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NJPR CURRENT TOPICS IN ICD-10 Presented by: Diane Stoner, RHIT, CCS Senior Health Information Consultant, NJPR AHIMA-APPROVED ICD-10 TRAINER 1.

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Presentation on theme: "NJPR CURRENT TOPICS IN ICD-10 Presented by: Diane Stoner, RHIT, CCS Senior Health Information Consultant, NJPR AHIMA-APPROVED ICD-10 TRAINER 1."— Presentation transcript:

1 NJPR CURRENT TOPICS IN ICD-10 Presented by: Diane Stoner, RHIT, CCS Senior Health Information Consultant, NJPR AHIMA-APPROVED ICD-10 TRAINER 1

2 NJPR Disclaimer The ICD-10 codes presented by NJPR are based on the 2013 Complete Official Draft Code Set of ICD-10-CM and ICD-10-PCS. Updates, corrections and revisions will be issued for the ICD-10 code set prior to and after implementation, therefore some of the codes presented may become invalid. The most current ICD-10 books, updates and revisions regularly issued by The Centers for Medicare and Medicaid Services (CMS) are the official source for code look up and assignment and should be referenced prior for coding instruction. NJPR and its instructors assume no responsibility for the use of these codes outside of its intended use and disclaim any liability that may result from the use of this information for coding and billing purposes. 2

3 ICD-10-PCS Code Changes –Four codes added under new technology application, valid October 1, 2013 –Three new codes added and three codes deleted, to correct body part value for temporary occlusion of abdominal aorta 3

4 ICD-10-PCS Code Changes Four codes added under new technology application Valid October 1, H005Z Insertion of Epiretinal Visual Prosthesis into Right Eye, Open Approach 08H105Z Insertion of Epiretinal Visual Prosthesis into Left Eye, Open Approach 30280B1 Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate into Vein, Open Approach 30283B1 Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate into Vein, Percutaneous Approach 4

5 ICD-10-PCS Code Changes Three new codes added, to correct body part value for temporary occlusion of abdominal aorta - New: 04V00DJ* Restriction of Abdominal Aorta with Intraluminal Device, Temporary, Open Approach - New: 04V03DJ* Restriction of Abdominal Aorta with Intraluminal Device, Temporary, Percutaneous Approach - New: 04V04DJ* Restriction of Abdominal Aorta with Intraluminal Device, Temporary, Percutaneous Endoscopic Approach 5

6 ICD-10-PCS Code Changes *Appendix G – Character meanings for the Heart and Great Vessels Root Operation V - Restriction Qualifier - character 7 J - temporary 6

7 ICD-10-PCS Code Changes Three codes deleted, to correct body part value for temporary occlusion of abdominal aorta - Deleted: 02VW0DJ* Restriction of Thoracic Aorta with Intraluminal Device, Temporary, Open Approach - Deleted: 02VW3DJ* Restriction of Thoracic Aorta with Intraluminal Device, Temporary, Percutaneous Approach - Deleted: 02VW4DJ* Restriction of Thoracic Aorta with Intraluminal Device, Temporary, Percutaneous Endoscopic Approach 7

8 New ICD-10-PCS codes for FY H[0,1]05Z - Insertion of Epiretinal Visual Prosthesis into Right Eye, into Left Eye, Open Approach (2 codes) 8

9 New ICD-9-CM codes for FY Implantation of epiretinal visual prosthesis Removal of epiretinal visual prosthesis Revision of epiretinal visual prosthesis 9

10 RETINAL IMPLANTS AND WHO NEEDS THEM Retinal implants restore vision in patients that are blind due to photoreceptor loss from retinitis pigmentosa. Retinitis pigmentosa is a rare, inherited, blinding disease in which light sensitive photoreceptor cells of the eye slowly and progressively degenerate and die. However the retinal neurons, e.g. bipolar cells or ganglion cells, are retained and still work. 10

11 HEALTHY EYES In a healthy eye, the photoreceptors (rods and cones) in the retina convert light into tiny electrochemical impulses that are sent through the optic nerve and into the brain, where they are decoded into images. If the photoreceptors no longer function correctly - due to conditions such as retinitis pigmentosa - the first step in this process is disrupted, and the visual system cannot transform light into images. 11

12 How does the Epiretinal Visual Prosthesis System work? The Argus® II System epiretinal implant that is fully implanted in and around the eye miniature video camera housed in the patient’s glasses captures a scene video is sent to a small patient-worn computer (i.e., the video processing unit – VPU processes and transformed into instructions that are sent back to the glasses real time video signals are wirelessly transmitted to the implant 12

13 How does the Epiretinal Visual Prosthesis System work? signals are then sent to the electrode array, which emits small pulses of electricity pulses are intended to bypass the damaged photoreceptors and stimulate the retina’s remaining cells which are secured at the level of ganglion cells overlying neurons signals are transmitted to a retinal stimulator that is secured at the level of ganglion cells transmits the visual information along the optic nerve to the brain process is intended to create the perception of patterns of light which patients can learn to interpret as visual patterns 13

14 GEM CROSSWALK New 2014 entry Example: 08H[0,1]05Z – Insertion of Epiretinal Visual Prosthesis into Right Eye, Open Approach (2 codes) To/from – Implantation of Epiretinal Visual Prosthesis 14

15 New ICD-10-PCS codes for FY B1 Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate into Vein, Open Approach 30283B1 Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate into Vein, Percutaneous Approach 15

16 New ICD-9-CM codes for FY Infusion of 4-Factor Prothrombin Complex Concentrate 16

17 What is Infusion of 4-Factor Prothrombin Complex Concentrate? Administration of prothrombin complex concentrate (PCC) is used for the immediate reversal of the anticoagulant effect of vitamin K antagonists, for example in case of intracranial hemorrhage or life-threatening bleeding. There are two types of PCCs  containing four (vitamin K-dependent) factors II, VII, IX and X.  containing mainly factors II, IX, and X. 17

18 What is Infusion of 4-Factor Prothrombin Complex Concentrate? Voils and Baird performed a systematic review on the efficacy of these agents in clinical studies, specifically comparing the 3-factor and 4-factor concentrates. The conclusion was that 4-factor PCCs result in a more reliable correction of the INR compared to 3-factor concentrates. Kcentra™ 4F-PCC is FDA-approved for rapid Warfarin reversal in patients experiencing an acute major bleed. 18

19 GEM CROSSWALK New 2014 entry Example: 3028[0,3]B1 – Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate in Vein, Percutaneous Approach (2 codes) To/From Infusion 4-Factor Prothrombin Complex Concentrate 19

20 New ICD-10-PCS codes for FY V00DJ*, restriction of abdominal aorta with intraluminal device, temporary, open approach 04V03DJ*, restriction of abdominal aorta with intraluminal device, temporary, percutaneous approach 04V04DJ*, restriction of abdominal aorta with intraluminal device, temporary, percutaneous endoscopic approach To/from Temporary (partial) therapeutic endovascular occlusion of vessel 20

21 Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments Ninety-nine percent (99%) of the cases showed no change in MS-DRG when coded in ICD-10-CM/PCS. Of the 1% of the cases with MS-DRG shifts. 45% of those shifted to higher weight MS-DRGs 55% shifted to lower weight MS-DRGs. Payment increases and decreases due to a change in DRG assignment are estimated to essentially net out. MS-DRG shifts due to re-coding in ICD-10 are caused by unavoidable differences between the two classification systems. 21

22 Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments 2014 GEM reimbursement update available Oct

23 INDEX ISSUES AND CLINICAL DOCUMENTATION OPPORTUNITIES 23

24 AKI Acute Kidney Injury (Nontraumatic) No ICD-10 CM index listing for acute nontraumatic kidney injury 24

25 ICD-10-CM Index Injury KidneyS SpecifiedS

26 No ICD-10 CM Index listing for… Injury Renal Kidney – see condition Renal – see condition Acute – see condition 26

27 S37.0 Injury of Kidney Excludes 2 note: acute kidney injury (nontraumatic) (N17.9) N17.9 Acute kidney failure, unspecified Acute kidney injury (nontraumatic) Excludes 2 note: traumatic kidney injury (S37.0-) 27

28 FRACTURE GUIDELINES and CDI ORTHO OPPORTUNITIES A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced. 28

29 ICD-10-CM Traumatic Fracture 7 th character A - initial encounter for closed fracture B - initial encounter for open fracture D - subsequent encounter for fracture with routine healing G - subsequent encounter for fracture with delayed healing K - subsequent encounter for fracture with nonunion P - subsequent encounter for fracture with malunion S - sequela 29

30 ICD-10-CM Traumatic Fracture 7 th character INITIAL ENCOUNTER The patient is receiving active treatment for the fracture Examples of active treatment surgical treatment emergency department encounter evaluation and treatment by a new physician patient who delayed seeking treatment for the fracture or nonunion. 30

31 ICD-10-CM Traumatic Fracture 7 th character SUBSEQUENT CARE Encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase Examples of fracture aftercare cast change or removal removal of external or internal fixation device medication adjustment follow-up visits following fracture treatment. 31

32 ICD-10-CM Traumatic Fracture 7 th character SEQUELAE Complication or the condition as a result of the injury Example – Scar –Sequelae is sequenced first. –Injury code is sequenced as a secondary diagnosis with the 7th character “S”. 32

33 GUSTILO OPEN FRACTURE CLASSIFICATION Classifies open fractures into three major categories (Type 1, Type II, Type III) depending on the mechanism of the injury, soft tissue damage and degree of skeletal involvement 33

34 GUSTILO OPEN FRACTURE CLASSIFICATION Type I – usually a simple fracture with wound less than 1 cm and minimal soft tissue injury Type II – usually a simple fracture with wound greater than 1 cm and moderate soft tissue injury Type III – fractures that involve extensive damage to the soft tissues including muscle, skin and neurovascular structures 34

35 GUSTILO OPEN FRACTURE CLASSIFICATION Subtype IIIA – open fracture with adequate soft tissue coverage despite fracture severity Subtype IIIB – open fracture with extensive soft tissue loss Subtype IIIC – open fracture which involves major arterial injury requiring repair for limb salvage 35

36 ICD-10-CM Traumatic Fracture 7 th character S52 Fracture of forearm List of appropriate 7th character is to be added to all codes from category S52 [unless otherwise indicated]. A initial encounter for closed fracture B initial encounter for open fracture type I or II initial encounter for open fracture NOS C initial encounter for open fracture type IIIA, IIIB, or IIIC 36

37 ICD-10-CM Traumatic Fracture 7 th character S52 Fracture of forearm List of appropriate 7th character is to be added to all codes from category S52 [unless otherwise indicated]. D subsequent encounter for closed fracture with routine healing E subsequent encounter for open fracture type I or II with routine healing F subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing 37

38 ICD-10-CM Traumatic Fracture 7 th character S52 Fracture of forearm List of appropriate 7th character is to be added to all codes from category S52 [unless otherwise indicated]. G subsequent encounter for closed fracture with delayed healing H subsequent encounter for open fracture type I or II with delayed healing J subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing S sequela 38

39 ICD-10-CM Traumatic Fracture 7 th character NONUNION Care of complications of fractures with nonunion are coded with the 7th character K- subsequent encounter for closed fracture with nonunion M - subsequent encounter for open fracture Type 1 or II with nonunion N - subsequent encounter for open fracture type IIIA, IIIB, IIIC with nonunion 39

40 ICD-10-CM Traumatic Fracture 7 th character MALUNION Care of complications of fractures with malunion are coded with the 7th character P - subsequent encounter for closed fracture with malunion Q - subsequent encounter for open fracture Type 1 or Type 2 with malunion R - subsequent encounter for open fracture Type IIIA, IIIB, IIIC with malunion 40

41 ICD-10-CM Fractures A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone. 41

42 ICD-10-CM Traumatic Fractures The aftercare Z codes should not be used for aftercare for traumatic fractures. For aftercare of a traumatic fracture, assign the acute fracture code with the appropriate 7th character. 42

43 CDI for ORTHO CASES Fx- open - closed - displaced - nondisplaced episode of care - initial - subsequent - sequela Gustilo open fracture classification choices Is fracture related to or due to osteoporosis - yes - no 43

44 SMOKING ICD or V15.82 ICD-10-CMsmoker – see dependence drug, nicotine Dependence drug, nicotineF with disorder F remission F specified disorder NEC F withdrawal F

45 SMOKING ICD-10-CM Same code choices for chewing tobacco, cigarettes, and other nicotine specified products Dependence, drug, nicotine, withdrawal is a CC. F17.2- codes Excludes 1 History of tobacco dependence Z

46 Alcohol use, abuse and dependence in ICD-10-CM USE Use (of ) alcohol F10.99 with sleep disorder F harmful — see Abuse, alcohol F10.99 is a CC because the code description reads “Alcohol use, unspecified with unspecified alcohol induced disorder” 46

47 Alcohol use, abuse and dependence in ICD-10-CM ABUSE alcohol (non-dependent) F10.10 with anxiety disorder F intoxication F with delirium F uncomplicated F mood disorder F10.14 other specified disorder F psychosis F delusions F hallucinations F sexual dysfunction F sleep disorder F unspecified disorder F

48 Alcohol use, abuse and dependence in ICD-10-CM DEPENDENCE alcohol (ethyl) (methyl) (without remission) F10.20 with amnestic disorder, persisting F10.26 anxiety disorder F dementia, persisting F10.27 intoxication F with delirium F uncomplicated F mood disorder F10.24 psychotic disorder F with delusions F hallucinations F

49 Alcohol use, abuse and dependence in ICD-10-CM DEPENDENCE alcohol (ethyl) (methyl) (without remission) F10.20 with remission F10.21 sexual dysfunction F sleep disorder F specified disorder NEC F withdrawal F with delirium F perceptual disturbance F uncomplicated F

50 ICD-10-CM Coding Guidelines Similarities Changes And Major Changes 50

51 ICD-10-CM Coding Guidelines Fracture 7 th characters Mental Health diagnosis with manifestations 51

52 ICD-10-CM Coding Guidelines HIV GUIDELINES Code ONLY confirmed cases as in ICD-9, this is an exception to the basic coding guidelines Code B20 – old 042 If a patient admitted for an HIV-related condition, use the HIV code followed by additional diagnosis codes for all reported HIV-related conditions If a patient with HIV disease admitted for an unrelated illness, code condition first followed by the HIV code Code Z21 for asymptomatic HIV status 52

53 ICD-10-CM Coding Guidelines Code only confirmed cases of influenza due to certain identified influenza viruses, and due to other identifiable influenza virus. This is an exception to the hospital inpatient guidelines. If documentation states “suspected”, “possible”, “probable” avian influenza or novel influenza or other identifiable influenza, a code from Category J11 (Influenza due to unidentified influenza virus) should be assigned. 53

54 ICD-10-CM Coding Guidelines Chronic kidney disease and hypertension ICD-10-CM presumes a causal relationship between HTN and CKD. Secondary code to identify the stage of kidney disease. If a patient has acute renal failure, an additional code for the acute renal failure is required. 54

55 ICD-10-CM Coding Guidelines Hypertensive heart diseases is coded when a causal relationship is stated (due to hypertension) or implied (hypertensive). An additional code is needed to identify the type of heart failure for patients with heart failure. 55

56 ICD-10-CM Sepsis Coding Guidelines Sequencing of sepsis codes is dependent on circumstances of admission Assign A41.9 if type of infection or causal organism is not further specified (ICD-9 = 038.9) Urosepsis is not recognized as a disease in ICD-10 56

57 ICD-10-CM Sepsis Coding Guidelines A minimum of 2 codes is required for the coding of Sepsis with Associated Organ Dysfunction –One code for underlying infection –One code from subcategory (severe sepsis) Severe Sepsis is implied when septic shock is documented. Additional codes for the associated acute organ dysfunctions are also required 57

58 ICD-10-CM Neoplasm Coding Guidelines The neoplasm table in the alphabetic index should be referenced first. However, if the histological term is documented, that term should be referenced first rather than going immediately to the neoplasm table, in order to determine which column in the neoplasm is appropriate. Carcinoid (tumor) – see Tumor, carcinoid Tumor, carcinoid has both benign and malignant codes 58

59 ICD-10-CM Coding Guidelines STAGES OF CHRONIC KIDNEY DISEASE (CKD) The ICD-10-CM classifies CKD based on severity. The severity of CKD is designated by stages 1-5. Stages of CKD –Stage 1 – N18.1 –Stage 2 – N18.2 (mild) –Stage 3 – N18.3 (moderate) –Stage 4 – N18.4 (severe) –Stage 5 – N18.5 Note: Code CKD, Stage 5 requiring chronic dialysis to N18.6 (ESRD) 59

60 ICD-10-CM Coding Guidelines ANEMIA ASSOCIATED WITH MALIGNANCY When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the code for Anemia in neoplastic disease. 60

61 ICD-10-CM Coding Guidelines CODE ASSIGNMENTS FOR ENCOUNTERS SOLELY FOR THE ADMINISTRATION OF CHEMOTHERAPY, IMMUNOTHERAPY AND RADIATION THERAPY Z51.0 – Encounter for antineoplastic radiation therapy Z51.11 – Encounter for antineoplastic chemotherapy Z51.12 – Encounter for antineoplastic immunotherapy 61

62 ICD-10-CM Coding Guidelines DIABETES GUIDELINES No more controlled vs. uncontrolled combination codes that include the type of DM, the body system affected and the complications affecting that body system should be sequenced based on the reason for a particular encounter. Assign as many codes as needed to identify all of the associated conditions that the patient has. 62

63 ICD-10-CM Coding Guidelines NERVOUS SYSTEM GUIDELINES DOMINANT/NONDOMINANT SIDE of HEMIPLEGIA Default codes should be dominant if the right side is affected. If the left side is affected, the default is non-dominant. 63

64 ICD-10-CM Coding Guidelines LATERALITY right left BILATERALITY When the condition is bilateral, it is correct to assign a code for the left and right sides when there is no bilateral code available. 64

65 ICD-10-CM Coding Guidelines Some of the Ear diagnosis codes ask us to - Use additional code to identify: Exposure to environmental tobacco smoke (Z77.22) Exposure to tobacco smoke in the perinatal period (P96.81) History of tobacco use (Z87.891) Occupational exposure to environmental tobacco smoke (Z57.31) Tobacco dependence (F17.-) Tobacco use (Z72.0) 65

66 ICD-10-CM Coding Guidelines ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris. The subcategories for these codes include coronary artery disease of the native coronary arteries, coronary artery bypass graft(s) and arteries of transplanted heart with angina. 66

67 ICD-10-CM Coding Guidelines A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis. 67

68 ICD-10-CM Coding Guidelines Acute and subsequent myocardial infarctions - ICD-9 Acute MI timeframe is 8 weeks ICD 10 Acute MI timeframe is 4 weeks ICD-10 Initial MI code I21 ICD-10 Subsequent MI code I22 Use a code from category I21 for the initial MI for that admission and any other subsequent admissions that occur in the next 4 weeks Any additional MIs that occurs during that 4 weeks timeframe from the initial MI is considered a subsequent MI and uses a code from the I22 category 68

69 ICD-10-CM Coding Guidelines The sequencing of the I22 and I21 codes depends on the circumstances of the encounter. Should a patient who is in the hospital due to an AMI have a subsequent AMI while still in the hospital, code I21 would be sequenced first as the reason for admission, with code I22 sequenced as a secondary code. Should a patient have a subsequent AMI after discharge for care of an initial AMI, and the reason for admission is the subsequent AMI, the I22 code should be sequenced first followed by the I21. An I21 code must accompany the I22 code to identify the site of the initial AMI, and to indicate that the patient is still within the 4 week time frame of healing from the initial AMI 69

70 ICD-10-CM Coding Guidelines Code I25.2 is used for an “old” or healed MI not requiring further care. 70

71 ICD-10-CM Coding Guidelines ICD-10-CM provides combination codes for complications commonly associated with Crohn’s disease. These combination codes can be found under category K50 (Crohn’s Disease). 71

72 ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES FINAL CHARACTER FOR TRIMESTER The majority of codes in Chapter 15 have a final character indicating the trimester of pregnancy. The time frames for the trimesters are as follows: 1 st trimester – less than 14 weeks, 0 days 2 nd trimester – 14 weeks, 0 days to less than 28 weeks, 0 days 3 rd trimester – 28 weeks, 0 days until delivery 72

73 ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES If trimester is not a component of a code, it is because the condition always occurs in a specific trimester, or the concept of trimester of pregnancy is not applicable. Certain codes have characters for only certain trimesters because the condition does not occur in all trimesters, but it may occur in more than just one. 73

74 ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES Assignment of the final character for trimester should be based on the trimester for the current admission/encounter. This applies to the assignment of trimester for pre-existing conditions as well as those that develop during or are due to the pregnancy. 74

75 ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES Whenever delivery occurs during the current admission, and there is “in childbirth” option for the obstetric complication being coded, the “in childbirth” code should be assigned. 75

76 ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES UNSPECIFIED TRIMESTER Each category that includes codes for trimester has a code for “unspecified trimester”. The “unspecified trimester” code should rarely be used, such as when the documentation in the record is insufficient to determine the trimester and it is not possible to obtain clarification. 76

77 ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES NEW Assign a code from category Z3A (weeks of gestation) on the maternal record to provide additional information about the pregnancy. SAME Assign a code from category Z37 (Outcome of Delivery) on all maternal records where a delivery has occurred. 77

78 ICD-10-CM Coding Guidelines Chapter 19 includes codes for traumatic fractures, burns, complications of care (pain from devices, transplant complications other than kidney) as well as adverse effects, poisonings, underdosing and toxic effects. 78

79 ICD-10-CM Coding Guidelines Codes from category T36-T65 (Adverse Effects, Poisonings, Underdosing and Toxic Effects) are combination codes that include the substances related to the adverse effect, the poisoning, underdosing and toxic effect as well as the external cause of the poisoning, underdosing and toxic effect. 79

80 ICD-10-CM Coding Guidelines Most categories in chapter 19 have seventh character classifications that are required for each applicable code. Most categories in this chapter have three extensions (with the exception of fractures): A, initial encounter, D, subsequent encounter and S, sequela. 80

81 ICD-10-CM Coding Guidelines The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7 th characters are provided to identify subsequent care. For example, assign the acute care injury code with the seventh character “D” (subsequent encounter). 81

82 ICD-10-CM Coding Guidelines ADVERSE EFFECT The drug has been correctly prescribed and properly administered. Assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug The code for the drug should have a 5 th or 6 th character “5” (for example T36.0X5 Adverse effect of penicillins). 82

83 ICD-10-CM Coding Guidelines POISONING Poisoning is the improper use of a medication including overdose, wrong substance given or taken in error, wrong route of administration. Poisoning codes have an associated intent: accidental, intentional self-harm, assault and undetermined. Use additional code(s) for all manifestations of poisonings. 83

84 ICD-10-CM Coding Guidelines UNDERDOSING Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. 84

85 ICD-10-CM Coding Guidelines Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded. 85

86 ICD-10-CM Coding Guidelines PRESSURE ULCERS Codes for pressure ulcers are combination codes that identify the site of the pressure ulcer as well as the stage of the ulcer. 86

87 ICD-10-CM Coding Guidelines Code based on severity using stages 1-4, unspecified and unstageable Unstageable = Cannot be clinically determined – not the same as unspecified Healed: Do not code pressure ulcers documented as healed on admission Healing: Code to stage documented in record Evolution of stage throughout admission: code the highest stage reported for that site 87

88 ICD-10-CM Coding Guidelines PRESSURE ULCERS The pressure ulcer category has specific coding instructions for gangrene -. “Code first any associated gangrene” 88

89 REFERENCES Ingenix OPTUM 2013 ICD-10-CM, The complete official draft code set TruCode 2013, 2Q CM.pdf. Prevention magazine, September 2013 issue, Answers Dr,Sanjay Gupta/The Neurosurgeon Published: Dec Marcel Levi Systematic review: 3-factor versus 4-factor prothrombin complex concentrate for warfarin reversal: does it matter? Voils SA, Baird B, Thromb Res 2012;130: Wikipedia.com A Fully Implantable Epiretinal Vision Prosthesis for Retinitis Pigmentosa Patients Thomas Schanze, Uwe Thomas, EpiRet GmbH, Winchester Straße 8 D Gießen Blind patients implanted with this prosthesis can perform spatial and motion tasks. BY CONNI BERGMANN KOURY, EDITOR-IN-CHIEF 2-sight.eu/en/product-en 89


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