Wiki 3M discrepancies vs index

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SBilb89

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Does anyone know how 3M arrives at their codes? I don't use it, but my contracted company does, and so they will often correct my codes based off of 3M, but I can' t arrive at the code 3M suggests using the index the old-fashioned way.
For example, for radiation necrosis of soft tissue 3M told them L59.8, which description-wise makes perfect sense to me- except that I can't arrive at that code via the index.

I've always operated under the principle that if I can't show how I arrive at a code through the index- I don't use it.

Here’s what I tried:
    • Radiation – no subentry for necrosis
    • Disorder, soft tissue – nothing related to radiation
    • Complication, radiation – no relevant entry
    • No entry at all for radionecrosis
Another example is for code T81.89, 3M tells them that there is a "use additional code" note to further describe the complication, but in codify and in my book I do not see that note under T81 at all.

I know 3M is supposed to be the best, most high-tech encoder, but frankly I don't trust it.
 
There is a Coding Clinic for this one - it is cited in the ICD-10-CM manual as well:

AHA: 2017, 1Q, 33

Question:

The patient developed necrosis of the skin and soft tissue because of radiation therapy. ICD-10-CM's Alphabetic Index under necrosis, radiation states, "see Necrosis, by site." However, there is no entry for soft tissue necrosis. What is the appropriate code assignment for soft tissue radionecrosis (STRN)?

Answer:

Assign code L59.8, Other specified disorders of skin and subcutaneous tissue related to radiation, for skin and soft tissue radionecrosis and code Y84.2, Radiological procedure and radiotherapy as the cause of abnormal reaction of the patient or of later complication without mention of misadventure at the time, to describe the external cause.
 
Also, I wanted to add that T81 wouldn't be the category for complications from radiation therapy. It would be T66. (From the index: Effect, adverse - radiation (diagnostic) (infrared) (natural source) (therapeutic) (ultraviolet) (X-ray) NOS which directs to the T66 category.)

T66 does have a subentry for skin directing to L59.9, though not a specific subentry for soft tissue. The T66 code does have an Excludes note for the specified adverse effects of radiation, which includes radiation-related disorders of the skin and subcutaneous tissue (L55-L59.9).

Of course, it's the Coding Clinic that gives the definitive guidance on using the L59.8 for the necrosis of skin and soft tissue. Just sharing the above for how you might even get in the L59.- ballpark to see that there is a reference to a coding clinic for L59.8
 
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