Use Coding Clinic for ICD-10 insight

Coders and CDI specialists may not always agree with the advice provided by the American Hospital Association's Coding Clinic, but the publication can serve as a sort of judge and jury for confusing coding situations.

 

“Whereas the ICD-9-CM or ICD-10-CM/PCS transaction sets, supplemented by the guidelines, are the Constitution, Coding Clinic serves as the Supreme Court in interpreting ICD-9-CM or ICD-10-CM/PCS and their guidelines,” says James S. Kennedy, MD, CCS, CDIP, president of CDIMD in Smyrna, Tennessee. In other words, Coding Clinic’s advice is official.

 

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.

 

Start with the ICD-10-CM Index to Diseases. Look terms up here first. “The index in many cases drives the bus,” Kennedy says.

 

Next, go to the ICD-10-CM Table of Diseases, which offers additional instructions, such as “code first,” “code in addition,” “in diseases classified elsewhere,” “Excludes1,” “Excludes2,” and other notes, Kennedy says.

The ICD-10-CM Official Guidelines for Coding and Reporting may add or subtract codes or influence sequencing. “If you want cheap education about what ICD-10 is, download the guidelines and read them,” Kennedy says.

 

At the bottom of the hierarchy are court opinions or other payer-specific regulations.

 

A similar hierarchy exists for ICD-10-PCS codes, Kennedy says. Here, the ICD-10-PCS Index is one place to start. The purpose of the Alphabetic Index is to locate the appropriate table that contains all information necessary to construct a procedure code. In some cases the index will list the entire code. In other cases, it will only list part of the code. Either way, coders should always consult the ICD-10-PCS Tables to find the most appropriate valid code.

 

However, coders don’t have to start at the index. They can proceed directly to the tables to choose the correct code. Coders have an additional resource for ICD-10-PCS: the ICD-10-PCS Reference Manual, a supplemental guide developed by 3M through a contract with CMS.

 

Next, consider advice from Coding Clinic for ICD-10-CM/PCS, and finally, be sure to review any court opinions or other payer-specific regulations.

 

Coding Clinic guidance is not always set in stone and unchanging, cautions Kyra Brown, RHIA, CCS, CDI manager/educator for Erlanger Health System in Chattanooga, Tennessee.

 

“You can’t hang your hat on older Coding Clinics,” Brown says. And that could present significant challenges after the transition to ICD-10. 

 

Coders don't have to throw out Coding Clinic advice for ICD-9-CM, but they do need to be careful when applying it in ICD-10-CM, says Nelly Leon-Chisen, RHIA, director of coding and classification for AHA in Chicago.

 

Consider gangrene and diabetes. In ICD-9-CM, coders can assume a cause-and-effect relationship between the diabetes and the gangrene as long as the physician does not document any other causes of the gangrene (Coding Clinic, First Quarter 2004, pp. 14-15). In ICD-10-CM, however, coders cannot assume a relationship between diabetes and gangrene or osteomyelitis, Leon-Chisen says. So either the physician needs to document that connection or the CDI specialists/coders will have to query for that additional specificity (Coding Clinic, Fourth Quarter 2013, p. 114).

 

Editor's Note: This article was originally published on JustCoding.com