Health Information Management

Q&A: Audit reveals ICD-9-CM code 414.12 reported in error

JustCoding News: Inpatient, December 9, 2009

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QUESTION: A recent audit at our site resulted in findings that inpatient coders were reporting codes for accidental puncture or laceration during a procedure (ICD-9-CM code 998.2) and the dissection of a coronary artery during surgery (ICD-9-CM code 414.12). Auditors indicated that per 1994 Coding Clinic guidance as well as the ICD-9-CM Manual itself, there is no "code also" guidance for code 998.2. Therefore, our coders have been mistakenly adding code 414.12, resulting in an $8,000 error because code 414.12 is an MCC.

Our organization has asked that we reach out to other resources to validate the auditors’ findings. Our HIM director and coding manager are clear on their standpoint that we need to abide by the auditors’ findings that ICD-9-CM code 414.12 is an extra code that we should not report to identify the complication of the surgery. However, I would like to get feedback from others in the coding community.

ANSWER: There is no specific guidance in the ICD-9-CM Coding Guidelines, chapter 17: Injury and Poisoning (800–999). However, in Section 1, Part B, Item 9 of the ICD-9-CM Manual the guidelines state, “Multiple codes may be needed for late effects, complication codes, and obstetric codes to more fully describe a condition”.

I would interpret this to mean that the proper way to report a patient suffering a dissected coronary artery caused by a procedural accident would be to include both of these codes to tell the whole story. This would also support medical necessity for the treatment of the dissection more specifically than to submit a claim without code 414.12.

I want to stress the importance of following specific guidelines as opposed to letting the $8,000 figure affect how you report this condition. We all know that changing coding methodology to directly affect payment is fraud.

Try referencing the following Coding Clinic issues:

  • 2007, second quarter, p. 9
  • 2006, first quarter, p. 15
  • 2002, third quarter, pps. 24 and 26

These references address ICD-9-CM code 998.2, and they are more recent than the 1994 citation the auditor provided.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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