Home Health Insight

Coding Guidelines were released today, effective Oct. 1, and it does not appear there is anything earth-shattering. With the new glaucoma codes have come a slew of new glaucoma guidelines. Here are some highlights:

Glaucoma additions break out guidelines for glaucoma 365,1-365.7, then breaks the guidelines out by: bilateral glaucoma with same stage, bilateral glaucoma stage with different stages, bilateral glaucoma with different types and different stages, patient admitted with glaucoma and stage evolves during the admission, and undetermined glaucoma stage. (Chapter 6.b)

There is a slight change in the wording of Late effects:
“A late effect is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used. The residual may be apparent early, such as in cerebrovascular accident cases, or it may occur months or years later, such as that due to a previous injury. Coding of late effects generally requires two codes sequenced in the following order: The condition or nature of the late effect is sequenced first.    The late effect code is sequenced second.

Exceptions to the above guidelines are those instances where the late effect code has been expanded (at the fourth and fifth-digit levels) to include the manifestation(s) or the classification instructs otherwise. The code for the acute phase of an illness or injury that led to the late effect is never used with a code for the late effect.” (Section 1.B.12)

Septic shock (Chapter 1.b.6.a, Chapter 1.b.6.b) include additions for sceptic shock codes:
785.52, Septic shock or 998.02, Postoperative septic shock.

Postprocedural infection and postprocedural septic shock changes address postprocedural infection and complications. Codes involved include: 998.59, 674.3x, 995.92, 998.02. (Chapter 1.10)

Anemia associated with malignancy. There is a clause addition to this area of the guidelines. “If anemia in neoplastic disease and anemia due to antineoplastic chemotherapy are both documented, assign codes for both conditions.” (Chapter 2.c.1)

Complications of care (Chapter 17.f.1) specifies that An additional code identifying the complication should be assigned with codes in categories 996-999, Complications of Surgical and Medical Care NEC, when the additional code provides greater specificity as to the nature of the condition.