Archive for ‘ICD-9 Coding’

November 23, 2011

M1308, the question that keeps on giving …

Several questions in CMS’s 3rd quarter Q&As deal with pressure ulcers and M1308.

The highlights (in my words, not CMS’s!):

  • Should a muscle flap be reported in M1308 as a current pressure ulcer? No. It is a surgical wound (as are skin advancement flap, or rotational flap)
  • If the pressure ulcer has a skin graft, how is it treated? Not as a surgical wound but as unstageable until it heals, then Stage III or IV.
  • How do you report a Stage III that is closing to the point of a pinpoint? As a Stage III …

Find CMS’s full answers here.

November 14, 2011

Jan. 1 M0090 date is the end for case-mix hypertension

CMS has clarified that payment changes relative to the removal of the hypertension codes will be effective with M0090 dates of 1/1/2012.

“Beginning with M0090 dates of January 1, 2012, 401.1 Benign essential hypertension codes and 401.9 Unspecified essential hypertension are removed from the HH PPS case-mix system. Specifically, 401.1 and 401.9 diagnosis codes will no longer result in additional points when computing the HIPPS codes”

Providers should not change the codes they use for hypertension unless they have been coding the 401 codes in error. Changing the codes just to get points is upcoding and we certainly do not want to prove CMS correct about case mix creep. You can be sure that they will be watching for trends in hypertension coding as a result of the case mix change.

Remember hypertension with chronic kidney disease (585) or renal sclerosis (587) changes the hypertension code to the 403 category. There is a presumed relationship between CKD and HTN with HTN causing the CKD.

However, a relationship between heart disease and HTN cannot be presumed. The physician must either state (e.g., heart failure due to hypertension) or imply the relationship (e.g., hypertensive heart disease).

Even if you do not have the information to be able to change the hypertension code to some other category besides 401, do not despair! Remember that hypertension and heart disease are together in Table 4. Even if you do not earn points with the hypertension codes, think how many of your patients with 401 codes also have codes from the 414 category (coronary atherosclerosis and chronic ischemia), 410 (acute myocardial infarction) and 428 (heart failure). Those codes are case mix, too, so you will not be losing any points!

Grouper information!

October 25, 2011

Dementia redux

I am already getting questions on dementia coding … here we go!

Question: Now that the new dementia codes (294.10, 294.11) have come out, do we only use them for a dementia related to another condition that was coded and use 290.0 for straight senile dementia OR do we have to use 294.1x for all dementia?

Lisa says: The new dementia codes are 294.20 and 294.21. Those are for dementia NOS. Senile dementia is coded when documented. 294.1x codes for use when associated with physical conditions such as those listed. 
September 28, 2011

Time for our annual date dance

As codes change Oct. 1, we need to think about which set of codes, 2011 or 2012, we need to use for our patients whose episodes cross over the code change period.

Actually, we need to look at what episodes or assessments cross the code change period. The choice of codes, and CMS confirmed this to me, is based on M0090, the completion of assessment. Soooo…

If the assessment is not complete by Oct. 1, we use 2011 codes for the RAP and EOE. If the assessment is complete by Oct. 1, use the 2012 codes.

What about payment changes over the fiscal year change? CMS has a formula that factors in payment issues. It’s not something for us to worry about.

September 26, 2011

Skin neoplasm codes go the way of 5th digits

All 173 codes are now 5th digits, following the recent trend in neoplasm codes. The bigger issue with these five-digit codes is that CMS has only designated 173.09 as a case-mix code, not the other codes. This takes away our case-mix codes. Almost all neoplasm 173 codes were all case-mix before the 2012 list came out. That should not be done without rulemaking, so there are may queries in to CMS about this issue.

Remember that the codes follow a patter with the 5th digit:

0 = unspecified

9 = other specified (and this is the case-mix code)

Also remember that the codes affected are not melanoma codes.

August 31, 2011

E.coli hits the 5th digit world

Effective Oct. 1, watch the E. coli codes …. they now need 5th digits.

041.49 is the code we are most likely to use.  Watch the use additional code instruction that is now attached to this group of codes.

Quick scenario: Your patient is being treated for a bladder infection caused by E. coli.

M1020: 595.0, acute bladder infection

M1022: 041.49, E. coli unspecified

August 18, 2011

All the new codes are here today!

My new codes webinar is Fridat Aug. 19 (TODAY!) at noon central time!

Learn everything you need to know about new codes and guidelines effective Oct. 1.

http://selmanholmanblog.com/2011/08/04/new-codes-seminar/#entry

August 16, 2011

I’m touring Texas!

Intermediate coders, get all the latest information on changes and the best coding education around. I’m

Highlights include:

  • Explain CMS guidance on sequencing.
  • Explain the relevance of OASIS C data items for diagnoses to payment.
  • Explain coding of diagnoses of infections, neoplasms, endocrine disorders such as diabetes, anemias, mental disorders, and the nervous system & sense organs.
  • Identify the differences between different kinds of ulcers.
  • Describe the purpose and appropriate use of V and E codes.
  • And tons more … including identifying new codes that will take effect October 1, 2011.

I will be in Dallas Aug. 24-25;  McAllen Aug. 31-Sept. 1; Houston, Sept. 7-8

IntermediateTourAugSep2011-1: Register and learn more!

August 11, 2011

New guidelines are here!

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.

August 4, 2011

New codes seminar!

My new codes seminar is rapidly approaching … come listen Aug. 19, 1-2:30pm CDT for a few highlights of the nearly 200 new and changed diagnosis codes for 2012 including:
• Expanded codes for E coli from one to 4 new codes.
• 40 new skin cancer codes that will add both case mix and non-routine supply points.
• New probably case mix codes for dementia without a specific underlying etiology will allow recognition of the presence or absence of behavioral issues and a change to what is described as a behavioral issue.
• Changes to the V code for history of pulmonary embolism.
• New complication codes associated with gastric band surgery, cystostomies and stem cell transplants.
• Specific V codes for acquired absence of joints when a prosthetic joint has been removed and replaced with a spacer.

NewCodesWebinar2011

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