Common ICD-10 Coding Errors Found in Audits: Part 3
The following is the third installment in a six-part coding education series from our Executive Director of Education, Patricia Maccariella-Hafey, RHIA, CDIP, CCS, CCS-P, CIRCC. In this series, Patricia reviews common ICD-10 CM and PCS coding errors discovered in audits and how they may impact reimbursement. Part three in our series takes a closer look at Accidental Intraoperative Laceration, SIRS due to Infection vs. Sepsis, and Observation to Inpatient Admission.
7. Accidental Intraoperative Laceration
Example: K91.71, Accidental intraoperative laceration of digestive system organ during procedure on digestive system
Coders are often over coding/reporting when physician documents that the laceration was expected/incidental/anticipated during difficult lysis of adhesions.
Coders are not always reporting or querying MD for intraoperative lacerations due to CDI or other directive at facility when apparently significant. At the very least a query should be done on any questionable intraoperative lacerations as to whether or not they are truly complications or expected/incidental/anticipated lacerations
8. SIRS due to Infection vs. Sepsis
There is no index entry for systemic inflammatory response syndrome (SIRS) due to infection. (do not automatically translate to sepsis).
Coders must not assume SIRS due to infection is coded to sepsis without query.
- Clinical indicators must be met to query
- Coding Clinic 3Q 2014 page 4
Severe sepsis and septic shock must be documented in order to assign these codes.
SIRS of non-infectious origin is coded R65.10 or R65.11. Assign underlying cause as PDX!
There is also new Sepsis criteria:
Note that this is CLINICAL criteria. No directives for coding have been released by the cooperating parties and CMS Quality Measures are still tied to older Sepsis criteria.
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.
- In lay terms, sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs.
- Patients with suspected infection who are likely to have a prolonged ICU stay or to die in the hospital can be promptly identified at the bedside with signs including alteration in mental status, systolic blood pressure ≤100 mm Hg, or respiratory rate ≥22/min.
Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.
- Patients with septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors and having a high serum lactate level despite adequate volume resuscitation. With these criteria, hospital mortality is in excess of 40%.
- A SOFA score ≥2 reflects an overall mortality risk of approximately 10% in a general hospital population with suspected infection.
- However SOFA criteria (Sequential Organ Failure Assessment) is clinical, and CMS criteria is quality oriented.
9. Observation to Inpatient Admission
Coders are not looking closely at orders for inpatient admission coming from observation.
ED admit, Creatinine 1/15 “2.46, 1/16 “2.03”, 1/20 “1.59” acute renal failure resolved with IV fluids 500 m
1,0000 hr. rate x 2. (N17.9, acute renal failure coded as PDX)
1/18 admission note: “LOS > 2MN Pt admit for, n/v, cough. Flu +. Tamiflu, nebs, prednisone PO, sputum cx. Pt not back to baseline, green phlegm and cough continues…“
PN 1/21 “..Plan: Viral bronchitis with positive influenza.”
In the above scenario, the auditor changed PDX from N17.9 to J11.1, influenza with other respiratory manifestatons
The information contained in this coding advice is valid at the time of posting. Readers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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