Top 5 ProFee Diagnosis Review Findings in 2018

by | Jan 2, 2019 | Coding Review, Coding Tips, Education, ICD-10 | 0 comments

Brett Randolph, RHIT, CDIP, CCS, AHIMA Approved ICD-10/PCS Trainer is Executive Director of Review Services at Health Information Associates. During his 25 years of HIM experience, Brett has worked at every level of the HIM Department including extensive experience as a Coder, Coding Manager, and Director. Very active in his local chapter, Brett has served as WVHIMA Past President and is the 2018 WVHIMA Distinguished Member. Brett Randolph, RHIT, CDIP, CCS
Executive Director of Review Services
AHIMA‑Approved ICD‑10‑CM/PCS Trainer

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.

  1. I10 – Essential (Primary) Hypertension
  2. E11.9 – Type 2 Diabetes Mellitus Without Complications
  3. K29.60 – Other Gastritis Without Bleeding
  4. R13.19 – Other Dysphagia
  5. 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.

References:

  • 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.).

References:

  • 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.

References:

  • 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.

References:

  • 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.

References:

  • 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.

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