Tuesday, December 22, 2015

So, I recently read a funny blog....

About Coding of all things.  It's called Coder Coach.  And the author does a code for the day, with a focus on humor.  I'm not as funny as she is, so I'm not even going to try.  But I think that I will try to be more diligent about posting--and I think I'll try to do a code a day (or week...or something).

Let's face it--ICD-10 has been a royal pain of an implementation.  So, by focusing on a new code with some regularity, I might be able to lend a hand.  No time like the present!

We'll start off, not with a code, but with at category.  This category may be the most misused category of codes I've ever seen.

I've been coding for more years than I like to admit.  Let's say north of 30.  While I've seen instances where these codes (and their predecessors in ICD-9) could have been used correctly, I've never actually seen them used correctly.  They are: Neoplasms of  Uncertain Behavior.  In ICD-10 they are found in the section Neoplasms of Uncertain Behavior, Polycythemia Vera and Myelodysplastic Disorders (D37-D48).

When I see a code for neoplasm of uncertain behavior submitted, no matter the body area, it's always because:

  1. The physician hasn't biopsied the lesion yet, and so he/she is uncertain of the histology; or
  2. The physician has biopsied the lesion, but hasn't yet received the pathology report

Neither of these is the correct usage of the code.  The beginning of the code section explains the correct use of the codes, but unfortunately, one of the downsides of Electronic Health Records (EHRs) is that none of these instructions are visible to most users.  Here's the instruction, straight from the ICD-10:

Note: Categories D37-D44, and D48 classify by site neoplasms of uncertain behavior, i.e., histologic confirmation whether the neoplasm is malignant or benign cannot be made.

As you might guess, the instances where you can correctly use these codes are relatively rare.  So, unless the pathologist cannot tell you whether to neoplasm is benign or malignant, these codes should not be used. 

This code category points out the importance of the coding instructions and guidelines.  As noted, these are generally lost in an EHR--that's not to say EHRs are bad, simply that they have their limitations.   So, what's a coder (or the physician who is coding) to do?  I strongly recommend that coders AND physicians read the sections of the Coding Guidelines that apply to them.  That means any specialty specific guidelines, and the entire Outpatient coding section.  You should also review the section of the code book that includes common codes you use.  And, when faced with the new and unusual (like these), take a quick glance at the book to see if there are special instructions like we found here. 

Now, if you have an EHR, you don't have to buy the code book to do that.  Every year, we post a full text copy of the ICD-10 on HCC University.

I'm going to do my best to keep posting these coding tips.  If I fall behind, feel free to email me at Coding@scanhealthplan.com to remind me.  I sometimes suffer from mild memory loss, NOS (R41.3)

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