MAY 9, 2016 INDIANA HEALTH INFORMATION MANAGEMENT ASSOCIATION ANNUAL MEETING INDIANAPOLIS, IN Danita Forgey Consulting

Tobacco Use

Contact with a knife?

Immunizations Z23 3E0234Z

7 th Digit Extensions When is a first visit a subsequent encounter and a second visit an initial encounter?

What We Have Learned Coding Guidelines Common Findings for ICD-10-CM/PCS Errors Updates from 1 st quarter Coding Clinic Danita Forgey Consulting

Coding Guidelines Excludes notes Code freeze prevented corrections prior to 10/1/16 If two conditions are unrelated, both codes can be assigned even with an excludes 1 note Coding Clinic 4 th quarter 2015, pg 40 Danita Forgey Consulting

Coding Guidelines X qualifier for ICD-10-PCS X = diagnostic Used for a biopsy or diagnostic procedure Danita Forgey Consulting

ICD-10-CM Infectious organisms Bacterial infection of unspecified site A49 Bacterial agents as the cause of disease classified elsewhere B96 Danita Forgey Consulting

ICD-10-CM Abscess and cellulitis Spinal stenosis Knee osteoarthritis Elevated D-dimer Danita Forgey Consulting

ICD-10-CM Edema Localized R60.0 Generalized R60.1 Unspecified R60.9 Danita Forgey Consulting

Obstetrics Principal Diagnosis Main circumstances or complications of the delivery Definition of principal diagnosis still applies Cesarean Reason for cesarean is principal diagnosis unless another condition meets definition of principal diagnosis Two or more conditions equally meeting the definition of principal diagnosis

Obstetrics Rh Incompatibility Rh- mother receives prophylactic Rhogam during admission O26.893, other specified pregnancy related conditions Can also assign code from Z67 category; Rh negative Danita Forgey Consulting

Non-obstetric Conditions Complicating Pregnancy O99.0_, anemia O99.1_, other diseases of blood/blood-forming organs O99.2_, endocrine, nutritional and metabolic Includes obesity and other O99.3_, mental disorders/nervous system diseases O99.4_, circulatory system O99.5_, respiratory system O99.6_, digestive system O99.7_, skin and subcutaneous O99.8_, other specified Includes abnormal glucose, streptococcus B and other infection carrier status, bariatric surgery status O99.89 – other specified diseases and conditions Danita Forgey Consulting

Anemia Anemia in chronic diseases classified elsewhere Neoplastic disease Chronic kidney disease Other chronic diseases classified elsewhere Sequencing Danita Forgey Consulting

Colon Polyps Hyperplastic polyps Coded to K63.5, colon polyp Adenomatous polyps Assign a code from D12, benign neoplasm Fourth digit indicates specific segment of colon Danita Forgey Consulting

COPD Exacerbation J44.0 COPD exacerbation with acute lower respiratory infection With pneumonia Sequencing Danita Forgey Consulting

Central Venous Catheter Insertion Body part value is the end placement of the device Can use postplacement x-ray Cavoatrial junction = Superior vena cava Coding Clinics: 3 rd quarter 2013, pg 18 3 rd quarter 2014, pg 5 4 th quarter 2015, pg 26 Danita Forgey Consulting

Sterilization Procedures Occlusion of the fallopian tube(s) Body system: Female reproductive (U) Root operation: Occlusion (L) Body part: right and left fallopian tube (5, 6), bilateral fallopian tubes (7) Approach: Open (0), percutaneous (3), percutaneous endoscopic (4), via natural or artificial opening (7), via natural or artificial opening endoscopic (8) Device: Extraluminal device (C), intraluminal device (D), none (Z) Qualifier: None (Z) Danita Forgey Consulting

Sterilization Procedures Tubal procedures Body system: Female reproductive (U) Root operation: Destruction (5) Body part: right and left fallopian tube (5, 6), bilateral fallopian tubes (7) Approach: Open (0), percutaneous (3), percutaneous endoscopic (4), via natural or artificial opening (7), via natural or artificial opening endoscopic (8) Device: None (Z) Qualifier: None (Z) Danita Forgey Consulting

Sterilization Procedures Tubal procedures Body system: Female reproductive (U) Root operation: Excision (B) Body part: right and left fallopian tube (5, 6), bilateral fallopian tubes (7) Approach: Open (0), percutaneous (3), percutaneous endoscopic (4), via natural or artificial opening (7), via natural or artificial opening endoscopic (8) Device: None (Z) Qualifier: None (Z) Coding Clinic 3 rd quarter 2015, pg 31 Danita Forgey Consulting

Obstetrics Perineal lacerations 1 st degree – perineal skin and vaginal mucosa 2 nd degree – perineal body and deeper tissues 3 rd degree – capsule and muscle of the anal sphincter 4 th degree – through the sphincter and into the anal/rectal mucosa Danita Forgey Consulting

Obstetrics Perineal laceration repairs 1 st degree: 0 HQ 9 XZZ, Repair perineum skin, external approach 2 nd degree 0 KQM 0 ZZ, Repair perineum muscle, open approach 3 rd degree 0 DQR 0 ZZ, Repair anal sphincter, open approach 4 th degree 0 DQP 0 ZZ, Repair rectum, open approach Danita Forgey Consulting

Heart Failure Heart failure with preserved ejection fraction Diastolic heart failure May also be called preserved systolic function Heart failure with reduced ejection fraction Systolic heart failure May also be called low ejection fraction or reduced systolic function Danita Forgey Consulting

Diabetes Cause and effect assumed with Chronic kidney disease Polyneuropathy Circulatory system Cause and effect also assumed with foot ulcer Cause and effect is NOT assumed for osteomyelitis Danita Forgey Consulting

Diabetes Alphabetic index Polyneuropathy in (due to) diabetes Danita Forgey Consulting

Hemorrhage due to anticoagulant Assign code for site of hemorrhaging Assign D68.32, Hemorrhagic disorder due to extrinsic circulating anticoagulant, Assign T , Adverse effect of anticoagulants Danita Forgey Consulting

ICD-10-PCS Excision is root operation for brush biopsies Drainage is root operation for bronchoalveolar lavage Danita Forgey Consulting

Endarterectomy Plaque extending from one artery into an adjacent branch is one continuous lesion Assign one procedure code with a body part value for the anatomical site furthest from point of entry Endarterectomy started at the femoral bifurcation and into the external iliac is coded to the external iliac Endarterectomy started at the common carotid and ending in the external carotid is coded to external carotid Danita Forgey Consulting

HPV Screening Preventative service every 5 years Ages Retroactive to 7/9/15 HCPCS code G0476 Must be billed by a lab entity until 1/1/17

HPV Screening Diagnosis codes Z11.51, encounter for screening for HPV WITH Z01.411, encounter for gynecological exam with abnormal findings OR Z01.419, encounter for gynecological exam (general)(routine) without abnormal findings CMS; MLN Matters Number: MM9434; Screening for Cervical Cancer with Human Papillomavirus (HPV) Testing —National Coverage Determination (NCD)

Resources Leon-Chisen, Nelly; ICD-10-CM and ICD-10-PCS Coding Handbook 2016; American Hospital Association, 2016 Centers for Medicare and Medicaid Services and National Center for Health Statistics; ICD-10-CM Official Guidelines for Coding and Reporting; FY2016 Centers for Medicare and Medicaid Services and National Center for Health Statistics; ICD-10-PCS Official Guidelines for Coding and Reporting; FY2016 American Hospital Association; Coding Clinic for ICD- 10-CM/PCS