With any new car, smartphone, or device, there are fun new features to test out and master. Newer can mean better, and this can even apply to a code set. Since the implementation of ICD-10 this month, CDI’s have had the opportunity to try out new queries, introduced to new guidance from Coding Clinic and official coding guidelines. Some query opportunities in CDI have been added or tailored for ICD-10 coding, and in some cases we’ve been given “no query needed” passes on some other diagnoses. The following highlights some of the more common conditions for queries and defaults that might impact in ICD-10.
New query opportunities:
- Sepsis – there is no longer a default for “SIRS due to infectious process.” Query for sepsis for an MCC or a new principal diagnosis and DRG.
- Nicotine dependence with withdrawal – this is now a CC.
- Diabetes mellitus with gangrene and diabetes mellitus with osteomyelitis – relationships are no longer assumed with these diagnoses. The provider must document the relationship. Gangrene, NEC and osteomyelitis, unspecified can stand on their own as CCs, but querying for the relationship with DM results in assignment of a combination code. This impacts sequencing the principal diagnosis and DRG assignment.
- Intestinal obstruction due to specified condition – there is an Excludes 1 note under diagnoses K56.60 and K56.69 (unspecified and other intestinal obstruction respectively) , that instructs the coder to “code to condition” when the relationship is documented. Considering the usual causes (Crohn’s, malignancy, hernia), this can mean a higher weighted DRG if listed as principal or secondary diagnoses. If surgery is performed, it can also result in a higher weighted surgical DRG.
- Anemia associated with malignancy – in the Neoplasm chapter of the ICD-10-CM code book, the coding guideline 2.c.1. indicates “when the admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis.” A query might be necessary to establish or strengthen this link, so that the above sequencing can be confidently assigned.
Modified query opportunities:
- Hepatic encephalopathy – only if it’s documented “with coma” is it an MCC.
- Drug dependence (except cannabis) – previously, “continuous” drug dependence would be a CC query opportunity. In ICD-10, certain drug dependencies, “uncomplicated,” are CCs as a default. With the new code structure available for drug use, abuse, and dependence, the query opportunity now lies in reviewing clinical indicators and treatment for possible dependence (vs. use or abuse).
New defaults (no query necessary):
- A fracture in a patient with known osteoporosis – “if that fall or trauma would not usually break a normal, healthy bone” is coded as a pathological fracture (M80.-). This coding guideline can be found in the ICD-10-CM code book, in the Musculoskeletal System and Connective Tissue chapter, 13.d.2.
- “When unilateral weakness is clearly documented as being associated with a stroke, it is considered synonymous with hemiparesis/hemiplegia.” This Coding Clinic guidance from first quarter 2015 recommends using a code from G81. – Hemiplegia, unspecified, to capture this CC if it’s from a current stroke. There is a separate code for hemiplegia and hemiparesis following cerebral infarction (I69.35-) in category I69 sequelae of cerebrovascular disease, if the weakness is a residual effect from a prior stroke.
What other documentation tips are you having fun with in ICD-10? Let us know. Share with others.
Keeping a visible reminder of these new features on your desk or in your reference guide can help with concept retention, practice, and accuracy.
Authored by Wendy Tsaninos, RN, MSTD, CCDS, CCS from Maxim Coding Center