ED Coding and Reimbursement Alert

Hypertension codes have less specificity except when reported with chronic kidney disease

ICD-10 Chapter 9 contains conditions from a wide range of cardiovascular diseases such as acute rheumatic fever, chronic rheumatic and other forms of heart diseases, diseases or arteries, arterioles and capillaries, diseases of veins, lymphatic vessels and lymph nodes and several other and unspecified disorders of the circulatory system. You will want to brush up on these since they account for nearly 20 percent of level 5 ED visits.

Don’t Worry About Hypertension Type When Assigning Your ICD-10 Diagnosis Codes

Unlike most translations where there is much more specificity than in ICD-9, the type of hypertension (benign, malignant, and unspecified) is not used in ICD 10 CM; there is only one code for essential hypertension (I10). Additional diagnosis codes may be required to identify additional conditions such as heart failure/heart conditions, type of heart failure and heart conditions with hypertension that do not have a causal relationship, says Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, AHIMA Certified ICD-10 Instructor and President, Edelberg Compliance Associates.

For example: Report hypertensive kidney disease with the following conditions:

• Assumes a cause-and-effect relationship between hypertension and kidney disease
• If chronic kidney disease is present, hypertensive chronic kidney disease is coded with category I12
• Stage I, II, III, IV, or end stage should be identified from N18
• If acute renal failure is present, code it as an additional diagnosis

If hypertensive heart and chronic kidney disease are both diagnosed, code combined from the I13 family. Chronic kidney disease is identified as a secondary diagnosis. Hypertension and chronic kidney disease are not reported separately, because you should assume a relationship between these conditions, even if not explicitly stated in the chart documentation. However, if acute renal failure is documented along with the chronic kidney disease, it should be coded separately, Edelberg explains.

You Can’t Have TMI When Coding For AMI

You will want to remember these tips for reporting cardiovascular emergencies. Myocardial Infarction is divided into three distinct levels; acute, unspecified and subsequent acute. The default code for unspecified term acute MI is I21.3 (ST elevation STEMI myocardial infarction of unspecified site) is. If it is a subsequent MI, which is defined as within 4 weeks of initial AMI, then two codes are required; one from I22 (subsequent STEMI and non-ST elevation [NSTEMI]); and a second, I21 for the current MI. Sequencing is dependent on documentation of the circumstance of the encounter.

What to document: Work with providers to remind them of the importance of documenting prior MI’s, particularly those that have occurred within four weeks prior to the patient’s ED visit, warns Edelberg.

Don’t Let Choosing An Angina Diagnosis Cause You Chest Pain

ICD-10 has combination codes for atherosclerotic heart disease with angina pectoris. When using one of these combination codes, you won’t need an additional code for angina pectoris. A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis.

Documentation tip: ED physicians need to use the term “angina” instead of chest pain or to specify the chest pain as ‘ischemic’ chest pain, which is an inclusion term for angina pectoris, unspecified, Edelberg advises.

Breathe Easy With These ICD-10 Respiratory Coding Tips

Chapter 10, Diseases of the Respiratory System, also includes many common ED presentations such as pharyngitis ,bronchitis, pneumonia, asthma, and emphysema. As with diseases of the circulatory system in Chapter 9, additional codes are required to identify exposure, history, dependence and use of tobacco/tobacco smoke.

Coders will want to review the ICD-10 Z codes that describe factors influencing health status and contact with health survives for relevance to ED respiratory related presentations. For example, the additional codes related to tobacco use include Z87.891 (Personal history of nicotine dependence), Z77.22 (Contact with and expected exposure to environmental tobacco smoke), Z57.31 (Occupational exposure to environmental tobacco smoke), and Z72.0 (Tobacco use). Most of the respiratory conditions require assigning these additional codes. Also in this category of respiratory diagnoses is status post administration of TPA in a different facility within the past 24 hours prior to admission to the current facility), another condition that requires provider documentation on a consistent basis, says Edelberg.

Look for Specific Documentation Of The Location Of Upper Respiratory Infections

ICD-10 is specific about the anatomical location of the infection. Upper respiratory infections including nasopharyngitis, sinusitis, pharyngitis, tonsillitis, laryngitis and tracheitis, obstructive laryngitis and epiglottitis, and upper respiratory infections, when acute with no underlying conditions are all speartae headings in Chapter 10.

Watch For Underlying Conditions With Pharyngitis Diagnoses

How you code that “sore throat” can make the difference in whether is supports a level 2 or a level 4 ED visit. Acute pharyngitis is coded only when the underlying condition cannot be identified in the documentation. Higher specificity supports testing and the medical decision making which, in turn, supports medical necessity for claims. Acute pharyngitis includes acute sore throat, streptococcal pharyngitis, acute pharyngitis due to other, unidentified organisms, and unspecified pharyngitis which includes the following acute conditions gangrenous pharyngitis, infective pharyngitis, pharyngitis NOS, sore throat NOS, suppurative pharyngitis and ulcerative pharyngitis, says Edelberg.

Don’t Forget To Recognize The Influence Of Influenza

This category requires coding of the associated influenza if applicable. Pneumonia with unspecified organism includes Bronchopneumonia w/unspecified organism; lobar pneumonia w/unspecified organism; Hypostatic pneumonia, with unspecified organism, other pneumonia, with unspecified organism and pneumonia w/unspecified organism, she adds.