Part 4: 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 reviews on our own coders. Yesterday we looked at the ICD-10-CM Chapter 9 and today we will focus on the fourth 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 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.
Chapter 10: J00-J99—Diseases of the Respiratory System:
Chapter 10 in ICD-10-CM has 11 sections. In looking through the recommendations made, it looks like sequencing of the PDX and specificity are the most common recommendations, followed by additions and deletions. This chapter covers acute respiratory infections and conditions as well as chronic respiratory diseases. Below are a few areas where coding opportunities were identified during HIA client and internal quality reviews.
- Sequencing of pneumonia or determining if pneumonia was ruled in/out
- Queries to clarify the clinical significance or clinical indicators for pneumonia and acute respiratory failure
- Re-sequencing of acute respiratory failure
- Re-sequencing of COPD diagnoses
- Further specificity on type of pneumonia or organism responsible
- Reporting a poisoning as PDX when due to drugs or other external causes/agents
- Reporting a new PDX from another chapter within ICD-10-CM such as from Chapter 1
- Querying to clarify if the condition is a postprocedural complication
- Not following the latest guidelines on sequencing when patient presents with COPD exacerbation and pneumonia
- Pneumonia being ruled out in the body of the record or diagnosis dropped without documented reason
- Multiple missed opportunities
In addition to the Official Coding Guidelines for ICD-10-CM for FY 2020, Pages 52-55 that address specific chapter guidelines to follow for reporting diseases of the respiratory 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, Third Quarter 2016 Pages: 10-11, 14-16
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2017 Pages: 96-98
- ICD-10-CM/PCS Coding Clinic, First Quarter 2019 Pages: 34-37
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2019 Pages: 6-7, 28, 31-32
- ICD-10-CM/PCS Coding Clinic, First Quarter 2017 Pages: 24-27
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2015 Pages: 15-16
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2016 Pages: 9-10
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2013 Page: 121
- ICD-10-CM/PCS Coding Clinic, First Quarter 2016 Page: 38
- ICD-10-CM/PCS Coding Clinic, First Quarter 2015 Page: 21
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2019 Page: 37
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2018 Pages: 24-25
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2014 Page: 4
Coding Tips for Chapter 10: J00-J99-Diseases of the Respiratory System:
- Follow all instructional notes within ICD-10-CM for sequencing and to determine if additional codes would be reported
- Exacerbation/decompensation is a worsening of a chronic condition
- Acute respiratory failure is a life-threatening condition may be the PDX if the focus of treatment is towards the failure (such as BiPAP or mechanical ventilation) unless there are chapter-specific guidelines that direct otherwise (such as obstetrics, poisoning, HIV and newborn)
- If admitted with acute respiratory failure and another acute condition the selection of PDX will depend on the circumstances of admission and may not be the same in every situation. If both conditions are equally responsible and the focus of care, and there are no chapter-specific sequencing rules, either condition may be sequenced as the PDX (Section II, C.)
- When documentation is unclear a query is necessary
- If there are no clinical indicators present to support acute respiratory failure, pneumonia or other condition in chapter 10, but the diagnosis is documented, a query is necessary to clarify the diagnosis and/or follow facility process on these situations (send to physician liaison or CDI)
- Only confirmed cases of certain identified influenza viruses or other influenza virus should be coded (category J09 and J10)
- When the provider documents “suspected,” “possible” or “probable” avian, novel or other identified influenza the appropriate code from category J11 for unidentified influenza virus should be assigned
- Ventilator associated pneumonia is only reported when clearly documented as such by the provider
- Emphysema is a specified form of COPD
- COPD exacerbation and emphysema diagnosed is assigned to J43.9—emphysema
- Aspiration bronchitis is reported with J69.0—pneumonitis due to inhalation of food and vomit
- Lobar pneumonia is only coded when the diagnosis is specifically documented by the physician as such
- If COPD and unspecified asthma are documented, only the code for COPD would be reported following the instructional note under category J44. If the asthma is documented as a specified type, then both COPD and asthma may be reported
- Pleural effusion associated with heart failure is a common finding and should only be reported when the effusion is specifically addressed or requires therapeutic intervention or diagnostic testing
- If the patient is status post lung transplant and now has pneumonia in the transplanted lung this is considered a complication of the transplanted lung since the pneumonia would affect the function of the organ
Most of the tips above are for pneumonia/COPD but there are many more diagnosis in this chapter of ICD-10-CM. Respiratory diseases are a tough area for coders since there are so many diseases in such a small area of the body. A lot of these diseases intertwine together and it is difficult to know which one to report or if multiple conditions may be reported. Following the instructional notes within ICD-10-CM is a must in this chapter.
Be on the lookout for Part 5 of this series. In that part, we will look at E00-E89—Endocrine, Nutritional and Metabolic Disorders.
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.
In June CMS released the final ICD-10-PCS codes for FY2022, which begins October 1, 2021. We are giving you a sneak peek at the changes. HIA will have a full educational module on these changes available later this summer.
CMS released the IPPS proposed rule on 4/27/21 outlining the proposed changes to the Inpatient Prospective Payment System for FY2022, which begins October 1, 2021. Later this year, sometime in August, CMS will release the Final Rule. Currently CMS is reviewing responses to their proposed rule and will address them in the final rule.
A medical coding audit is a process that includes internal or external reviews of medical coding and billing accuracy, procedures or policies in place, and any other component that affects the medical record documentation. Medical coding audits…
Anticoagulants and antiplatelets are used for the prevention and treatment of blood clots that occur in blood vessels. Oftentimes, anticoagulants and antiplatelets are referred to as “blood thinners,” but they don’t actually thin the blood at all. These drugs slow down the body’s process of making clots. Their main function is to keep the patient’s blood from clotting or turning into solid clumps of cells. These drugs do this by interfering with either fibrin or platelets in the blood.
Carotid artery disease is a vague category that can incorporate many different carotid artery issues. Some physicians may feel that they are being clear the patient has plaque, stenosis, or occlusion of the artery, but in ICD-10-CM the specificity must be included in the documentation.
10 ICD-10 Codes for Superheroes. Superman: T78.2XXA Anaphylactic reaction; substance: kryptonite. Batman: F44.81 Dissociative identity disorder. Robin: F60.7 dependent personality. The Hulk: L30.4 Erythema intertrigo. Wonder Woman: T24.032A Burn of unspecified degree of left lower leg. Black Panther S93.401A Sprain…
Practices have not seen many revisions to the Evaluation and Management (E/M) office / outpatient visit guidelines in three decades – until now. As of January 1, there are new E/M coding guidelines. We’ll get to those in a bit, but first let’s look at why they changed.
Pseudoseizures are a form of non-epileptic seizure. These are difficult to diagnose and oftentimes extremely difficult for the patient to comprehend. The term “pseudoseizures” is an older term that is still used today to describe psychogenic nonepileptic seizures (PNES).
With the implementation of ICD-10-CM came different codes and coding rules for many diagnoses. One of these is the coding of bowel obstruction when the patient presents for this condition that is caused by another condition.
This is Part 5 of a five part series on the new 2021 CPT codes. For the remaining areas we will just briefly summarize the section. Due to the intricate nature of these sections in CPT, it is recommended that the coder read the entire section notes associated with the new codes.
This is Part 4 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes in the urinary, nervous, ocular and auditory systems. There are 2 new urinary/male reproductive system codes with no revisions or deletions; 3 new female reproductive codes with 2 deletions, 0 new with 4 deleted nervous system codes with 5 revisions; 5 new eye category III codes; and finally a 2 new auditory codes with one deletion.
This is Part 3 of a five part series on the new 2021 CPT codes. In this series we will explore the cardiovascular system CPT changes. There are 5 new cardiovascular CPT codes added with 0 deletions and 4 revisions.
This is Part 2 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include some examples to help the coder understand the new codes. There are 0 new musculoskeletal CPT codes added with 0 deletions and 2 major revisions along with an extensive update to arthroscopic loose body removal requirements. For the respiratory system, there were 2 new codes, one code deletion and no revisions.
This is Part 1 of a five part series on the new 2021 CPT codes. In this series we will explore the CPT changes for FY2021 and include examples to help the coder understand the new codes. For 2021 in general, there were 199 new CPT codes added, 54 deleted and 69 revised.
In January, new CPT codes were released. There were 248 new CPT codes added, 71 deleted and 75 revised. Most of the surgery section changes were in the musculoskeletal and cardiovascular subsections. These included procedures such as skin grafting, breast biopsies, deep drug delivery systems, tricuspid valve repairs, aortic grafts and repair of iliac artery.
We have seen many updates and changes to COVID-19 (SARS-CoV-2) since the pandemic started. On January 1, 2021 we will see even more changes as outlined in this post. Also the CMS MS-DRG grouper will be updated to version 38.1 to accommodate the changes.
In the previous three parts of this four-part series, we discussed the new ICD-10-CM diagnosis code changes, ICD-10-PCS procedure code changes and FY2021 IPPS changes. In this last Part 4 of the series, we will review the NTAP procedure codes and reimbursement add-on payments for FY2021.
In the previous two parts of this four part series, we discussed the new ICD-10-CM diagnosis code changes and ICD-10-PC procedure code changes. In this session we will review the major IPPS changes for FY2021.
This is Part 2 of a 4 part series on the FY2021 ICD-10 Code and IPPS changes. In this part, the ICD-10-PCS procedure codes are presented. For FY2021 ICD-10-PCS there are 78,115 total codes (FY2020 total was 77,571); 556 new codes (734 new last year in FY2020)…
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.
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.