Thursday, March 29, 2018

Special Guest Posting by Coding Quality Specialist, Megha Patel, CCS, CPC- Official Coding Guideline Changes

Good afternoon, all.  Today, we're lucky to have a special guest post, by one of SCAN's Coding Quality Specialists, Megha Patel, CCS, CPC.  Megha has done a lot of hard work for us, compiling all the significant changes to the Official Guidelines for Coding and Reporting, beginning with the switch from ICD-9-CM to ICD-10-CM:

ICD -9 to ICD-10 Official Coding Guideline Updates
1.      10/01/2015:

ICD-9 to ICD-10 updated October 1, 2015.

·         CAD with Angina: Use combination codes for CAD with Angina, A causal relationship can be assumed in a patient with both Atherosclerosis and angina pectoris. It is not necessary to code Angina Pectoris separately.
·         Sequelae of CVA: Weakness due to previous CVA should be coded as Hemiplegia/Hemiparesis.
·         Sequelae of CVA: Hemiplegia/Hemiparesis/Monoplegia identify whether the dominant or non-dominant side of affected.  If provider didn’t documented dominant or non-dominant, the default is to assume the right side is the dominant side. If left side affected, the default is non-dominant.
·         DM with Hyperglycemia: Uncontrolled DM, Inadequately Controlled, Out of controlled, Poorly Controlled should be coded as Hyperglycemia.
·         Diabetes Ketoacidosis: ICD-10 CM does not provide a specific code for Type II diabetic Ketoacidosis. Assign code E13.10 Other Specified Diabetes with Ketoacidosis as per Coding Clinic First Quarter of 2013.

2.      03/18/2016:

·         DM with Complications Assumed relationship. The guidelines published in the first quarter 2016 issue of AHA Coding Clinic on pg. 11. According to this clarification, the subterm “with” in the index should be interrupted as a link between diabetes and any of those conditions indented under the word “with”.
** The linkage between diabetes and Osteomyelitis used to be assumed in ICD-9 but it is not assumed in ICD -10 (10/01/2015-10/01/2016 Not coded). There is no assumed relationship till October 1, 2016.

3.      10/01/2016:

·         Uncontrolled DM: Uncontrolled DM is classified by type and whether it is hyperglycemia or hypoglycemia. There is no default code for “uncontrolled DM”. Effective Oct. 1, 2016, uncontrolled diabetes can be referenced as Hyperglycemia or Hypoglycemia.
·          Hypertension with CHF: Presumes a causal relationship between hypertension and heart involvement. 
·         COPD with Asthma: COPD with asthma only coded as J44.9. If type of asthma not documented J45.909 should not be coded.  “Unspecified” is not type of asthma.

4.      10/01/2017:

·         Diabetic Ketoacidosis: October 1, 2017 updated with new codes for Diabetes Ketoacidosis (Type II). E11.10 Type II DM with Ketoacidosis w/o Coma and E11.11 Type II DM with Ketoacidosis w/ Coma.
·         COPD, Emphysema and Chronic Bronchitis all documented: Assign J449 only, because J43.9 Emphysema has Exclude 1 note (Emphysema with chronic bronchitis). J44.9 has Include note Chronic Bronchitis with emphysema. (J439 is Emphysema without Chronic Bronchitis) (J449 is Emphysema with Chronic Bronchitis).
·         COPD with Emphysema: J43.9 Emphysema assigned as Emphysema is specific type of COPD.
·         Emphysema with an Acute Exacerbation of COPD: Assign J43.9. Both codes have Exclude 1 note to each other. J439 is without Chronic Bronchitis and J449 is with Chronic Bronchitis. Emphysema is type of COPD so Acute Exacerbation of COPD is covers in J43.9.

Thanks, Megha--for doing all the heavy lifting!
Remember, you can always download the full text of the ICD-10-CM guidelines on our website, at

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