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Medical Coding News Archives

September Coding Corner

 
September 19, 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 month edition will highlight new codes or guidelines regarding the ICD-10 update effective October 1, 2016.

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

Excludes 1 guideline

An exception to the Excludes 1 guideline has been created to identify the coding of two unrelated condition involving the Excludes 1 note. If the documentation does not clearly state if two conditions included in the Excludes 1 are unrelated, then the coder should query the provider for clarification.

Zika virus infections

This is a new guideline created during this update to address this new disease. According to the 2017 ICD-10-CM guideline only confirmed cases of the Zika virus should be coded using diagnosis code A92.5 (Zika virus disease). Currently Section II.H of the ICD-10-CM guideline state that “suspected”, “possible” or “probable” diagnosis can be coded at the time of discharge, but the coding of the Zika virus is an exception to this guideline and should not be coded if documented as uncertain. .

“With” guideline

According to the 2017 ICD-10-CM guideline, a causal relationship should be presumed between two conditions linked by the term “with” in the Alphabetic Index or Tabular List. This relationship is presumed even with the absence of physician documentation linking the two conditions. If the physician documentation clearly states the two conditions are unrelated, then a causal relationship should not be presumed. This is a significant update to the guidelines for 2017 and mirrors AHA Coding Clinic advice from First and Second Quarters 2016.

ICD-10-PCS

Coronary Artery Bypass

Multiple new or revised PCS codes involving coronary artery bypass procedures have been added effective October 1, 2016. New codes have been added to identify the type of nonautologous tissue substitute used during a bypass procedure. Generic language included in procedure code titles such as “one site” has been revised to identify the exact coronary artery or vein to that was bypass from. For example PCS code 02104ZF (Bypass Coronary Artery, One Site from Abdominal Artery, Percutaneous Endoscopic Approach) has been revised to state Bypass Coronary Artery, One Artery from Abdominal Artery, Percutaneous Endoscopic Approach.

Nonautologous Tissue Substitute

Multiple PCS codes have been added or revised to identify the type of nonautologous tissue substitute used during a coronary artery bypass procedure. A new 6th character of ‘8’ has been created to identify the device of Zooplastic tissue substitute during a bypass procedure. As an example, the new PCS code 0210083 (Bypass Coronary Artery, One Artery from Coronary Artery with Zooplastic Tissue, Open Approach) has been created to identify when Zooplastic tissue is used during a coronary artery bypass procedure.

Pacemaker Insertion

New PCS codes have been added to identify the insertion of a pacemaker. Prior to October 1, 2016, the 6th character of ‘D’ is coded to identify that this as an intraluminal device insertion. However, this character does not identify the device that was inserted. The new 6th character ‘N’ has been created to identify the insertion of a pacemaker device. For example, PCS code 02H40NZ (Insertion of Intracardiac Pacemaker into Coronary Vein, Open Approach) has been created to differentiate between an intracardiac pacemaker and other devices.

 

 
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