Wrapping up 2018 ICD-10 Code Changes

Since 2015 ICD-10 has been keeping the home health industry busy with coding changes. If you have been reading our blog series regarding 2018 ICD-10 code updates, it may seem a bit overwhelming.  However, this is our last blog in this series, and it will cover any of the remaining new, revised or deleted codes that are part of the overall 728 code updates, which were ushered in fiscal 2018.

Diseases of the Skin and Subcutaneous Tissue

Chapter 12 covers diseases of the skin and subcutaneous tissue.  These diseases are covered by codes L00-L99.  This chapter alone includes 72 new codes just to specify the severity of a non-pressure chronic ulcer of the lower extremity.  A few examples of these new codes include:

L97.318 Non‐pressure chronic ulcer of right ankle with muscle involvement with other specified severity

L97.326 Non‐pressure chronic ulcer of left ankle with bone involvement without evidence of necrosis

L97.925 Non‐pressure chronic ulcer of unspecified part of left lower leg with muscle involvement with evidence of necrosis

If you do not know the etiology or cause of the ulcer you should try to determine as auditors whether you are looking for two codes with the L97 codes.  If the cause of the ulcer is known, then it should be coded first.  Any gangrene associated with an ulcer should also be coded first.

Key Points Related to Diseases of the Musculoskeletal System and Connective Tissue

Chapter 13 or codes M00-M99 cover diseases related to the musculoskeletal system and connective tissue.  We will just review some of the high-level changes from this chapter.  First, most of the codes within Chapter 13 have site and laterality designations. The site represents the bone, joint or muscle involved.  If more than one bone, joint or muscle is involved, there are “multiple sites” codes, which should be used. Next, the M80 code is used to code a pathological fracture or insufficiency fracture, which is a bone fracture caused by a disease, such as osteoporosis, that resulted in weakness in the bone structure.  The M81 code should be used for osteoporosis without a current fracture.  Finally, age related osteoporosis is the default if the type of osteoporosis is not documented.

The Last ICD-10 Code Changes – Chapter 18

Chapter 18 deals with symptoms, signs, and abnormal clinical and laboratory findings that are not classified anywhere else.  They are designated by codes R00-R99.  Below are a few examples of these codes and what they cover:

R06.03 Acute respiratory distress – a new code

Note:  Do not assign a R06 code with a code for COPD, bronchitis, asthma or any other condition that would cause respiratory distress.

R29.6 Repeated falls – Only use when the reason for the fall is unknown or is under investigation.  Z91.81 is used for a history of falls and for the risk of future falls.  We are mentioning this code is because it can be used in conjunction with R29.6 when appropriate (i.e. if the cause of the fall is not known and the patient is still at risk of falling).

2018 ICD-10 Coding Changes Made Simple

Yes, 2018 ICD-10 coding changes can be made simple thanks to our knowledgeable 5 Star team.  Our highly skilled certified RN coders can become your outsourced coding department or can assist your staff to ensure maximum reimbursement is achieved.

If you would like to learn more about our training options and/or other educational materials we offer, please feel free to contact us at [email protected] or 866-428-4040.

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Wrapping up 2018 ICD-10 Code Changes

2018 ICD-10 Code Changes for Diseases of the Circulatory System

Chapter 9 deals with the diseases of the circulatory system. With the 2018 ICD-10 code changes, 19 codes were added to this chapter.  In our continuing series on the 2018 ICD-10 code changes, this blog will explore these updates and more regarding Chapter 9.

Pulmonary Hypertension

Pulmonary Hypertension is classified to category 127, which is known as other pulmonary heart diseases.  There are also secondary Pulmonary Hypertension codes associated with certain conditions or adverse effects related to drugs or toxins. Within this category, there are seven new Pulmonary Hypertension codes, which are sequenced based on the type of encounter:

  • 0  Primary Pulmonary Hypertension is expanded.
  • 20 Pulmonary Hypertension unspecified or NOS.
  • 21 Secondary Pulmonary Arterial Hypertension, is group 1 and is drug induced.
  • 22 Pulmonary Hypertension due to left heart disease is group 2.
  • 23 Pulmonary Hypertension due to lung disease and hypoxia is group 3.
  • 24 Chronic Thromboembolic Pulmonary Hypertension is group 4.
  • 29 Other secondary Pulmonary Hypertension is group 5.

As illustrated above, there are groups 1-5, but according to the codes, the cause for Pulmonary Hypertension should be coded first.

  • Group 1 is caused by drug toxicity from drugs such as appetite suppressants, or a condition such as HIV, Portal Hypertension, or Congenital Heart Disease.
  • Group 2 refers to left heart disease associated or cardiac valve diseases.
  • Group 3 is related to respiratory diseases such as Cystic Fibrosis, Interstitial Lung Disease, Sleep Apnea, Pleural Effusion, or Bronchiectasis.
  • Group 4 is related to Pulmonary Embolism.
  • Group 5 is used if there are multiple, but unclear factors that led to Pulmonary Hypertension, or hematologic, metabolic or systemic disorders.

Eisenmenger’s Syndrome

Eisenmenger’s Syndrome is any untreated congenital cardiac defect with intracardiac communication that leads to pulmonary hypertension, reversal of flow, and cyanosis. This is related to a congenital heart defect, causing right to left shunt to be irreversible.  It is represented by new code 127.83.  When coding for Eisenmenger’s Syndrome, the Q code for heart defect should be coded first.

Myocardial Infarction

Myocardial Infarction or more commonly known as a heart attack also is an ailment covered in Chapter 9.  When coding for Myocardial Infarction you must consider whether to code it as NSTEMI or STEMI.  NSTEMI is the complete blockage of a minor coronary artery or partial blockage of a major coronary artery causing partial damage to the heart muscle.  About 30 percent of Myocardial Infractions are Non STEMI. This is also categorized as Non-Transmural as it does not extend through all thicknesses of the heart muscle.  While STEMI is the complete occlusion of a major coronary artery due to atherosclerosis.  This is transmural and damages the full thickness of the heart muscle including the endocardium, myocardium and epicardium layers of the heart muscle.  The remaining 70 percent of Myocardial Infarction are STEMI (this is the default if not documented).

Before we cover the Myocardial Infarction codes, below is a listing of the sub-types:

  • Type 1 ‐ MI related to ischemia from a primary coronary event (e.g., plaque rupture, thrombotic occlusion).
  • Type 2 ‐ MI secondary to demand ischemia and coded as NSTEMI unless documented otherwise.

The following types are all associated with a revascularization procedure and should follow the causal code.  The “Code also” and “Code first” notes should be followed related to complications, and for coding of postprocedural Myocardial Infarctions during or following cardiac surgery.

  • Type 3 ‐ MI resulting in sudden cardiac death.
  • Type 4a ‐ MI associated with percutaneous coronary intervention.
  • Type 4b ‐ MI associated with in‐stent thrombosis.
  • Type 5 ‐ MI associated with coronary artery bypass surgery.

Below are the codes related to Myocardial Infarction:

  • 0 through I21.3 – All Type 1 STEMI
  • 4 – Type 1 Non‐STEMI and nontransmural or subendocardial acute MIs.
  • 9 – Default for an acute MI NOS, initial MI with no documentation of type or site.
  • A1 – Type 2 myocardial infarction due to demand ischemia. “Code also” the underlying cause (Type 2 MIs are not caused by atherosclerotic plaque).
  • A9 – Other (Type 3,4, and 5) are associated with a revascularization procedure and follow another code for the procedure or complication.

Heat Failure 

Heart Failure is also covered in Chapter 9.  All heart failure codes are inclusive of any pulmonary edema, so they should not be coded separately. The heart failure codes are detailed below:

  • 1 – Left ventricular failure or left heart failure. The heart does not completely relax, and the ventricles do not fill.
  • 2‐ Systolic (congestive)heart failure means the heart does not contract fully; therefore, not enough blood is pushed out.
  • 3 ‐ Diastolic (congestive) heart failure.
  • 4 ‐ Combined systolic (congestive) and diastolic (congestive) heart failure.
  • 81 – Right heart failure.
  • 82 – Biventricular heart failure.
  • 83 – High output heart failure.
  • 84 – End stage heart failure.
  • 89 – Other heart failure. Note: Code the type of heart failure, if known.
  • 9 – Heart failure, unspecified.

Below are the stages that correspond with the codes above:

  • Stage A heart disease – The patient does not have heart failure, but is at risk for heart failure. Code is Z91.89
  • Stage B heart disease – Heart disease is present, but there are no symptoms presently.
  • Stage C heart disease – Structural changes in the heart and symptoms are present.
  • Stage D heart failure – End stage heart failure – I50.84.

Overwhelmed?  We can Help!

This blog is just an overview of Chapter 9. Your team may be overwhelmed by this amount of information as well as the other 2018 ICD-10 changes.  However, our highly skilled staff can assist in many different areas.  Our certified RN coders can work with your clinicians to ensure your coding is compliant, accurate and results in maximum reimbursement.  We also offer many onsite as well as remote training options. Finally, your team can gain valuable knowledge from our many manual and DVD options.  For further information, please contact us at [email protected] or 866-428-4040.

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2018 ICD-10 Code Changes for Diseases of the Circulatory System

Are You Knowledgeable About ALL 2018 ICD-10 Coding Changes?

In our continuing series on the 2018 changes to the ICD-10 codes, we will cover the updates that occurred in chapters 6-8.  As you will learn, some chapters were more heavily impacted than others; nonetheless your staff must be aware of all these key changes.

Chapter 6 – Diseases of the Nervous System

When discussing the nervous system, you must consider the central nervous system as well as the peripheral nervous system.  Chapter 6 includes codes for degenerative nerve disorders, congenital disorders, movement disorders, muscle disorders, post/intraoperative disorders and pain not coded elsewhere.  Many codes covered in this chapter are related to conditions coded in other chapters and require multiple codes.

Below are three new codes dealing with diseases of the nervous system:

  • G12.23

Primary lateral sclerosis, similar to ALS but progression is slower and is usually not fatal.

  • G12.24

Familial motor neuron disease is in a gene mutation and usually another person in the family will have the same condition.

  • G12.25

Progressive spinal muscle atrophy, another genetic disorder that affects muscle movement.  It is caused by the loss of motor neurons in the spinal cord and brainstem.

Chapter 7 – Diseases of the Eye and Adnexa

Chapter 7 was more heavily impacted by the 2018 ICD-10 coding changes with 55 new codes.

  • H44.2

Twenty of the 55 codes are new and relate to specific types of degenerative myopia.

  • H54

Nine of the 55 codes further specify blindness in both eyes.  The H54 codes are used specifically for eye conditions such as cataracts, retinopathy, glaucoma, hemianopsia and others. These conditions should be coded first.  Note – legal blindness in the USA uses the H54.8 code, not the H54.0 codes.

Also, new H54 codes for blindness, follow the coding guidelines below to determine the seventh character for vision relating to the eye not included in the code:

If “blindness” or “low vision” of both eyes is documented but the visual impairment category is not documented, assign code H54.3 – Unqualified visual loss, both eyes.  If “blindness” or “low vision” in one eye is documented but the visual impairment category is not documented, assign a code from H54.6 – Unqualified visual loss, one eye.  If “blindness” or “visual loss” is documented without any information about whether one or both eyes are affected, assign code H54.7 – Unspecified visual loss.

Chapter 8 – Diseases of the Ear and Mastoid Process

In this round of ICD-10 updates there were no changes to Chapter 8.  However, it is key to note that hearing loss is coded to H90.  The H90 code specifically includes:

  • Conductive and sensorineural hearing loss (largest sub-category of hearing loss codes)
  • Ototoxic hearing loss
  • Presbycusis
  • Sudden idiopathic hearing loss
  • Other hearing loss
  • Unspecified hearing loss

Our Team Stands Out from the Competition 

2018 brought many ICD-10 coding changes to the industry.  5 Star can help ensure not only that your staff is trained on the latest industry updates, but your coding can even be outsourced to our knowledgeable team.  The 5 Star team is comprised of highly skilled, certified RN coders.  We can manage all your coding needs by working with your clinicians to ensure accuracy, clinical compliance and optimized reimbursement for your agency.  For further information about our coding services, training, or manuals/DVDs, please contact us at [email protected] or 866-428-4040.

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Are You Knowledgeable About ALL 2018 ICD-10 Coding Changes?

The Impact of 2018 ICD-10 Codes on Mental, Behavioral and Neurodevelopmental Disorders

The recently implemented 2018 ICD-10 codes affect many different areas of diagnoses, including mental, behavioral and neurodevelopmental disorders, which is the focus of Chapter 5.  With these changes, more accurate diagnostic recording will be experienced.  In our continuing series on the 2018 ICD-10 code updates, we will focus this blog on the changes that impacted Chapter 5.

Alzheimer’s

Alzheimer’s disease, which causes the decline in mental and physical function is the most common cause of mental deterioration.  More than five million people in the US are affected by Alzheimer’s, and it is now the sixth leading cause of death in America.  In 2017, this disease alone cost the nation $259 billion, but by 2050 it is expected to be a $1.1 trillion issue.

The coding for this widespread disease was impacted by the 2018 ICD-10 coding instructional changes.  The G30 code is used for Alzheimer’s.  Alzheimer’s is the most common form of dementia, and dementia is inherent in the Alzheimer’s diagnosis.  Dementia does not have to be documented by a physician to be coded with Alzheimer’s.  You should use the F02 code with Alzheimer’s to further define the dementia.  The F02 code is a manifestation code and is never used alone.

Specific Alzheimer’s Case

Below is a specific case related to Alzheimer’s and proper coding:

An 80-year-old patient is admitted to home health with diagnosis of late onset Alzheimer’s. The referral states the patient is starting to wander, and does not recognize where he is or how he got there.  Also, he is sometimes hostile with his spouse and does not seem to recognize her at times.  The patient has CHF (which is exacerbated and the focus of the home health episode) with bibasilar crackles with productive frothy cough and lower extremity +2 edema, CAD and essential HTN.  BP has fluctuated since the symptoms of CHF have worsened. The home health order is for SN for Cg instruction and assessment of CHF disease process, Alzheimer’s education and MSW for resource education and support.  SN frequency is 3wk1, 2wk2.  MSW is 2mo1.

M1021  I50.9 Heart Failure Unspecified

M1023   I10 Hypertension, essential

M1023   I25.10 Atherosclerotic heart disease of native coronary arteries without angina pectoris

M1023   G30.1 Late onset Alzheimer’s

M1023   F02.81 Dementia with behavior disturbance

M1023   R45.5 Hostility

M1023   Z91.83 Wandering in diseases classified elsewhere

In this example, the focus of care and diagnosis requiring the most number of visits is the CHF so it is coded as primary.  Hypertension is exacerbated and CAD is coded as a comorbidity as it contributes to the cardiac issues the patient is experiencing. The Alzheimer’s is coded as G30.1, which is late onset (due to the patient’s age).  This code is more specific.  Dementia is coded even though it is not mentioned specifically as it is inherent to Alzheimer’s.  The patient has a behavior problem associated with the dementia so the Z91.83 code is used.  Wandering is considered a behavior problem when coding dementia, but is not inherent to dementia; therefore, it is coded.  There are certain R45 codes you could use to describe behaviors the patient with dementia has.  These should be used if they help to better describe the patient and support increased LOS or visits.  Any time you use a symptom code it must follow the definitive or causal diagnosis code.

New Addiction Remission Codes

Seven of the new 2018 ICD-10 codes are related to addiction remission.  These codes are related to categories F10-F19.  The physician must document that the patient is in remission.  Mental and behavioral disorders due to psychoactive substance use (categories F10-F19 with -11, -.21) require the provider’s clinical judgment.  The appropriate codes for “in remission” are assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification.

There are codes for use, abuse and dependence, but you only code one.  If the physician documentation states all—use, abuse and dependence of the same substance then you code for dependence.  If abuse is documented, the patient has an intense desire to use a substance in increasing amounts to the exclusion of all other activities, but is not dependent.  If a patient is categorized as dependent then the user has a physical need and suffers withdrawal if the substance is not available.

Mild substance use disorders in early or sustained remission are classified to the appropriate codes for substance abuse in remission.  Moderate or severe substance use disorders in early or sustained remission are classified to the appropriate codes for substance dependence in remission.

Specific Addiction Case

Below is a specific example related to addiction and proper coding:

A patient is admitted for wound care related to facial lacerations to the forehead and cheek, which were sustained in an auto accident.  He was driving under the influence of alcohol, veered off the roadway and struck a tree. He was arrested since this was his third DUI. The physician states the patient has a severe dependence on alcohol, along with a sleep disturbance and a bipolar disorder, which are both related to alcohol use.

M1021 S01.80XD Laceration without foreign body of other part of head

M1023 S01.411D Laceration without foreign body right cheek and temporomandibular area

M1023 F10.24 Alcohol dependence with alcohol induced mood disorder

M1023 F10.282 Alcohol dependence with alcohol induced sleep disorder

M1023 V47.0XXD Car driver injured in collision with fixed or stationary object in nontraffic accident (optional)

The lacerations are the focus of care so they are coded first.  The alcohol dependence and alcohol induced conditions will impact the POC so they are coded also.  The V code or external cause code is voluntary and does not need to be coded.  If the agency chooses to include external cause codes, the codes for place of encounter are not coded in home health, only for initial encounter coding.

Avoidant / Restrictive Food Intake Disorder

Eating disorders are a major issue with at least 30 million people of all ages and genders in the U.S.  Every 62 minutes at least one person dies as a direct result from an eating disorder, which translates into the highest mortality rate of any mental illness.  The 2018 ICD-10 code changes deal with avoidant/restrictive food intake disorder (ARFID), which was previously known as selective eating disorder (SED).  Now it is designated by code-F50.82.  This is an eating as well as a feeding disorder.  The consumption of certain foods is limited based on the food’s appearance, smell, taste, texture, brand, presentation, or a past negative experience with the food.

Symptoms of ARFID are usually found in conjunction with symptoms of other disorders such as obsessive-compulsive and autism.  Although many people with ARFID have symptoms of these disorders, they usually do not qualify for a full diagnosis.  However, some form of feeding disorder is found in 80 percent of children that also have a developmental disability.

ARFID can also be considered an anxiety disorder.  Specific food avoidances could be caused by food phobias.  Great anxiety may result when a person is presented with these new or feared foods.  Those who suffer from ARFID do not have a fear of gaining weight, but the psychological symptoms and anxiety created are similar.

Experience Success

The team at 5 Star can help to guarantee success regarding the 2018 ICD-10 coding changes.  Whether your in-house staff needs training on these coding updates or you are in need of outsourced coders, our highly skilled team of certified, experienced RN coders can help.  For further information regarding our coding services and training options, please contact us at [email protected] or 866-428-4040.

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The Impact of 2018 ICD-10 Codes on Mental, Behavioral and Neurodevelopmental Disorders

Coding of Endocrine, Nutritional, and Metabolic Diseases

The recently implemented 2018 ICD-10 code changes have had far-reaching effects.  As part of our continuing series on these updates, this blog will cover Chapter 4 of ICD-10 coding (codes E00-E89) changes and how they impact endocrine, nutritional and metabolic diseases.

New Codes

Amyloidosis

 Amyloidosis is a rare disease that occurs when an abnormal protein called amyloid builds up in your organs.  Amyloid is produced in your bone marrow and can be deposited in any tissue or organ.  Amyloidosis can affect different organs in different people, but it frequently attacks the heart, kidneys, liver, spleen, nervous system and digestive tract.  Severe amyloidosis can lead to life-threatening organ failure. There are many different types of Amyloidosis and some of the new ICD-10 codes affect specific diagnoses.

There are three new codes for Amyloidosis, along with the expansion of E85.8 other amyloidosis as detailed below:

  • E85.8 Other amyloidosis
  • E85.81 Light chain (AL) amyloidosis – is the most common type and can affect your heart, kidneys, skin, nerves and liver. Previously known as primary amyloidosis.
  • E85.82 Wild-type transthyretin-related (ATTR) amyloidosis – Hereditary amyloidosis (familial amyloidosis) is an inherited disorder that often affects the liver, nerves, heart and kidneys.
  • E85.89 Other amyloidosis

Diabetes Mellitus (DM)

In the 2018 ICD-10 coding changes there are two new codes for DM, expanding the E11.1 code and dealing further with ketoacidosis.  Ketoacidosis is a buildup of acids in your blood, and it can happen when your blood sugar is too high for too long.  It is rare in Type 2 DM; therefore, if it is documented in a Type 2 DM you should verify it with the physician.  If it is used in home health care it is most likely only in M1011 and/or in M1017.

The new codes include:

  • 1 Type 2 DM with ketoacidosis
  • 10 Type 2 DM with ketoacidosis without coma
  • 11 Type 2 DM with ketoacidosis with coma

Related to DM, is the 2018 Insulin Guideline.  Accordingly, an additional code should be assigned from category Z79 to identify the long-term (current) use of insulin or oral hypoglycemic drugs.  If the patient is treated with both oral medications and insulin, only the code for long-term (current) use of insulin should be assigned.  Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter or for a Type 1 DM.

NEC Manifestations

In the provider documentation there must be links with the conditions in order to code the NEC manifestations (please see those related below).  Any code for intraoperative or post procedure complications must be documented as related to each other in order to code.  Always check the instruction at the beginning of your numeric code to be sure you have the needed documentation for the following.

  • Arthropathy NEC
  • Circulatory complication NEC
  • Complication, specified NEC
  • Kidney complications NEC
  • Neurologic complication NEC
  • Oral complication NEC
  • Skin complication NEC

So Much More to Explore

Chapter 4 of the ICD-10 codes has incorporated many new updates, and this blog just scratches the surface.  If you would like to learn more about these revisions, and how the 5 Star team can help ensure your staff is up-to-date, please contact us at [email protected] or 866-428-4040.

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Coding of Endocrine, Nutritional, and Metabolic Diseases

ICD-10 Codes Updated . . . Again

The 2018 fiscal year was accompanied by updates to the ICD-10 codes again.  These changes included 360 new codes, 142 deleted codes, and 226 revised codes.  Of course, certain diagnoses were impacted more than others.  For example, there are 72 new codes just to better describe non-pressure ulcers while nine new codes are specific to heart failure.  However, it is not only critical to be knowledgeable about these ICD-10 code changes, but also to follow coding guidelines.  In this series on 2018 ICD-10 codes, we will first provide a coding refresher and then follow-up with additional blogs that review the codes as they relate to specific diagnoses.

Guidelines vs. Classification Instructions / Conventions

The guidelines are defined as a set of rules that were developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself.  They have been approved by the four organizations that make up the cooperating parties for the ICD-10-CM, which include the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the CMS (Centers for Medicare and Medicaid Services), and the NCHS (National Center for Health Statistics).  These guidelines were created to assist the healthcare provider and the coder to determine diagnoses.

However, the instructions and conventions of the classification take precedence over the guidelines.  These guidelines are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, which incorporate conventions, but also provide additional information.

Achieving Accurate Coding

Consistent, complete documentation is critical because without it accurate coding cannot be achieved.  However, this is only attainable if there is a joint effort between the healthcare provider and the coder.  The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.  There must be consistency and complete documentation in the medical record.  If coding is incorrect or not supported by the medical record the entire episode of care is at risk of nonpayment or take back!

Assigning Codes

Now let’s move onto assigning the proper codes.  An assigned diagnosis code is based upon the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has the condition is sufficient.  Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.  This becomes the primary diagnosis, which is the condition or problem/reason for home care and chiefly responsible for the services provided.

However, any additional diagnoses for conditions managed during the episode should be included in the medical record too.  If more than one diagnosis is treated choose the one that is most acute or requires the most intensive services.  Any secondary diagnoses must be relevant to the care rendered or affect the patient’s responsiveness to treatment or rehab, even if it is not the focus of the home health POC.

Any diagnosis listed must be documented in the POC as well as the OASIS.  A chronic condition always will impact the POC; therefore, it is particularly critical that it is coded and addressed in the POC.  The Primary Dx on the POC, UB-04 and the OASIS must match.  Codes that need to be included, but do not fit in M1023 can be reported on the POC in the narrative section.  For further guidance on these three forms (OASIS, POC and UB-40), please visit the Medicare Claims Processing Manual instructions for FL 67 and 67 a-q.

Dealing with Certain Words

There are certain key words used in coding such as “with” or “in” that need to be interpreted correctly.  When these words appear in a code title, the Alphabetic Index, or an instructional note in the Tabular List, they should be interpreted to mean “associated with” or “due to”.  The classification presumes a causal relationship between the conditions linked by these terms in the Alphabetic Index or Tabular List.  Any of the conditions listed under the “with” sub-term can be coded without the physician stating that these conditions are linked, unless another guideline states there must be a documented linkage between the two diagnoses.  An example would be sepsis and organ failure that is not clearly stated as due to sepsis.

Skilled Coding

Correct coding can be a daunting task.  Whether you are looking to outsource your coding or require coding assistance, the 5 Star team is here to help.  We have a highly skilled staff of certified, experienced RN coders who can take care of your coding needs, working with your clinicians to ensure accuracy, clinical compliance and optimized reimbursement.  For further information on our coding services and training options, please contact us at [email protected] or 866-428-4040.

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ICD-10 Codes Updated . . . Again