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Danita Forgey Consulting What We Have Learned Coding Guidelines Common Findings for ICD-10-CM/PCS Errors Updates from 1st quarter Coding Clinic Danita Forgey Consulting Coding Guidelines Excludes notes Code freeze prevented corrections prior to 10/1/16 If two conditions are unrelated, both codes can be assigned even with an excludes 1 note Coding Clinic 4th quarter 2015, pg 40 Danita Forgey Consulting Coding Guidelines X qualifier for ICD-10-PCS X = diagnostic Used for a biopsy or diagnostic procedure Danita Forgey Consulting ICD-10-CM Infectious organisms Bacterial infection of unspecified site A49 Bacterial agents as the cause of disease classified elsewhere B96 Danita Forgey Consulting ICD-10-CM Abscess and cellulitis Spinal stenosis Knee osteoarthritis Elevated D-dimer Danita Forgey Consulting ICD-10-CM Edema Localized R60.0 Generalized R60.1 Unspecified R60.9 Danita Forgey Consulting Obstetrics Rh Incompatibility Rh- mother receives prophylactic Rhogam during admission O26.893, other specified pregnancy related conditions Can also assign code from Z67 category; Rh negative Danita Forgey Consulting Non-obstetric Conditions Complicating Pregnancy O99.0_, anemia O99.1_ , other diseases of blood/blood-forming organs O99.2_ , endocrine, nutritional and metabolic Includes obesity and other O99.3_, mental disorders/nervous system diseases O99.4_, circulatory system O99.5_, respiratory system O99.6_, digestive system O99.7_, skin and subcutaneous O99.8_, other specified Includes abnormal glucose, streptococcus B and other infection carrier status, bariatric surgery status O99.89 – other specified diseases and conditions Danita Forgey Consulting Anemia Anemia in chronic diseases classified elsewhere Neoplastic disease Chronic kidney disease Other chronic diseases classified elsewhere Sequencing Danita Forgey Consulting Colon Polyps Hyperplastic polyps Coded to K63.5, colon polyp Adenomatous polyps Assign a code from D12, benign neoplasm Fourth digit indicates specific segment of colon Danita Forgey Consulting COPD Exacerbation J44.0 COPD exacerbation with acute lower respiratory infection With pneumonia Sequencing Danita Forgey Consulting Central Venous Catheter Insertion Body part value is the end placement of the device Can use postplacement x-ray Cavoatrial junction = Superior vena cava Coding Clinics: 3rd quarter 2013, pg 18 3rd quarter 2014, pg 5 4th quarter 2015, pg 26 Danita Forgey Consulting Sterilization Procedures Occlusion of the fallopian tube(s) Body system: Female reproductive (U) Root operation: Occlusion (L) Body part: right and left fallopian tube (5, 6), bilateral fallopian tubes (7) Approach: Open (0), percutaneous (3), percutaneous endoscopic (4), via natural or artificial opening (7), via natural or artificial opening endoscopic (8) Device: Extraluminal device (C), intraluminal device (D), none (Z) Qualifier: None (Z) Danita Forgey Consulting Sterilization Procedures Tubal procedures Body system: Female reproductive (U) Root operation: Destruction (5) Body part: right and left fallopian tube (5, 6), bilateral fallopian tubes (7) Approach: Open (0), percutaneous (3), percutaneous endoscopic (4), via natural or artificial opening (7), via natural or artificial opening endoscopic (8) Device: None (Z) Qualifier: None (Z) Danita Forgey Consulting Sterilization Procedures Tubal procedures Body system: Female reproductive (U) Root operation: Excision (B) Body part: right and left fallopian tube (5, 6), bilateral fallopian tubes (7) Approach: Open (0), percutaneous (3), percutaneous endoscopic (4), via natural or artificial opening (7), via natural or artificial opening endoscopic (8) Device: None (Z) Qualifier: None (Z) Coding Clinic 3rd quarter 2015, pg 31 Danita Forgey Consulting Obstetrics Perineal lacerations 1st degree – perineal skin and vaginal mucosa 2nd degree – perineal body and deeper tissues 3rd degree – capsule and muscle of the anal sphincter 4th degree – through the sphincter and into the anal/rectal mucosa Danita Forgey Consulting Obstetrics Perineal laceration repairs 1st degree: 0HQ9XZZ, Repair perineum skin, external approach 2nd degree 0KQM0ZZ, Repair perineum muscle, open approach 3rd degree 0DQR0ZZ, Repair anal sphincter, open approach 4th degree 0DQP0ZZ, Repair rectum, open approach Danita Forgey Consulting Heart Failure Heart failure with preserved ejection fraction Diastolic heart failure May also be called preserved systolic function Heart failure with reduced ejection fraction Systolic heart failure May also be called low ejection fraction or reduced systolic function Danita Forgey Consulting Diabetes Cause and effect assumed with Chronic kidney disease Polyneuropathy Circulatory system Cause and effect also assumed with foot ulcer Cause and effect is NOT assumed for osteomyelitis Danita Forgey Consulting Diabetes Alphabetic index Polyneuropathy in (due to) diabetes Danita Forgey Consulting Hemorrhage due to anticoagulant Assign code for site of hemorrhaging Assign D68.32, Hemorrhagic disorder due to extrinsic circulating anticoagulant, Assign T45.515-, Adverse effect of anticoagulants Danita Forgey Consulting ICD-10-PCS Excision is root operation for brush biopsies Drainage is root operation for bronchoalveolar lavage Danita Forgey Consulting Endarterectomy Plaque extending from one artery into an adjacent branch is one continuous lesion Assign one procedure code with a body part value for the anatomical site furthest from point of entry Endarterectomy started at the femoral bifurcation and into the external iliac is coded to the external iliac Endarterectomy started at the common carotid and ending in the external carotid is coded to external carotid Danita Forgey Consulting Resources Leon-Chisen, Nelly; ICD-10-CM and ICD-10-PCS Coding Handbook 2016; American Hospital Association, 2016 Centers for Medicare and Medicaid Services and National Center for Health Statistics; ICD-10-CM Official Guidelines for Coding and Reporting; FY2016 Centers for Medicare and Medicaid Services and National Center for Health Statistics; ICD-10-PCS Official Guidelines for Coding and Reporting; FY2016 American Hospital Association; Coding Clinic for ICD10-CM/PCS