Q&A: Procedure code for esophagogastroduodenoscopy

Q: What is the correct procedure code for an esophagogastroduodenoscopy? Our coder coded 0DQ68ZZ, which groups to DRG 326, the same as an esophagectomy. The relative weight (RW) is 5.45. This does not seem right. Could you please clarify?

A: This was addressed in Coding Clinic, Fourth Quarter, 2014. The coder is correct in their assignment. The only difference is that this was in the esophagus, but the intent is the same. I am assuming it is because the clips act as a “suture” to stop the bleed, and therefore it is considered a “repair,” much like suturing for the integumentary system.

Coding Clinic states:

Question: A patient presents with bleeding duodenal ulcer and an esophagogastroduodenoscopy was carried out. Multiple clips were applied to the vessels to control the multiple hemorrhaging ulcers. Should “control” be assigned for the root operation? What is the ap­propriate ICD-10-PCS procedure code?

Answer: The root operation “control” is defined as only applicable for procedures to correct postoperative bleeding, and so it does not apply to this procedure. This procedure is a repair of the duodenum. Most of the body’s organs and tissues are vascular, and they bleed when cut or eroded. Repair of a cut or eroded body part is coded to the body part repaired, rather than to a vascular system body part. In this case, the duodenal ulcers are being repaired via an endoscop­ic approach, with clips placed on vessels eroded by the ulcers. Assign the following ICD-10-PCS code: 0DQ98ZZ Repair duodenum, via natural or artificial opening endoscopic

I think why this seems so problematic is that in ICD-9, the code would likely be 42.33, endoscopic excision or destruction of lesion or tissue of esophagus, which includes control of esophageal bleeding and was considered a non-operating room procedure. The ICD-9 code was very generic. When translating to an ICD-10 code, the intent of the procedure seems to have been taken into consideration. This procedure is the same intent as suturing sites like the duodenum and stomach for bleeding, which was assigned to a surgical DRG. This would be my guess as to why it maps to DRG 326, though I agree that the RW seems very high.

Editor’s note: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS Director of HIM/Coding for HCPro in Middleton, Massachusetts answered this question. Contact her at smccall@hcpro.com. For information regarding CDI Boot Camps visit http://hcmarketplace.com/clinical-doc-improvement-boot-camp-1.