Health Information Management

Take advantage of opportunities to clarify ICD-10-CM questions before implementation

APCs Insider, October 31, 2014

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By Steven Andrews, Editor
Clinically, there's no doubt that tobacco use can lead to respiratory illnesses. But for coders to report that link in ICD-10-CM, providers are going to have to specifically document it.
The AHA recently covered the new rules for reporting nicotine use, abuse, and dependence in a presentation highlighting Coding Clinic guidance on a variety of ICD-10-CM codes and concepts.
The patient must have a condition related to his or her substance use, abuse, or dependence, and it must meet the definition of a reportable diagnosis. Additionally, the physician must document the relationship between the diagnosis and the substance use, abuse, or dependence.
Consider this scenario: A patient who has been a smoker for more than 30 years is diagnosed with COPD. Clinically speaking, the smoking almost always causes COPD. Not every smoker gets COPD and non-smokers get it as well. However, when the patient is a smoker with COPD, it’s a good bet the conditions are linked.
Coders cannot assign code F17.218 (nicotine dependence, cigarettes, with other nicotine induced disorders) unless the provider has documented a cause-and-effect relationship.
Coders can’t make the link between smoking and COPD unless the physician links the conditions in his or her documentation. If the physician doesn’t document the link assign:
  • J44.9, chronic obstructive pulmonary disease, unspecified
  • F17.210, nicotine dependence, cigarettes, uncomplicated
You may need to query the physician to get that connection, at least initially. Coding Clinic has been a resource for coders for interpreting many of the gray areas of ICD-9-CM, and they're likely to need it even more as they move to a new code set.
CMS is also offering an ICD-10 Provider Call November 5, from 1 to 3:30 p.m. Eastern, which will offer a question-and-answer session for providers looking for guidance on coding and implementation issues they've encountered during training and testing.
Prepare for the 2015 OPPS final rule
The 2015 OPPS final rule is currently with the Office of Management and Budget, its final step before publication. The rule is expected to be released by the end of next week, in order to give providers 60 days to prepare for the changes coming January 1. HCPro will be providing full coverage of the rule from Jugna Shah, MPH, president and founder of Nimitt Consulting in Washington, D.C., at and in a special email soon after its release. For more information and complete analysis of the finalized changes, sign up for HCPro's 2015 OPPS final rule webcast with Shah and Valerie A. Rinkle, MPA, associate director within the healthcare practice at Navigant Consulting, in Medford, Oregon.

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