New coding clinic brings valuable guidance

Those of us in the health information management (HIM) coding profession were excited to see the third-quarter issue of the American Hospital Association (AHA) Coding Clinic on ICD-10-CM/PCS come out. Contained within the 31 pages for this issue is guidance and advice on several ICD-10-CM (diagnosis) and ICD-10-PCS (Procedure Coding System) scenarios and questions. There are a total of 45 different coding topics discussed, 25 of which relate to diagnosis coding, with the remaining PCS scenarios or questions.

We continue to hear questions regarding the coding of diabetes with associated conditions. In the new Coding Clinic, diabetes mellitus with arteriosclerotic peripheral artery disease is discussed, and the appropriate codes listed to assign are E11.51, Type 2 diabetes with diabetic peripheral angiopathy without gangrene, and also code I70.2-, Atherosclerosis of native arteries of extremities.

When a patient has a documented “necrotic pressure ulcer of heel with diabetic peripheral vascular disease and neuropathy” and has excisional debridement performed on the ulcer, the sequencing of the diagnosis codes was another topic cited. The listed guidance was to assign I96, Gangrene, unspecified, as the principal diagnosis. This advice is based upon the instruction found under the code category L89, Pressure ulcer: “code first.” The pressure ulcer code, L89.623 Pressure ulcer left heel, stage 3, would be listed as a secondary diagnosis. Read over the complete answer from Coding Clinic to fully understand this scenario.

I’ve seen a diagnosis documented as “Type 1.5 diabetes mellitus,” and the question of what code to assign in such a scenario was also included in this Coding Clinic issue. The correct ICD-10-CM code category is E13, Other specified diabetes for type 1.5 or a combination of type I and type 2 Diabetes. This guidance will certainly be helpful in both inpatient and outpatient settings.

The next interesting coding topic included centered on the code assignment for “right upper lobe pneumonia” without a causal organism identified. When the documentation lists a specific lobe of pneumonia, (i.e. right, left, or more than one lobe) without a responsible organism, then “Lobar pneumonia, unspecified organism,” code J18.1, would be assigned. If the type of pneumonia and organism are identified via the documentation, then a combination code would be assigned; this combination code would identify the type of pneumonia and the organism.

For a “transcatheter aortic valve replacement via transaortic approach,” Coding Clinic suggested to use the “percutaneous” value with this code. This type of surgical procedure utilizes a mini-sternotomy to access the site, then a catheter is used to deliver the valve percutaneously.

Another piece of PCS code guidance provided was in relation to a “transvenous transcatheter placement of valve in inferior vena cava.” The question raised was whether this procedure utilized two stabilizing stents in the inferior vena cava, and if so, what ICD-10-PCS code would be assigned. The listed advice was to assign PCS code 06V03DZ, Restriction of inferior vena cava with intraluminal device, percutaneous approach, for the insertion of the transcatheter valve into the inferior vena cava. It should be noted that the root operation of “restriction” was used due to the partial closing of an orifice or the lumen of a tubular body part.

It’s clear from the short summary above that there are some very important pieces of coding advice in this Coding Clinic issue. We need to keep in mind that the AHA Coding Clinic is not just an ICD-10-CM coding publication for hospitals; it applies to all healthcare settings, while ICD-10-PCS advice relates to the inpatient setting. As the Official Guidelines tell us, we should review all documentation for the entire record in order to determine the specific reason for each encounter and the conditions treated, as this will achieve accurate and compliant coding. The same applies to the AHA Coding Clinic: one must review the full content of each issue in order to understand the advice and achieve accurate, compliant coding.

All coding and CDI professionals should have access to the AHA Coding Clinic publication each quarter. I also recommend that there be a discussion with your staff quarterly to ensure their understanding of the instructions. The guidance, advice, and suggested code assignment contained in this third-quarter issue are effective for discharges/encounters occurring on or after Sept. 24, 2018.


Program Note:

Listen to Gloryanne Bryant report this story this morning on Talk Ten Tuesday, 10-10:30 a.m. ET.


Gloryanne Bryant, RHIA, CDIP, CCS, CCDS

Gloryanne is an HIM coding professional and leader with more than 40 years of experience. She has an RHIA, CDIP, CCS, and a CCDS. For the past six years she has been a regular speaker and contributing author for ICD10monitor and Talk Ten Tuesdays. She has conducted numerous educational programs on ICD-10-CM/PCS and CPT coding and continues to do so. Ms. Bryant continues to advocate for compliant clinical documentation and data quality. She is passionate about helping healthcare have accurate and reliable coded data.

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