HIMagine That! Falling Down the Rabbit Hole with TTOs

October 26th, 2012 / By Sue Belley, RHIA, Donna Smith, RHIA

Donna:   Sue! I fell down the rabbit hole again.

Sue:        Okay, Alice. What’s up?

Donna:   I’m buried in ICD-10 code translation and this time I’m trying to figure out how to translate the ICD-9 code for TTOs to ICD-10.

Sue:        TTO…tell me what that is again?

Donna:   Trans-tracheal-oxygenation.

Sue:        The procedure where the doc makes a little incision through the skin of the throat into the trachea and inserts a catheter to deliver oxygen, right?

Donna:   Yeah, that. So I was trying to look at how to code TTOs in the ICD-10-PCS code book. And in the 2012 update, I see there is a new device character for an intraluminal device, endotracheal airway, which should allow us to accurately report this procedure

Sue:        Okay, I’m following you so far.

Donna:   In ICD-9, due to limited expandability, TTO is included in “other operations on the trachea.” But I also noticed that the GEMS translate this procedure to insertion in the mouth or throat via a natural or artificial opening. Wouldn’t you consider it to be percutaneous instead?

Sue:        Yes, it’s like doing an emergency tracheotomy with your ballpoint pen to keep an airway open.

Donna:   See? I’m lost in Wonderland where things aren’t always what they appear to be. If we use the GEMS for coding or as a reference we might not get the accurate code. TTO is not inserted in the mouth.

Sue:        Well, I think this just demonstrates why we really need to have a good understanding of the procedure performed.  Also, it reinforces why actual coding can’t be accomplished with GEMS translation. Lucky for us we have plenty of time to sort this out due to the one year delay. (grins)

Donna:   Now you’re talking like the Mad Hatter.

Donna Smith is a Project Manager with the Consulting Services business of 3M Health Information Systems.

Sue Belley is a Project Manager with the Consulting Services business of 3M Health Information Systems.