Revisão de próteses

"Como se codificam as substituições dos componentes das próteses articulares?
 Até onde vai Revision e quando se codificam outras root operations?"


(Responde Fernando Lopes)
 
 
Parece ter existido um mal-entendido na aplicação da root operation Revision o que justifica uma revisão dos conceitos definidos na ICD-10-PCS, explicados nas Guidelines e exemplificados no Coding Clinic (CC).
 
Nem todas as revisões se codificam como Revision:
“Revision of vein graft,” in ICD-10-PCS terms, it is not a revision. Revision is defined as correcting, to the extent possible a
portion of a malfunctioning device or the position of a displaced device. This surgery is a new bypass (CC 3Q 2018 p.9)
 
As revisões de procedimentos cirúrgicos (sem devices) não se enquadram em Revision:
What is the correct root operation for revision of the bile duct anastomosis?
Answer: ... re-suture of the common bile duct anastomosis with the common bile duct of the transplanted liver. The excision of the anastomosis was done in order to re-suture the anastomosis. The root operation “Repair” is most consistent with what was done. (CC 3Q 2016 p.27)
 
A root operation Revision aplica-se quando o procedimento é realizado num device:
Procedures performed on a device only and not on a body part are specified in the root operations Change, Irrigation, Removal and Revision, and are coded to the procedure performed.
Example: Irrigation of percutaneous nephrostomy tube is coded to the root operation Irrigation of indwelling device in the Administration section. (Guideline B6.1c)
 
O reposicionamento de um device codifica-se como Revision do device:
In this case, the graft is not functioning properly. Endostaples were used to secure the position of the distal migrated endograft, which caused the type 1 endoleak. The objective of the surgery is to correct the leak. The appropriate root operation is “Revision,” since the endostaple device was used to reattach the stent graft (endograft) (CC 1Q 2010 p.10)
 
The previously placed aortic valve is malfunctioning, because a leak has developed along the perimeter of the valve where it is attached. This procedure is performed to correct a portion of a malfunctioning or displaced device, and so the root operation is Revision. (CC 3Q 2014 p32)
 
Revison codifica a 'correção' dum dispositivo e não a sua substituição:
... a revision should be reported when the objective of the procedure is to correct the position or function of a previously
placed device, without taking out and putting a whole new device in its place (CC 2Q 2015 p.19)
 
Examples of revision surgery include re-cementing of a prosthetic joint or adjusting a pacemaker lead. (CC 2Q 2015 p.19)
 
The loose tibial component is then re-cemented to the underlying bone. How is this procedure coded? 
Answer: Because the existing device is not removed or replaced but is corrected instead, this is a “Revision” procedure (CC 4Q 2016 p.112)
 
Any time a joint replacement is adjusted, but not removed, the procedure is coded to the root operation “Revision.” (CC 4Q 2017 p.107)
 
Revision não codifica a substituição de componentes:
Please note that when only the leads are replaced, assign codes for the removal of the old lead, as well as for the insertion of the new lead. When only the pulse generator is replaced, assign codes for the removal of the old generator as well as the insertion of the new generator (CC 4Q 2012)
 
The surgeon removed the old hooks and rods and placed new ones. In this case the root operation “Revision” is not appropriate since the entire device was removed and replaced. (CC 4Q 2014 p.29)
 
Although documented as a “revision” arthroplasty, root operation “Revision” is not used here. When the components of a replaced joint are removed and new components (i.e., femoral head, femoral stem, acetabular component, liner) are inserted, codes are assigned for the placement of new components and for the removal of the old components. (CC 4Q 2016 p.111)
 
Revision só se aplica a partes (portions) dos dispositivos. Sa a revisão dum dispositivo for total (substituição do dispositivo ou da prótese completa) em vez de Revision codifica-se o procedimento inicial (por exemplo, Replacement).
Revision: Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device. (Root Operation definitions)
 
In ICD-10-PCS, “Revision” is defined as correcting, to the extent possible, a malfunctioning or displaced device. A complete redo of the original root operation would be coded to the root operation performed (CC 1Q 2015, p.33)
 
The previously placed external drainage system was removed, a subcutaneous tunnel was made from the chest to the abdomen, and a new lumboatrial shunt was placed. Therefore, the correct root operation is “Bypass” rather than “Revision.” (CC 4Q 2018 p.86)
 
Se a revisão implicar a substituição do componente ou da prótese, codifica-se a remoção do dispositivo existente e o procedimento inicial (implantação do componente ou da prótese):
A complete redo of a procedure is coded to the root operation performed, in this case, a removal and replacement. (CC 2Q 2015 p.18)
 
A patient with painful right total knee arthroplasty presents for revision of the arthroplasty. The previous components were removed and new tibial and femoral components were inserted and cemented into place. Should this be coded as a
revision or replacement procedure?
Answer: Since the components were removed and replaced, this procedure should be coded as a replacement procedure. Additionally, the removal of the previously placed components should be separately reported. (CC 2Q 2015 p.18)
 
When the components of a replaced joint are removed and new components (i.e., femoral head, acetabular surface, femoral surface, and liner) are inserted, codes are assigned for the placement of new components and for the removal of the old components. (CC 2Q 2015 p.19)
 
The antibiotic spacer in the humeral canal was removed. A new antibiotic impregnated spacer was manufactured using cement, vancomycin powder and tobramycin powder, and a pin, and the spacer was placed into the humeral canal. Assign the following ICD-10-PCS codes Insertion + Removal ( CC2Q 2017 p.21)
 
Não é necessário que haja remoção, adição ou substituição de componentes para que se codifique Revision:
... a revision should be reported when the objective of the procedure is to correct the position or function of a previously
placed device, without taking out and putting a whole new device in its place. (CC 2Q 2015 p.19)
 
Se a revisão consistir apenas na inserção de um novo componente não se codifica Revision mas o procedimento realizado:
A code for Supplement is assigned for placement of the new liner. The liner is placed to physically reinforce the replaced joint; it is not functioning as a replaced body part. (CC 2Q 2015 p.19)
 
A inserção de parafusos (destinados ao reforço de um fixador preexistent) está contemplada no procedimento de revisão:
Revision can include correcting a malfunctioning or displaced device by taking out or putting in components of the device such as a screw or pin. (Root Operation definitions)
 
Materials such as sutures, ligatures, radiological markers and temporary post-operative wound drains are considered integral to the performance of a procedure and are not coded as devices. (Guideline B6.1b)
 
Additionally, the fixation instrumentation (i.e., rods, plates, screws, etc.) is included in the fusion root operation, and no additional code is assigned. (CC 2Q 2017 p.
 
 
Fernando Lopes