ACDIS tip: AHA Coding Clinic, fourth quarter 2022 update

by Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC

As usual, American Hospital Association (AHA) Coding Clinic closes out the year with back-to-back releases. The fourth quarter Coding Clinic was published just days after the release of third quarter publication. Traditionally, this last publication of the year reviews the new and revised codes implemented for the upcoming fiscal year. This publication does not disappoint. The issue offers a summary of changes to the ICD-10-CM and ICD-10-PCS Official Guidelines for Coding and Reporting. If you have not reviewed those changes, I encourage you to do so by either accessing the new guidelines at CMS.gov or by reviewing this Coding Clinic.

I will not speak in much detail related to the Guideline changes. The most significant is section I.B.16 related to Documentation of Complications of Care. The bolded text below is the updated wording to this guideline.

Code assignment is based on the provider’s documentation of the relationship between the condition and the care or procedure, unless otherwise instructed by the classification. The guideline extends to any complications of care, regardless of the chapter the code is located in. 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.

This updated guidance changes the landscape in how we are to consider surgical complications. I would suggest this be discussed throughout your organization to include the CDI and coding teams, quality department, and medical staff. All should understand when a complication will be reported and the need to seek clarification if unclear.

There is a review of the ICD-10-PCS new technology additions to Section X. This section is always of interest to me, to see the new initiatives/treatments and technology being administered. These codes are very specific, and I would suggest that if you provide any of the following procedures, you review the new PCS tables for accurate capture of the procedures.

• X0HK3Q8, Implantation of Sphenopalatine Ganglion Stimulator for Ischemic Stroke: The goal is to increase collateral blood flow to preserve brain tissue.
• X0HQ3R8, Implantation of Paired Vagus Nerve Stimulator, Using an External Controller: This paired vagus nerve stimulation is used to stimulate the motor cortex of the brain to improve upper extremity motor function after stroke. This code is specific for the Vivistim® Paired VNS system.
• X020X18, Computer-Assisted Transcranial magnetic Stimulation of Prefrontal Cortex: This procedure is used to treat major depressive disorder in adults.
• X2A7358, Pressure-Controlled Intermittent Coronary Sinus Occlusion (PiCSO): This is an adjunct procedure performed with percutaneous coronary intervention (PCI) following an acute myocardial infarction. PiCSO focuses on the microvasculature and can assist in reducing the size of infarction.
• XF5(0,1,2)X08, Extracorporeal Histotripsy of Targeted Liver Tissue Using Ultrasound-guided Cavitation: This provides an automated external beam ablative therapy to treat hepatocellular carcinoma.
• XKU(C,D)068, Posterior Vertebral Body Tethering: This procedure stabilizes the vertebral column and restricts hyperflexion by linking the posterior elements of neighboring vertebrae.
• XNH(6,7)(0,3)58, Internal Fixation Device with Tulip Connector: This procedure is used as an adjunct to a sacroiliac fusion in an effort to treat spinal instabilities or deformities.
• XRH(B,D)018, Insertion of Posterior Spinal Motion Preservation Device: These codes capture the placement of posterior motion preservation devices, as an alternative to spinal fusion.
• XRR(G,H)0(L,M)8, Replacement of Synthetic Substitute meniscus of Knee: These codes allow capture of replacement of the medial and lateral menisci with a synthetic substitute. This allows a less invasive procedure for those with meniscal tears due to injury or degeneration.
• XXE0X48, Computer-Aided Analysis for Detection and Classification of Epileptic Events: This procedure utilizes artificial intelligence to analyze semiologic data such as velocity and acceleration of movements, seizure frequency, duration, and heart and respiratory rates to detect and classify epileptic events.
• XXE3X58, Quantitative Flow Rate for Noninvasive Analysis of Coronary Angiography: This procedure allows advanced 3-D mathematical modeling of angiographic images.
• XXE3X68, Simulation for Assessment of Coronary Obstruction Risk: This procedure utilizes simulation software to assess the risk of coronary obstruction in patients with severe aortic stenosis.
• XXE5X38, Gene Expression Assay: This procedure identifies and measures the gene expression assay of prevalent genes in blood that correlates to a systemic response to infection and indicates the possibility of infection-positive systemic inflammation.
• XY0YX28, Extracorporeal Antimicrobial Administration During Renal Replacement Therapy: This code will allow reporting of the installation of taurolidine and heparin during renal replacement therapy to reduce the risk of catheter-related blood stream infection.

Code table XWO now includes 11 new therapeutic substances for Introduction to Anatomical Regions. The fourth quarter Coding Clinic offers specific descriptions of these substances and their indications for use.

Code table XW1, Transfusion of Anatomical Regions, now includes four new substances. This results in eight new codes specifying the transfusion via peripheral and central veins. The fourth quarter Coding Clinic offers specific descriptions of these substances and their indications for use.

The Coding Clinic summarizes the addition of 1,176 new ICD-10-CM codes. I spoke to a number of these new additions in my summary of the fiscal year 2023 Inpatient Prospective Payment System (IPPS) final rule. Again, I encourage you to read the fourth quarter Coding Clinic in its entirety. It is true that many of these codes would not be a focus of your CDI reviews, but knowledge is power, and it is important for us to understand what codes are available and the needed specificity. It is mentioned more than once within the IPPS final rule that the code set evolves in an effort to capture more statistical information and identify trends. This data influences both resource allocation and improvements in patient care. And we as CDI professionals can assist in that effort by working to obtain strong, complete documentation, supporting accurate code assignment.

Editor’s note: Prescott is the interim director and director of CDI education for ACDIS, based in Middleton, Massachusetts. Contact her at lprescott@acdis.org.