Home Health Coding and OASIS Expert

Mind this acute change with myocardial infarctions.

As a home health coder, you need a thorough understanding of how to code for hypertension, myocardial infarctions, late effects of strokes and other circulatory conditions. Give yourself a refresher on how coding for these conditions will change under ICD-10.

See what’s New in Chapter 9

The codes for reporting diseases of the circulatory system are outlined in Chapter 9 of your ICD-10 coding manual. While much of the same logic you use in ICD-9 will still be in place once you switch to the new code set, there are a few differences to make note of, said Judy Adams, RN, BSN, HCS-D, HCS-O, with Adams Home Care Consulting in Asheville, N.C. during her session at the Coding Institute’s 2014 CodingCon.

Hypertension: You’ll no longer see choices for malignant, benign, and unspecified among your hypertension code options in ICD-10. You’ll code for all essential (primary) hypertension with I10.

Acute MIs: In ICD-9, acute MI codes were appropriate for infarctions that occurred within the last eight weeks. In ICD-10, you’ll only list an acute code for MIs that occurred within the last four weeks.

Late effects: The same rules apply for home health when reporting the residuals of a stroke — don’t list an acute CVA code. But in ICD-10, you’ll stop referring to “late effects” and begin calling these conditions “sequelae.”

Dominant side: When reporting hemiplegia, hemiparesis, or monoplegia, in ICD-9, you’re asked to select whether the condition impacts the dominant or non-dominant side. But ICD-10 asks you to report whether the condition impacts the right or left side as well as the dominant or non-dominant side.

When the documentation indicates the affected side, but doesn’t tell you whether it’s the patient’s dominant or non-dominant side, you should make your ICD-10 code choice with the following guidance in mind:

• For ambidextrous patients, the default choice is dominant.
• If the left side is affected, the default choice is non-dominant.
• If the right side is affected, the default choice is dominant.

With these guidelines in mind, try coding the You Be the Coder scenario on page 29.