It’s a Wonderful Life?

by Dianna Foley, RHIA, CHPS, CCS 


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

Each year the Klutz family observe the tradition of watching “It’s a Wonderful Life” together during the holiday season.  Each of the children has a favorite part, related of course, to an injury or poisoning.  For some coding fun, assign the ICD-10-CM codes to each Klutz child’s preferred section of the beloved movie.

Egon is partial to the part where George gets a bloody (cut) lip from a punch by the bartender in the bar brawl.

Janine favors George’s loss of hearing (left ear) related to being in the icy pond water while saving his brother from drowning.

Peter chooses the drowning of Harry in the pond, which would happen if George never existed.

Raymond prefers the scene between George and Mr. Gower in the drugstore, when the old pharmacist strikes George and causes his sore ear (left) to bleed.

Little Dana, although very young, has been taught about Mr. Yuk and poisonings, so she is fixated on the child that was poisoned and died at home as a result of Mr. Gower’s medication error in the alternate universe of a Bedford Falls without George Bailey.

Click HERE for the answers.

Endovascular Revascularization

This edition of “Spotlight on CPT” examines endovascular revascularization of the lower extremities.  These procedures are performed when patients have occlusive peripheral vascular disease.  All the codes in this section (37220-37235) apply regardless of whether the procedure is performed via an open or transcatheter percutaneous approach.  Every code in this section includes balloon angioplasty if it is performed.

This series of codes has several inclusive components:

• Access and/or selective catheterization of vessel
• Radiological supervision and interpretation related to intervention
• Embolic protection
• Arteriotomy closure by pressure 
• Application of closure device 
• Imaging which documents the intervention and completion of the procedure

The procedures that are included in these revascularizations are transluminal angioplasty, atherectomy, and stent placements.  Three arterial vascular territories are addressed with these codes: iliac, femoral/popliteal, and tibial/peroneal. 

• Iliac vessels-common iliac, internal iliac, and external iliac
• Fem/Pop vessels-this territory is considered one vessel for these procedures
• Tibial/Peroneal vessels-anterior tibial, posterior tibial, and peroneal (the common tibio-peroneal trunk is part of this territory, but not considered a separate vessel)

Each of these vascular territories have specific coding guidelines.  For example, in the fem/pop territory there are no add-on codes, only the most extensive procedure is coded.  More specifics can be found in the notes that precede this series of codes. 

These revascularization procedures are built on a hierarchy.  Coding professionals should assign a code for the most intensive services provided per vessel treated.  Add-on codes are used to assign codes for additional vessels within a territory, not when distinct lesions are treated in the same vessel.  Multiple stent insertions in the same vessel are only reported once.  When an occlusion traverses two vessels, for example the common iliac and into the internal iliac, and is treated with one intervention (stent) across both vessels, only one procedure is coded.  This would be coded to 37221 and no additional code would be assigned.  However, if there are bifurcation lesions requiring intervention in distinct branches of the iliac or tibial/peroneal territories, then two codes would be assigned. 

If procedures such as mechanical thrombectomy or thrombolysis are performed to address the occlusion, they should be separately reported. 

Now, light has been shed on coding endovascular revascularizations.

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.

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!


Click HERE for the answers.

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. 

Make sure you check out the OHIMA Career Center for job opportunities!  It's free for Job Seekers!

Do you have a question??  Ask an HIM expert!  We will do our best to answer questions on any topic ranging from HIM, management, beginning your HIM career, CEUs, OHIMA, AHIMA, etc.!  Submit your question HERE.

Halloween Howlers

by Dianna Foley, RHIA, CHPS, CCS 


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

This Halloween each Klutz child went to a different party and of course, ended up with an injury.  See what transpires.

Raymond participated in a donut-eating race at the church party he attended and choked on the donut.  Quick thinking with some swift slaps on the back dislodged the offending food from his throat.  Little Dana went to a party at her friend Julia’s house where there was a mummy wrapping event.  Her partner wound so much toilet paper around her feet and ankles that little Dana tripped and fell on the sidewalk ending up with a big abrasion and bruise on her nose.  At the Boy Scout party Peter attended in the nearby forest, each child was carving a small pumpkin.  He slipped with the knife and had a superficial laceration on the palm of his left hand.  Egon went to the party at the high school where he dislocated the left side of his jaw while bobbing for apples.  It just so happened that one of the parents chaperoning the party was a dentist and knew just what to do to pop it back into place. Finally, Janine and a few girlfriends had a sleepover where they decorated each other with face paint in the bedroom of her best friend’s trailer.  Unfortunately, Janine developed an allergic urticaria to the paint and had to go home.  All-in-all minor mishaps for the Klutz children…at least this Halloween.

Click HERE for the answers.