ICD-10-PCS Body Part Value Selection for Cerebral Lobectomy

Cerebral Anatomy

When selecting ICD-1o-PCS body part character values, it is helpful to be familiar with the anatomy of the affected body part. The following is a very basic overview, but it provides enough of a visual of cerebral anatomy for the coder to be able to “see” how the cerebrum is divided into distinct parts.

Hemispheres

The human brain is divided down the middle, from front to back, into two halves; the right and left cerebral hemispheres.
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Lobes

Each cerebral hemisphere is divided into four sections called lobes: frontal, parietal, temporal and occipital.

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Cerebral Lobectomy

A cerebral lobectomy is removal of all or a portion of a diseased or damaged lobe of the brain. Lobectomies are performed to treat neurological conditions such as brain tumors or epilepsy.

ICD-10-PCS Coding

The references and tools found within the ICD-10-PCS code classification provide the direction needed to confidently select the correct body part character value for cerebral lobectomy procedures.

Alphabetic Index

A search of the index for the term Lobectomy, in connection with the central nervous system, directs the coder to see the root operation Excision and code table 00B.

Code Tables

Surprisingly, review of table 00B, as directed by the index, reveals that there are no body part values for cerebral lobes. The only associated options for cerebral lobes are 0 Brain and 7 Cerebral Hemisphere. The necessity to choose a body part value can leave the coder wondering how to decide between them.

Body Part Key

When there are questions about selection of a body part value, the ICD-10-PCS Body Part Key provides official guidance.

A search of the Body Part Key indicates that if the body part documented in the operative/procedure note is “cerebrum”, with no further specification, the body part character value to be assigned is Brain.

If the body part documented in the operative/procedure note indicates a specific lobe of the brain (frontal, occipital, parietal or temporal), the body part character value to be assigned is Cerebral Hemisphere.

Coding Guideline

ICD-10-PCS coding guideline B4.1a supports the assignment of body part value 7 Cerebral Hemisphere for procedures where a partial or complete removal of a cerebral lobe is performed.

The guideline states, “If a procedure is performed on a portion of a body part that does not have a separate body part value, code the body part value corresponding to the whole body part.”

Since there are no specific body part values for the lobes of the brain, we code the body part value for the whole body part they belong to, which is cerebral hemisphere.

This coding action is also supported by Coding Clinic which directs assignment of a code for Excision of cerebral hemisphere, when a right temporal lobectomy is performed.

Example:

Mrs. Gonzalez, a 63 yr. old female patient, is taken to surgery for removal of a tumor of the left occipital lobe of her brain. Previous biopsy of the tumor indicates it is benign. The operative report describes removal of the tumor, and minimal brain tissue involved with the tumor, accomplished via craniotomy.

ICD-10-PCS Procedure Code:

• 00B70ZZ Excision of Cerebral Hemisphere, Open Approach, No Device, No Qualifier

Take Aways

• The brain is divided into two cerebral hemispheres, each of which is further divided into four cerebral lobes (frontal, occipital, parietal and temporal)
• A cerebral lobectomy involves removal of all or a portion of a cerebral lobe.
• The code table directed by the index to report excisions of the central nervous system does not have body part values for lobes of the brain
• Direction in the Body Part Key indicates assignment of the body part value 7 Cerebral Hemisphere for procedures performed on cerebral lobes
• Coding guideline B4.1a and Coding Clinic support the direction in the Body Part Key

References

• ICD-10-PCS Body Part Key
• ICD-10-PCS Alphabetic Index
• ICD-10-PCS Code Tables
• Coding Clinic, Second Quarter 2016: Page 18
• https://www.yalemedicine.org/clinical-keywords/frontal-lobectomy
• https://link.springer.com/referenceworkentry/10.1007/978-3-319-57111-9_43#citeas
  
  

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.