Item 43e. PDA Ligation or PDA Closure by Catherization

Q: I am getting an error notice when I add surgery codes for PDA Ligation or PDA Closure by Catheterization.

A:  If a closure of the ductus arteriosus by ligation or catheterization was performed, code at least one of the following three surgery codes should be present:

  • S515 Open thoracotomy for patent ductus arteriosus closure
  • S516 Thoracoscopic surgery for patent ductus arteriosus closure
  • S605 Interventional catheterization for patent ductus arteriosus closure

If an infant had PDA repair as part of other heart surgery, PDA surgery should be coded as Yes, and a specific surgical code for PDA Surgery (S515, S516, S605) as well as any codes related to the other heart surgery should be entered. For example, if the PDA ligated as a component of the repair or palliation of congenital heart disease, use a specific surgical code for PDA surgery (S515, S516, S605) and code S504.


Item 44a. Necrotizing Entercolitis

Item 44b. Nec Surgery

Item 45. Focal GI Perforation

Q: How would I code an infant with free air in the abdomen when we don't know whether it was from NEC or from isolate ileal perforation? Should I answer NEC as "No" or "Unknown"?

A: If the infant has free air in the abdomen, but does not satisfy the criteria in the definition of NEC, then the answer to NEC is "no".


Q: For the same situation as above, how should I answer for Focal GI perforation?

A: If the infant with free air did not have a focal GI Perforation identified at surgery or postmortem, the answer to Focal GI Perforation is "No".


Q: Should I code an infant who receives a peritoneal drain as NEC surgery even though it may not survive for definitive surgery to figure out why the perforation?

A: If the infant had peritoneal then the answer to NEC Surgery is "No". Instead you must answer "Yes" to Item 47a. Other surgery and use surgery code S333.

Item 45a. Focal Intestinal Perforation 

Q. We recently reviewed the patients with Focal Intestinal Perforations in our NICU and our medical director had questions regarding whether some babies met the CPQCC definition of a Focal Intestinal Perforation. When a baby had a perforation as a result of a meconium plug, would it be considered a Focal Intestinal Perforation in CPQCC, or would it not be considered a FIP in CPQCC, or would it be considered something else entirely?


A.This seems like a bit of a gray area so appreciate the question. I think that because FIP is really intended to be a supplemental variable that distinguishes NEC from isolated perforation, and meconium plug perforation is kind of a different entity, I think that it would seem appropriate to not count this as FIP. Presumably the condition would be indicated in some other fashion due to the surgery that occurred to address it.





Item 46a. Retinopathy of Prematurity

Q: Would Avastin treatment for ROP be considered as surgery?

A: No. Avastin is a drug and therefore would not be considered as surgery.


Q: In the NICU database the ROP question is for patients GA less than 32 weeks. With the AAP recommendations for ROP screening GA 30 weeks. If we do not perform a screen between the 30 and 32 weeks, will it appear as a fall out for this category?


A: For CPQCC reports like the CCS report, risk adjusted, and other comparison charts, we restrict the denominator to 22 6/7 to 29 6/7 weeks GA or < 1500 grams (as you noted, this would be in line with the AAP recommendations for those who they say all babies in those categories should get exam).


However, we take into account some centers will want to see metrics for < 32 week babies and therefore have this data available on the report site.  This is because for some babies up to 32 weeks, the AAP also notes eye exam may be reasonable. 

But for the main CPQCC reports, the data used only includes those babies < 30 weeks (as per AAP).



Item 47a. Other Surgery

Q: Would a removal of a percutaneous gastrostomy or jejunostomy tube count as surgery?

A: Only if the removal was done under general or spinal anesthesia.


Q: Would a broviac placement count as surgery?

A: Central lines or line placement is not considered surgery even if performed under general or spinal anesthesia. 


Q: What surgery code should we use for esophageal dilations?

A: S211 if esophagoscopy (with or without biopsy) was performed. S200 if the procedure was done under general or spinal anesthesia.


Q: What surgery code should we use for coarctation repair? 

A: S504 Repair or palliation of congenital heart disease.


Q: Why so much detail on the GI surgeries and so little on the cardiacs?

A: The number of different cardiac procedures is so large that we went for the simplest solution.  However, we do have information on the congenital defect from the birth defect codes so that these can be linked.


Q: S503, what do you want coded under a major vascular injury surgery?

A: The use of “injury” suggests the code should be used for repair of iatrogenic injuries of major vessels not for repair of birth defects.


Q: Does an infant who has a hernia repair, circumcision or central line qualify?

A: Only procedures that require general anesthesia qualify as surgery. Please review Appendix C on page 5 of the NICU Data Center Appendices.



Q: What if the baby was admitted 2 days of life, but did not receive surgery until Day 40. Does this qualify?

A: If an infant was admitted to your NICU on or before Day 28 and has a surgery requiring general anesthesia at any point during the admission, this baby qualifies.


Item 47a. Surgical complications

Q: If a patient experiences surgical complication from a procedure not listed in Appendix D (Other Surgery), should I still record it?

A: Yes.