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NCCQ March 2022 > Chapter L Arteries and Veins > Flashcards

Chapter L Arteries and Veins Flashcards

1
Q

How many supplementary codes from Chapter Y are used with the HALO procedure?

A

Haemorrhoidal Artery Ligation requires 2 Y codes:

L70.3 Ligation of artery NEC

Y52.4 Peranal transrectal approach to organ

Y53.2 Approach to organ under ultrasonic control

Z37.8 Specified lateral branch of abdominal aorta NEC PCSL2

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2
Q

Which type of stent is usually not used in endovascular aortic aneurysm repair therefore coders should seek advice, whether it is indeed a stent graft?

A

Bare metal stents

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3
Q

When an operation is carried out on a branch of an artery and the artery of origin has a devoted named category, but the operated branch is not listed as an inclusion term at the named artery category, what is the correct way of coding it?

(Example: posterior tibial artery originates from popliteal artery, classified at named category L63)

A

A named artery category must not be used, a code from the range L65-L72 must be used instead with subsidiary site code from Chapter Z

PChSL2

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4
Q

When can an operation on a branch of an artery be classified at the named category?

A

PChSL2 Only when the branch is listed as an inclusion term at the named category . E.g. coeliac artery is an inclusion term at the named category L47 Transluminal operations on other visceral branch of abdominal aorta

PChSL2

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5
Q

When is it permissible to assign the code L97.6 Insertion of vascular closure device?

A

When it is the the only procedure that took place.

PCSL6

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6
Q

How many chapter level standards are there applying to Chapter L?

A

Chapter L has the biggest number of chapter standards - 5.

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7
Q

If there is no index trail or specific 4th character code to classify removal of bypass graft of a vessel, how must the removal be coded?

A

The removal of bypass grafts must be coded to the original operation bypass category with the fourth-character .8 plus code Y26.4 Removal of other repair material from organ NOC

PChSL4

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8
Q

Codes from which 3 categories supplement Chapter L codes for insertion of stents and stent grafts? How do we know the supplementary code is needed?

A

Codes from categories L76, L89 and O20 are used in addition, when indicated by the NOTES at the category or code level.

PChSL3

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9
Q

Chapter L consists of 99 categories, L00-L99, is that true or false?

A

False, Chapter L has additional overflow categories O01–O05, O15, O20. Besides, some of the categories are retired ( for instance L11, L64)

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10
Q

Which blood vessels are excluded from Chapter L?

A

Coronary blood vessels (classified in Chapter K) and certain other specific blood vessels classified in other chapters (e.g. ligation of maxillary artery using sublabial approach is coded to
E12.1.)

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11
Q

Which code can be used to specify procedures carried out on both left and right pulmonary arteries, when using codes from category L04?

A

Category L04 classifies procedures on both pulmonary arteries, so it is not necessary to add code Z94.1 to indicate a bilateral operation.

Coding guidance within Chapter L

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12
Q

When angioplasty/venoplasty and insertion of stent or stent graft are performed at the same time, should we code

  • Both
  • Angioplasty/Venoplasty only
  • Stent/Stent graft insertion only
A

Only the code for the stent/stent graft insertion is required, because the angioplasty/venoplasty is implicit within the stent/stent graft insertion code.

PChSL3

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13
Q

Is the Primary procedure code for Embolisation of Uterine Fibroids a Chapter Q or a Chapter L code?

A

Chapter L:

L71.3 Percutaneous transluminal embolisation of artery

Y53.- Approach to organ under image control or Y68.- Other approach to organ under image control

Z96.6 Uterine artery

Z94.- Laterality of operation PCSL3

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14
Q

When coding a bypass operation, if we cannot find a specific 4th character at categories L16-L28 and L48-L63 for the anastomotic sites described in the operation note, how must we code the bypass?

A

Categories L16-L28 and L48-L63 must be assigned to the .8 within the relevant category.

PCSL1

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15
Q

When a stent graft has been inserted and the number and type of stent grafts is not known, which supplementary code should we use by default?

A

O20.9 Unspecified endovascular placement of stent graft.

PChSL3

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16
Q

Category L73 Mechanical embolic protection of blood vessel is not an extended category. Why can codes L73.8 and L73.9 NOT be used?

A

The code L73.1 Mechanical embolic protection NEC would be used to denote a mechanical embolic protection which is not covered more precisely by any other code

Chapter L Guidance

17
Q

If a branch of an artery is listed as an inclusion term at the named artery category, it can be classified in that category. Which other code must be added to identify the inclusion term?

A

A site code from Chapter Z must be added to identify the branch of an artery listed as an inclusion term

PChSL2

18
Q

How must a repair/replacement of Aortic Arch be coded?

A

It must be classified to a code for the replacement of thoracic segment of the aorta, followed by Z34.2 Aortic arch to further specify the particular section of the thoracic aorta. PCSL8

19
Q

Would a subsidiary code Y73.1 Cardiopulmonary bypass be required with any of the operations classified in Chapter L?

A

Yes, for instance open operations carried out on aorta or vena cava could require CPB, Chapter K codes are not the only codes used with CPB.

20
Q

When must the category L84 Combined operations on varicose vein of leg be used in preference to L85 Ligation of varicose vein of leg and L87 Other operations on varicose vein of leg?

A

When any ligation, stripping or avulsion of varicose veins of leg are performed at the same time

PCSL5

21
Q

When a stent graft is made up of multiple components from a single stent graft kit which were modified and connected together, would we code insertion of single stent graft or each component as a separate stent graft?

A

Single stent graft

PChSL3 guidance

22
Q

When a therapeutic transluminal procedure cannot be classified either at 4th character level at the named category or at specific fourth-characters within categories L66 and L71, how must the procedure be coded?

A

‘Other specified’ and ‘unspecified’ procedures on named arteries - .8 and .9 subcategories (example L63.8, L63.9) must be used instead. PChSL1

23
Q

What is the nature of the Fistuloplasty of arteriovenous fistula procedure and which code combination would be required to fully reflect it?

A

It is carried out to treat narrowing/blockage of the fistula by dilation:

L74.3 Attention to arteriovenous shunt

Y40.- Dilation of organ NOC

Y53.- Approach to organ under image control or Y68.- Other approach to organ under image control (if image control is used)

Z site code (when the site is stated)

Z94.- Laterality PCSL4

24
Q

Drug-eluting balloons are classified at angioplasty codes within Chapter L. How must drug-eluting balloons be coded?

A

Y37.2 Introduction of substance into organ using drug-eluting balloon NOC must be assigned in addition to the code for the angioplasty

PChSL5

25
Q

How should we capture extensions to an existing stent graft that are placed during a separate procedure to the original stent graft insertion? (New insertion or Attention to stent graft?)

A

These must be classified using L27.8 Other specified transluminal insertion of stent graft for aneurysmal segment of aorta and Y15.- Attention to stent in organ NOC

PChSL3

26
Q

When a Frozen Elephant Trunk procedure is performed, which supplementary code must be assigned with categories L18-L21?

A

A supplementary code from O20 Endovascular placement of stent graft PCSL8

NB: FET is a technique that combines both open and endovascular treatment for extensive aortic disease

27
Q

Can the following sizes of the aneurysms

  • Small = 5mm or less
  • Medium = 6mm–10mm
  • Large = 11mm–20mm
  • Giant = greater than 20mm

be used to make decision on 4th character choice at category O01 Transluminal coil embolisation of aneurysm of artery?

A

Yes, as instructed by the standard PCSL7

28
Q

When a section of aorta is replaced as an emergency open procedure to treat aortic dissection, what should we consider when making a choice between the following categories:

L18 Emergency replacement of aneurysmal segment of aorta

L20 Other emergency bypass of segment of aorta

A

The details of the diagnosis: L20 is chosen for the diagnosis of an aortic dissection without aneurysm. PCSL8

29
Q

In a scenario where both Descending and Infrarenal aneurysmal segments of aorta were repaired at the same time, which repair codes from chapter L should we be assigning?

  • Only the repair of the Descending aorta (the closest segment to the heart)
  • Only the repair of the Infrarenal aorta (the furthest segment from the heart
  • Both segments
A

Both - When multiple segments of the aorta are replaced/repaired and the individual segments are classifiable to different four character codes, each segment replaced/repaired must be coded separately. PCSL8

30
Q

What is the title of Chapter L?

A

Arteries and veins

31
Q

When the operated artery has a devoted named category (example: femoral artery), but the therapeutic transluminal operation carried out does not have a devoted code at the 4th character level within that category (example: percutaneous transluminal thrombolysis), how should that operation be coded?

A

Specific 4th character codes from categories L71 Therapeutic transluminal operations on other artery and extended category L66 Other therapeutic transluminal operations on artery must be used and an additional site code must be assigned. PChSL1

32
Q

Which approach is often used to perform operations classified in Chapter L?

A

Arteriotomy approach and/or image control, captured by codes in categories Y53, Y68, Y78

33
Q

When must the range L65-L72 not be used ?

A

When an intervention is classifiable within a named artery category from the range L01–L63 PChSL1

34
Q

When the number and type of stent(s) is not known, which supplementary code should we use by default?

A

L76.9 Unspecified endovascular placement of stent.

PChSL3

NCCQ March 2022 (8 decks)

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