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Medical Coding News Archives

June Coding Corner

June 14, 2016:

As we continue this journey in ICD-10, Optum360 Coding Professionals have identified areas where medical coding professionals are struggling for uniformity and correct coding amongst their peers. In the Optum360 Coding Corner, we will discuss coding variances for ICD-10-CM and ICD-10-PCS found on a monthly basis and explore the codes, coding concepts and conventions for those variances. This information comes from Optum360 Enterprise CAC’s data collection. We will also highlight new coding information when applicable, to keep the coding community informed.

ICD-10-CM (both Inpatient and Outpatient settings)

1. Alcohol Intoxication

An exception to the new use, abuse and dependence guidelines exist when documentation states "Alcohol Intoxication." Alcohol intoxication has a separate heading in the ICD-10 Alphabetic index. Under this heading, the coder is directed to use codes from category F10.12 (Alcohol abuse with intoxication). This is one of the few instances in which a code for abuse can be assigned without the documentation of the word "abuse."

2. S – Seventh character Sequela

Accordingly to ICD-10-CM guidelines, the 7th character "S" is used when a complication arises as a direct result of an injury. An example of a complication after an initial injury would be scar formation after a burn. The 7th character of "S" is appended to the injury code. The initial injury code should be reported with 7th character of "S" and the code for the sequela is reported as an additional code.

3. Diabetes with Associated conditions

AHA Coding Clinic in both First Quarter and Second Quarter 2016 discuss changes to the way complications and manifestations of diabetes are related for coding purposes. In ICD-10, the Alphabetic Index assumes a cause-and-effect relationship is between DM and certain diseases of the kidneys, nerves and circulatory system. A linkage between the DM and the secondary condition has to be documented by the physician but the codes do not have to be listed together. If the documentation states that DM is not a cause of the secondary condition then a Diabetic complication code should not be reported.


1. Lymph Node Removal

When an isolated lymph node is removed then the root operation of Excision should be reported as the root operation. When documentation states that various levels of lymph nodes are removed then each level is considered a chain. When an entire lymph node chain is removed then the root operation of Resection should be reported.

2. Chemotherapy Infusion

For patients receiving chemotherapy, it may be necessary to insert a Central Venous Catheter (CVC) for administration. The line may also be attached to port or pump for use during chemotherapy. When coding an infusion or injection into a CVC or another type of central line then the body system character of central vein (4) should be reported in the administration code and not peripheral vein (3).

3. Bypass Procedures in PCS

PCS guideline B3.6a establishes the guideline on how to report a bypass surgical procedure. When coding a bypass procedure in PCS it is necessary to identify the body part bypassed from and the body part bypassed to. The 4th character of the PCS code will identify the bypassed from body section. The 7th character of the PCS code will identify the body part bypassed to.


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