Health Information Management

Tool: 3rd/4th Quarter Coding Clinic CDI updates available for ACDIS members

CDI Strategies, December 9, 2010

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Editor’s note: ACDIS recently published Coding Clinic update, a review of the most recent issues of AHA Coding Clinic for ICD-9-CM highlighting issues relevant to CDI.  The complete special report is available to ACDIS members under the CDI Journal, October edition. Following is an excerpt from the special supplement.

by James S. Kennedy, MD, CCS
It’s time to review Coding Clinic, 3rd Quarter and 4th Quarter 2010, as we partner with physicians to clarify inconsistent, incomplete, imprecise, conflicting, and illegible clinical documentation in the medical record. Items addressed include:
Metastasis of a lung cancer into another lobe of the lung (3rd Quarter, p. 3): In an interesting scenario, Coding Clinic was asked how to code a primary lung cancer that metastasized into another lobe of the lung. The question placed special emphasis on whether the second lesion would be coded as a primary lesion of the lung or as a metastasis.
Iatrogenic cerebrovascular infarction (3rd Quarter, p. 5): Citing a little-known rule from the ICD-9-CM Official Guidelines for Coding and Reporting, Coding Clinic states that a coder should report complication code 997.02 (Iatrogenic cerebrovascular infarction or hemorrhage) as well as code E934.4 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use) in the instance of a patient whose hemorrhagic conversion was caused by tPA therapy. Hospitals sensitive to their complications indexes should be aware of this guidance.
End-stage renal disease and acute kidney failure (3rd Quarter, p. 15): In what is perhaps the most unusual entry in Coding Clinic, 3rd quarter 2010, the publication states that acute kidney failure is not an acute exacerbation of chronic kidney failure and, thus, as two separate and distinct conditions (per Coding Clinic), both may be coded if documented by the provider. Coding Clinic extrapolated this advice to end-stage renal disease (ESRD) as well.
Other items addressed include:
  • Ventilator weaning hours (3rd Quarter, pp. 3–4)
  • Transtracheal oxygen therapy (3rd Quarter, p. 6)
  • Skin grafts and debridement (3rd Quarter, pp. 7–8)
  • Transbronchial needle aspiration of the lymph node (3rd Quarter, p. 9)
  • Pacemaker interrogation with controlled sick sinus syndrome (3rd Quarter, p. 9)
  • Incision and drainage of ulceration (3rd Quarter, p. 11)
  • Low anterior resection vs. sigmoid colectomy (3rd Quarter, p. 12)
  • Pulmonary hypertension vs. systemic hypertension (3rd Quarter, pp. 12–13)
  • Angioplasty of precerebral vs. intracerebral arteries (3rd Quarter, pp. 17–18)
  • Code assignment is guided by the Palliative care (3rd Quarter, p. 18–19)
  • Hypertensive urgency and emergency (4th Quarter, p. 135)

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