M3A3 – ICD-10-PCS coding
Review the case study below and code the correct procedure(s) using ICD-10-PCS. Provide the rationale for your code selection.
PREOPERATIVE DIAGNOSIS: Recurrent hemoptysis
POSTOPERATIVE DIAGNOSIS: Recurrent hemoptysis
PROCEDURE PERFORMED: Bronchoscopy. Reason for that is recurrent hemoptysis.
DESCRIPTION OF PROCEDURE:
After informed consent under local and IV sedation, a bronchoscopy was attempted at the bedside for evaluation of recurrent hemoptysis. The patient has severe nonischemic cardiomyopathy. Is here for LVAD evaluation with severe RV dysfunction as well. His CT scan did not show any kind of intraparenchymal or bronchial abnormalities. He had improvement in his symptoms, but started having another episode of hemoptysis, which is dark red color. We went in to evaluate for intrapulmonary source.
Upon inspection of the vocal cords, they opened and closed without any abnormality. No upper airway abnormality was found. No blood was found. We went ahead and inspected the right side as well as the left side. It was completely clean. We flushed it. There was no evidence of any bloody secretions come out. Everything looked normal. We terminated the procedure thereafter.