Part 3: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
In 2019, HIA reviewed over 725,600 ICD-10-CM codes from many different facilities including review on our own coders. Yesterday we looked at the ICD-10-CM Chapter 1 and today we will focus on the third area with the most coding opportunities found during HIA reviews.
- Z00-Z99—Factors influencing health status and contact with health services
- A00-B99—Certain Infectious and Parasitic Diseases
- I00-I99—Disease of the Circulatory System
- J00-J99—Diseases of the Respiratory System
- E00-E89—Endocrine, Nutritional, and Metabolic Diseases
For Part 3 of this 5 part series, we will look at Chapter 9 within ICD-10-CM—I00-I99—Diseases of the Circulatory System. This chapter contains so many of the everyday diagnoses that we code such as hypertension, heart disease and stroke. Some of the most common recommendations made by HIA in 2019 for this Chapter was:
- Sequencing of the PDX
- Not reporting combination codes correctly
- Failing to follow the “with” guideline in ICD-10-CM
- Not following the timeframe for acute myocardial infarctions
- Reporting type 2 AMI as the PDX instead of the underlying cause
- Missed complications and major complications
- Missed ICD-10-PCS codes
- Coding cardiac catheterization without pressure measurements documented
- Clarifying the validity of documented diagnoses such as acute heart failure without aggressive treatment
In addition to the Official Coding Guidelines for ICD-10-CM for FY 2020, Pages 46-52 that address specific chapter 9 guidelines to follow for reporting diseases of the cardiovascular system, there are multiple AHA Coding Clinics that discuss some of these in detail. Here are a few of these:
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2019 Pages: 5, 22-23, 32-33
- ICD-10-CM/PCS Coding Clinic, First Quarter 2017 Pages: 44-47
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2018 Pages: 9-10
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2016 Pages: 26-28, 84-86, 140
- ICD-10-CM/PCS Coding Clinic, First Quarter 2013 Pages: 24-26
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2017 Pages: 12-16, 84-86
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages: 90-98, 102-103
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2017 Pages: 11-12
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2015 Pages: 16-17
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2018 Pages: 5-6
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2016 Pages: 22-23
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2018 Pages: 88-89
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2019 Pages: 6-7
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2019 Pages: 3-6, 8
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2014 Pages: 21-22
- ICD-10-CM/PCS Coding Clinic, First Quarter 2019 Pages: 16, 33-34
- ICD-10-CM/PCS Coding Clinic, First Quarter 2016 Pages: 39-40
Coding Tips for Chapter 9: I00-I99—Disease of the Circulatory System
- Read and follow all instructional notes within ICD-10-CM Tabular
- ICD-10-CM presumes a causal relationship between hypertension and heart and/or kidney involvement unless the provider documents that the conditions are unrelated
- ICD-10-CM assumes rheumatic origin when valve disease affects multiple valves and the valvular heart disease is not described as non-rheumatic
- Follow the “with” in the Alphabetic Index
- ICD-10-CM presumes a causal relationship when a patient has both atherosclerosis and angina pectoris (unless other cause is identified)
- When a patient presents with acute myocardial infarction (AMI) and coronary artery disease, the AMI is sequenced first
- The documentation of “intraoperative” or “postprocedural” may be only specifying a timeframe of when a condition occurred and a query may be needed to clarify if this is a true complication
- If a type 1 non-ST elevation myocardial infarction (NSTEMI) evolves to Type 1 ST elevation myocardial infarction (STEMI), assign the STEMI code
- If a type 1 STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI
- Timeframe for AMI’s in ICD-10-CM is 4 weeks (this was 8 weeks in ICD-9)
- Type 2 myocardial infarctions are coded with the underlying cause sequenced first
- Non-traumatic myocardial injury is coded to I51.89 (other ill-defined heart disease)
- The provider must link the diagnoses of heart failure and diastolic/systolic dysfunction
- The term “decompensated” indicates that there has been a flare up of a chronic condition
- Assign only one code if more than one type of atrial fibrillation is documented
- Verify the number of stents used when patient is undergoing percutaneous coronary artery stenting
Be on the lookout for Part 4 of this series. In that part, we will look at J00-J99—Diseases of the Respiratory System.
References listed above.
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
This is Part 1 of a 4 part series on the FY2021 changes to ICD-10 and the IPPS. In this part, we discuss some of the new ICD-10-CM diagnosis changes. Here is the breakdown: 72,616 total ICD-10-CM codes for FY2021; 490 new codes (2020 had 273 new codes); 58 deleted codes (2020 had 21 deleted codes); 47 revised codes (2020 had 30 revised codes)
Acute pulmonary edema is the rapid accumulation of fluid within the tissue and space around the air sacs of the lung (lung interstitium). When this fluid collects in the air sacs in the lungs it is difficult to breathe. Acute pulmonary edema occurs suddenly and is life threatening.
“Client S” is a small, not-for-profit, 40 bed micro-hospital in the Southeast. HIA performed a 65-record review this year for Client S and found an opportunity with 15 of them. 9 had an increased reimbursement with a total of $43,228 found.
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
A higher CMI corresponds to increased consumption of resources and increased cost of patient care, resulting in increased reimbursement to the facility from government and private payers, like CMS. We know that documentation directly impacts coding.
Lately we have seen several cases where the endarterectomy was assigned along with the coronary artery bypass (CABG) procedure when being performed on the same vessel to facilitate the CABG. A coronary artery endarterectomy is not always performed during a CABG procedure, so when it is performed it becomes confusing as to whether to code it separately or not.
Assign code Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases” for all patients who are tested for COVID-19 and the results are negative, regardless of symptoms, no symptoms, exposure or not as we are in a pandemic.
The Centers for Medicare & Medicaid Services (CMS) announced new procedure codes for treatments of COVID-19 – effective as of August 1, 2020. Among the new codes are Section X New Technology codes for the introduction or infusion of therapeutics including Remdesivir, Sarilumab, Tocilizumab, transfusion of convalescent plasma, as well as introduction of any other or new therapeutic substances for the treatment of COVID-19.
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Integrity (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
For Part 5 of this 5-part series, we will look at Chapter 4 within ICD-10-CM—E00-E89—Endocrine, Nutritional, and Metabolic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
For Part 2 of this 5-part series, we will look at Chapter 1 within ICD-10-CM—A00-B99—Certain Infectious and Parasitic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.