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Hint: Check the coding guidance for each transplant-related ICD-10-CM code carefully.

Patients who receive organ transplants can be at risk for complications, among other complex medical situations. Look at these three questions about organ transplant coding and find guidance on the ICD-10-CM coding of these situations.

Rely on Excludes1 Note

Question 1: A physician performed an examination on a heart-lung transplant patient and ordered a coronary angiography. After reviewing the results, the physician diagnosed the patient with cardiac allograft vasculopathy. How do I code this diagnosis?

Answer 1: While cardiac allograft vasculopathy has its own ICD-10-CM diagnosis code, T86.290 (Cardiac allograft vasculopathy), for heart transplant recipients, there’s an Excludes1 note for heart-lung transplant patients, according to AAPC’s Codify. In this case, you should look to the parent code for heart-lung transplants, which is T86.3-, and then look for the code that describes complications.

In this situation, the physician specifies the diagnosis, yet there is no unique code to report cardiac allograft vasculopathy in a heart-lung transplant patient. So, look to T86.39 (Other complications of heart-lung transplant).

Code the Cause for CMV Infection in Liver

Question 2: A physician sees a liver transplant patient and suspects that they’re experiencing a complication due to feeling “off” and feverish. The provider ordered tests to check the bilirubin levels, which the results showed were abnormal. The provider performed a physical examination and based on the patient’s history, a physical examination, and a polymerase chain reaction (PCR) test for cytomegalovirus (CMV), the physician diagnoses the patient with CMV infection after liver transplant. How do I code these conditions?

Answer 2: CMV is a common opportunistic infectious agent in organ transplant patients; clinicians typically want a quantitative test to confirm CMV infection and determine the viral load. This information can help the clinician determine the likelihood of tissue-invasive infection and guide the choice of antiviral therapy.

You can find coding information for transplant complications in Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88) of the ICD-10-CM code book. In section 1.C.19.g.3.a, you’ll find “Transplant complications other than kidney,” which says that T86 (Complications of transplanted organs and tissues) codes should be used for both complications and rejection of transplanted organs. The guidance says: “A transplant complication code is only assigned if the complication affects the function of the transplanted organ. Two codes are required to fully describe a transplant complication: the appropriate code from category T86 and a secondary code that identifies the complication.”

With that in mind, look to code T86.43 (Liver transplant infection), which has a note to “Use additional code to identify infection.” You can report the CMV infection with B25.1 (Cytomegaloviral hepatitis).

Report Patient’s Transplant Status, Too

Question 1: A patient recently underwent a right kidney transplant and received a follow-up examination after the transplant. I have a consulting radiologist’s report for a complete ultrasound (US) exam of the patient’s kidneys and retroperitoneal structures. The report includes documentation of the patient’s abdominal aorta, common iliac artery origins, inferior vena cava, and kidneys. The radiologist noted probable cysts on both kidneys. How should I report the patient’s transplant status, according to ICD-10-CM guidelines?

Answer 1: If you’re looking to report the patient’s transplant status, you can follow these steps to navigate the ICD-10-CM complete code set. Since the radiologist performs the US as part of follow-up care after the kidney transplant, you’ll need to assign an aftercare code. To locate the correct code, search the indentations in the Alphabetic Index to follow Aftercare > following surgery (for) > organ transplant > kidney. You can then verify Z48.22 (Encounter for aftercare following kidney transplant) in the Tabular List.

You can also assign Z94.0 (Kidney transplant status) to indicate that the provider saw the patient because the patient recently received a kidney transplant. According to the ICD-10-CM Official Guidelines, section I.C.21.c.3, “Status codes indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition.” This includes transplanted organ or tissue status since the status code is informative and can affect the patient’s treatment.

 Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC