by Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
The LibmanLightbox module on coding of the Alfapump Solution to Repeat Paracentesis created a good question this week. A coder asked if this really is a bypass and what body part is being bypassed. The coder suggested we should use the root operation drainage instead. Both great questions.
The cavities of the body are all tubular, including the cavities in the Anatomical Regions, General body system, the chambers of the heart, chambers of the eyes, and the ventricular system of the brain. The Alfapump procedure really is a bypass because it re-routes fluid from the peritoneal cavity to another cavity, the bladder, coded as 0W1G3J6. This is actually very similar to the ventriculoperitoneal shunt procedure that re-routes cerebrospinal fluid (CSF) to the peritoneal cavity.
Drainage is different. The root operation Drainage is to drain fluid or gases from the body to the outside, like an external ventricular drain, a chest tube or Foley catheter (even though we don’t code Foleys!). There has been some published guidance that does not follow this concept and that can be confusing.
To test if something can be bypassed, check for a Bypass table in the body system you are working with, and do not forget to check the Anatomical Regions, General. If there is a Bypass table with the body part named in it, you can bypass it. Also, remember that when coding tubular body parts, you need to look at the tubular body part group first and check to see if Bypass, Dilation, Restriction or Occlusion is appropriate. Do not jump to another group until you are positive that one of those four is not the answer.
My ICD-10-PCS: Root Operation Decision Making course provides more tips on figuring out which root operation to assign.
For reference, here is a video from the manufacturer of the Alfapump.
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