We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
Answer:
This is a great question. I have previously sent out a HIA Coding Tip on this very subject. It can be located and read here: https://www.hiacode.com/education/codingtips/bronchoscopy-removal-mucus-plugs-foreign-body/
Mucus plugs occur within the bronchus. They are formed when mucus accumulates in the lungs and can plug up or reduce the airflow in small or large airways. They can lead to collapsed alveoli (air sacs) and that is why the physician removes them. The patient may have chest pain or shortness of breath because of them. Usually they are washed or suctioned away and sometimes Mucomyst is used locally to help remove the mucus plug.
Mucoid casts are large, thick, tenacious mucus “molds or impressions” of the inner lining of the bronchial tubes. They can appear as large gelatinous looking or rigid “casts.” They can occur as a result of infection, allergic inflammation, or reaction to a presence of a foreign body or chemicals. They can be coughed up, however, if they remain in the bronchial tubes, they can cause shortness of breath, chest pain and hypoxemia. These are removed similar to mucus plugs, by washing them away, by
use of Mucomyst and by suctioning during bronchoscopy.
As stated in the coding tip above, the root operation is “Extirpation” which is “taking or cutting out solid matter from a body part.” These mucus plugs or mucoid/bronchial casts are considered solid matter. The body part value is bronchus, as stated in the coding tip. The specific bronchus lobe that the mucoid casts or mucus plugs are removed from is coded. Since there is no selection in ICD-10-PCS for “bilateral bronchus,” the coder must code the specific bronchus lobe in which mucus plugs or mucoid casts are removed. If there is any question as to where they are being removed, best practice is to query the physician.
References
https://www.hiacode.com/education/codingtips/bronchoscopy-removal-mucus-plugs-foreign-body/
AHA Coding Clinic for ICD-10-CM/PCS, Third Quarter 2017: Page 14
https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-7-43
We know that every case is unique. The above post is simply our opinion based on the information we have received. We encourage readers to research subsequent official guidance in the areas associated with this topic as they can change rapidly.
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