Top 5 ProFee Diagnosis Review Findings in 2018
In 2018, we conducted thousands of ProFee reviews from many different specialties for our clients. Below are the top five ProFee diagnosis changes HIA uncovered.
- I10 – Essential (Primary) Hypertension
- E11.9 – Type 2 Diabetes Mellitus Without Complications
- K29.60 – Other Gastritis Without Bleeding
- R13.19 – Other Dysphagia
- I25.10 – Atherosclerotic Heart Disease of Native Coronary Artery Without Angina Pectoris
I10 – Hypertension:
Many of the changes to I10 (hypertension) were due to not following the official coding guidelines when the patient also has heart disease and/or kidney disease. ICD-10-CM assumes a relationship between hypertension when the patient has heart disease or kidney disease. The two conditions are linked by the term “with” in the Alphabetic index. These conditions should be coded as related unless the provider specifically states that they are not related or documents a different cause for the kidney or heart disease.
- ICD-10 Official Guidelines: Section I. Conventions, general coding guidelines and chapter specific guidelines, C. chapter-Specific Coding Guidelines. 9. Chapter 9: Disease of Circulatory System (I00-I99) a. Hypertension
- Hypertension, Diabetes and Chronic Kidney Disease, coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2018; Page 88-89.
E11.9 – Type 2 Diabetes Without Complications:
As with hypertension changes, many of the changes to E11.9 (Type 2 Diabetes w/o complication) were related to conditions that are presumed to be related to diabetes. These fall under the “with” guidelines. Review the Alphabetic index for any condition that is presumed to be related to diabetes (chronic kidney disease, foot ulcer, gangrene, etc.).
- ICD-10 Official Guidelines: Section I. Conventions, general coding guidelines and chapter specific guidelines, C. chapter-Specific Coding Guidelines. 4. Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89) a. Diabetes Mellitus
- A. Conventions for the ICD-10-CM – Coding Clinic, Fourth Quarter ICD-10 2018 Page: 57
K29.60 – Other Gastritis Without Bleeding:
Changes to K29.60 (Gastritis w/o Bleeding) were also related to the “with” guideline. This is a change from previous guidance given for ICD-9-CM coding. Prior to the “with” guideline for ICD-10-CM coding, it was suggested to query the provider to confirm the cause of the bleeding if the relationship was not stated in the record. Now, since the tabular index lists Gastritis “with” bleeding it would be appropriate to code gastritis with bleeding, unless the provider states the bleeding was not due to the gastritis. In addition to the “with” guideline, remember there are codes for the specific type of gastritis. Make sure to code the most specific code if appropriate.
- ICD-10 Official Guidelines: Chapter 20: Disease of the Digestive System
- Conventions for the ICD-10-CM – Coding Clinic, Fourth Quarter ICD-10 2018 Page: 57
- Gastrointestinal Bleeding due to Multiple Possible Sources – Coding Clinic, Third Quarter ICD-10 2018 Pages 21-22
- Hematemesis due to Ulcerative Esophagitis and Duodenitis – Coding Clinic Third Quarter 2018 Pages 22-23
R13.19 – Other Dysphagia:
Specificity resulted in many of the changes to R13.19 (Other Dysphagia). In reviewing the accounts, documentation supported the specific type of dysphagia (functional, hysterical, neurogenic, etc.) or that dysphagia was a result (following) another condition (CVA, intracerebral hemorrhage, etc.). Coders must always review the entire encounter to assure they are selecting the most specific code. If the dysphagia is following a specific condition, such as a CVA, make sure to select the appropriate code to reflect this condition.
- ICD-10 Official Guidelines: Cerebrovascular Accident and Disease, C. Chapter-Specific Coding Guidelines, d. Sequelae of Cerebrovascular disease
- Dysphagia – Coding Clinic, Fourth Quarter 2007, Page 92 to 94
I25.10 – Atherosclerotic Heart Disease of Native Coronary Artery (CAD) Without Angina Pectoris:
Changes to this code were a result of documentation that the patient had angina. Under ICD-9-CM angina was coded separately from coronary artery disease (CAD). Under ICD-10-CM there is a code for CAD without angina, and codes to reflect if CAD is with angina and the type of angina. Make sure to review the index and select the codes that are appropriate to reflect if CAD is with or without angina.
- ICD-10 Official Guidelines: Diseases of the Circulatory System, Chronic Ischemic Heart Disease
The information contained in this post 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.
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
In Part 12, we focused on intra-operative peripheral neuro monitoring used during spinal fusion surgery. In Part 13, we are going to focus on harvesting of autograft and is it coded. Remember in Part 6, we learned that autograft is bone from the patient.
In Part 11, we focused on identifying the computer assisted navigation used during spinal fusion surgery. In Part 12, we are going to focus on intra-operative peripheral neuro monitoring.
In Part 10, we focused on identifying whether or not hardware from a previous spinal fusion is coded. In Part 11, we are going to discuss computer assisted navigation.
In Part 9, we focused on identifying if decompression was also performed and if so, on which body part. In Part 10, we are going to focus on identifying if hardware was removed from a previous fusion site.
In Part 8, we focused on identifying if a discectomy was performed, and if so, if it was a partial or a total discectomy. In Part 9, we are going to focus on identifying if a decompression was performed, and if so, was it of the spinal cord, spinal nerves or both?
In Part 7, we focused on identifying any instrumentation that may be used during a spinal fusion. In Part 8, we are going to focus on identifying if a discectomy is performed and if this is an excision or a resection of the disc.
In Part 6, we focused on identifying the type of bone graft product used for the spinal fusion. In Part 7, we are going to focus on identifying any instrumentation or device used.
In Part 5, we focused on identifying the approach being used for the spinal fusion. In Part 6, we are going to focus on identifying the type of bone graft used for the spinal fusion.
In Part 4, we focused on determining the spinal column being fused. In Part 5, we are going to focus on identifying what approach is being used to complete the spinal fusion (anterior, posterior or both).
This past year, HIA implemented “Buddy Up,” a program designed to help the new hire have a smooth transition into their new HIA roles with the assistance of a “buddy.” What is a Buddy? The Buddy is simply a peer who can guide the new hire in order to make them feel more comfortable. We are very proud of this program and have many success stories that we would like to share. Take a look at the wonderful feedback we have received below.
In Part 3, we focused on determining the level of the fusion(s) and how to determine the number of vertebrae fused. In Part 4, we are going to focus on identifying which column is being fused (anterior, posterior or both).
Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
In Part 1, we learned the diagnoses associated with the need for spinal fusions, and in Part 2 the need to identify if the fusion is an initial or refusion of the vertebrae. In Part 3, we are going to focus on determining the level(s) of fusion, as well as the number of vertebrae fused.
In Part 2, we are going to look at the differences between initial fusion and a refusion. In ICD-9, there were specific codes to show if the fusion was an initial fusion, or if it was a refusion. In ICD-10-PCS, initial fusions and refusion procedures are coded to the same root operation “fusion.”
This is Part 1 of a 14 part series focusing on education for spinal fusions. Spinal fusion coding is a tough job for coders. There are so many diseases/disorders that result in the need for spinal fusion, and even more choices in reporting the ICD-10-PCS codes.
The official definition from the Centers for Medicare & Medicaid Services (CMS) states that a Medicare overpayment is a payment that exceeds amounts properly payable under Medicare statutes and regulations. When Medicare identifies an overpayment, the amount becomes a debt you owe the Federal government.
The question asked in a physician query may be the most important element of the document. Query questions need to be as simple and concise as possible. The physician should have no doubt what the coder is asking.
Coding complications of transplanted organs has always been a coding dilemma. With the implementation of ICD-10-CM that didn’t change. However, coders have multiple directives to help in determining what a complication of the transplant is vs. non-transplant conditions and diseases.
We interviewed our most productive coders, reviewers and members of our education team, asking them what steps they take to find a rhythm that works for them. This week, we talked with Beth Martilik, MA, RHIA, CDIP, CCS, Assistant Director of Education, about the steps she takes to find her routine.
With the implementation of ICD-10-CM came more codes for reporting many different conditions and diseases, and atrial fibrillation is one of those. For many years there was only one code available for reporting this condition, even when the physician further specified the type of atrial fibrillation that the patient had. In ICD-10-CM, there are four codes to report atrial fibrillation.
We have a case where the physician removes mucoid casts found during bronchoscopy. We have also seen mucus plugs removed during bronchoscopy. The MD performs bronchial washings then removes a large amount of tenacious and thick mucoid casts via bronchoscopy. Is this coded drainage, extirpation or excision? What body part is used?
The key to making the query process more efficient is to look for words or documentation while reviewing the record that may signal a potential query opportunity and to note the finding at that time. By the time a coder reaches the end of a record, documentation may have been found to eliminate the need for the query.
Question: This patient is noted to have “Lymphangitic carcinomatosis of lungs with mediastinal lymph nodes.” How would I code the diagnosis? Would I code metastatic cancer to the lung (C78.01) or metastatic cancer to the lymph nodes (C77.1)?
This would be considered a “mechanical” complication of the stent graft since the MD states it is a fracture of the endograft and it is folded over on itself. I would change T82.898A TO T82.598A for Other mechanical complication of other cardiac and vascular devices and implants, initial encounter. I did not use “displacement” because the surgeon did not state that the graft was displaced, only that it collapsed upon itself causing obstruction.
We interviewed our most productive coders and reviewers, asking them what steps they take to find a rhythm that works for them. This week, we talked with Valerie Abney, CDIP, RHIT, CCS, about the steps she takes to find her routine.
Osteoporosis alone is responsible for over a million fractures every year. Stress fractures are not as common but they do occur. There are more than 1 million total joint replacements in the U.S. each year, so there was a need to create codes for injuries that occur around or near the prosthesis. These are called “periprosthetic” fractures.
Back in April, the Office of the Inspector General (OIG) published a report detailing its findings from a review of two groups of high-risk diagnosis codes, acute stroke and major depressive disorder. The objective was to determine whether selected diagnosis codes submitted to the Centers for Medicare and Medicaid Services for use in CMS’s risk adjustment program complied with Federal requirements.
There seems to be differences of opinions on the issue of a 40w0day gestation Can you clarify if P08.21 should be assigned for 40w0day infant or if it would not be assigned unless the infant’s gestation age was 40w1day or greater?
Coders may find situations where a patient is documented as meeting SIRS or sepsis criteria, or has some clinical indicators reflective of possible sepsis, but the physician never documents sepsis as a diagnosis. Should the coder always query for sepsis in these instances?