Coding Clinic Advice Highlights from Second Quarter

Guidance and advice effective with discharges occurring on and after June 21, 2019.

The American Hospital Association (AHA) Coding Clinic for ICD-10-CM/PCS for the second quarter of 2019 was released last month, and there are some interesting topics and guidance within this volume (Volume 6, Number 2).

Due to copyright restrictions, the contents and guidance can not be reproduced in this article verbatim, so it’s imperative that coding and clinical documentation improvement (CDI) professionals read through the full issue. All guidance in this Coding Clinic issue is effective for encounters/discharges occurring on and after June 21, 2019.

The new issue contains 43 questions and answers related to ICD-10-CM (diagnosis coding) and 14 questions and answers related to ICD-10-PCS (procedure coding system) for hospital inpatient coding. This includes three correction notices; for ICD-10-CM, there is guidance correcting previous guidance published late in 2018 regarding post-procedural infection due to sepsis when the procedure was obstetrical. New guidance also states to assign a code for “sepsis following an obstetrical procedure” as an additional code.

The first-quarter 2018 guidance for ICD-10-PCS regarding the appropriate code for a TIPS (transhepatic portosystemic shunt revision) was corrected from the device value “D” to synthetic substitute value “J.” The final correction in this issue tweaked guidance for ICD-10-PCS from the second quarter of 2017 stating that the body part value of “cervical vertebral joint” was to be assigned for insertion of a spinal instrumentation device; instead, the body part should be “cervical vertebra,” per this correction. Be sure to read over the full guidance for the above corrections.

Within the cardiac or circulatory coding area, there were several scenarios listed offering guidance and clarification. Guidance includes the coding of cardiac valve insufficiency and valve stenosis as rheumatic. If the provider does not specify the specific cause of the valve disease, then we should assume it is rheumatic. Thus, for aortic valve stenosis and mitral valve insufficiency without documentation of the cause, we assume a rheumatic origin and assign a code for “Rheumatic disorders of both mitral and aortic valves.” 

Another cardiac coding scenario addressed in this issue covered an electrocardiogram (ECG) showing “asystole” without any documentation of cardiac arrest, with the classification indicating “Asystole (heart)” to see Arrest, cardiac. Coding Clinic says it would be inappropriate to assign cardiac arrest in this case. Please be sure to read the full and complete content of this Q&A. 

A coding scenario that is often challenging is when there is medical record documentation via an ECG that indicates a complete AV block, with a few seconds of asystole that is then converted to sinus bradycardia. The question is should the asystole (cardiac arrest, per the classification) be coded? The guidance from Coding Clinic is not to assign the code for asystole, but to assign the “Atrioventricular block, complete” ICD-10-CM code. 

The next coding scenario I’d like to highlight is one I’ve encountered several times, “elevated troponin.” The question focuses on whether this is an elevated serum enzyme, a plasma protein, or blood chemistry? The answer from Coding Clinic is that elevated troponin is a blood chemistry, and we would assign the ICD-10-CM code for “Other specified, abnormal finding of blood chemistry.” I’m sure this will be helpful advice for many.

The final cardiac coding scenario in the Q&A that I’d like to bring to your attention is when there is documentation of the diagnosis of “chronic persistent atrial fibrillation” in the medical record, and the question is, considering the specific codes for “chronic” and “persistent,” would both codes be assigned? Being that chronic atrial fibrillation is a non-specific term and that persistent atrial fibrillation is a more specific term (and often occurs for seven days or longer and may require cardioversion), you would only assign the ICD-10-CM code for “persistent atrial fibrillation.”  

Two ICD-10-PCS Q&As from this issue I’d like to highlight are the coding of an endoscopic wound VAC placement (an unusual procedure) and coding of a Kiva® kyphoplasty. The ICD-10-PCS code for the situation of an endoscopic wound VAC sponge placement for the purpose of assisting with the healing of a gastric perforation would be coded to “Insertion of other device into the stomach, via natural or artificial opening, endoscopic.” Please read the full Q&A for this scenario to fully understand the rationale for this PCS code.

Another procedure in this issue of Coding Clinic that is interesting is the “Kiva® kyphoplasty” with bone cement inserted for a compression fracture of L5. With this procedure, the PCS code would be “Supplement lumbar vertebra with synthetic substitute, percutaneous approach,” and no additional code is necessary. The Kiva® manufacturer website is a good resource to check out, and be sure to read the full content of the Coding Clinic advice.

AHA Coding Clinic is an official coding source and guidance that must be read and followed. Please be sure to obtain this new issue and read through all the pages of guidance for both ICD-10-CM and ICD-10-PCS. Happy coding!

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