In the Optum360 Coding Corner, we highlight areas in which medical coding professionals are struggling for uniformity and correct coding amongst their peers. In this article, we discuss coding variances for ICD-10-CM, ICD-10-PCS and/or CPT® found on a monthly basis and explore the codes, coding concepts and conventions for those variances. We also highlight new coding information when applicable to keep the coding community informed.
ICD-10-CM (both Inpatient and Outpatient settings)
Laterality and Osteoarthritis
When physician documentation states osteoarthritis (OA) with laterality of the shoulder, hip or knee, the ICD-10 index entry directs the coder to the primary OA code. The physician documentation does not always specify if the OA is primary. According to the fourth quarter Coding Clinic 2016, it is appropriate to code primary OA when laterality is documented. For example, if the documentation states osteoarthritis of the left knee, then the correct ICD-10 code is M17.12 (Unilateral primary osteoarthritis, left knee).
Branches of body parts PCS Guideline B4.2
New guidance has been added to the above guideline when coding cardiovascular procedures. When coding a non-cardiovascular procedure and the body part does not have its own value in PCS, then the closest proximal body part PCS character is selected. When coding cardiovascular procedures, if coding to the proximal body part requires assigning a different body system, then the general body part value is selected.
Dialysis sessions single versus multiple treatments
It is important that coders understand the correct definition when choosing the duration value for single versus multiple dialysis treatments in PCS. According to Coding Clinic first quarter 2016, “a duration value is assigned based on documentation of a single (continuous) treatment or multiple (separate) treatments.” For example, if a patient is admitted to the hospital and receives dialysis treatment on two separate days, then PCS code 5A1D60Z (performance of urinary filtration, multiple) should be coded. If the aforementioned patient received just one day of dialysis during the admission, then PCS code 5A1D00Z (Performance of urinary filtration, single) should be coded.
CPT is a registered trademark of the American Medical Association.