Coding Tips

New MI Codes: The ICD-10-CM updates for October 1st brought three new MI codes: Code Description CC/MCC I21.9 Acute myocardial infarction, unspecified MCC I21.A1 Myocardial infarction type 2 MCC I21.A9 Other myocardial infarction type MCC New guidelines have been published to provide guidance on how to apply the new MI codes and existing guidelines revised for…

The ICD-10-PCS code changes for 10/1/2017 contain over 3,500 new codes. These new codes focus on correcting deficiencies in providing specific options for various character values in a variety of procedures. Many of the new codes will invalidate and nullify previous Coding Clinic advice for specific code assignment when the exact character value was not…

Scenario: A 64-year-old patient with new onset ascites presents for abdominal paracentesis. An ultrasound guided diagnostic and therapeutic paracentesis are both performed via a catheter. Is it appropriate to report two procedure codes for the diagnostic and therapeutic paracentesis? Answer: 0W9G3ZZ – Drainage of peritoneal cavity, percutaneous approach, for the diagnostic and therapeutic paracentesis Rationale:…

Fasciotomy for Compartment Syndrome Scenario: Postoperative diagnosis: status post polytrauma left lower extremity status post motorcycle accident with elevated compartment pressure for the lateral as well as the medial compartments. Procedure: The compartment pressures of the patient’s four compartments were measured. For the anterior and lateral compartments the measurement was 32, for the posterior compartment…

Ischemic Stroke Therapy with tPA Scenario: A patient is presented to the ER with weakness and expressive aphasia and CT head reveals an ischemic infarct of the left posterior cerebral artery. The patient was started on tPA and a repeat CT scan showed the left stroke with intracerebral hemorrhagic conversion in the left hemisphere. The…

Scenario: A patient is admitted for a cholecystectomy and during the medical clearance the patient is diagnosed with “Stage A heart failure”. The patient has hypertension, DM, and a family history of cardiomyopathy. How is the heart failure coded? Answer: Assign code Z91.89 Other specified personal risk factors for Stage A heart failure. Assign additional…

Impella® External Heart Assist Device The Impella® heart pump is a temporary ventricular support device designed to provide hemodynamic support to a patient with depressed heart function. The device is FDA approved for use in high-risk percutaneous coronary intervention and in instances where a patient is suffering from cardiogenic shock following a heart attack or…

Scenario: An elderly primigravida mother is admitted at term and has a normal spontaneous vaginal delivery. What ICD-10-CM code(s) would be assigned to this visit? Answer: O80 Encounter for full-term uncomplicated delivery Rationale: ICD-10-CM Guideline I.C.15.b.2 Codes from category O09, Supervision of high-risk pregnancy, are itended for use only during prenatal period. For complications during…

Hypertension, Diabetes and CKD 1. HTN & CKD Many of us have been perplexed and confused by recent Coding Clinic advice in regard to Hypertension and CKD. While we may not always agree with published advice the official coding guidelines and coding clinic guidance are the rules that we must follow when reporting ICD-10-CM/PCS codes….

Scenario: A patient is admitted to University Hospital in cardiogenic shock due to an acute LAD blockage. The patient was taken to the cath lab where 2 lesions were found. One, in the proximal LAD, was stented with a single DES and in the distal lesion 2 kissing DES were deployed. Following the PTCA a…