Coding Transplantations
Transplantations will be used by coders when a physician puts a part or all of a living body part taken from another individual or animal to physically take the place or function of all or a portion of a similar body part. For example, a surgeon places a donor kidney in a patient?s body. The body part value represents the site of the transplantation. The qualifier value denotes the type of transplantation whether it is allogeneic, syngeneic, or zooplastic. In transplantation procedures, the native body part may or may not be removed and the transplanted body part may take over all or part of the function of the transplanted organ.
Transplantation represents a small number of procedures in ICD-10-PCS.For transplantation codes, the third character Y is reported.
Examples of transplantation procedures include:
- Orthotopic heart transplant using porcine heart .The donor heart is taken from an animal (pig), so zooplastic as the qualifier value is reported 02YA0Z2.
- Transplantation of right lower lung lobe, from an identical twin 0BYF0Z1.
- Transplantation of large intestine, using organ donor matched intestine, open approach 0DYE0Z0.
- Bone marrow transplants, stem cell transplant and pancreatic islet cell transplants are not coded in the surgery section. For a bone marrow transplant, refer section 3 – administration and the root operation 2 – transfusion.
When reporting kidney transplant, documentation must have medical necessity, including a covered diagnosis.
Insurance companies have several factors that are not medically necessary for a kidney transplant, including:
- Known history ,current malignancy including metastatic cancer.
- Recurrent malignancy.
- Untreated systemic infection making leading to chronic infection.
- Other irreversible end-stage diseases which are not linked to the kidney disease.
Some of the diagnosis codes covered by insurance:
Type 2 diabetes mellitus with other diabetic kidney complication E11.29
Type 1 diabetes mellitus with other diabetic kidney complication E10.29
Type 2 diabetes mellitus with hyperglycemia E11.65
Type 1 diabetes mellitus with hyperglycemia E10.65
Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease I12.0
Glomerular disorders in diseases classified elsewhere N08
Chronic nephritic syndrome with diffuse mesangial proliferative glomerulonephritis N03.3
Chronic kidney disease, stage 1 N18.1
Chronic kidney disease, stage 1 (mild) N18.2
Chronic kidney disease, stage 1 (moderate) N18.3
Chronic kidney disease, stage 4 (severe) N18.4
Chronic kidney disease, stage 5 N18.5
End stage renal disease N18.6
Chronic kidney disease, unspecified N18.9
Polycystic kidney, unspecified Q61.3
Polycystic kidney, adult type Q61.2
Other polycystic kidney, infantile type Q61.19
Unspecified complication of kidney transplant T86.10
Kidney transplant rejection T86.11
Kidney transplant failure T86.12
Codes for facility reporting of kidney transplant ICD-9-PCS (or Volume III) include:
Transplantation of right kidney, allogeneic, open approach 0TY00Z0
Transplantation of right kidney, syngeneic, open approach 0TY00Z1
Transplantation of right kidney, zooplastic, open approach 0TY00Z2
Transplantation of right kidney, allogeneic, open approach 0TY10Z0
Transplantation of right kidney, syngeneic, open approach 0TY10Z1
Transplantation of right kidney, zooplastic, open approach OTY10Z2
Excision of right kidney, open approach 0TB00ZZ
Excision of left kidney, open approach 0TB10ZZ
Resection of right kidney, open approach 0TT00ZZ
Resection of left kidney, open approach 0TT10ZZ
Resection of bilateral kidneys, percutaneous endoscopic approach 0TT20ZZ