ICD 10 Coding Alert

With a month of actually using ICD-10 updates under your belt, check in to make sure your coding choices are accurate.

You know that staying on top of ICD-10 updates is crucial to comprehensive and accurate coding and billing, and it’s important to make sure you’re on top of your game and utilizing the updated guidelines correctly.

“The importance of staying updated on ICD-10 Official Guidelines can’t be understated. Learning about changes second-hand can result in errors,” says Ray Cathey, PA, FAAPA, MHS, MHA, CCS-P, CMSCS, CHCI, CHCC, president of Medical Management Dimensions in Stockton, California. “The annual update is released every July, for services after October each year. The earlier you get the changes, the more prepared you are when they’re implemented.”

It’s important for coders to stay updated not only on the guidelines,  but also on coding clinics when they are published, as well as up-to-date coding books. All of these references provide vital information regarding correct coding, adds Cathy Morse, BA, CCS, CIC, coding supervisor of inpatient services at Wentworth Douglass Hospital in Dover, New Hampshire.

Don’t Miss Revisions to Myocardial Infarction Section

Subsequent MI: The section for “Subsequent acute myocardial infarction” has added an entirely new concluding paragraph.

If the patient experiences a subsequent myocardial infarction (MI) of one type within four weeks of a MI of a different type, then you should report the correct codes from category I21- (Acute myocardial infarction) to identify each type. You should not report a code from I22- (Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction) in this case, the guidelines caution.

You should only report codes from category I22- if both the initial and subsequent MIs are type 1 or unspecified, the guidelines maintain.

Other types of MI: If you look in the “Other types of Myocardial Infarction” section, you will see further clarification on which codes you should report for Type 1 MI. You should report codes I21.0 (ST elevation (STEMI) myocardial infarction of anterior wall) through I21.4 (Non-ST elevation (NSTEMI) myocardial infarction) and I21.9 (Acute myocardial infarction, unspecified) for Type I MI, according to the guidelines.

Understand Important Underdosing Clarification

In Chapter 19, e. 5. c. you will also find some new information about underdosing which is defined as “taking less of a medication than is prescribed by a provider or a manufacturer’s instruction,” according to the guidelines. Now, you should note that if a patient stops taking a prescribed medicine as his own choice, not as directed by his physician, this is also considered underdosing.

To report underdosing, you would look to Chapter 19 and pick a code from categories T36 through T50 (Poisoning by, adverse effects of and underdosing of drugs, medicaments, and biological substances). You should never report an underdosing code as the patient’s principal diagnosis.

Don’t miss: “If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded,” according to the guidelines.

Also, you should report noncompliance codes Z91.12- (Patient’s intentional underdosing of medication regimen); Z91.13- (Patient’s unintentional underdosing of medication regimen); and Z91.14- (Patient’s other noncompliance with medication regimen), or complication of care codes Y63.6 (Underdosing and nonadministration of necessary drug, medicament or biological substance) through Y63.9 (Failure in dosage during unspecified surgical and medical care) with the correct underdosing code to indicate intent, if known.

Note These Hurricane Aftermath Additions

The 2019 guidelines add new section I.B.19 in to the “General Coding Guidelines” section, which specify how you should code healthcare encounters during a hurricane’s aftermath. Take a look at the following external cause code rules to remember when reporting after a hurricane.

Rule 1: You should report external cause of morbidity codes to identify what caused the patient’s injuries as a result of the hurricane, per the guidelines. However, never report an external cause code as a patient’s principal diagnosis. Instead, you should sequence the correct injury code before an external cause code. Pertinent details that external cause codes describe include the cause of the injury; the intent; where the injury occurred; the patient’s activity at the time of the injury; and the patient’s status (whether civilian or military).

Important: In the aftermath of a hurricane, the guidelines consider a healthcare setting “any location where medical care is provided by licensed healthcare professionals.”

Rule 2: When it comes to sequencing, codes for hurricanes and other cataclysmic events should take priority over external cause codes, per the guidelines. So, you should sequence cataclysmic event external codes before other external cause of injury codes.

Exception to the rule: Child and adult abuse and terrorism external cause codes should take priority over all other external cause codes, including cataclysmic events.

Always report as many external cause codes as needed to fully describe each cause. If a patient sustains an injury as a direct result of the hurricane, report the correct code for his injuries, followed by X37.0XX- (Hurricane) (with the appropriate 7th character A, D, or S) and include any other applicable external cause of injury codes. Code X37.0XX- includes any injuries a patient receives as the result of flooding caused by a levee breaking related to the hurricane.

Beware: You should report X38.XXX (Flood) (with the appropriate 7th character) if the patient’s injury was caused from flooding resulting directly from the storm. However, do not report X36.0XX- (Collapse of dam or man-made structure causing earth movement) when the hurricane causes the collapse. Instead, you should only report X36.0XX- for collapses of man-made structures due to earth surface movements, not for storm surges caused by hurricanes.

Rule 3: If a patient sustains an injury that did not result directly from the hurricane, then you should report the correct external cause code to describe the injury’s cause, but do not report X37.0XX-. However, if it’s not clear whether the patient’s injury was a direct result of the hurricane, you can assume the injury was due to the hurricane and report X37.0XX-, per the guidelines, along with any other applicable external cause of morbidity codes.