Wednesday, December 21, 2016

Top 10 ICD-10-CM Questions-Part I

Top 10 ICD-10-CM Questions (PART 1)

Diabetes Mellitus with Diabetic Ketoacidosis

1Q. How would we code a patient that presents with Type 2 diabetes mellitus with diabetic ketoacidosis?

1A. When a patient presents with diabetes mellitus with ketoacidosis we would use the ICD‐10 code E13.10 (other specified diabetes mellitus with ketoacidosis without coma).

While we do have few perfect choices, it was deemed important to identify that this patient does have ketoacidosis.

Handling Coding Disputes with Payers

2Q. How do we address coding disputes with payers, when what they require goes against AHA Coding Clinic advice orthe CMS official guidelines?

2A. The first thing that we need to do is determine that this is really a coding dispute and not a coverage or payment issue. So one of the first things that we should do is contact the payer and ask for clarification if we are not sure of the reason for the denial.

If we find that the payer truly does have a policy that conflicts with the official coding rules or guidelines, we should make every effort to resolve this issue. One of the first things to do is send the payer a copy of the guidelines with an explanation of how their policy and the guidelines conflict.

If the payer refuses to change their policy, proceed to ask for a copy of their requirements in writing.

It is important to keep track of all correspondence that has transpired between you and the payer. Keep track of dates and the names of the people with whom you have communicated. You should also verify the existence of the policy in question with supervisory staff.

It is also important to keep a file of all of the documentation that you have received from the payer. You should be able to reproduce these documents in the event of an audit. DOCUMENT. DOCUMENT. DOCUMENT.

Smoker (tobacco user vs. dependence)

3Q. Physician documents that the patient is a smoker. How is this coded in ICD‐10‐CM? Would we code this as abuse or dependence?

3A. In ICD‐10, when the provider documents that the patient is a “smoker” we would use the code F17.200 (Nicotine dependence unspecified, uncomplicated).

Diabetes and Osteomyelitis

4Q. Does ICD‐10 assumes a link between diabetes and osteomyelitis?

4A. Yes, ICD-10-CM does assume a relathionship between diabetes and osteomyelitis as per 2016 October guidelines.

Pneumonia and Hemoptysis

5Q. In ICD‐10 hemorrhagic is no longer a nonessential modifier for pneumonia. Is it appropriate to report a separate code for hemoptysis?

5A. Yes, it would be appropriate to separately report a code for the hemoptysis. You would report code R04.2.

Admission for Rehabilitation

6Q. Does ICD‐10 allow for the coding of the acute CVA when the patient is admitted to an inpatient rehab facility?

6A. No, for ICD‐10 we will use a code from the subcategory I69.3, sequlae of cerebral infarction, as the principal diagnosis.

Admission for Rehabilitation following Cerebral Infarction

7Q. A patient is admitted to an inpatient rehab facility following an acute CVA, with aphasia. The patient also has several comorbid conditions. How would this case be coded in ICD‐10?

7A . In this instance, the aphasia (I36.321) is the principle diagnosis. The codes for the co‐morbid
conditions would also be coded.

Admission for Rehabilitation following Femur Fracture Treatment

8Q. Patient is admitted to an IRF following treatment for an acute intertrochanteric femur fracture for physical therapy. How would this visit be coded?

8A. For this particular encounter we would use code S72.141D; displaced intertrochanteric fracture of right femur, subsequent encounter.

Encounter for Dialysis

9Q. Since ICD‐10 does not have a code that is equivalent to V56.0, encounter for dialysis, how would these cases be coded in ICD‐10?

9A. In ICD‐10‐CM these encounters will be coded to the underlying disease/reason for the dialysis at the principle diagnosis.

42 Weeks of Gestation

10Q. ICD‐10 has two codes for a gestational age of 42 weeks or more. 42 weeks or more Z3A.42 or Z3A.49 greater than 42 weeks. We need a better understanding of when we would use these codes.

10A. We would assign code Z3A.42 for any number days in week 42 up to the beginning of week 43.

We would assign the code Z3A.49 for a gestational date  of 43 weeks.


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