Health Information Management

Even the rich and famous get sick

HIM-HIPAA Insider, December 1, 2014

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As healthcare professionals, we’re all familiar to some degree with HIPAA. You know, the law that makes it illegal to release protected health information, among other things. Hospital employees have been fired for snooping into celebrities’ records. So it’s always interesting to see what health information celebs voluntarily share.

 
Angelina Jolie went very public with her decision to undergo a double mastectomy because of a higher likelihood she would get breast cancer.
 
Actor Hugh Jackman has been equally candid about his repeated bouts of skin cancer. How would we code Jackman’s cancer? First we need to know what kind of cancer he’s had. Luckily for us, he’s told the world it’s basal cell carcinoma (BCC).
 
BCC is the most common type of skin cancer, so in the Table of Neoplasms, we would look under skin. Not surprisingly, we see we need to know where on the skin his cancer was. Through the magic power of the Internet, we know it was on his nose—all three times.
 
Scanning down the many rows of skin cancer, we finally find nose, which gives us C44.301 (unspecified malignant neoplasm of skin of nose). Well, that’s not right. We know what kind of cancer it is.
 
Let’s go back to the table and look up nose. Okay, we have lots of choices under nose, including skin. And under skin, we find a specific entry for BCC—C44.311 (basal cell carcinoma of skin of nose).
 
The Table of Neoplasms has six columns to describe the nature of the neoplasm (neoplasm does not equal cancer). You probably noticed, though, that BCC only has one possible code and it’s under Malignancy, primary. That’s because a carcinoma by definition is cancer. Neoplasm is not necessarily cancer, carcinoma is definitely cancer.
 
Fortunately for Jackman, BCCs are easily treated and are rarely, if ever, fatal.
 
Actor Michael J. Fox has been suffering from Parkinson’s disease since 1991. ICD-10-CM includes multiple codes for Parkinsonism, but only one for Parkinson’s disease—G20. Numerous conditions fall under G20, including:
  • Hemiparkinsonism
  • Idiopathic Parkinsonism or Parkinson’s disease
  • Paralysis agitans
  • Parkinsonism or Parkinson’s disease NOS
  • Primary Parkinsonism or Parkinson’s disease
If the physician documents any of those terms, you’ll report G20.
 
Actor and comedian Robin Williams also suffered from Parkinson’s disease, as well as depression throughout his lifetime. He also reportedly suffered from delusions and/or hallucinations caused by Lewy bodies dementia.
 
If we look up dementia in the ICD-10-CM Alphabetic Index, we find a large number of choices depending on the type of dementia. Lewy bodies show up twice in the list, first under the subterm “with,” then as a standalone entry, “Lewy bodies.” Both entries lead you to the same code, G31.83 (dementia with Lewy bodies).
 
You’ll also notice codes F02.80 (dementia in other diseases classified elsewhere without behavioral disturbance) and F02.81 (dementia in other diseases classified elsewhere with behavioral disturbance) appear in brackets after G31.83. The specific code depends on whether the patient is exhibiting behavioral disturbances, including:
  • Aggressive behavior
  • Combative behavior
  • Violent behavior
Wandering has its own code—Z91.83.
 
Codes that appear in brackets in the Alphabetic Index are manifestation codes.
 
Certain conditions have both an underlying cause and multiple body system manifestations due to that cause. In most cases, the manifestation codes will have in the code title, “in diseases classified elsewhere.” Codes with this title are a component of the etiology/manifestation convention.
 
“In diseases classified elsewhere” codes cannot be the first-listed or principal diagnosis. You can only report them with the code for the underlying condition and you always report it after the underlying condition.
 
Note that you would not code the delusions and/or hallucinations because they are an integral part of the dementia.
 
This article originally appeared on HCPro’s ICD-10 Trainer blog.



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