I appeared on Talk Ten Tuesdays recently and briefly discussed some topics from the American Hospital Association (AHA) Coding Clinic for the third quarter of 2023, which featured commentary on ICD-10-CM/PCS. I have to say up-front that this publication is one of the must-have reads for both coding and clinical documentation integrity (CDI) professionals.
I enjoy reading it, and I often read each edition more than once. I hope you also find it valuable and helpful. Along with the conventions and official guidelines, the publication provides additional official coding guidance and is a foundational resource for accurate coding.
The latest issue contains many ICD-10-CM coding topics, including but not limited to the following:
The ICD-10-PCS (inpatient procedure coding) includes the following topics related to coding guidance (this is not an all-inclusive list):
I’ll share with you one ICD-10-CM scenario in which a patient with acute kidney injury (AKI) had a nontraumatic renal subcapsular hematoma. The patient came to the ED complaining of right flank pain. There was a CT performed, and that showed the hematoma. The patient had no knowledge of any trauma or injury. Thus, for this situation, you would assign and sequence N28.89, Other specified disorders for nontraumatic renal hematoma, as the principal diagnosis and N17.9, Acute kidney failure, as a secondary code.
Another topic covered in this latest issue was “cervical epidural hematoma, with no trauma or procedures.” In this situation, a patient underwent surgical decompression and evacuation of the epidural hematoma, and there was no documentation of any trauma or injury. For this scenario, you would assign ICD-10-CM code G95.19, Other vascular myelopathies, for a cervical epidural hematoma, specified as not due to a procedure or injury.
Another ICD-10-CM issue addressed involved the question of whether to assign a code when the patient has “bra strap grooving due to macromastia.” Per the AHA authors, you in fact would report an ICD-10-CM code for the “bra strap grooving.”
For the ICD-10-PCS coding scenarios, another question involved the proper coding of the “HeRO” ® Thrombectomy Graft: would this root operation be extirpation or revision? HeRO stands for “Hemodialysis Reliable Outflow.” This is a graft that is a fully subcutaneous system that provides reliable, continuous blood flow directly from a target artery to the central venous system into the heart. The HeRO Graft has no venous anastomosis because the tip of the venous outflow component is located in the mid- to upper-right atrium. This is considered to be a root operation of “extirpation” in ICD-10-PCS. I would suggest visiting the Cryolife website and viewing an available video about this device and procedure to enhance your knowledge and understanding of them.
An interesting procedure for coding is the JADA® System, which is intended to provide control and treatment of abnormal postpartum uterine bleeding or hemorrhage when conservative management is warranted. The JADA System can provide visible and observable control of bleeding within minutes. In ICD-10-PCS, this is coded as control. Yes, this procedure helps assist in draining any accumulated blood, but the objective is not to drain the uterine cavity, but rather to stop the bleeding (via control).
Now, the Coding Clinic for the fourth quarter of 2023 has also been released, and it has details on the new ICD-10-CM and PCS codes for the 2024 fiscal year, for which there are already educational webinars available. In addition, there is a section regarding serosal tears. The coding of serosal tears has been confusing during recent years, and as such, there is additional attention placed on it. I’m glad they wrote about this topic, as I myself had submitted three case examples for them to give guidance for, so please read that coding clarification over closely.
You can submit your own questions online to Coding Clinic, and it is free and easy. Submitting questions is something I strongly advocate for, as I believe it is the responsibility of coding and CDI professionals. Again, the best practice when it comes to the AHA Coding Clinic is to read the guidance thoroughly. Discuss it with your coding and CDI staff as a group, as it is a great way to collaborate, for there is always something to learn from it.
Be sure to register for the on-demand webinar on AHA Coding Clinic also!
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