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This presentation is geared to the inpatient coder, and it will cover the correct ICD 10 PCS coding for both open and percutaneous heart valve replacements. We will discuss normal intraoperative and post operative care versus abnormal intraoperative events and post operative care. This discussion will take a hard look at what is separately billable and what is not. We will look at when it is appropriate to code post operative respiratory insufficiency and acute blood loss anemia.

The presentation will cover the anatomy of the heart valves and how this impacts diagnosis code assignment. Non-rheumatic valvular disease is often incorrectly assigned as the principal diagnosis, can you guess why? All of this will incorporate what needs to be documented to support coding. We will review correct ICD 10 PCS code assignment for the surgery.

Learning Objectives/Agenda

• Understand the anatomy for each valve in the heart and the physiology of opening the chest cavity.
• Learn when it is appropriate to code post operative complications versus expected post operative care for open heart surgery.
• Be able to determine the appropriate diagnosis for the valve dysfunction
• We will look at the correct criteria for appropriate queries to address complications of care
• Learn how to correctly assign PCS codes for the surgery based on approach and technique.

Why is this topic important?

I see a great number of denials with high dollar impact to hospitals where these surgeries have been miscoded. The diagnoses and the procedures add weight to the DRG and need to be applied correctly. The complications of care are identified as (MCC) Major Complications and Comorbid conditions or simply (CC) Complications and Comorbid conditions that impact the DRG assigned. Assigning the wrong diagnosis code will follow a patient for life, and skew AI metadata.

Who would benefit from this topic?

• Inpatient Coders
• DRG Auditors
• CDI Coders
• Cardiothoracic coders
• Anyone in healthcare who likes learning new information!

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

Nancy is a registered nurse with 44 years of experience in healthcare, with the last 33 years of it having been in coding. She has worked as a CDI nurse and inpatient DRG coding educator and auditor for the past 12 years. She is bringing her day-to-day audit findings back to the coders to help them understand their denials and to avoid them in the future.