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Prevalence & New ICD-10-CM Code Updates Childhood obesity remains a pressing public health concern in the United States. According to the CDC, approximately 1 in 5 children and adolescents — about 19.7% of those aged 2–19 years—are affected. That’s an estimated 14.7 million young people across the country. 📊 Obesity Trends Among U.S. Youth Childhood obesity isn’t distributed evenly. Rates vary across age groups , racial/ethnic backgrounds , and socioeconomic status : By Age Ages 2–5: 12.7% Ages 6–11: Data not specified in this summary Ages 12–19: 22.2% By Race & Ethnicity Hispanic: 26.2% (highest prevalence) Non-Hispanic Black: 24.8% Non-Hispanic White: 16.6% Non-Hispanic Asian: 9.0% By Family Income Children in households at or below 130% of the Federal Poverty Level (FPL) have a 25.8% obesity rate—highlighting a clear socioeconomic link. 🏷️ New ICD-10-CM Codes for Pediatric Obesity – Effective October 1, 2024 To support more accurate diagnosis and classification, the FY 2025 ICD-10-CM updates introduced new and revised codes for pediatric obesity and BMI. 📌 New Obesity Classification Codes These now distinguish between three classes of obesity , based on BMI: E66.811 – Obesity, Class 1 (BMI: 30–34.9) E66.812 – Obesity, Class 2 (BMI: 35–39.9) E66.813 – Obesity, Class 3 (BMI: ≥40) 📌 Pediatric BMI Code Updates BMI coding for youth aged 2–19 years is now more detailed, enabling better tracking and clinical alignment with growth charts. Z68.54 – REVISED: Pediatric BMI at 95th percentile to <120% of the 95th percentile Z68.55 – NEW: Pediatric BMI at 120% to <140% of the 95th percentile Z68.56 – NEW: Pediatric BMI at ≥140% of the 95th percentile ⚠️ Reminder : Pediatric BMI codes apply to ages 2–19 . Adult BMI codes are for patients 20+ years . 💡 Why These Code Changes Matter The updated codes aim to: Improve diagnostic accuracy for healthcare providers. Align more closely with current pediatric obesity guidelines . Support better data tracking and research . Help identify patients at higher risk for comorbidities linked to severe obesity. 🔍 Final Thoughts These coding updates aren’t just bureaucratic changes—they’re designed to enhance the way we identify, track, and treat obesity in young patients. Accurate coding leads to more personalized care, better public health interventions, and stronger advocacy for at-risk children.  Sources: Childhood Obesity Facts | CDC ICD-10-CM Guidelines FY25, October 1, 2024 New Childhood Obesity ICD-10-CM Codes – Partner Promotion Materials

New COVID-19 Coding Guidelines

A recent question to the AHA Coding Clinic asked whether Parkinson’s Disease (PD) with tremor could be coded as Parkinson’s Disease with dyskinesia . The official guidance was clear: “Codes in subcategory G20.B- , Parkinson’s disease with dyskinesia, should only be assigned when dyskinesia associated with Parkinson’s disease is specifically documented by the provider. ” New ICD-10-CM Codes Effective October 1, 2023: G20.A1 – Parkinson’s disease without dyskinesia, without mention of fluctuations G20.A2 – Parkinson’s disease without dyskinesia, with fluctuations G20.B1 – Parkinson’s disease with dyskinesia, without mention of fluctuations G20.B2 – Parkinson’s disease with dyskinesia, with fluctuations G20.C – Parkinsonism, unspecified  Tremor vs. Dyskinesia in Parkinson’s Disease Both tremor and dyskinesia are movement disorders associated with PD, but they differ significantly in cause, presentation, and treatment. Here's a breakdown: 1. Tremor in Parkinson’s Disease Definition: Involuntary, rhythmic, oscillatory movement of a body part Typical Type in PD: Resting tremor — appears when the body part is at rest and improves with movement Characteristics: Frequency: 4–6 Hz Location: Commonly begins in one hand (e.g., “pill-rolling” tremor between thumb and fingers) Asymmetry: Often starts on one side of the body Triggers: Worse at rest, improves with movement or posture Cause: Dopamine depletion in the basal ganglia Treatment: Dopaminergic medications (e.g., Levodopa) Deep Brain Stimulation (DBS) in advanced cases 2. Dyskinesia in Parkinson’s Disease Definition: Abnormal, involuntary movements that are fluid, dance-like, or jerky Type in PD: Levodopa-induced dyskinesia (LID) — occurs as a side effect of long-term levodopa therapy Characteristics: Timing: Occurs at peak dopamine levels or during medication transitions Appearance: Chorea (random jerky movements), dystonia (sustained contractions), or both Location: May involve limbs, trunk, or face Triggers: High-dose or long-term levodopa use Cause: Pulsatile dopamine stimulation causes maladaptive changes in the basal ganglia Treatment: Adjusting levodopa (e.g., smaller, more frequent doses) Adding adjunct therapies (amantadine, dopamine agonists) Advanced options: DBS or continuous infusion (e.g., Duodopa) Key Differences Between Tremor and Dyskinesia Nature: Tremor: Rhythmic and oscillatory Dyskinesia: Irregular, flowing, or jerky Timing: Tremor: Worse at rest, better with movement Dyskinesia: Tied to medication timing (often peak-dose) Cause: Tremor: Dopamine deficiency Dyskinesia: Long-term use of levodopa Treatment Focus: Tremor: Dopamine replacement Dyskinesia: Medication adjustment or adjuncts Clinical Pearls Tremor is a core symptom of Parkinson’s and may be present at diagnosis. Dyskinesia is typically a treatment-related complication , appearing after years of therapy. Proper distinction between tremor and dyskinesia is essential for correct coding and treatment planning. Additional Clarification from Coding Clinic (Q4 2023) “Parkinson’s disease is a progressive neurodegenerative condition presenting with motor symptoms (e.g., tremors of hands, arms, legs, or head) and non-motor symptoms (e.g., depression, anxiety, pain). Dyskinesia is defined as involuntary movements of the face, arms, legs, or trunk. Fluctuations refer to alternating ON episodes (positive response to levodopa) and OFF episodes (return of symptoms as medication wears off).”

 Syndrome of Inappropriate Antidiuretic Hormone (SIADH) occurs when the pituitary gland releases excessive antidiuretic hormone (ADH) , leading the body to retain fluid and dilute sodium levels in the bloodstream. This condition causes hyponatremia and hypo-osmolality , often triggering a complex clinical picture. What Causes SIADH? SIADH can develop in response to several underlying conditions or external factors: CNS disturbances: Stroke, hemorrhage, infection, and trauma can trigger abnormal ADH release. Cancer: Especially small cell lung cancer, extrapulmonary small cell carcinomas, head and neck cancers, and olfactory neuroblastomas. Medications: SSRIs, NSAIDs, opiates, some antineoplastic drugs, ciprofloxacin, haloperidol, and high-dose imatinib. Surgery: Often linked to pain response. Hormonal deficiencies: Including hypothyroidism and hypopituitarism. Exogenous hormone use: Vasopressin, desmopressin, and oxytocin. HIV infection Hereditary SIADH Diagnostic Criteria: Schwartz and Bartter Clinical Framework A diagnosis of SIADH typically includes: Serum sodium < 135 mEq/L Serum osmolality < 275 mOsm/kg Urine sodium > 40 mEq/L Urine osmolality > 100 mOsm/kg Normal skin turgor and blood pressure (absence of clinical volume depletion) Exclusion of other hyponatremia causes Correction of sodium levels via fluid restriction Important Note: Code only the SIADH, not the hyponatremia, as hyponatremia is considered integral to the disease process . Clinical Scenario A 68-year-old male presents to the ED with confusion , nausea , and a 12-pound weight gain over the past week. He was diagnosed with small cell lung cancer two months ago. Vitals: BP: 160/90 mmHg HR: 110 bpm Labs: Serum sodium: 122 mEq/L Serum osmolality: Decreased Urine: Elevated osmolality and high sodium concentration Indicators Suggestive of SIADH Hyponatremia: Sodium level of 122 mEq/L Diluted Serum Osmolality: From water retention Concentrated Urine: High osmolality and sodium levels despite low serum sodium Recent Weight Gain: 12 lbs in one week, pointing to fluid overload Underlying Malignancy: Small cell lung cancer is a well-known cause of ectopic ADH production Documentation Tips 1. Accurate Diagnosis Clearly state “SIADH” and link it to the underlying cause , such as cancer. 2. Clinical Findings Review provider and nursing notes for symptoms like confusion, nausea, and fluid retention. Confirm vital signs and weight gain. Include lab values: sodium, serum/urine osmolality, and urine sodium. 3. Treatment Plan Document fluid restriction orders . Check MAR for medications such as vasopressin receptor antagonists . Note any improvements in symptoms and lab values after treatment. ⚠️ Tip: High blood glucose can artificially lower serum sodium levels. Use a sodium correction calculator to determine the true sodium level. References Centers for Medicare and Medicaid Services. (2024). ICD-10-CM Official Coding Guidelines. cms.gov Pinson, R., & Tang, C. (2024). The CDI Pocket Guide. cdiplus.com Prescott, L., & Manz, J. (2024). ACDIS CDI Pocket Guide. acdispro.com Sterns, R. (2024). Pathophysiology and etiology of SIADH. UpToDate. Yasir, M., & Mechanic, O.J. (2023). Syndrome of Inappropriate Antidiuretic Hormone Secretion. StatPearls Publishing.

Understanding Stroke and Its Long-Term Impact Stroke is the third most common cause of disability and the second most common cause of mortality worldwide. The global 30-day fatality rate following an initial ischemic stroke is estimated at 16–23% . A U.S. study of 220 ischemic stroke survivors revealed a range of neurologic deficits at six months post-stroke, including: Hemiparesis (50%) Cognitive defects (46%) Hemianopia (20%) Aphasia (19%) Sensory deficits (15%) Additionally, survivors experienced long-term disabilities such as: Depression (35%) Inability to walk without assistance (31%) Institutionalization (26%) Bladder incontinence (22%) What is a Stroke? A stroke , also known as a cerebrovascular accident (CVA) , occurs when the blood supply to part of the brain is interrupted or reduced , preventing brain tissue from receiving oxygen and nutrients. As a result, brain cells begin to die within minutes . Types of Strokes Ischemic Stroke The most common type, accounting for approximately 87% of all strokes. It occurs when a blood clot blocks or narrows an artery leading to the brain. Hemorrhagic Stroke Occurs when a blood vessel in the brain bursts , leading to bleeding in or around the brain . Common Late Effects of CVA Physical: Hemiplegia, hemiparesis, dysphagia, ataxia Cognitive: Memory loss, attention deficits, executive function impairments Speech and Language: Aphasia, dysarthria Sensory: Visual field loss, neglect (lack of awareness of one side of the body) Emotional and Behavioral: Depression, anxiety, personality changes Other: Bladder and bowel control issues, fatigue Recrudescence of Stroke Symptoms Recrudescence refers to the reappearance of previously resolved neurological deficits from a prior stroke. These symptoms are typically mild , short-lived , and not due to a new stroke . Key considerations: Recrudescence is coded as a “late effect of stroke.” Follows the same coding and sequencing guidance as the principal diagnosis (PDX). Can be reported alongside a new acute infarction , if applicable. Clarity in documentation is essential to accurately capture the etiology of stroke-related symptoms— query the provider if necessary. Query Example for Clarification Dear Dr. Carlson , Patient with PMH of CVA. Per H&P, admitted with “dysphagia.” Other diagnoses include severe malnutrition, with plans for a PEG tube. Can this patient’s dysphagia be specified as the most likely cause? For example: Dysphagia is recrudescence of previous stroke Dysphagia related to other (please specify) ___ Unknown/undetermined Other clinical indicators/treatment from the patient’s record: H&P notes: “dysphagia, severe malnutrition, and failure to thrive. ST/PT/OT to see. Family thinks dysphagia has been going on for a while.” Treatment: RD consult, PEG tube placement, PT/OT/ST Why It Matters: A favorable query response could shift the DRG from DRG 392 (Esoph, gastro, and misc digestive disorders w/o MCC) with the PDX of dysphagia , to DRG 057 (Degenerative nervous system disorders w/o MCC) with the PDX of weakness/dysarthria as a late effect of CVA .

When medical coders take PTO or a leave of absence, hospitals and healthcare entities can face the risk of disruptions in their revenue cycle. Medical coding is a critical part of the revenue cycle management process because it ensures that the healthcare provider is reimbursed for the services rendered. Disruptions in the coding process can cause delays, errors, and inaccuracies in billing, which directly impacts cash flow and financial health. To mitigate this risk, hospitals often rely on consultant vendors or outsourcing partners that specialize in providing temporary coverage for coding functions. These agencies are invaluable tools for hospitals looking to cover medical coders during PTO or leave periods and offer several benefits to healthcare systems needing to augment their staff.

UASI Solutions, a leader in health information management and revenue cycle solutions, is pleased to announce the appointment of Donna Sherburne as the new Director of Coding Services. Sherburne joins UASI from The Coding Network, bringing a wealth of expertise and a proven track record of leadership in medical coding and compliance. With over 20 years of experience in the healthcare industry, Sherburne has consistently demonstrated her ability to enhance coding operations, ensure compliance, and drive excellence in healthcare revenue cycle management. Her knowledge and strategic approach will further strengthen UASI’s commitment to providing industry-leading coding solutions that support healthcare organizations in achieving accuracy, efficiency, and financial integrity. “Donna’s extensive experience and dedication to coding excellence align perfectly with UASI’s mission to deliver high-quality solutions to our clients,” said Chief Operating Officer, Josh Tracy. “Her leadership will play a key role in advancing our coding services, ensuring that our clients continue to receive best-in-class support tailored to the ever-evolving healthcare landscape.” Sherburne’s addition to the UASI team underscores the company’s ongoing investment in top-tier talent and its commitment to staying at the forefront of industry advancements. By leveraging her expertise, UASI will continue to provide innovative solutions that help clients navigate regulatory complexities, optimize coding accuracy, and enhance overall operational performance. “I am thrilled to be joining UASI and look forward to collaborating with the team to drive continued excellence in coding services,” said Sherburne. “UASI’s reputation for quality and client-focused solutions aligns with my passion for ensuring the highest standards in medical coding and compliance.” Sherburne’s appointment is part of UASI’s strategy for growth and innovation in mid revenue cycle consulting and outsourced services. As the company continues to expand its offerings and enhance its solutions, the addition of top industry professionals like Sherburne will reinforce UASI’s position as a trusted partner for healthcare organizations nationwide.

UASI Solutions Welcomes Jim Sowar to Board of Directors Cincinnati, OH — March 31, 2025 — UASI Solutions, a leading national provider of revenue cycle solutions for healthcare organizations, is pleased to announce the appointment of Jim Sowar to its Board of Directors. Mr. Sowar brings over three decades of experience in the healthcare sector, having served as the National Tax Leader for the Health Care Provider sector at Deloitte and as the Managing Partner for Deloitte's Cincinnati office. "We are thrilled to welcome Jim to our Board," said Nancy Koors, CEO at UASI Solutions. "His extensive expertise in healthcare and his deep understanding of the industry's complexities will be invaluable as we continue to enhance our services and support healthcare organizations as they navigate increased financial pressures, technology and outsourcing opportunities nationwide." Throughout his career, Mr. Sowar has demonstrated a commitment to excellence and leadership. He has been instrumental in advising healthcare clients on a range of issues, including community benefit reporting, corporate structuring, and compliance matters. His insights have been featured in various industry publications, and he has been recognized for his contributions to the field. "I am honored to join the Board of UASI Solutions," said Mr. Sowar. "UASI has a strong reputation for delivering high-quality revenue cycle solutions to healthcare providers. I look forward to collaborating with the team to further the company's mission and contribute to its continued success." UASI Solutions has been empowering healthcare organizations with mid-revenue cycle solutions for over 40 years. The company's comprehensive services are designed to optimize revenue, enhance compliance, and improve operational efficiency for healthcare providers across the nation. About UASI Solutions Founded in 1984, UASI Solutions is a nationally recognized leader in the mid revenue cycle. The company offers a comprehensive range of healthcare consulting and solutions, including coding services, clinical documentation improvement (CDI), risk-based services, and revenue integrity. UASI is dedicated to helping healthcare facilities achieve correct reimbursement, maintain compliance, and improve operational efficiency.