

Tennessee Subscriber

Answer: You should use seventh character A because the patient is undergoing active treatment.

Code T82.858- (Stenosis of vascular prosthetic devices, implants and grafts) has these seventh character options:

• A, Initial encounter
• D, Subsequent encounter
• S, Sequela.

The 2016 ICD-10 Official Guidelines (www.cdc.gov/nchs/data/icd/10cmguidelines_2016_Final.pdf) for Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88), state, “For complication codes, active treatment refers to treatment for the condition described by the code, even though it may be related to an earlier precipitating problem. For example, code T84.50XA, Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter, is used when active treatment is provided for the infection, even though the condition relates to the prosthetic device, implant or graft that was placed at a previous encounter.”

One of the examples the Official Guidelines give for “active treatment” is surgical treatment.

Seventh character D is the equivalent of aftercare, meaning after active treatment, such as imaging to check healing status, medication adjustment, or follow-up visits after treatment.

Seventh character S for sequela is equivalent to late effects. So you would use S on T82.858- if the patient presented for treatment of a complication or issue the stenosis caused, and you would sequence first the code for the complication or issue the cardiologist treats. An example the Official Guidelines give for sequela is a scar that results from a burn. You report the scar being treated first and then report the burn code with an S at the end.