Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see this edition’s case studies below:
Case Summary
Patient is a 61-year-old female with a history of hypertension, diabetes, peripheral vascular disease and gangrene who was taken to the OR for an amputation of the left 2nd toe.
Operative report (excerpt):
PROCEDURE PERFORMED: Amputation of second toe in the left foot
…Then we dissect the soft tissue and periosteum elevated from the bone and we moved over amputation level around the middle shaft of the second metatarsal bone and then we used a saw to sharply cut the bone and we used scissors to dissect and cut the soft tissue and totally amputated the second toe at mid metatarsal level…
DRG Options
Audit Considerations & Strategies
- The coder originally assigned PCS code 0Y6S0Z2 – Detachment of left 2nd toe, mid, open approach
- It was noted throughout the progress notes, operative report, and discharge summary, that the patient had a “toe amputation” which is likely why the coder assigned the detachment of toe PCS code
- However, in reviewing the operative report, the surgeon clearly notes that the amputation was performed through the “middle shaft of the second metatarsal bone” which is assigned to PCS code 0Y6N0ZB – Detachment of left foot, partial 2nd ray, open approach
- Adding this PCS code shifts the DRG from 256 to 240
- According to Coding Clinic 2nd Quarter 2017, page 3, a partial amputation of the foot is defined as an “amputation anywhere along the shaft or head of the metacarpal bone of the foot” and a mid-toe amputation is defined as an “amputation through the proximal interphalangeal joint or anywhere along the middle phalanx”
- Whenever coding toe amputations, always pay close attention to where the “toe amputation” is being performed
- If the “toe amputation” involves the metatarsal bones then it should be coded as a partial ray detachment of the foot
Reference
- Qualifiers for the Root Operation Detachment, Coding Clinic – 2nd Quarter 2017: Page 3