Top 10
ICD-10-CM Questions (PART 1)
Diabetes Mellitus with Diabetic Ketoacidosis
1Q. How would we
code a patient that presents with Type 2 diabetes mellitus with diabetic
ketoacidosis?
1A. When a patient presents with diabetes
mellitus with ketoacidosis we would use the ICD‐10 code E13.10 (other specified
diabetes mellitus with ketoacidosis without coma).
While we do have few perfect choices, it was deemed important to
identify that this patient does have ketoacidosis.
Handling Coding Disputes with Payers
2Q. How do we address coding
disputes with payers, when what they require goes against AHA Coding Clinic
advice orthe CMS official guidelines?
2A. The first thing that we need to do is determine that this is really
a coding dispute and not a coverage or payment issue. So one of the first
things that we should do is contact the payer and ask for clarification if we
are not sure of the reason for the denial.
If we find that the payer truly does have a policy that conflicts with
the official coding rules or guidelines, we should make every effort to resolve
this issue. One of the first things to do is send the payer a copy of the
guidelines with an explanation of how their policy and the guidelines conflict.
If the payer refuses to change their policy, proceed to ask for a copy
of their requirements in writing.
It is important to keep track of all correspondence that has transpired
between you and the payer. Keep track of dates and the names of the people with
whom you have communicated. You should also verify the existence of the policy
in question with supervisory staff.
It is also important to keep a file of all of the documentation that
you have received from the payer. You should be able to reproduce these
documents in the event of an audit. DOCUMENT.
DOCUMENT. DOCUMENT.
Smoker (tobacco user vs. dependence)
3Q. Physician
documents that the patient is a smoker. How is this coded in ICD‐10‐CM? Would
we code this as abuse or dependence?
3A. In ICD‐10, when the provider documents
that the patient is a “smoker” we would use the code F17.200 (Nicotine
dependence unspecified, uncomplicated).
Diabetes and Osteomyelitis
4Q. Does
ICD‐10 assumes a link between diabetes and osteomyelitis?
4A. Yes, ICD-10-CM does assume a relathionship
between diabetes and osteomyelitis as per 2016 October guidelines.
Pneumonia and Hemoptysis
5Q. In
ICD‐10 hemorrhagic is no longer a nonessential modifier for pneumonia. Is it
appropriate to report a separate code for hemoptysis?
5A. Yes, it would be appropriate to separately
report a code for the hemoptysis. You would report code R04.2.
Admission for Rehabilitation
6Q. Does
ICD‐10 allow for the coding of the acute CVA when the patient is admitted to an
inpatient rehab facility?
6A. No, for ICD‐10 we will use a code from the
subcategory I69.3, sequlae of cerebral infarction, as the principal diagnosis.
Admission for Rehabilitation following Cerebral Infarction
7Q. A patient is admitted to
an inpatient rehab facility following an acute CVA, with aphasia. The patient
also has several comorbid conditions. How would this case be coded in ICD‐10?
7A . In this instance, the aphasia (I36.321) is
the principle diagnosis. The codes for the co‐morbid
conditions would also be coded.
Admission for Rehabilitation following Femur Fracture Treatment
8Q. Patient is admitted to
an IRF following treatment for an acute intertrochanteric femur fracture for
physical therapy. How would this visit be coded?
8A. For this particular encounter we would
use code S72.141D; displaced intertrochanteric fracture of right femur,
subsequent encounter.
Encounter for Dialysis
9Q. Since ICD‐10 does not
have a code that is equivalent to V56.0, encounter for dialysis, how would
these cases be coded in ICD‐10?
9A. In ICD‐10‐CM these encounters will be
coded to the underlying disease/reason for the dialysis at the principle
diagnosis.
42 Weeks of Gestation
10Q. ICD‐10 has two codes
for a gestational age of 42 weeks or more. 42 weeks or more Z3A.42 or Z3A.49
greater than 42 weeks. We need a better understanding of when we would use
these codes.
10A. We would assign code Z3A.42 for any number
days in week 42 up to the beginning of week 43.
We would assign the code Z3A.49 for a gestational date of 43 weeks.
