Posts tagged ‘coding guidelines’

February 7, 2012

Don’t forget the buddies!

The coding world got upset during the Open Door Forum not too long ago. The CMS spokesperson was talking about the removal of data validity flags on etiology/manifestation pairs and said the grouper would capture the points if the manifestation was coded anywhere under the etiology.

Someone then asked for clarification and again he said that the manifestation did not have to be coded directly after the etiology (not an exact quote). The spokesperson was not speaking of the coding guidelines, but of the grouper and data validity flags. CMS is not overriding the coding guidelines and making a new rule just for us!

Coding guidelines are clear, and here’s a quote from Appendix D section 6 (December 2011) of the OASIS-C Guidance Manual from CMS:
“Criteria associated with etiology/manifestation pairs coding are listed below:

The etiology code is the underlying disease and must be sequenced first, before the code for a related manifestation. When a diagnosis is under consideration as an etiology diagnosis, the HHA is expected to ensure that a valid manifestation code is sequenced immediately following the assignment of the etiology code.”

So, don’t go breaking up your buddy codes!!

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.

January 20, 2011

Coding guidelines direct you on unstageable pressure ulcer coding

I often get questions about how to code a pressure ulcer that now has a muscle flap. Luckily, the coding guidelines are clear on this point (and many others regarding pressure ulcers) in its Chapter 12 guidelines:

2) Unstageable pressure ulcers
Assignment of code 707.25, Pressure ulcer, unstageable, should be based on the clinical documentation. Code 707.25 is used for pressure ulcers whose stage cannot be clinically determined (e.g., the ulcer is covered by eschar or has been treated with a skin or muscle graft) and pressure ulcers that are documented as deep tissue injury but not documented as due to trauma. This code should not be confused with code 707.20, Pressure ulcer, stage unspecified. Code 707.20 should be assigned when there is no documentation regarding the stage of the pressure ulcer.

As a quick aside: don’t routinely use 707.20. I would only consider using it when there is a pressure ulcer under a cast or other device where the stage cannot be determined and it doesn’t meet the definition of unstageable in the guideline.

You can code aftercare after a flap or skin graft. Remember on OASIS that the pressure ulcer covered with a muscle flap can be classified as a surgical wound in M1340 only. This is where the coding guidelines and the OASIS guidance take a whole different path. After the now-flapped pressure ulcer has been declared a surgical wound, the coding guidelines still consider the muscle flapped pressure ulcer an unstageable pressure ulcer. (Pressure ulcers with skin grafts are still pressure ulcers!)

Consider this scenario:

Your patient has a pressure ulcer on coccyx that was repaired with a muscle flap. Code the aftercare of surgery first: V58.77, then 707.03, 707.25 for the unstageable pressure ulcer on the coccyx.
You have a surgical wound in M1340 and no pressure ulcers in M1306.