It is important that https://traderoom.info/ managers and outpatient facility coders stay actively engaged with the rulemaking notices and publications for the hospital OPPS. Each year, the Office of the Federal Register releases a Notice of Proposed Rulemaking to announce any planned changes to the OPPS. The NPRM allows a commenting period before final changes are implemented. After all comment considerations, the OPPS final rule, along with updates to the ASC payment system, is published.

There was a question related to the insertion of a preCARDIA device and how this should be reported. This device is now being used to treat an acute decompensation of heart failure. A balloon catheter and a pump controller are used to occlude the superior vena cava intermittently. The goal is to rapidly reduce congestion in the venous system , contributing to improved cardio-renal function. This intervention allows for improved response with a goal of shorter length of stay and fewer hospital readmissions.

ICD-10-CM/PCS Coding Clinic Update: Fourth Quarter

Assign codes for the specific symptoms (such as generalized weakness, debility, etc.). Assign the appropriate personal history code (code Z86.19, Personal history of other infectious and parasitic diseases, for discharges/encounters prior to January 1, 2021, or code Z86.16, Personal history of COVID-19, for discharges/encounters after January 1, 2021) as a secondary diagnosis. Assign code U07.1, COVID-19, as the principal diagnosis, and code J96.01 Acute respiratory failure with hypoxia, as a secondary diagnosis.

Gloryanne is an HIM what is coding clinic professional and leader with more than 40 years of experience. For the past six years she has been a regular speaker and contributing author for ICD10monitor and Talk Ten Tuesdays. She has conducted numerous educational programs on ICD-10-CM/PCS and CPT coding and continues to do so.

Coding Systems Used in the Outpatient Facility Setting

The expansive location features exam rooms as well as surgery, dentistry and radiology rooms. Additionally, there’s an on-site laboratory, pharmacy, ultrasound and kennel. Noncommercial use of original content on is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. No, these new codes are only intended for use when these drugs are being administered to treat COVID-19.

• Adherence to these guidelines when assigning ICD-10 diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act .
• AHA Coding Clinic for ICD-10-CM/PCS and AHA Coding Clinic for HCPCS, published quarterly by the AHA Central Office, provides expert guidance supporting coders, auditors, and insurers with coding advice.
• This change means that many new procedures will be eligible for payment in an outpatient setting, proving that staying up to date on rule changes is essential to successful outpatient facility coding and reimbursement.
• For additional coding guidance for ICD-10-CM for COVID-19 and beyond go to the AHA Coding Clinic Advisor website to see the latest updates.

I personally enjoy working on these denials because they are challenging, forcing me to continue to learn and grow as a coder, as well as giving me a different way to look at the chart when I’m coding than I had before. A Certified Inpatient Coder (CIC™) can be ideal to review these types of denials, as we are usually very detail-oriented and already have at least a general understanding of clinical concepts, having participated in education alongside CDI nurses. When the DRG is changed upon review by the health insurance auditor to a lower-paying DRG, it isn’t typically identified as a DRG downgrade — that is something you must watch for and identify. Look for loopholes, specifically for differences in criteria used to review claims. Another reason for the increase in clinical validation denials could be due to the reviewers looking for something in particular and completely overlooking other supporting clinical indicators. The ability to recognize ambiguous documentation and understand the criteria the provider used to determine a diagnosis are very useful skills, however.

Getting Acquainted With Category II Codes

Published since 1984, Coding Clinic brings the latest official coding information to coding professionals, auditors, third-party payers, government agencies, and consultants who are interested in and dedicated to improving the accuracy and uniformity of medical coding. CMS’ affirmation of the Coding Clinic as the official source of coding information is noted in the Federal Register, Vol. Coding Clinic for ICD-10-CM and ICD-10-PCS is the quarterly newsletter published by the American Hospital Association’s Central Office on ICD-10-CM and ICD-10-PCS. Yes, underimmunization status codes may be assigned based on nursing or other clinician documentation where information regarding the patient’s vaccination status can be found.

Desk copies are also complimentary, but are reserved for teachers or professors who have already assigned the Handbook in a course. Review copies will be distributed as a ePub file, and desk copies will be distributed as a PDF. If you are eligible for a desk copy, you are required to submit documentation showing that you have adopted the 2021 ICD-10-CM and ICD-10-PCS Coding Handbook for your class your program.

When sequencing diagnoses, we are to follow the Official Guidelines for Coding and Reporting and assign the diagnosis, condition, or problem identified as being chiefly responsible for the encounter. There is no specific sequencing instruction for the B04 code classifying monkeypox. The medical coding systems currently used in the United States are ICD-10-CM/PCS and HCPCS . The Healthcare Common Procedure Coding System is used to report hospital outpatient procedures and physician services.

These represent existing services or procedures widely used and, when appropriate, approved by the Food and Drug Administration . CMS also is offering free assistance, including its “Road to 10” website aimed specifically at smaller physician practices. This collection includes primers for clinical documentation, clinical scenarios and other specialty-specific resources to help with implementation. The AMA advocates at the federal and state levels on key health care issues impacting patients and physicians. However, coders and CDI specialists should be careful not to look at Coding Clinic in a vacuum, Kennedy says. They also need to follow the coding hierarchy for diagnosis coding in ICD-10-CM.

It is important to note that not all conditions that occur during or following medical care or surgery are classified as complications. There must be a cause-and-effect relationship between the care provided and the condition, and the documentation must support that the condition is clinically significant. It is not necessary for the provider to explicitly document the term “complication.” For example, if the condition alters the course of the surgery as documented in the operative report, then it would be appropriate to report a complication code. Query the provider for clarification if the documentation is not clear as to the relationship between the condition and the care or procedure.

• These codes should only be assigned when these drugs are administered to treat COVID-19.
• Within the “questions and answers” portion of the latest Coding Clinic, there were 25 diagnostic topics discussed, and coding guidance was provided.
• Again, it was stated in the Coding Clinic that “emphysema is a form of COPD.” There is an instructional note “excludes 1” at J44, which, as mentioned, does not allow J44.0 and J43.9 to be coded together.
• The ICD-10-CM code set is used in all clinical settings to capture diagnoses and the reason for the visit.

Coders assign a code for every service or procedure a provider performs. CPT® even includes codes called unlisted codes for those services and procedures not specifically named in another defined CPT® code. Specifically, CPT® codes are used to report procedures and services to federal and private payers for reimbursement of rendered healthcare.

Note that effective January 1, 2021, there is a new code, J12.82, for pneumonia due to coronavirus disease 2019. For an encounter for antibody testing that is not being performed to confirm a current COVID-19 infection, nor is being performed as a follow-up test after resolution of COVID-19, assign Z01.84, Encounter for antibody response examination. Yes, Presumptive positive COVID-19 test results should be coded as confirmed.

Although subcategory T80.5, identifies anaphylactic reaction to serum, it is the closest available code to capture this condition. Assign codes T78.49XA, Other allergy, initial encounter; R07.89, Other chest pain; and R09.89, Other specified symptoms and signs involving the circulatory and respiratory systems. The currently approved COVID-19 vaccines in the United States are not serum based, and therefore code T80.62XA-, Other serum reaction due to vaccination, initial encounter is not appropriate. Any immunocompromised patient is at higher risk for becoming infected with COVID-19, but HIV does not cause COVID-19. Code both conditions separately, with sequencing depending on the circumstances of admission – just like a patient suffering from diabetes or any other chronic condition that puts them at higher risk for the COVID-19 infection. The intent of the guideline is to code only confirmed cases of COVID-19.

This scenario meets the exception to the Excludes1 guideline as a circumstance when the two conditions are unrelated to each other. Coding professionals should query the provider if the provider documented COVID-19 before the test results were back and the test results come back negative. Providers should be given the opportunity to reconsider the diagnosis based on the new information. Please refer to the supplement to the ICD-10-CM Official Guidelines for coding encounters related to the COVID-19 coronavirus outbreak for guidance for coding of discharges/services provided before April 1, 2020. Minimum of 4 years of progressive on-the-job coding experience with ICD-10-CM and CPT coding in a health care environment and/or medical office setting.