ICD-10 Coding

ICD-10 Coding

Presented by

Jennifer Warfield, BSN, HCS-D, COS-C Education Director, PPS Plus April 19-20, 2017

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General Guidelines ? Chapter conventions & instructions of the classification take precedence over general guidelines ? Where a placeholder "X" exists, it must used for the code to be valid Example: T45.2X4D ? S & S codes are generally not coded unless a definitive diagnosis is not known. Code only if directed to do so by the classification.

Sequela (late effects) ? The residuals that remain after the acute phase of the injury or illness is over. 1 or 2 codes may be necessary. Code what you can see followed by the acute injury code.

Example: Severe scarring of R elbow due to an old 3rd degree burn. L90.5 (adherent scar) T22.321D

? Provider documentation must be present to state that the condition (residual) is a direct result of the previous illness or injury.

Laterality codes available - 1 = right - 2 = left

? For bilateral sites the last character indicates laterality. When a condition exists on both sides and there is no available bilateral code, use the code for L & R.

? Update: Coders do not need to assign bilateral code for condition if a previous encounter resolved the condition on one side of the body and the present encounter is for the condition on the other side. Example: Patient had bilateral osteoarthritis of knees but R knee was previously replaced. Code osteoarthritis for L knee.

More Guidelines ? Combination codes for 2 codes where a relationship has been documented by the provider. Example: DM with retinopathy ? Expanded codes for injuries, complications and alcohol or substance abuse and manifestations Example: Nicotine dependence, cigarettes w/ withdrawal Update: Codes for psychoactive substance use, abuse or dependence should only be assigned based on the physician's documentation and when they meet the definition of a reportable diagnosis. ? Acute & chronic guidelines unchanged ? Acute MI is considered until 4 weeks (28 days) ? HTN (I10) no longer has designation of benign, malignant or unspecified ? Fractures are coded using acute code with the appropriate 7th character for HH (no aftercare codes for fractures) ? No therapy only codes

7th Character A or D? Clarifications made regarding the 2017 coding guidelines updates in October 2016

? 7th character "A", initial encounter is used for each encounter where the patient is receiving active treatment for the condition. Examples: Surgical treatment, evaluation and continuing treatment by the same or a different physician in the initial encounter but also in cases where active treatment is on-going. ? Antibiotic therapy for a post-op infection in HH ? Wound vac care in HH

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ICD-10

? 7th character "D", subsequent encounter is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Examples: Follow-up visits, cast change or removal, aftercare in HH. ? Rehab therapy by PT or OT after fracture or injury ? Suture removal ? Dressing changes

7th Character Examples 1. Patient admitted to HH with an infected post-op wound and is still on antibiotics.

This is still considered active treatment and a 7th character of "A" is used. ? T81.4XXA

2. Patient was at home receiving routine aftercare for a wound and a Z48 code was used. Patient readmitted to hospital because wound dehisced and became infected. Treated in hospital and discharged home with antibiotics and orders for dressing changes. This is still active care and a 7th character of "A" is used. ? T31.81XA & T81.4XXA

3. At recertification, wound is granulating, patient is no longer on antibiotics and routine care is being provided to wound. 7th character of "D" would is used. ? T31.81XD

Excludes 1 Notes

Excludes 1 ? Not coded here! Any diagnoses listed here cannot be coded with the diagnosis you have selected. These two codes cannot be used together.

Example: Type 2 DM (E11) Excludes 1: Diabetes due to underlying conditions (E08.-)

Gestational diabetes (O24.4-)

Update to Excludes 1:

? Many confusing & ambiguous excludes notes in 2016 Manual ? Some of the Excludes 1 notes didn't make sense. For example, Codes

R40-R46 (signs & symptoms of emotional state and behavior) contained excludes notes for the entire group of Codes F01-F99 (All mental, behavioral & neuro development disorder codes) indicating that these two groups of codes could not be coded together. Solution: If the two conditions are not related to one another, it is permissible to report both codes together despite the Excludes 1 notation.

Excludes 2 Notes Excludes 2 ? Not included here! Means that the condition included here is not part of the condition represented by the code you have chosen and you may use these together.

Example: Acute sinusitis (J01.1-) Excludes 2: Chronic sinusitis (J32)

"With" Guidelines ? June 2016 Coding Clinic confirmed new guidelines for causal conditions ? The sub-term "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetical Index, or an instructional note in the Tabular Index. ? Any condition listed under a sub-term "with" in the index should be interpreted as linked to the main term when both conditions are present. ? "The classification presumes a causal relationship between the two conditions linked by these terms unless a provider has specifically documented an alternative etiology.

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ICD-10

So What Does This Mean? ? If a physician documents another etiology for the condition the coder should not code to a complication or assume the link. ? The entire record should be reviewed to determine whether a relationship between the two conditions exists. ? The sub term "with" in the index should be interpreted as a link between diabetes and any of these conditions indented under the word "with". ? The physician documentation does not need to provide a link between (for example) the diagnoses of diabetes & CKD. ? This link can be assumed since the chronic kidney disease is listed under the sub term "with". ? These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated and due to some other underlying cause.

Specifically "With" Conventions Reference Diabetes in the Alpha Index

? Diabetes with Amyotrophy Arthropathy Autonomic (poly) neuropathy Cataracts

? Convention not limited to Diabetes. This convention applies to all conditions. See Dementia See Hypertension

"With" Examples ? No previous assumption could be made with Diabetes & Osteomyelitis. ? Under new guideline, osteomyelitis is now listed under the sub-term "with" for Diabetes. Therefore, coders can assume that there is a causal relationship. E11.69 ? Diabetes, Type II with other specified manifestations M86.- ? Osteomyelytis

New OASIS Items Two new OASIS items that has direct affect on ICD 10 Coding

1. M1028 ? Active Diagnoses 2. M1060 ? Height and Weight

M1028 ? Active Diagnoses

(M1028) Active Diagnoses ? Comorbidities & Co-existing Conditions ? Check all that apply

See OASIS Guidance Manual for a complete list of relevant ICD-10 codes.

1 - Peripheral Vascular Disease (PVD) or Peripheral Arterial Disease (PAD) 2 - Diabetes Mellitus (DM)

? Identifies physician or designee confirmed diagnoses that are active and associated with the current episode

? Active diagnoses are those that have a direct relationship to the patient's current functional, cognitive, mood or behavior status; medical treatments; nurse monitoring; or risk of death at time of assessment.

? Do not include diagnoses that have been resolved or do not affect the patient's current functional, cognitive, mood or behavior status; medical treatments; nurse monitoring; or risk of death at time of assessment.

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Diagnoses Codes Appropriate for M1028 Codes that start with the first 4 characters of:

? I70.2 Atherosclerosis of native arteries of extremities ? I70.3 Atherosclerosis of bypass grafts of extremities ? I70.4 Atherosclerosis of autologous vein bypass ? I70.5 Atherosclerosis of nonautologous vein ? I70.6 Atherosclerosis of nonbiological bypass ? I70.7 Atherosclerosis of other type of bypass ? I70.91 Generalized atherosclerosis ? I70.92 Chronic total occlusion of artery of the extremities

Codes that start with 173. ? I73. Other peripheral vascular disease

Codes that start with the first 3 characters of: ? E08. Diabetes due to underlying condition ? E09. Drug or chemical induced diabetes mellitus ? E10. Type I diabetes mellitus ? E11. Type II diabetes mellitus ? E13. Other specific diabetes mellitus

What about combination codes for DM & PVD (E11.5-)?

M1060 ? Height & Weight

(M1060) Height & Weight ? While measuring, if the number is X.1 - X.4 round down; X.5 or greater, round up

inches pounds

a. Height (in inches). Record most recent height measure since the most recent SOC/ROC

b. Weight (in pounds). Base weight on most recent measure in last 30 days; measure weight consistently, according to standard agency practice (for example, in a.m. after voiding, before meal, with shoes off, etc.)

? BMI code assignment may be based on medical record documentation from clinicians that are not the patient's provider.

? However codes for obesity or overweight must be documented by patient's provider.

? ICD-10 code for BMI can be calculated from height and weight in M1060

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