Recent Coding Clinic Decisions

The last quarter  2010 and the first quarter 2011 Coding Clinic rulings were recently released. Because there are so many decisions, we'll post them over the next week in small batches so that the posts aren't too long  We hope that this information is helpful to you!

Volume: 2011

Issue:  First 

Title:  Postoperative Aspiration Pneumonia

The question of the  correct code assignment for a diagnosis of postoperative aspiration pneumonia was made, noting that  ICD-9-CM’s Tabular List under code 997.39 provides the following inclusion terms: “Pneumonia (aspiration) resulting from a procedure.” The questioner went on to note that the instructional note under category 997 states, “Use additional code to identify complication.” Should code 997.39, Respiratory complications, Other respiratory complications, be assigned along with code 507.0, Pneumonitis due to solids and liquids, Due to inhalation of food or vomitus, to describe postsurgical aspiration pneumonia?

Coding Clinic answered that it was appropriate to assign both codes together. The questioner was instructed to assign code 997.39, Respiratory complications, Other respiratory complications, and code 507.0, Pneumonitis due to solids and liquids, due to inhalation of food or vomitus, for postsurgical aspiration pneumonia. Coding Clinic went on to indicate that the title of code 997.39 is broad  and that the  assignment of code 507.0 provides additional information about the specific respiratory complication.

Volume:  2011

Issue:  First 

Title:  Pancytopenia due to Drug

The questioner indicated confusion about coding drug-induced pancytopenia. Coding Clinic had previously advised how to code chemotherapy induced aplastic anemia but did not address pancytopenia secondary to drugs. The ICD-9-CM indexes pancytopenia to code 284.1, Pancytopenia. However, code 284.1 is excluded from pancytopenia due to or with aplastic anemia (284.9) as well as that which is drug induced (284.89). If the provider documents “pancytopenia due to chemotherapy” and there is no documentation of “aplastic anemia,” how is this coded?

Coding clinic answered that based on the instructional note under code 284.1, the correct code would be Other specified aplastic anemias 284.89, along with the appropriate E-code to identify the drug. Although there is no medical record documentation of aplastic anemia, the instructional note indicates that drug-induced pancytopenia is classified to code 284.89.

Volume: 2011

Issue:  First 

Title:  Transbronchial Biopsy of Lung  (inpatient procedure coding)

The questioner noted that a procedurewas listed as bronchoscopy due to nodular infiltrates and atelectasis and airway examination. In addition, washings, brushing and biopsy were taken from the left lower lobe and washings from the right lower lobe. Additionally, the provider has clarified that a transbronchial biopsy of the left lower lobe was performed. No lung tissue was identified on the pathology report. How should this be reported?

Coding clinic indicated that based on the provider’s documentation, they should assign procedure code 33.27, Closed endoscopic biopsy of lung, for the transbronchial biopsy. Although there was an absence of lung tissue in the pathology report, it did not preclude the assignment of the code when the procedure is performed by the provider. Tissue samples may be inadequate or inconclusive, leading to the lack of lung tissue in the path report.

 

Volume:  2011

Issue:  First 

Title:  Trichilemmal (Pilar) Cyst

The questioner indicated that a  patient presented for outpatient surgery for removal of a scalp lesion. The provider documented “skin lesion, scalp––excised.” The pathology report indicates “trichilemmal cyst (pilar cyst).” ICD-9-CM classifies a cyst of the scalp as a sebaceous cyst. There is confusion as to whether this should be coded as a trichilemmal or sebaceous cyst. What is the correct diagnosis code for this encounter?

Answer:

The questioner was told to assign code 704.8, Other specified diseases of hair and hair follicles, for the trichilemmal (pilar) cyst.

Volume:  2011

Issue:  First 

Title:  Postoperative Hemorrhage and Postoperative Hematoma

The questioner was concerned about  inconsistency in hospital coding of postoperative hemorrhage vs. postoperative hematoma.  They noted that when a surgical wound is slightly oozing blood and is treated with pressure, it is being coded as a postoperative hemorrhage. By the same token, if a small hematoma is noted after surgery, but not treated, it is still being coded as postoperative hematoma. Could you provide us with guidance so that we can consistently code these conditions?

Coding Clinic answered quite strongly, reiterating the Official Coding Guidelines on complications of  care:  “As with all procedural or postprocedural complications, code assignment is based on the provider’s documentation of the relationship between the condition and the procedure” (Section I.C.17.f.1.a) Further, the Guidelines specify that “for reporting purposes, the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring clinical evaluation; or therapeutic treatment; or diagnostic procedures; or increased nursing care and/or monitoring.” Coding Clinic reminded the questioner that  not all conditions that occur during or following surgery are classified as complications. First, there must be more than a routinely expected condition or occurrence. In addition, there must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a complication. The coder cannot make the determination whether something that occurred during surgery is a complication or an expected outcome. Finally, they stated (emphasis added) Only a physician can diagnose a condition, and the physician must explicitly document whether the condition is a complication. If it is not clearly documented, the coder should query the physician for clarification.

Volume:  2011

Issue:  First 

Title:  Superior Semicircular Canal Dehiscence Syndrome

The question was regarding a 53-year-old male who presented  with “left superior semicircular canal dehiscence syndrome (SSCDS).” What is the correct code assignment for this syndrome?

Coding Clinic answered to assign code 386.8, Other disorders of labyrinth, along with code 733.99, Other disorders of bone and cartilage, for SSCDS. In addition, codes for any other manifestations of the syndrome that are present should be coded.  Coding Clinic noted that treatment can involve reparative surgery, resurfacing the dehiscence of the semicircular canal, and that the etiology of the syndrome is unknown.

We'll post more rulings on Monday.  Have a great weekend.