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 http://hccuniversity.com/asset/154d663f-95bf-4a59-a1fd-a6e4eb7c8477

Important Information on ICD-10 Excludes 1 Notes

Although the general ICD-10 instruction is that an Excludes 1 note means you cannot code two conditions together, the National Center for Health Statistics has posted an exception on their website. The NCHS is one of the 4 cooperating parties for ICD-10, and is responsible for posting the ICD-10 code book and guidelines.  The exception reads as follows:

"We have received several questions regarding the interpretation of Excludes1 notes in ICD-10-CM when the conditions are unrelated to one another. Answer: If the two conditions are not related to one another, it is permissible to report both codes despite the presence of an Excludes1 note. For example, the Excludes1 note at code range R40-R46, states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes. However, if dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and bipolar disorder. In another example, code range I60-I69 (Cerebrovascular Diseases) has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I69-."



You can read the exception on their website, as well as download important ICD-10 documents at: http://www.cdc.gov/nchs/icd/icd10cm.htm

CMS Posts New ICD-10 Clinical Content

CMS continues to post clinical content, common ICD-10 codes and coding vignettes for providers.  The latest is OB/ GYN, and it can be viewed here. 

One problem with some of CMS content in the past--they assumed that physicians understand documentation requirements, and all content tells physicians what to code for what disease.   The site has been beefed up, and there are Clinical Documentation tips now

I strongly recommend this site for clinicians and coders alike--coders and physicians must follow the same rules when coding--and all of those rules are based on clinical documentation and the ICD-10 Official Guidelines for Coding and Reporting, available free of charge on the National Center for Health Statistics website.  All other ICD-10 content is there as well at www.cdc.gov/nchs.

Although the guidelines are long, physicians can read only those specialty specific guidelines that they normally treat, along with the section on Outpatient Coding (all physician coding uses the outpatient guidelines, regardless of where the services were rendered).

And remember, SCAN contracted providers can send coding questions to us at: Coding@scanhealthplan.com.

The SCAN Tools Team