Black (and Blue) Friday

by Dianna Foley, RHIA, CHPS, CCS 


Test your ICD-10-CM coding skills with this Klutz family experience.



An annual Klutz family tradition is a Christmas shopping excursion to the nearby mall on Black Friday.  Each child is tasked with finding a gift for a child their age, which they then donate to their church for distribution to a needy family for Christmas.  Of course, no Klutz outing is complete without some injury or another, so read on to see what befalls the children this year.  Try your hand at coding the ICD-9-CM diagnosis and external cause codes for each injury.

Raymond was the first to find his gift, which was the last small tin full of toy soldiers.  As he grabbed it from the shelf, he was shoved from behind by another child who was reaching for the same toy, striking his forehead on the shelf, and netting himself a rather large contusion in the process.     
Little Dana found a “Little Miss Muffet” doll for her gift.  Unfortunately, as she was carrying it over to the cash register with her mother, she dropped it and when she reached to pick it up with her left hand, someone in the crowd stepped on her little finger.  Tears welled in her eyes, and her mother, who was an old hand at such injuries having four other children, realized that while it was going to be bruised, there was no broken bone. 

Janine decided on a coloring book of nature with an assortment of colored pencils.  Her injury came when she removed the pencils from the metal peg they were hanging from and accidentally jabbed her right thumb on the peg.  As a Klutz child, she knew to examine the area for a puncture, but saw the thumb was only developing a mild bruise, so it wasn’t going to require a tetanus shot, thank goodness!

Egon chose a football for the gift he would donate.  He was passing it to Peter (just to try it out, mind you!) when Peter became distracted by spotting the gift he would give, and the football hit him in the right eye.  Since, this wasn’t the first time Peter had had a black eye, he went to the vending machines, got a cold can of pop, and put it by his eye to help reduce the swelling.  On his way back, he picked up the robot building kit he’d seen earlier for the gift he would give. 

On the way back to the car, in the mall parking lot, Egon, who was carrying all the wrapping paper, boxes, and bows for the gifts, tripped and landed on his left knee.  It was clear there was a small hematoma over his left patella, but nothing broken. 

Mr. and Mrs. Klutz loaded the children into the car and went back home.  Pleased with their children and their spirit of the holidays as well as relieved there were no major injuries…on this excursion anyway!


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Diabetes 1.5

This edition of “In the kNOW”  shares information on proper coding for diabetes 1.5.  Most coding professionals are familiar with type 1 and type 2 diabetes.  Type 1 diabetes occurs when the pancreas does not produce insulin at all or very little.  This prevents cells from absorbing glucose necessary to produce energy and requires insulin administration for treatment.  Type 2 diabetes on the other hand can be due to either insulin resistance or insufficient insulin production with treatment either oral hypoglycemic medications or insulin.  

 

Diabetes 1.5 is also known as latent autoimmune diabetes in adults or LADA.  Where type 1 diabetes usually is diagnosed in childhood, type 1.5 diabetes is most often being identified in patients over 30.  Progression of the disease is slow, with initial management being similar to that for type 2: weight reduction, exercise, proper diet, and possibly oral medications.  As the disease progresses, which could be months to years, it will become necessary to switch to insulin as the main treatment.

Patients should be aware of the three P’s of diabetes.  These symptoms can often indicate that the patient is a diabetic: polyphagia (excess hunger), polyuria (excess urination), and polydipsia (excess thirst). 

Coding professionals know that type 1 diabetic conditions will fall into the E10 category: Type 1 diabetes.  Type 2 diabetes is found in category E11.  Type 1.5 diabetes will be category E13; Other specified diabetes.

A recent Coding Clinic from 2018, the third quarter, shares that if a physician indicates a patient has both type 1 and type 2 diabetes, that correlates to type 1.5 with category E13 being the appropriate category for coding that type of diabetes.

Coding professionals are reminded to use combination codes for diabetes “with” conditions.  Using type 2 diabetes in the following examples it would include conditions such as neuropathy (E11.40), hyperglycemia (E11.65), chronic kidney disease (E11.22), etc.  

It should also be mentioned, when the type of diabetes is not specified by the provider in the record, the default is type 2.  

Capturing the long-term use of insulin (Z79.4) or oral hypoglycemic medications (Z79.84) is also important when coding for diabetes.  While the classification does not require the use of the Z79.4 for insulin usage in type 1 diabetic patients, other types of diabetes have an instructional note reminding coders to add the long-term use of medication code as appropriate.  The long-term use of insulin may be coded for type 1 diabetics if a facility chooses.  A reminder that when insulin is used temporarily for a short-term control of type 2 diabetes, it should not be coded. 

 

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.

Professional Practice Experiences in an Evolving HIM World

All HIM students are required to complete professional practice experience (PPE) time in a HIM practice environment.  The most typical PPE environment is a HIM department at a healthcare organization (hospital, long term care facility, physician’s office, etc.), but many other opportunities exist, such as insurance companies, software vendors, or government agencies.  In recent years, the number of sites willing and available to host student PPEs have declined, so students and/or preceptors may need to get creative.  PPEs are critical learning experiences for students who have little to no background in the HIM field.

The traditional PPE is a one-on-one encounter between student and preceptor spread across days or weeks.  It covers a variety of topics and may include meetings, completing a project, or answering specific questions from the student’s homework assignments.  With the “do more with less” staffing approach that’s prominent in various industries, it’s becoming more complicated to get dedicated PPE preceptors for students.

One way to combat the lower number of PPE sites/preceptors is to hold group sessions.  In this manner, an organization will schedule dates, times, and topics for students to attend.  Instead of traveling around to meetings or visiting different physical departments at the organization, sessions are held in a conference or training room, and speakers are rotated through.  This experience is not as personalized as the traditional PPE but allows for many students to meet with a variety of professionals while minimizing the time commitment of the professionals.

 
With the increasing availability of technology, students are completing some PPE hours remotely.  CAHIIM does not allow the entire PPE time to be replaced with simulated activities; however, it has been possible for students to attend meetings or see a demo of the software via WebEx or similar teleconferencing programs.  This may be a more tailored discussion between preceptor and student than the group option, but it may not share important contextual information the student would likely see if he/she were present on site.

Although it takes much time and effort to be a PPE preceptor (been there, done that), it can lead to potential new employees, greater networking, and even earn you CEUs.  PPE preceptors and mentors can earn one CEU for every 60 minutes of direct contact with a maximum of five CEUs per student, and a maximum of ten CEUs allowed in each recertification cycle.

As with anything else in healthcare (and to go along with the 2020 Annual Meeting theme), change is inevitable.  We must learn to adapt without compromising the integrity of student education since the students of today are the workforce of tomorrow.  

About the Author 

Carol Barnes, MS, RHIA is currently a Director on the OHIMA FY19-20 Board in charge of the Professional HIM Development strategy.  Carol is an adjunct faculty with The University of Cincinnati HIM program.

Ask HIM: I'm looking for a coding job. What's the difference between a Coder II, III and IV position?

Question from Anonymous: Hi!  I recently obtained my CCS credential. As I look for jobs, I see Coder II and III and IV.  I've searched google and see different answers with no definitive answers.  Could someone please tell me the differences in those coding jobs? Thanks for your help!

Answer from OHIMA: Hello! Different coder levels may vary a bit from facility to facility.  But generally speaking, these are different experience levels.  If you look within the job description, each title/level should have a different set of skills and experience that is required. For example - if a facility has levels from I-IV, Coder I would be an entry level position; Coder IV would be the most experienced. 

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