1. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Linda Best 11.45 - 12.30 Thursday, 8th December 2011 Complex issues in coding

2. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding  Coding is not always simple  Complexity due to - Multiple different conditions - Multiple components of the one condition - Complex surgery - Multiple codes to translate the medical or surgical statement

3. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Multiple coding - Reflect the various components of a disease For example: Young’s syndrome N46Male infertility J98.4Other disorders of lung J47Bronchiectasis

4. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Multiple coding (cont) - Ensure the entire concept is captured For example: Laparoscopic hepatectomy 90346-00 [953] Total hepatectomy 30390-00 [984]Laparoscopy

5. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Multiple coding (cont) - When directed by a coding note For example: "Use additional code to identify presence of hypertension".

6. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding - Multiple conditions For example: Patient admitted with a stroke, hemiplegia and dysphagia, unstable hypertension, develops urinary retention, UTI, decubitus ulcer. Has longstanding emphysema and all these conditions are treated during the episode of care

7. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Codes I64Stroke, not specified as haemorrhage or infarction G81.9Hemiplegia, unspecified R13Dysphagia I10Hypertension R33 Retention of urine N39.0Urinary tract infection, site not specified L89.9Decubitus ulcer and pressure area, unspecified J43.9Emphysema, unspecified

8. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding (cont) - Multiple codes for a condition For example: Type 2 Diabetic patient with microvascular complications of end-stage kidney disease and retinopathy.

9. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Codes E11.71Type 2 diabetes mellitus with multiple microvascular and other specified nonvascular complications N18.5Chronic kidney disease, stage 5 H35.0Background retinopathy and retinal vascular changes

10. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding (cont) - Multiple codes for a condition For example: A patient with AIDS is admitted with a principal diagnosis of Kaposi sarcoma of skin, and additional diagnoses of wasting syndrome and CMV retinitis.

11. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Codes C46.0 Kaposi sarcoma of skin B21 Human immunodeficiency virus [HIV] disease resulting in malignant neoplasms H30.9 Chorioretinal inflammation, unspecified B25.8 Other cytomegaloviral diseases R64 Cachexia

12. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding (cont) - Multiple trauma Code for each injury Code for the external cause of the injury Code for the place of occurrence of the external cause Code for the patient’s activity at the time of the external cause

13. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding (cont) - Obstetrics Codes for antepartum conditions Codes for conditions related to labour and delivery Codes for postpartum conditions

14. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding (cont) - Obstetrics (cont) Additional codes for further specificity e.g. O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium Coding note “Use additional code to identify specific condition” Outcome of delivery

15. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding (cont) - Medical and surgical complications Code for each complication (+/- site code) Code for the external cause of the complication Code for the place of occurrence of the external cause

16. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding (cont) - Complex surgery ‘Code also notes’ For example: 40903-00[1] Neuroendoscopy Intraventricular neuroendoscopy Code also when performed: insertion of shunt (40003-00, 40003-01, 40003-02, 40003-03 [5]) third ventriculostomy (40012-00, 40012-01 [19])

17. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding (cont) - Complex surgery (cont) Need to capture all components For example: CABG x3 using LIMA and saphenous vein x2 under GA, ASA 3 with CPB. Post-op required 30 hours of ventilation.

18. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Codes 38500-00 [674] Coronary artery bypass, using 1 LIMA graft 38497-01 [672] Coronary artery bypass, using 2 saphenous vein grafts 38600-00 [642] Cardiopulmonary bypass, central cannulation 92514-39 [1910] GA, ASA 3 13882-01 [569] Management of continuous ventilatory support, > 24 and < 96 hours

19. Serbia Health Project – Additional Financing Training for Trainers on AR-DRG, 05-09.12.2011 Република Србија МИНИСТАРСТВО ЗДРАВЉА Complex coding cont.  Complex coding (cont) - Specialty standards Viral Hepatitis Tobacco use Outcome of delivery Personal history