ICD-10-CM 2017 Guideline Changes: Ulcers, Fractures, High-Risk Pregnancies

The 6th edition of “In the kNOW” continues the review of I.C (Chapter-Specific Coding Guidelines) which are applicable to all healthcare settings. 
 
Chapter 12 (Diseases of the Skin and Subcutaneous Tissue) saw revisions to pressure ulcer guidelines.  These are very significant changes for coders to be aware of.  I.C.12.a.5 is the guideline for patients admitted with pressure ulcers documented as healing.  For pressure ulcers that were present on admission (POA) but healed at the time of discharge, coders are to assign the code for the site and stage of the ulcer at the time of admission.   The biggest change is seen in I.C.12.a.6 for patients admitted with pressure ulcers that evolve into another stage during the admission.  Coders are now being directed that to appropriately capture that condition will require two codes; one for the site and stage of the pressure ulcer at the time of admission, and one for the same ulcer site and highest stage reported during the patient’s stay.  

Chapter 13 (Diseases of the Musculoskeletal System and Connective Tissue) had one update at I.C.13.c under Coding of Pathological Fractures.  This guideline expands the description of the 7th character to include “routine care of the fracture during the healing and recovery phase as well” as treatment of complications of fractures such as malunions or nonunions, as well as sequela.

There are several guideline updates in Chapter 15 (Pregnancy, Childbirth, and Puerperium).  Supervision of high-risk pregnancy at I.C.15.b.2 states that O09 category codes are only for use during the prenatal period.  High-risk pregnancies that result in a complication arising during labor or delivery should be coded with the appropriate complication code(s).  If no complications occur, then O80 for uncomplicated delivery should be assigned.  I.C.15.b.4 provides guidance for an obstetric patient who is admitted and then delivers.  In cases like that, the condition that necessitated the admission should be the principal diagnosis, and in a case where multiple conditions caused the admission, the diagnosis most related to the delivery should be assigned as the principal diagnosis.  Any complications should be assigned secondarily.  I.C.15.h looks at long-term use of insulin and oral hypoglycemic drugs for OB patients who are diabetic.  This reiterates the new guidance in I.C.4.a.3 and I.C.4.a.6 for using Z79.84 for long-term use of oral hypoglycemic drugs just as Z79.4 is used for long-term insulin use.  Here there is additional information given that says if a patient’s diabetes is said to be controlled with both oral hypoglycemic drugs and insulin, then only code the insulin control.  I.C.15.i goes on to address gestational diabetes.  Codes in O24.4 are for diet controlled, insulin controlled, or oral hypoglycemic controlled diabetes.  If there is documentation of both diet and insulin control, only code the insulin.  If there is documentation of both diet and oral control, code only the oral.  The codes Z79.84 and Z79.4 are NOT to be used in addition to codes from O24.4.

Our next issue will explore the final Chapter-specific guideline changes to ICD-10-CM for 2017.

This link will direct you to the CMS webpage for everything ICD-10-CM related:
https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html
 
Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.