Master R Codes: Dive Deep Into ICD-10-CM Chapter 18 Coding Guidelines

This is an Ask & Learn session about ICD-10-CM’s R codes, presented by John Piaskowski and the Coding Advisory Team: LaTonya Atkinsons, Linda Renner, Claire Stevenson, and Natasha Timberlake. This webinar will focus mainly on the proper use of R codes, located in Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99). This open discussion explains codes R00-R99 and the related signs and symptoms that help differentiate them when selecting correct diagnosis codes.

Using R codes can get tricky because there are many similar guidelines for alike types of diagnostic situations. These codes are typically used when a definitive diagnosis has not yet been established by the healthcare provider, and they cover a wide range of symptoms and signs, from changes in skin color to abnormal cardiovascular examination results. This session talks about multiple impacting factors such as sequalae, manifestations, combination codes, and how they differ from signs and symptoms of confirmed conditions. It also explores elements of queries, risk adjustment, and documentation standards related to coding signs and symptoms.

Some example questions and answers in the webinar include:
• What is the American Medical Association (AMA) definition of a sign and symptom?
• My provider always codes a primary conditions and codes its signs and symptoms. How can I correct this?
• My provider documents signs and symptoms in addition to the presumed related primary diagnosis. How do I know if it related?
• My provider is seeing a patient for their annual wellness exam. One finding they documented was ataxia with history of stroke. Would this be captured with R27.0 and Z86.73?
• ICD-10-CM states to code dementia with Alzheimer’s when they are both present. Isn’t dementia a sign and symptom of Alzheimer’s?
To find out the answers to these questions download the webinar today!

Learning Objectives/Agenda

• The American Medical Association (AMA) definition of signs and symptoms

• How to correctly apply ICD-10-CM guidelines and critical thinking in selecting the chief reason for an inpatient admission

• How R codes can be listed as the primary diagnosis in the absence of a real confirmed diagnosis

• That when signs and symptoms are integral to a condition, they do not need to be coded with the primary condition

• How to handle situations and coding when the code choices are uncommon signs and symptoms

• How R codes and coding guidelines interact and their relationship to how they are coded

Why is this topic important?

This topic is important because at a core level, knowing the distinction between signs, symptoms, and primary conditions are vital for maximizing your diagnosis code selection without redundancy. This can be a tricky task for both new and experience coders because provider have different perspectives than coders. To help overcome this, coders must be consistent and documentation complete. A constant review of the guidelines is key to making correct coding a routine.

Who would benefit from this topic?

• Coders of all levels
• New coders and those looking for expertise in selecting diagnosis codes
• Providers
• Coding and billing managers
• Risk adjustment coders
• Clinical documentation integrity specialists

What’s the presenter's background/expertise on this topic?

Piaskowski has 13 years of experience in surgical documentation and the impact it has on coding and auditing. He is a certified as an AAPC instructor and holds certifications in medical auditing, cardiology, cardiovascular and thoracic surgery, interventional radiology, urology, general surgery, gastroenterology, orthopedic surgery, and risk adjustment coding. Piaskowski is the chairperson of the AAPC Coding Advisory Committee and AAPC Surgical SME that sat on multiple exam committees. He works as a specialty medicine auditor at Capital Health in New Jersey and is a vascular surgery/interventional radiology auditor for AAPC Audit Services, and a content creator for AAPC.

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