Part 5: 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 fifth 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 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.
Chapter 10: E00-E89—Endocrine, Nutritional, and Metabolic Diseases:
Chapter 4 in ICD-10-CM has 10 sections. In looking through the recommendations made, it looks like revisions and addition of the diagnoses are the most common recommendations. The “with” guideline is beginning to sink in with most coders but we still find recommendations due to this guideline. This chapter covers malnutrition, obesity and diabetes as well as other endocrine, nutritional and metabolic diseases. Below are a few areas where coding opportunities were identified during HIA client and internal quality reviews.
- Coders not using the “with” guideline when diabetes is documented with another condition that is presumed associated in ICD-10-CM (such as retinopathy, nephropathy, etc.).
- Sequencing of the appropriate diabetes code with manifestations when multiple manifestations are present
- Coding diabetes with unspecified complications or without complications in addition to a specified code for diabetes with a specific complication
- Only reporting dehydration when patient has hypernatremia or hyponatremia in addition. In ICD-10-CM, both may be reported
- Reporting unspecified obesity when documentation supported morbid obesity
- Reporting malnutrition without clinical indicators to support the diagnosis
- Missed query opportunities to clarify the specific malnutrition state
- Missed hyperlipidemia when patient is on long term medications
- Missed hypercholesterolemia when patient is on long term medications
- Missed further specificity on diagnoses that is available in the record
- Coding hypothyroidism in a patient s/p thyroidectomy to unspecified instead of postsurgical
In addition to the Official Coding Guidelines for ICD-10-CM for FY 2020, Pages 36-38 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, Fourth Quarter 2016 Pages: 9-14
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2013 Pages: 114-115
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2013 Page: 20
- ICD-10-CM/PCS Coding Clinic, First Quarter 2016 Pages: 12-13
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2018 Pages: 3-5
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2016 Pages: 36-37
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2017 Pages: 7, 102, 108-109
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2016 Page: 42
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2017 Pages: 24-26
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2018 Pages: 5-6, 79-80
Coding Tips for Chapter 4: E00-E89-Endocrine, Nutritional and Metabolic Diseases:
- Follow all instructional notes within ICD-10-CM for sequencing and to determine if additional codes would be reported
- Per coding guidelines, obesity is always considered to be clinically significant
- Per ICD-10-CM Official Guidelines for Coding and Reporting FY 2020 Pages 12 & 13, “The word “with” or “in” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”)…The word “with” in the Alphabetic Index is sequenced immediately following the main term or subterm, not in alphabetical order.”
- Diabetes is a significant complicating factor in pregnancy. A code from Chapter 15 (O00-O9A)—Pregnancy, Childbirth, and the Puerperium should be sequenced first followed by a code from Chapter 4 for the specific type of diabetes documented
- Review the entire medical record to look for specificity of any diagnoses
- Remember to code BMI when there is an associated condition documented by the provider
- Remember to report any long term use of medications the patient may be taking
Most of the tips above are for diabetes but there are many more diagnosis in this chapter of ICD-10-CM. Diabetes is just the most common reported code so there are more chances for errors. Following the instructional notes within ICD-10-CM is a must in this chapter.
Thank you for taking the time to read this 5 Part series on the codes/chapters with the most recommendations for reviews in 2019.
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 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.
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.
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 the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.