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Coding Clinic Diabetes 2016

Coding Tip Of The Month - February 2017 | Uasi

Coding Tip Of The Month - February 2017 | Uasi

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May | 2016 | Hhs Blog

May | 2016 | Hhs Blog

Editors note: This postappeared in the May 16 issue of The Monday Fix, a weekly email from HHS featuring coding tips. Click here if youd like to subscribe. It may be time to rethink the way youre coding some stated and assumed relationships in light of new Coding Clinic guidance. Two back-to-back articles released last week by AHIMA proved to be an eye-opener for many home health coders, updating and replacing previous information about cause-and-effect coding practices. A Code Cracker Blog post on the Journal of AHIMA website and an article in the May issue of Codewrite, AHIMAs e-newsletter, both referenced new Coding Clinic advice that reverses much of the thinking among home health coders on the use of subterm conditions listed next to primary diagnoses under the category with. The articles acknowledged Coding Clinic advice that the word with should be interpreted to mean a cause-and-effect relationship if: 1.The patient has both diagnoses confirmed by the physician, and 2.There is no other cause provided for the subterm condition. Examples were offered by AHIMA for a diagnosis of diabetes mellitus, which has some 53 conditions listed under the subterm with in ICD-10 coding manuals. Those conditions may now be coded as complications of diabetes mellitus if the documentation supports both and if no other cause is given. This means, for example, that coders may accurately assign the code E11.22 (for Type 2 Diabetes with Chronic Kidney Disease) if the physician has separately documented that the patient has both DM and CKD. There is an assumed relationship because CKD appears in the list of conditions associated with DM. And the new interpretation does not apply only todiabetis mellitus and its 53 subterm conditions; it appliesto any diagnosis where the word with appea Continue reading >>

What's Up

What's Up "with" Diabetic Coding?

/ 2 Comments /in Coding , Uncategorized /by Giovanna Govea Responding to coder questions has always been one of my great joys. The challenge of searching for the underlying cause or the analysis of a detailed operative note is second only to a Dr. Seuss favorite with my Grands. Lately, diabetic coding has been a frequent topic for clarification. According to the American Diabetes Association,29.1 million Americans have been diagnosed with diabetes with another 86 million identified with pre-diabetes. The manifestations and associated conditions are staggering, as this disease impacts many body systems. In ICD-9-CM code assignment with the designation of primary or secondary whether type I or II, controlled, uncontrolled and with a documented association of manifestations common to diabetes was the guidance. ICD-10-CM implementation eliminated the controlled and uncontrolled designation, opting for a more robust manifestation instruction. The American Hospital Association (AHA) Coding Clinic publications for first quarter 2016, again second quarter 2016 reiterate the ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 I.A.15 which says: With the word with should be interpreted to mean associated with or due to when it appears in the code title, the Alphabetic Index, or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated. For conditions not specifically linked by these relational terms in the classification, provider documentation must like the condit Continue reading >>

Hrs I Coding Elevated Online Campus: Weekly Coding Clinic Update - Diabetes Mellitus And Associated Conditions

Hrs I Coding Elevated Online Campus: Weekly Coding Clinic Update - Diabetes Mellitus And Associated Conditions

Weekly Coding Clinic update - Diabetes Mellitus and Associated Conditions by Kim Carr - Friday, July 7, 2017, 10:54 AM Going forward, Im going to do my best to do weekly Coding Clinic updates on those that I see that can be pertinent. Todays is Coding Clinic 1st Q 2016 pages 11, 12 & 13. These cover Diabetes Mellitus and Associated Conditions: Question: The ICD-10-CM Alphabetic Index entry for 'Diabetes with' includes listings for conditions associated with diabetes, which was not the case in ICD-9-CM. Does the provider need to document a relationship between the two conditions or should the coder assume a causal relationship? Answer: According to the ICD-10-CM Official Guidelines for Coding and Reporting, the term "with" means "associated with" or "due to," when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List, and this is how it's meant to be interpreted when assigning codes for diabetes with associated manifestations and/or conditions. The classification assumes a cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves, and circulatory system. Assumed cause-and-effect relationships in the classification are not necessarily the same in ICD-9-CM and ICD-10-CM This is different than ICD-9. The only cause and effect relationship we could assume in Diabetes in ICD-9 was Osteomyelitis and Gangrene. Now we can assume certain diseases of the kidneys, nerves and circulatory system associated with Diabetes Mellitus and we do not have to query. Question: A patient, who is a type 2 diabetic, is admitted with a chronically infected ulcer of the left mid-foot. The provider documented, "Diabetic foot ulcer with skin breakdown, positive for Methicillin resistant Staphylococcus aureus (MRSA) infection." Continue reading >>

First Quarter 2016 Coding Clinic Highlights

First Quarter 2016 Coding Clinic Highlights

First Quarter 2016 Coding Clinic Highlights Navin: The new phone books here! The new phone books here! Harry: Well I wish I could get so excited about nothing. Navin: Nothing? Are you kidding?! Page 73, Johnson, Navin, R.! Im somebody now! Millions of people look at this book every day! This is the kind of spontaneous publicity, your name in print, that makes people. Im in print! Things are going to start happening to me now. - Quote from the 1979 Steve Martin movie The Jerk This excerpt is one of my favorite scenes in this movie. Fast forward a few decades and I could easily replace Navins opening line with the First Quarter 2016 Coding Clinic is here, the First Quarter 2016 Coding Clinic is here! Especially exciting is a new Coding Clinic about documenting the type of Heart Failure and two Coding Clinics specific to Diabetes. A Physician documenting Congestive Heart Failure in the record has long been an opportunity for a Physician Query to clarify the type (systolic, diastolic, systolic and diastolic) and the acuity (acute, chronic, acute on chronic). Effective with March 18, 2016 discharges things are going to start happening to the need to query. A question was asked (page 10 of the Coding Clinic) to reconsider the prior advice that coders cannot assume the type of heart failure based on documentation of heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Based on information from the American College of Cardiology (ACC) coders can now make the following links for the types of heart failure. The abbreviation HFpEF may be called Heart Failure with Preserved Systolic Function which now may also be called Diastolic Heart Failure. The abbreviation HFrEF may be called Heart Failure with Low Ejection Fraction, Continue reading >>

Coding Diabetes Mellitus With Associated Conditions

Coding Diabetes Mellitus With Associated Conditions

Overseen by AHIMA’s coding experts for the Journal of AHIMA website, the Code Cracker blog takes a look at challenging areas and documentation opportunities for coding and reimbursement. Check in each month for a new discussion. There has been some confusion among coding professionals regarding interpretation of the coding guideline of “with.” An area that contains many instances of using this guideline in ICD-10-CM is coding Diabetes Mellitus with associated conditions. There are 53 instances of “with” subterm conditions listed under the main term Diabetes. The ICD-10-CM Official Guidelines for Coding and Reporting states the following at Section I.A.15: The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word “with” in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order. There was a recent clarification regarding this guideline published in the first quarter 2016 issue of AHA Coding Clinic on page 11. According to this clarification, the subterm “with” in the Index should be interrupted as a link between diabetes and any of those conditions indented under the word “with.” Following this guidance as we look to the main term Diabetes in the ICD-10-CM Codebook Index, any of the conditions under the subterm “with” such as gangrene, neuropathy, or amyotrophy (see below for the full list) can be coded without the physician stating that these conditions are linked. The classification assumes a cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves, and circulatory system. The following are all the subterms under “with” under th Continue reading >>

Coding Clinic Clarification On Causal Conditions

Coding Clinic Clarification On Causal Conditions

Coding clinic clarification on causal conditions If this is your first visit, be sure to check out the FAQ & read the forum rules . To view all forums, post or create a new thread, you must be an AAPC Member . If you are a member and have already registered for member area and forum access , you can log in by clicking here . If you've forgotten your username or password use our password reminder tool . To start viewing messages, select the forum that you want to visit from the selection below. Coding clinic clarification on causal conditions Coding clinic clarification on causal conditions I questioned Coding Clinics directly regarding clarification on this issue, and just received their response: "ICD-10 CM presumes a casual relationship between two conditions when they are linked by the term "with" . The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the alphabetic index, or an instructional note in tabular list." Diabetes, diabetic (mellitus) (sugar) E11.9h "The sub term "with" in the index should be interpreted as a link between diabetes and any of these conditions indented under the word "with". The physician documentation does not need to provide a link between (for example) the diagnoses of diabetes and chronic kidney disease. This link can be assumed since the chronic kidney disease is listed under the sub term "with". These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated and due to some other underlying [cause]. So I guess that settles it then? I goes against everything I was taught but there it is. When I read the instruction regarding the word "with" I still assumed this me Continue reading >>

Hcc University: Coding Clinic Q1 2016 Addresses Diabetic Complications

Hcc University: Coding Clinic Q1 2016 Addresses Diabetic Complications

SCAN is committed to partnering with our physician providers in offering high quality geriatric care to our members. A significant part of that effort is to assist our providers in the provision of accurate coding that will contribute to the quality of care and support the expected revenue from the Medicare program. To this end, we present the following tools and education for all the physicians and groups providing care to our members. Coding Clinic Q1 2016 Addresses Diabetic Complications In the Q1 2016, AHA Coding Clinic addresses a number of issues--two of which are hot topics for coders in risk adjustment. Most of the questions we get in the Coding Inbox ([email protected]) deal with "Diabetes and ______________", and whether or not the ICD-10CM assumes a causal relationship. Usually, this is because the physician has not made a link in the medical record, and the coder is unsure whether or not they can code the diabetic complication. In ICD-9, the question also came up a lot--and most often, the answer was NO. Coding Clinic took this subject on once again, for ICD-10CM.. InSection I. Conventions, general coding guidelines and chapter specific guidelines of the Official Guidelines for Coding and Reporting, the ICD-10 describes how the word "with" is to be interpreted: The word with should be interpreted to mean associated with or due to when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular Continue reading >>

Coding Clinic Solves Documentation Issues, Changes Paradigm For Diabetes And Heart Failure Coding

Coding Clinic Solves Documentation Issues, Changes Paradigm For Diabetes And Heart Failure Coding

Coding Clinic Solves Documentation Issues, Changes Paradigm for Diabetes and Heart Failure Coding By Allen R. Frady, RN, BSN, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer As many of you may know by now, the often-discussed question of what to do about physicians use of new clinical practice terms that do not correspond to ICD-10 codes was recently addressed in the Coding Clinic for the first quarter of 2016. Heart failure with reduced ejection fraction or preserved ejection fraction now can be coded without further specification by the physician. Additionally, terms such as heart failure with preserved systolic function or reduced systolic function and other such terms now can be assigned without further clarification from the attending physician. Whats more, the abbreviations HFpEF and HFrEF also officially now are being accepted as documentation specifying type of heart failure. The terms acute or chronic still will need to be present in the chart somewhere, of course. This is a full reversal of previous Coding Clinic advice indicating just the opposite. For those of you who may not know how those terms translate, the following terms should be helpful: a) reduced ejection fraction = systolic heart failure; b) preserved ejection fraction = diastolic heart failure; c) preserved systolic function = diastolic heart failure; d) reduced systolic function = systolic heart failure; e) HFrEF = systolic heart failure; and f) HFpEF = diastolic heart failure. There isnt a version that translates into combined systolic and diastolic heart failure. This change of heart apparently came after review of additional information from the American Cardiology Association. Perhaps even more interesting, however, is something that appears in another section of the same issue of Coding Cl Continue reading >>

Icd-10 Coding Clinic Corner: Diabetes And Osteomyelitis

Icd-10 Coding Clinic Corner: Diabetes And Osteomyelitis

MiraMed Philippines Group, LLC - Philippine Branch Osteomyelitis is a type of bone infection where progressive inflammatory destruction occurs after the formation of new bone. Acute osteomyelitis is the clinical term for a new infection in bone. This infection occurs predominantly in children and is often disseminated via the blood stream (hematogenously). In adults, osteomyelitis is usually a subacute or chronic infection that develops secondary to an open injury to bone and surrounding soft tissue. In acute osteomyelitis, bacteria lodge in bones where circulation is slow. The bacteria then multiply and cause destruction of the bone. The destruction is the result of the body's response to the infection, which creates pus and increased pressure in the bone. Finally, there is decreased circulation and bone death (necrosis). As the disease progresses, areas of bone may become isolated by the infection and lack of circulation, forming islands or segments of necrotic bone that remain infected (sequestra). These areas become a source of recurrent episodes of acute infection and possible draining wounds. The infection can also spread to other areas of the body. This pattern of recurring infection or failure of the bone to heal is chronic osteomyelitis. When areas of the bone die, circulation through the bone stops and treatment is very difficult. Systemic drugs may not be effective at this point and surgery is necessary. Acute osteomyelitis develops within two weeks after disease onset, subacute osteomyelitis within one to several months and chronic osteomyelitis after a few months. The specific organism isolated in bacterial osteomyelitis is often associated with the age of the patient or a common clinical scenario (i.e., trauma or recent surgery). Staphylococcus aureus is Continue reading >>

Reaction To Coding Clinic Stating Icd 10 Assumes A Relationship Between Diabetes And Kidney Disease, As Well As Neuropathy?

Reaction To Coding Clinic Stating Icd 10 Assumes A Relationship Between Diabetes And Kidney Disease, As Well As Neuropathy?

Allen Frady Education Specialists at ACDIS Reaction to Coding Clinic Stating ICD 10 Assumes a Relationship between Diabetes and Kidney Disease, as well as neuropathy? It appears that the linkage between diabetes and ckd as well as the linkage between diabetes and neuropathy are now to be coded without a physicians linkage. See Below Question: A patient, who is a type 2 diabetic, is admitted with a chronically infected ulcer of the left mid-foot. The provider documented, Diabetic foot ulcer with skin breakdown, positive for Methicillin resistant Staphylococcus aureus (MRSA) infection. She also had been diagnosed with polyneuropathy, end-stage renal disease (ESRD), on hemodialysis maintenance. Does the ICD-10-CM assume a cause-and-effect relationship between the diabetes mellitus, the foot ulcer, polyneuropathy and ESRD? How should this case be coded? Answer: ICD-10-CM assumes a causal relationship between the diabetes mellitus and the foot ulcer, the polyneuropathy, as well as the chronic kidney disease. Assign code E11.621, Type 2 diabetes mellitus with foot ulcer, as the principal diagnosis. Codes L97.421, Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin; E11.42, Type 2 diabetes mellitus with diabetic polyneuropathy; B95.62, Methicillin resistant Staphylococcus aureus infection as the cause of disease classified elsewhere; E11.22, Type 2 diabetes mellitus with diabetic chronic kidney disease; N18.6, End stage renal disease; and Z99.2, Dependence on renal dialysis, should be assigned as additional diagnoses. Coding advice or code assignments contained in this issue effective with discharges March 18, 2016. Continue reading >>

Coding, Classification And Reimbursement

Coding, Classification And Reimbursement

Subject: First Quarter 2016 Coding clinic on Diabetes with associated conditions How are you interpreting the Coding clinic on page 11-12, DM with associated conditions? Some colleagues are interpreting this as a change in how we have coded DM associated conditions. ie."The classification assumes a cause and effect relationship between diabetes and certain disease of the kidneys, nerves and circulatory system. Assume cause and effect relationships in the classification are not necessarily the same in ICD-9-CM and ICD-10-CM." The second Coding Clinic on page 12-13, Diabetic Foot Ulcer seemsquestion/answer follows suit. I see where one could understand that from the above wording, but the previous threads on this website, contradict this! I, too, would NOT assume a relationship. Subject: First Quarter 2016 Coding clinic on Diabetes with associated conditions How are you interpreting the Coding clinic on page 11-12, DM with associated conditions? Some colleagues are interpreting this as a change in how we have coded DM associated conditions. ie."The classification assumes a cause and effect relationship between diabetes and certain disease of the kidneys, nerves and circulatory system. Assume cause and effect relationships in the classification are not necessarily the same in ICD-9-CM and ICD-10-CM." The second Coding Clinic on page 12-13, Diabetic Foot Ulcer seemsquestion/answer follows suit. I see where one could understand that from the above wording, but the previous threads on this website, contradict this! I, too, would NOT assume a relationship. I was confused by this (and still am). As soon as I read it, I immediately e-mailed my coding supervisor to ask for clarification. She said that they discussed it last week in a meeting that I was unable to attend and agree Continue reading >>

Coding Tip: Dm With Assumed Conditions

Coding Tip: Dm With Assumed Conditions

Diabetes continues to be a challenge for coders since the new instruction/guideline was released in AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, First Quarter 2016. This is effective with March 18, 2016 discharges. ICD-10-CM does assume the link between diabetes and multiple common conditions. In the past, these were not assumed and only coded as related to diabetes when clearly documented or queried by the coder for further clarification. In the index of ICD-10-CM you will see several assumed conditions. Please continue to familiarize yourself with these so when you are coding the records you will know they are assumed conditions. Heres a list of the associated diabetic conditions where the link is assumed in ICD-10-CM: If the MD documents another etiology for the condition DO NOT code to a diabetic complication or assume the link with diabetes. Clarification of link of diabetes and osteomyelitis was published in the 4Q2016 AHA Coding Clinic. AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, First Quarter 2016 AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, Fourth Quarter 2016 ICD-10-CM Official Guidelines for Coding and Reporting FY 2017 The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly. Continue reading >>

Icd-10 Coding Challenge: Updated Coding Guideline A.15 “with”

Icd-10 Coding Challenge: Updated Coding Guideline A.15 “with”

A 47-year-old patient was admitted to the hospital with a chief complaint of an ulcer at the base of his left great toe. Patient has a history of diabetes mellitus, type 2, nephropathy with CKD stage 3, GERD, asthma and esophagitis. The patient’s medications include insulin, a proton pump inhibitor and a steroid inhaler. After examination, it was determined that this was a diabetic foot ulcer with exposure of the fat layer. The wound was cultured and the patient was placed on IV antibiotics. Two days later the patient was taken to the Operating Room for an excisional debridement of the ulcer down to the bone. The patient was discharged from the hospital on day #5 with a diagnosis of poorly controlled diabetes mellitus with diabetic foot ulcer and acute osteomyelitis. The patient is sent home with IV antibiotic therapy and instructions to follow up in outpatient Wound Clinic for outpatient treatment of the ulcer. Please assign diagnosis and procedure codes for this scenario. ANSWERS E11.621 Type 2 diabetes mellitus with foot ulcer L97.522 Non-pressure chronic ulcer of other part of left foot with fat layer exposed E11.65 Type 2 diabetes mellitus with hyperglycemia Z79.4 Long term (current) use of insulin E11.69 Type 2 diabetes mellitus with other specified complication M86.172 Other acute osteomyelitis, left ankle and foot Z79.2 Long term use of antibiotics E11.21 Type 2 diabetes mellitus with diabetic nephropathy E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease N18.3 Chronic kidney disease, stage 3 K21.0 Gastro-esophageal reflux disease with esophagitis J45.909 Unspecified asthma, uncomplicated Z79.51 Long term use of inhaled steroids 0KBW0ZZ Excision of left foot muscle open approach BLOG RESPONSE This month’s scenario provides us with an opport Continue reading >>

Coding Clinic 1st Quarter 2016 Updates

Coding Clinic 1st Quarter 2016 Updates

Coding Clinic Updates: Significant Changes to CHF and Diabetes Coding The release of Coding Clinic 1st Quarter 2016 (effective with discharges which started on March 18, 2016) brought about two significant changes. The first change is the acceptance of the more contemporary heart failure classification terms that refer to ejection fraction and systolic function. These terms are outlined below: As a reminder, the provider must still document whether the heart failure is acute, chronic, or acute on chronic. It must also be documented if the patient has combined or systolic and diastolic dysfunction. Per previous Coding Clinic advice, the terms exacerbation and decompensated are coded as acute. The second major change is the release of new guidance on how to code diabetes. Prior to this Coding Clinic, certain conditions were assumed to be related to diabetes and therefore did not require a linking statement between diabetes and a particular condition. The latest Coding Clinic significantly changes what can and cannot be assumed to be due to diabetes. The table below summarizes the new changes: This new guidance opens up the question of whether other conditions can also be assumed to be due to diabetes. For example, documentation of neuropathy is much more common than polyneuropathy, but can a coder assume that neuropathy is due to diabetes? To err on the safe side, a query should be placed to clarify if the patient has neuropathy or polyneuropathy. If the patient has neuropathy, then a query should be placed to establish a causal relationship between the two conditions. If the patient has polyneuropathy, then it is assumed to be due to diabetes. And what about other common diabetic complications, for example, peripheral vascular disease? Can we assume that peripheral vasc Continue reading >>

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