Coding Guidance for Parkinson’s Disease and Encephalopathy Revealed in AHA Coding Clinic

As a health information management (HIM) coding professional, I always anxiously await the quarterly publication of the American Hospital Association (AHA) Coding Clinic for ICD-10-CM/PCS.  

This is something that should be on all coding professionals’ calendars each quarter, and we should all allocate time to read through the content, noting the effective dates of the guidance. The May 2017 issue was released on May 17, and the coding advice and/or code assignments contained in this issue were effective with discharges and encounters occurring on and after the same date.

Just to offer a little background information about the AHA Coding Clinic: it is the official publication for ICD-10-CM/PCS coding guidelines and advice, as designated by the four cooperating parties. The cooperating parties have final approval of the cod­ing advice provided in the publication and include the following: the American Hospital Associa­tion, American Health Information Management Association, Centers for Medicare & Medicaid Services (formerly HCFA), and National Center for Health Statistics.

The ICD-10-CM guidance within the Coding Clinic addresses all healthcare settings, not just hospitals, while ICD-10-PCS is specifically for hospital inpatient encounters. Sometimes there is confusion about this, as the American “Hospital” Association is the publishing arm of the Coding Clinic, so there could be the inaccurate perception that the guidance only applies to hospitals.

Within the structure of each Coding Clinic is an editorial advisory board (EAB), which usually meets twice a year to discuss the code set, coding guidelines, and coding questions that have been submitted to the Central Office. Besides having two representatives from the coding professional (industry), there are medical (physician) representatives who participate on the AHA Coding Clinic® ICD-10-CM/PCS Editorial Advisory Board.

These include:

  • A representative from the American College of Physicians
  • A representative from the American Medical Association
  • A representative from the American College of Surgeons
  • A representative from the American Academy of Pediatrics
  • Medical Advisors from the Centers for Medicare & Medicaid Services

Although I can’t cover all the guidance contained within the latest issue of Coding Clinic in this article, I’ve highlighted a few details in an attempt to entice you to read the full issue. The issue begins with some good information about ICD-10-PCS’s qualifiers for the root operation of Detachment, including how they are defined and how they are to be assigned for coding and reporting purposes. We need to remember that the specific qualifiers used for Detachment are dependent on the body part value in the upper and lower extremities and body systems.

In this issue, there are also some scenarios and guidance regarding the ICD-10-CM coding of newborn encounters for the physician setting. This is definitely valuable guidance to help those who work with clinical coding in the physician setting.

Understanding the difference between “Parkinsonism” and “Parkinson’s disease” was also discussed in this issue, providing some great insight into the classification of the two conditions. Additionally discussed is the use of both the G20 code for Parkinson’s disease and F02.81, Dementia in other diseases classified elsewhere with behavioral disturbance, for Dementia with aggressive behavior.

Maybe in the future the classification system will address with specific codes the additional complications of Parkinson’s disease, such as gait disturbance, which puts a patient at risk for falls and fractures; and dysphagia or swallowing difficulties, which put patients at risk for aspiration. Also associated with Parkinson’s disease are cognitive impairment, depression, and sleep problems/disorders. I can see some new combination codes in the future being introduced to capture these common problems associated with Parkinson’s disease.

Code G93.41, Metabolic encephalopathy, is assigned to capture “septic encephalopathy” – or, if the provider documents “sepsis associated encephalopathy,” per this latest issue of Coding Clinic. The code G94, Other disorders of brain in diseases classified elsewhere, would not be assigned, as this code reflects those conditions with index entries that directly point to code G94 for certain etiologies.

I’ve heard many coding and clinical documentation improvement (CDI) professionals discuss patients who have had a CVA/stroke with encephalopathy present. The guidance provided from Coding Clinic is that “encephalopathy” secondary to a CVA/stroke is not inherent to a CVA/stroke, and as such it should be coded separately with code G93.49, Other encephalopathy.

In this issue there is also some helpful clarification regarding nicotine dependence and remission, as well as guidance on the coding for the use of E-cigarettes with code F17.290, Nicotine dependence, other tobacco product.

Again, I could not cover all the guidance contained in this issue, so please read through it in full and discuss it in a staff meeting and with your colleagues.


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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