AHA Coding Clinic Third Quarter

Today, I am going to expand on some interesting points from the American Hospital Association (AHA) Coding Clinic for the third quarter of 2024. Remember, I am not one of the cooperating parties, and my advice is just my opinion.

• One of the decision points on determining what code to use for a neoplasm is to decide whether the neoplasm is benign, malignant, or indeterminate. There are certain tumors that have the propensity to transform into malignant status, but their current state is “pre-malignant.” A question was asked about noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). The answer was that this is considered a neoplasm of uncertain behavior.
  
  The index of neoplasms doesn’t list each morphological type of tumor; the choices are malignant primary or secondary, cancer in situ, benign, uncertain, and unspecified behavior. Not every site has every category. Sometimes the pathologist just isn’t sure whether the tumor is malignant or just has the potential to become cancerous. If you Google the specific type and it says “pre-malignant,” “potential for transformation,” “lymphomatoid,” or “borderline,” that may suggest uncertain behavior.
  
  Remember that “unspecified” behavior doesn’t indicate the provider’s inability to ascertain whether it is malignant or benign presently. “Unspecified” is basically the provider just not denoting which it was, and the coder can’t tell which. It is similar to the difference between W and U for present-on-admission (POA) indicators.
  
  
• Normally we don’t code insignificant conditions that do not require evaluation, treatment, or increased nursing care or length of stay. They are not considered reportable secondary diagnoses. Mongolian spots could seemingly be one of those conditions, because they are of themselves benign birthmarks. Coding Clinic states that the significance is that they often co-exist with other congenital defects, like inherited disorders of metabolism or vascular birthmarks. Since they may have implications for future healthcare needs, you should capture them, and the correct code is Q82.5, Congenital non-neoplastic nevus.
  
  
• There was a question regarding the coding of spontaneous intracranial hypotension due to a cerebrospinal fluid fistula, and the response was to use G96.811, Intracranial hypotension, spontaneous, and G96.08, Other cranial cerebrospinal fluid leak. Be sure you only use this code if the intracranial hypotension is non-iatrogenic (i.e., spontaneous). If it occurs as a result of a postprocedural dural tear, you would not use this code.
  
  
• Remember, if a device is placed during a surgery but is removed prior to the completion of the procedure, you do not assign a code. This came from a question about ureteral stent placements for improved visualization during abdominal surgery.
  
  
• There was a question about how to code “buccal administration of an abortifacient to induce labor for the termination” of a pregnancy. The response was 10A07ZX, Abortion of products of conception, abortifacient, via natural or artificial opening. You are really coding the procedure of abortion, and the abortifacient is the mechanism, like vacuum or laminaria. Via natural or artificial opening is the approach. Remember that you pick the procedure that was performed, and in this case, that would be the abortion. You aren’t really coding the “administration” of the abortifacient like you code “introduction” of antineoplastic or antibiotic medication. The abortion code via abortifacient lives in the Obstetrics section, as opposed to the Administration section.
  
  
• Several questions reference a provider documenting “diabetes without complications” and also a condition that invokes the “with” convention of automatic linkage. The advice is to query for clarification to be certain that the two conditions are unrelated. My advice is to educate your provider, or you will be doing this over and over and over again. Give them a list of conditions that automatically result in the diabetes with…a code. Explain that they need to state that the second condition is unrelated to the diabetes or that the other condition is due to something else.
  
  
• You have to resist the need to code B37.7 for organ dysfunction, Candidal sepsis for candida fungemia. It’s like when we used to use A41.9, Sepsis, unspecified organism, for documentation of septicemia. Disseminated or systemic candida is coded as B37.7.
  

As always, I recommend you check out the complete Coding Clinic for yourself.

This article has been corrected. Reference is made to the AHA Coding Clinic third quarter, not the fourth quarter. We apologize for the error.