Inpatient Facility Coding & Compliance Alert

Hint: Focus on allogeneic, syngeneic, and zooplastic to choose the best 7th character.

If your facility offers transplant services, then you need to pay attention to the seventh character qualifier of ICD-10-PCS codes. Remember, one misrepresented character could mean the difference between a denial and the reimbursement you ethically deserve.

Step 1: Define Transplantation or 3rd Character of “Y”

According to PCS guidelines, a transplantation procedure means “putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part.” For example, you might encounter a heart or kidney transplant.

Note: Before you start checking to see if you can report multiple procedures, take into account another part of the definition: “During transplantation, the native body part may or may not be taken out. The organ transplanted may or may not take all the function of the native organ.” That means you shouldn’t consider reporting the removal of the failing kidney in addition to the transplantation of the new one.

Important: Report the transplantation code according to the organ you are transplanting.

Pitfall: If you have a bone marrow transplantation claim, don’t look at transplantation codes. Instead, turn to a “transfusion” service, which you will find in the administration section— not a “transplantation” procedure from the medical and surgical section.

Step 2: Identify the Genetic Compatibility in Your 7th Character

One of the biggest challenges of a transplant PCS code is to identify your seventh character, which will depend on whether the body part is allogeneic, syngeneic, or zooplastic. Here’s what each of these terms means:

• Allogeneic — If the surgeon uses a graft of tissue that comes from a donor that is genetically different from (but the same species as) the recipient. That means the tissue comes from one person’s body and is grafted to another person. You’ll see this term also identified as an “allogeneic graft,” “allogeneic homograft,” “homograft,” “homologous graft,” or “homoplastic” graft.
• Syngeneic —This type of graft comes from a donor who is genetically identical to the recipient. In other words, this might involve identical twins or between animals of a single highly inbred strain. You’ll see this term also identified as an “isogeneic graft,” “isogeneic homograft,” “isograft,” “isologous graft,” “isoplastic graft,” “syngeneic graft,” and “syngeneic homograft.” You might also see “syngraft isograft.”
• Zooplastic — If you see the “zoo” part of this term and think it must have to do with animals, then you would be correct. This is a graft in which the tissue comes from an animal. The physician transfers this tissue to a human. For instance, surgeons sometimes transfer a heart valve from a pig to replace a damaged heart valve in a human.

Step 3: Try Your Hand at These Examples

To reiterate how you report these transplantation services, you should try your hand at coding these examples using PCS tables.

Tip: Break down your code by each character.

Example 1: A brother donates his heart to his twin. How would you report this procedure?

Hint: Because this involved a twin, you would choose a syngeneic seventh character.

Solution: Your code is 02YA0Z1.

Example 2: Your physician documents “a right renal transplantation, allograft.” How should you report this procedure?

Hint: You should alter where you look for your PCS code in a different table because this involves a kidney. Therefore, your second character is “T” for the Urinary System.

Solution: Your full code is 0TY00Z0.

Example 3: Your physician documents an “allogeneic transplant of heart.” How should you report this procedure?

Solution: The code you should report is 02YA0Z0.