ICD-10-CM 2017 Guideline Changes: Laterality, Coma and Stroke Scale, and Complications of Care

In the last edition of “In the kNOW”, the spotlight was on the ICD-10-CM guideline changes from Section I.A addressing conventions for the ICD-10-CM.  This included the expanded guideline concerning the term “with” and a new guideline on diagnosis code assignment and clinical criteria.  The next part of conventions, general coding guidelines, and chapter specific guidelines that will be reviewed will cover I.B (General Coding Guidelines).
 
The first guideline with an update in Section I.B is 13 which focuses on laterality.  Coders are instructed on the appropriate way to code bilateral conditions when that condition is treated in separate encounters.  This revised guideline states that the bilateral condition should be coded as such even during the first encounter to treat the condition, as at that time both side are still affected.  After treatment of one side which corrects the condition, only a unilateral code should be assigned for a second visit, since the condition is now only present on one side.  The exception to this is if the original treatment did not completely resolve the condition, then the bilateral code assignment would still be warranted.

Section I.B.14 presents the next guideline change and discusses the inclusion of the coma scale and NIH stroke scale (NIHSS) documentation.  This is the same guideline that provides information for BMI, pressure ulcer stages, and depth of non-pressure ulcers.  Under the revision, coders are instructed that they may take the documentation of the coma scale from an emergency medical technician, much as they might take the BMI from a dietitian.  There is a reminder that the diagnosis of acute stroke must be provided by the physician.  Further, coders are reminder that the diagnoses of coma scale and NIHSS-like BMI- may only be used as secondary diagnoses.
 
The final guideline change to Section I.B is to guideline 16 where documentation of complications of care is outlined.  A small change was made to the wording in this guideline which explains that the coding of a complication of care must be based on the physician’s documentation indicating a relationship between the condition and the care or procedure provided, unless otherwise instructed by the classification.  Those final words presented in bold are the revision to the guideline and simply allow coders to assign complications if directed by the classification system.
 
The next “In the kNOW” will begin to highlight changes under the chapter specific guidelines.   

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.

ICD-10-CM 2017 Guideline Changes: Excludes1 Notes, "If Applicable", and More!

October 1, 2016 will be bringing significant updates to the ICD-10-CM guidelines and this segment of “In the kNOW” will highlight some of those updates.  Other editions of “In the kNOW” will continue to explore more of these changes.

The first updates to examine are in Section I of the guidelines which address conventions, general coding guidelines, and chapter specific guidelines.  Section I. A (Conventions for the ICD-10-CM) has four changes, the first of which addresses Excludes1 notes (I.A.12.a).  An Excludes1 note tells coders that two conditions should never be coded together.  This update explains that there is an exception to this rule that occurs when the two conditions are not related.  If in doubt about whether or not the conditions are related, coders are instructed to query the physician.  This guideline update is an affirmation of the Coding Clinic advice published in 4^th quarter 2015 which provided the same guidance.

A smaller change is found at Section I.A.13 (Etiology/manifestation convention) where the phrase “if applicable” was inserted to clarify the ICD-10-CM’s convention that requires the underlying condition be sequenced first, if applicable, followed by the manifestation. 

Section I.A.15 has perhaps the most significant change of all and that is guidance on the interpretation and usage of the term “with”.  Coders have known that “with” can be interpreted to mean “associated with” or “due to”.  Now coders are instructed that there is a presumption of a causal relationship whenever two conditions are linked by those words or phrases whether in the Alphabetic Index or the Tabular List.  Coders are further directed to code those conditions as if they are related even in the event there in no physician documentation that officially links them, unless there is clear documentation that the conditions are unrelated.  If these relational terms are absent in the classification, then the documentation provided by the physician must link the conditions in order to code them as related.  The content of this guideline is supported by the 1^st quarter 2016 Coding Clinic’s advice on coding “diabetes, with.”  

The final guideline change for Section I.A is a new guideline at Section I.A.19 (Code assignment and Clinical Criteria).  This guideline clarifies that diagnosis codes are to be based on the provider’s diagnostic statement that the condition exists.  This statement is sufficient documentation in order to assign a code, and coder’s do not have to base the code assignment on the clinical criteria that a provider may have used to determine the diagnosis.  

These final two guideline changes are sure to generate a great deal of discussion over the next months.  Stay tuned for further clarifications should they become available.

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.

ICD-10-PCS 2017 Guideline Changes: Multiple Procedures, Distinct Sites, Autografts

This installment of “In the kNOW” will continue to share ICD-10-PCS changes that will impact coders come October 1, 2016.  The focus in this issue will be on changes to the PCS guidelines.   

There were a few guidelines with minor wording changes or inclusion of more examples.  For instance, in guideline B3.2 that addresses the coding of multiple procedures that are performed during the same operative episode, a new example states that if there are multiple lesions being excised from the colon from different body parts (ascending and descending), then code both procedures.  

B3.4a clarified an example by providing additional information.  So the example “Fine needle aspiration biopsy of the lung”, now reads “Fine needle aspiration biopsy of fluid in the lung”.  The remainder of the example is the same, specifying that “Drainage” is the appropriate root operation for this procedure and a Diagnostic qualifier should be used for the biopsy.

The first major change to the guidelines occurs with B3.6b and shifts the focus from the number of distinct sites in coronary arteries to the actual number of coronary arteries involved.  Coders will see that the entire first sentence of the 2016 version of the guideline that specified “distinct sites” has been deleted.  In the last sentence the phrase “artery sites” was replaced with “arteries” to complete the switch.  No longer should coders code by number of arterial sites, but under these 2017 revisions, code the actual number of arteries.  This is reiterated in guideline B4.4 where the wording is changed from “number of sites treated” to “number of arteries treated”.  Coders are then instructed to use one procedure code specifying multiple arteries in situations where the same procedure is performed which would include the same device and qualifier values.     

The revision to B3.7 supports the root operation revision that was discussed in our first “In the kNOW” article.  It simply adds the phrase “or other acute bleeding” to the definition of “Control” and then proceeds to address the need to use a more definitive root operation in the event the bleeding remains uncontrolled.

The last change to discuss is that B3.9 was revised from “If an autograft is obtained from a different body part” to “If an autograft is obtained from a different procedure site”.  The remainder of the guideline stayed the same stating that a separate procedure for getting the graft should be coded, if it was necessary for completing the objective of the procedure. 

This link will direct you to the CMS webpage for everything ICD-10-PCS related: https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-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.

ICD-10-PCS 2017 Changes: New Root Operation "Perfusion", "Control" and "Creation" Revised

“In the kNOW” newbreaks are a new OHIMA coding feature for our membership.  The first “In the kNOW” will highlight some of the ICD-10-PCS changes that will impact coders come October 1, 2016.

One year after implementation of ICD-10, coders will be bombarded with thousands of new codes, not to mention some significant changes to guidelines and root operations.  This installment presents the changes to ICD-10-PCS 2017 root operations.  There is one new root operation that will be effective on October 1, 2016 and that is “Perfusion”.  This new root operation is found in the Extracorporeal Therapies section and is defined as “extracorporeal treatment by diffusion of therapeutic fluid.”

The root operation “Control” was revised.  The definition expanded from “the stopping or attempting to stop postprocedural bleeding” only, to now state “the stopping or attempting to stop postprocedural or other acute bleeding.”  Coders should determine if the method to control the bleeding involved any other (more specific) root operation such as “Resection”, “Bypass”, or “Extraction”, in which case the more specific root operation would be assigned instead of “Control.”

The other significant root operation revision involves “Creation”.  The previous definition of “Creation” limited its application to sex change operations only as it was for the “making of a new genital structure that does not take over the function of a body part”.  The revised definition for “Creation” is “putting in or on biological or synthetic material to form a new body part that to the extent possible replicates the anatomic structure or function of an absent body part”.  In addition to continued use for gender reassignment surgery, the revised definition expands application to include procedures that will correct congenital anomalies; for example, creating right and left atrioventricular valve from the common atrioventricular valve.  

This link will direct you to the CMS webpage for everything ICD-10-PCS related: https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-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.

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