Monday, August 22, 2011

Full Encounter Data Update

The rules for Full Encounter Data are ever evolving.  Today, CMS released the new Encounter Data Quarterly Newsletter.  It seems the rules for Full Encounter Data are ever evolving.  Initially, CMS told Health Plans that they would not be submitting Interim hospital bills.  In this newsletter, CMS has indicated that Interim bills will be submitted. 

In the category of good news, CMS has indicated that if Health Plans don't have the full 9 digit ZIP code, they can use 9999 for the last 4 digits.  Medical groups should submit the correct ZIP code whenever possible, but if it's unavailable, 9999 will pass the CMS edits.

Finally, sometime this month, CMS will release the Encounter Data Companion Guides. 

We'll post the newsletter on HCC University on the Full Encounter Data/ICD-10 page in the next few days.

Thursday, August 18, 2011

2012 ICD-9-CM Guidelines Posted

The Official ICD-9-CM coding guidelines, effective 10-1-2011, were posted on the National Center For Health Statistics website.  A copy of the new guidelines will be posted on the Tools page at shortly.

Few changes are included, but there are some of note.  There are new sections added to describe:
  • Appropriate coding of post-procedural infection and post-procedural septic shock (I.C.1.b.10.c.)
  • Appropriate coding of types and stages of glaucoma (I.C.6.b.) and
  • Guidelines for complications of care (I.C.17.f.1.)

Tuesday, August 16, 2011

Coding Symptoms Inherent in a Disease

In the first quarter of 2010, the following question was submitted to Coding Clinic:

What is the correct code assignment for a diagnosis of “compensated respiratory acidosis” in a patient with chronic obstructive pulmonary disease (COPD)?

Coding Clinic advised that only one code should be assigned--496 for the COPD.  This answer illustrates a coding principle that sometimes is problematic--symptoms of a disease are not coded when they are inherent to the disease.  Often, physicians will list these symptoms or signs when they are causing a specific problem for the patient.  For example, tremor is a hallmark of Parkinson's disease, and a physician may note that the tremor exists, is increasing or is decreasing.  Coders may be tempted to code the tremor because the physician has evaluated it--but it's a part of the disease. In that case, only the Parkinson's disease should be coded.

Sometimes, it's not so clear that a problem is a usual part of the disease.  For example, in the second quarter of 2010, a patient presented with gross hematuria due to a prostate malignancy.  While the prostate malignancy caused the hematuria, it isn't a usual part of the disease, and the questioner was instructed to code the hematuria, and the prostate cancer as a secondary diagnosis. In that case, the hematuria was a complication, and complications are coded separately.

When in doubt, coders should query the physician as to whether a listed symptom or sign is a usual part of the disease process, or a complication.  This affords coders a great opportunity to work collaboratively with the physician--it allows the coder the opportunity to both gain information from the physician, and provide the physician with information regarding coding rules.