Wednesday, June 19, 2013

The Great Cat Extraction - 10D07Z8

I've been spending the last couple of months training clients on ICD-10-CM and ICD-10-PCS and one of the things I love most about it is that I continue to learn more about ICD-10 and it's getting easier.  As a matter of fact, I now feel more qualified to teach ICD-10 than ICD-9.  But of course, I could pick ICD-9 back up again quickly if I had to.  You can't erase nearly two decades of experience overnight!

Many who know me well and have sat through my training sessions know that I like to teach by analogy (much the same way this blog is written).  So when I unpack my laptop and training materials at a client, I also unpack a series of stories, jokes (well, I think they're funny), and tricks to remembering all the knowledge that I'm about to lay on them.  Probably one of my favorites is the Great Cat Extraction, which I was reminded of yesterday when I took my sweet little Mandy to the vet.

My cat Mandy is 6 petite pounds of pure purring pleasantness.  Until you try to get her into her pink fluffy carrier to go somewhere.  Then she develops the will and strength of an Olympic wrestler and I'm still not quite sure how it happens, but the neck arches back and in true cartoon form, her extremities extend in all directions so that she resembles a star.  Try shoving that into a carrier.  And yesterday when we got to the vet, I thought I would be clever getting her out and unzip the top of the carrier.  No go.  Somehow, she buried her head into a corner and it kept getting caught as I tried to pull her out.  Poor kitty.

You may be wondering what the heck the Great Cat Extraction has to do with coding.  Well, it comes up in our discussion of the root operations Delivery and Extraction in the Obstetrical section of ICD-10-PCS.  The root operation Delivery is defined as, "Assisting the passage of the products of conception from the genital canal," or more cleverly, simply defined as "catching the baby" without the use of instrumentation or manipulation.  The way this was described to me is that the baby is going to come whether the doctor or midwife is there to catch it or not.  There is only one code in the Delivery table: 10E0XZZ (I still think that looks like a license plate number). 

The root operation Extraction, on the other hand, is defined as. "Pulling or stripping out or off all or a portion of a body part by the use of force."  Okay, first: ouch.  Second, if you look at the options for this table, which I've pasted here below for you, you will see that Extraction includes everything from cesarean section (the row that includes Open as the approach) to vacuum extraction (the row that has Products of Conception as the body part and Via Natural or Artificial Opening as the approach) to dilation and curettage (the last row, which has Products of Conception, Retained and Products of Conception, Ectopic as the body parts). 

Normal position for a fetus at the time of delivery is head down, but some babies are breech.  Version is usually attempted on breech babies to turn them into correct position, but they can be delivered in breech position with some finesse.  But a breech extraction is by no means a normal or simple delivery.  Trying to get the baby's limbs to deliver without injuring it or getting caught is very much like the Great Cat Extraction.  The code for a breech extraction is 10D07Z8 - this is assuming that no internal version was performed.  So when you think breech extraction, think Mandy the itty bitty kitty with the strength and limb extension of a gymnast.

 By the way, everything came out okay at the vet.  Including the cat.  Eventually.