Coding Tip: Unspecified Condition Codes and Combination Codes

by Mar 1, 2019Coding Tips, Education, ICD-10, Patricia Maccariella-Hafey0 comments

Patricia Maccariella-Hafey, RHIA, CDIP, CCS, CCS-P, CIRCC has over 35 years expertise in the areas of ICD-9-CM, CPT, DRG/APC validation Professional Fee E&M coding, Interventional Radiology, and Facility E&M coding. Patricia is currently Director of Education a healthcare consulting firm specializing in coding compliance review, education and contract coding services.

Pat Maccariella‑Hafey

Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador

One area that coders struggle with is when to report a separate condition code when an already assigned combination code includes the condition. For example, if an obstetric patient is admitted and delivers, and the physician documents “obstetric patient delivered with anemia,” should both code O99.02 Anemia complicating childbirth and D64.9, Anemia, unspecified be coded or should only O99.02 be assigned?

The answer is that only code O99.02, Anemia complicating childbirth should be assigned. Coders may argue that there is a “code also” note under O99.- in the tabular that states “Use additional code to identify specific condition.” However, note the word “specific” in that note In our case, the unspecified anemia is not a specific type of anemia, so an additional code would NOT be assigned. Had the physician documented “iron deficiency anemia” then code D50.9, Iron deficiency anemia would have been coded since this is a specific type of anemia.

The same would be true in an obstetric delivery patient in which the physician documented “obesity complicating pregnancy.” Code O99.214, Obesity complicating childbirth would be coded, however it would be unnecessary to code E66.9, Obesity, unspecified as it is not a specific code. Code O99.214 already has “obesity” within the combination code. Had the physician documented “morbid obesity,” then code E66.01, Morbid obesity would be added as it is a specific code.

References That Support the Decision

There are several references that support the above determination. Coding Clinic, Third Quarter, 2018, page 4 has an example of diabetic atherosclerotic peripheral artery disease. It was asked if the specific I70.2- code should also be coded. AHA replied to only code the E11.51 code unless an additional code provides specificity about the atherosclerosis, such as the vessel, manifestations or laterality. “Multiple coding should not be used when the classification provides a combination code that clearly identifies all of the elements documented in the diagnosis. When the combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code.”

In Coding Clinic, First Quarter, 2017, page 25, the advice is to NOT report unspecified, uncomplicated asthma code J45.909 with COPD code J44.9, as it isn’t a type of asthma.

In the AHA Handbook, Chapter 24, it states “When a code from chapter 15 describes the condition adequately, only that code is assigned. It is appropriate, however, to assign an additional code when it provides needed specificity.”

So in summary, the coder should NOT report a secondary code for a condition that is already included in a combination code, unless that secondary code provides specificity of the that condition.

AHA Coding Clinic, Third Quarter, 2018, page 4
AHA Coding Clinic, First Quarter, 2018, page 16
AHA Coding Clinic, Fourth Quarter, 2017, page 96
AHA Coding Clinic, First Quarter, 2017, page 25
AHA ICD-10 Coding Handbook, Chapter 24, Other Conditions Complicating Pregnancy, Childbirth, or the Puerperium

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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