Health Information Management

New ICD-10-CM guidelines are out

HIM-HIPAA Insider, October 6, 2014

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We’re still living under a code freeze as we (eagerly) await ICD-10 implementation. However, the four Cooperating Parties are still tweaking the ICD-10-CM guidelines. Both the Centers for Disease Control and Prevention and CMS posted the new guidelines on their websites. You can also download PDFs of the codes and indexes as well.

Not surprisingly, the guidelines don’t contain major changes. However, you should download the guidelines and read through them (if you haven’t already). You’ll notice that most of the guidelines are the same as those we currently use in ICD-9-CM, but you still need to spot the differences.
New for 2015 are these specific examples of sequelae:
  • Scar formation resulting from a burn
  • Deviated septum due to a nasal fracture
  • Infertility due to tubal occlusion from old tuberculosis
The Cooperating Parties also updated the guidelines for sepsis, specifically the guideline for postprocedural infection and postprocedural septic shock.
 
When the patient develops a postprocedural infection and severe sepsis, first report the code for the precipitating complication, such as code T81.4 (infection following a procedure). You should also report R65.20 (severe sepsis without septic shock) and a code for the systemic infection.
 
If the postprocedural infection leads to septic shock, you still code the precipitating complication first, but now report code T81.12- (postprocedural septic shock) and a code for the systemic infection.
ICD-10-CM now includes additional information on the seventh character for pathologic fractures. The seventh character denotes the episode of care.
 
Use seventh character A when the patient is undergoing active treatment, which now includes evaluation and continuing treatment by the same or a different physician.
 
The guidelines further state:
While the patient may be seen by a new or different provider over the course of treatment for a pathological fracture, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.
 
You’ll find the same information under the guidelines for chapter 19, Injury, poisoning, and certain other consequences of external causes. You’ll also see some additional information on complications:
For complication codes, active treatment refers to treatment for the condition described by the code, even though it may be related to an earlier precipitating problem.
 
The guidelines further clarify that seventh character D is used when the patient has an x-ray to check the healing status of a fracture.
 
When it comes to external cause codes, the guidelines now specify that the seventh character for external cause should be the same as the one for the code assigned for the associated injury or condition for the encounter.
 
You probably know that you only assign a place of occurrence code once. Well, most of the time. ICD-10-CM now specifics that when the patient suffers a new injury during hospitalization (which should be rare), you can assign an additional place of occurrence code.
 
This article originally appeared on HCPro’s ICD-10 Trainer blog.



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