Inpatient Facility Coding & Compliance Alert

Tip: Don’t overlook additional guidelines.

Endovascular embolization involves inserting a catheter into an artery (usually in the groin) and threading a device into the aneurysm to disrupt the blood flow and cause the blood to clot. This procedure seals off the aneurysm from the artery.

The most common type of device used to treat brain aneurysms are coils. Currently, there are two types of coils used: bare platinum coils (BPCs) and bioactive coils. Your code assignment is based on the type of coil the surgeon uses.

Coil coding options: Endovascular embolization of a brain aneurysm using BPCs is classified to code 39.75 (Endovascular embolization or occlusion of vessel[s] of head or neck using bare coils) and includes bare metal coils. Endovascular embolization of a brain aneurysm using bioactive coils is assigned to code 39.76 (Endovascular embolization or occlusion of vessel[s] of head or neck using bioactive coils) and includes biodegradable inner luminal polymer coils and coils containing polyglycolic acid.

Non-coil options: Endovascular embolization of a brain aneurysm using a device other than coils is assigned to code 39.72 (Endovascular embolization or occlusion of head and neck vessels). Since the creation of codes 39.75 and 39.76 in 2009, coil embolization of a brain aneurysm is no longer classified to code 39.72. It may be necessary to query the physician for clarification if the documentation does not provide information on the type of coil inserted.

Watch for Specific Guidelines Under ICD-10-PCS

To assign the most appropriate procedure code in ICD-10-PCS, you must first identify the correct root operation. The root operation, which is the third character of the ICD-10-PCS code, defines the objective of the procedure.

Definition: According to the ICD-10-PCS Coding Guidelines, “In order to determine the appropriate root operation, the full definition of the root operation as contained in the PCS Tables must be applied.”

Extra info: In addition, ICD-10-PCS has a specific guideline regarding embolization procedures. Guideline B3.12 states, “If the objective of an embolization procedure is to completely close a vessel, the root operation Occlusion is coded. If the objective of an embolization procedure is to narrow the lumen of a vessel, the root operation Restriction is coded. … Embolization of a cerebral aneurysm is coded to the root operation Restriction, because the objective of the procedure is not to close off the vessel entirely, but to narrow the lumen of the vessel at the site of the aneurysm where it is abnormally wide.”

Answer: Therefore, the code assignment for coil embolization of an intracranial artery is 03VG3DZ. The following explains the meaning of each character:

• 0: Medical and Surgical (Section);
• 3: Upper Arteries (Body System);
• V: Restriction (Root Operation);
• G: Intracranial Artery (Body Part or Region);
• 3: Percutaneous (Approach);
• D: Intraluminal (Device); and
• Z: No Qualifier (Qualifier).

If the surgeon used bioactive coils, then the code assignment would be 03VG3BZ, with the only difference being the sixth character for device.

It is interesting to note that clipping of a cerebral aneurysm through a craniotomy is classified to code 03VG0CZ. Most of the characters are the same as the endovascular embolization with the exception of the approach (fifth character), which is open, and device (sixth character), which is an extraluminal device.