Health Information Management

Tip: Stay up to date with quarterly Coding Clinic releases

CDI Strategies, October 1, 2009

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Although some CDI departments view AHA Coding Clinic for ICD-9-CM as a publication exclusively for HIM/coding staff, ignoring it is a mistake, says James S. Kennedy, MD, CCS, director of FTI Healthcare in Atlanta, GA.
Coding Clinic offers official coding advice sanctioned by the ICD-9-CM Cooperating Parties that affects strategies or determines consequences integral to physician query. Not to keep up with it inhibits [CDI specialists’] service to the coding and medical staff, which is to conduct required queries facilitating accurate and prompt ICD-9-CM coding and reporting,” Kennedy says.
Many of the answers in Coding Clinic are based upon clinical scenarios often encountered by CDI specialists, so they need to be in tune with its guidance and requirements, Kennedy says. For example, the most recent Coding Clinic, third quarter 2009, contains an entry on glioblastoma with vasogenic edema in which Coding Clinic allows coders to report 348.5 (cerebral edema, an MCC) as an additional diagnosis when the provider has evaluated and documented the clinical significance of the vasogenic edema. Often, vasogenic edema is treated with high dose dexamethasone or mannitol. “Some CDI specialists don’t know to look for that,” Kennedy says.
Likewise, the same Coding Clinic includes a scenario in which a patient sustains a myocardial infarction at one facility and is subsequently transferred to a second facility for a coronary artery bypass graft. Coding Clinic states that the acute myocardial infarction must be coded as a principal diagnosis at the second facility instead of coronary artery disease, even though the reason for the transfer was to address the patient’s coronary artery disease. Some CDI specialists may wish for the acute myocardial infarction to be secondary diagnosis as to serve as an MCC; Coding Clinic advises against that. 
“Given that Coding Clinic is official advice used by outside regulators to challenge query and coding appropriateness, CDI specialists and coders alike must familiarize themselves with its logic in order to successfully defend their coded output,” Kennedy says.
Editor’s Note: ACDIS plans to offer a summary of important Coding Clinic updates for CDI specialists in future issues of CDI Journal and CDI Strategies. CDI specialists are encouraged to review Coding Clinic for themselves, which is available on most encoders.
To order electronic or paper versions of AHA Coding Clinic for ICD-9-CM directly from the American Hospital Association, go to the AHA online store.

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