Thursday, November 11, 2010

What's New In Coding Clinic?

As you know, Coding Clinic is the official interpreter of ICD-9 coding guidelines.  So, when coding guidelines are unclear, Coding Clinic makes an official ruling.  There are a number of new Coding Clinic rulings, some of which may come up in Risk Adjustment.

Some recent Coding Clinic postings:

Coding Clinic, 2010 Q3, Acute on Chronic Kidney Failure. –The questioner asked what the correct coding was if a patient with documented acute kidney failure and End Stage Renal Disease (ESRD).  In addition, they wanted to know if the acute kidney failure was an exacerbation of the chronic kidney failure.

Coding Clinic replied that these are two separate diseases, and if both were documented, both should be coded.

Coding Clinic, 2010 Q4, Hypertensive Urgency—The questioner asked what the correct coding assignment was for hypertensive urgency.

Coding Clinic replied that the physician should be queried to determine what the specific type of hypertension was.  If still not further specified, the correct code was 401.9, Essential Hypertension, unspecified.  The alphabetic index now (as of the 2011 ICD-9) indicates that hypertensive urgency is coded 401.9.

NOTE: Hypertensive Urgency is described as systolic blood pressure over 180 mm Hg or diastolic blood pressure above 120 mm Hg.   Like Hypertensive Emergency (hypertensive crisis), Hypertensive Urgency generally requires hospitalization.

Coding Clinic 2010, Q2 – Infection due to Dialysis Catheter – The questioner asked what the correct code for infection due to a dialysis catheter. 

Coding Clinic replied that coding would be dependent on where the catheter was placed, i.e.,
if the infection is due to a centrally placed catheter, then the correct code is  999.31, Infection due to central venous catheter. If the infection is due to a peripherally placed catheter, then 996.62, Infection and inflammatory reaction, Due to vascular device, implant and graft is the correct code.

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