Q4 Coding Clinic Vital Takeaways

The American Hospital Association’s (AHA’s) Coding Clinic edition for the fourth quarter of 2024 has been published, and it includes several key changes of which providers nationwide should take heed, according to one renowned subject-matter expert.

James S. Kennedy, MD, CCS, CDIP, CCDS, founder and President of CDIMD, a Nashville-based physician and facility advisory and consulting firm that advocates ICD-10-pertinent clinical documentation and coding integrity, said one change in particular focuses on lymphoma.

When lymphoma involves the CNS (central nervous system, to include the brain, spinal cord, and meninges), it must be made clear in documentation whether the condition originated in the CNS (e.g., C83.390, Primary CNS lymphoma) or out of the CNS, with metastasis to the CNS (C83.398, Diffuse large B-cell lymphoma of other extranodal and solid organ sites), Kennedy noted – adding that if C83.398 applies, the ICD-10-CM Guidelines prohibit adding an additional code for C79.3-(1 or 2) for Secondary malignant neoplasm of brain and cerebral meninges.

“Engage your oncology staff to differentiate between lymphoma in remission (MS-DRG CC, APR SOI 1), a new ICD-10-CM concept for FY 2025, from ‘history of lymphoma’ (which has no impact at all),” Kennedy said. “Consider starting with the references provided to the ICD-10-CM Coordination and Maintenance committee in support of the proposal for add codes for ‘lymphoma in remission.’” 

Another key change, Kennedy said, was a request that physicians classify hypoglycemia as one of the following:

• Level 1          Glucose < 70 mg/dL (< 3.9 mmol/L) and ≥ 54 mg/dL (≥ 3.0 mmol/L);
• Level 2          Glucose < 54 mg/dL (< 3.0 mmol/L); or
• Level 3          A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia, irrespective of glucose level.

“If hypoglycemia level 1, 2, or 3 are documented, ICD-10-CM requires two codes, the first for the general setting of the hypoglycemia (e.g., with diabetes) and a second code for the level,” Kennedy said. “Of note, should a patient have level 3 hypoglycemia, which is usually treated with glucagon or intravenous D50W, engage the provider to document the metabolic encephalopathy due to the hypoglycemia that resulted in the patient’s altered mental or physical status.” 

A recent Diabetes Association statement elaborates on this point, and can be found online here:  https://diabetesjournals.org/care/article/47/Supplement_1/S111/153951/6-Glycemic-Goals-and-Hypoglycemia-Standards-of

Also, Kennedy noted, there are new ICD-10-CM codes for obesity class and corresponding definitions:

• E66.811, Obesity, class 1: Defined in adults as a body mass index (BMI) of 30.0 to 34.9; defined in children as BMI > 95th percentile;
  
• E66.812, Obesity, class 2: Defined in adults as a body mass index (BMI) of 35.0 to 39.9; defined in children as BMI > 120 percent of the 95th percentile (which also has a new code, Z68.55, Body mass index [BMI] pediatric, 120 percent of the 95th percentile for age to less than 140 percent of the 95th percentile for age; and

• E66.813, Obesity, class 3: Defined in adults as BMI that is equal to or greater than 40; defined in children as BMI > 140 percent of the 95th percentile.

“Note that ICD-10-CM did not eliminate code E66.01, Morbid (severe) obesity due to excess calories, with the creation of a code for class 3 obesity,” Kennedy said. “Since changes in the ICD-10-CM classification negate previous applicable Coding Clinic (second quarter of 2022, page 9) advice, coders cannot any longer equate obesity, class 3, as morbid obesity to assign E66.01, unless the physician explicitly documented ‘morbid obesity.’”

Kennedy is a coding and clinical documentation integrity (CDI) expert with more than 20 years of experience.  He is a frequent guest on Talk Ten Tuesday, as well as a sought-after speaker to medical staff, health information management (HIM) and CDI associations. He has been designated as a Certified Coding Specialist and Certified Documentation Improvement Practitioner by the American Health Information Management Association (AHIMA), and as a Certified Clinical Documentation Specialist by ACDIS.

He authored AHIMA’s book on MS-DRGs in 2006-2007 (now out of print), contributed significantly to the American Medical Association’s text on HCC risk adjustment, and has previously served on the advisory board of ACDIS.

The AHA ICD-10-CM/PCS Coding Clinic serves as the regulatory foundation for application of codes to conditions and procedures, and identifies the appropriate situation(s) in which to apply or not apply and submit codes for reimbursement purposes. Each coding professional is responsible for maintaining their skills and ensuring that compliant coding is practiced, in order to ensure revenue and data integrity.

Each quarter the AHA examines outstanding coding issues, new procedures, and technology, and provides updates to previous coding guidance.

Editor’s Note:

A newsletter offering a summary of the latest Coding Clinic edition can be accessed online here: https://www.codingclinicadvisor.com/blog/highlights-ahas-coding-clinic-fourth-quarter-2024-release-icd-10-cm-and-icd-10-pcs.

There are 252 new ICD-10-CM codes and 371 new ICD-10-PCS codes since the last update, with 13 revised and 36 deleted ICD-10-CM codes. There are no revised ICD-10-PCS code titles, and 61 ICD-10-PCS codes have been deleted from the classification.