Health Information Management

News: Coding Clinic conversion unlikely, but some areas require clarification

CDI Strategies, October 13, 2011

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By Jennifer Avery, CCS, CPC, CPC-H, CPC-I

As an AHIMA ICD-10 certified trainer, I have been doing a lot of work on various ICD-10 projects. When it comes to working with the new coding system, I find myself wondering whether the first ICD-10 Coding Clinics are going to address some of the key issues for which we currently have ICD-9 Coding Clinics. Hopefully, most of you are aware that the American Hospital Association’s Coding Clinic for ICD-9-CM  is not being converted for ICD-10.
I identified various areas for which many of the Coding Clinics which we currently use will no longer be necessary in ICD-10 due to the specificity of the codes and the fact that in some instances when we currently have to report multiple ICD-9 codes, we will be able to apply only one ICD-10 code (which clears up sequencing issues).
However, there are some areas that the new ICD-10 codes don’t address. And because we won’t be able to apply the ICD-9 Coding Clinics, I think we need to start looking at them from the perspective of our current common coding scenarios by applying the ICD-10 codes and identifying areas for which we will need clarification. Otherwise we run the risk of leaving it up to those proverbial “powers that be” to identify these key areas in time for implementation on October 1, 2013.
For example, there is an ICD-10-PCS code under the “Extracorporeal Assistance and Performance” section with a root operation “Restoration.” One of the examples of procedures that would be coded to this root operation is “Attempted cardiac defibrillation, unsuccessful.” But what happens if they attempt the procedure multiple times? Do we report the procedure more than once?
Another area for which I have questions relates to ventilation management. Currently in ICD-9, we have guidance regarding postoperative ventilation management. However, as ICD-9 Coding Clinics are not being converted for ICD-10, this question comes up once again about when it would be appropriate to report postoperative ventilation management. If there is no guidance when ICD-10 takes effect, many coders may apply the rules that we already have in place with the ICD-9 system while others may not, causing variations in coding and reimbursement across the board.
I also have a question related to the ICD-10-PCS system regarding the qualifier “diagnostic.” I have not seen any advice as to when we would use this qualifier; therefore it has been left up to interpretation. When the question came up in a training class, the instructor stated that if the physician said “excisional biopsy” for a lumpectomy, for example, the qualifier would be X for “Diagnostic.” If the physician simply said “excision,” then the qualifier would be Z to indicate “No Qualifier.” However, I have not found any guidance on the subject in writing as to whether we can use the word “biopsy” as an assumption to code the qualifier X for “Diagnostic.” Currently there are no guidelines for assigning character 7, which means that we will need to look to ICD-10 Coding Clinic to clarify its use.
These are just a few questions I thought of off the top of my head. I am sure the more I work with the system, the more questions I will come across. These are just some of the reasons why it is important that coders and CDI professionals work within the new ICD-10 system now to start picking at possible areas of confusion and developing internal policies to handle situations in the absence of Coding Clinic advice. I would feel a little better if we at least knew that these were being addressed.
Editor’s Note: Avery wrote this article for publication on the ICD-10 Trainer Blog. Avery is an instructor for HCPro’s Revenue Cycle Institute in Danvers, MA. She teaches Certified Coder Boot Camp® both live and online, as well as the Certified Coder Boot Camp®–Inpatient Version. For additional information, read The Clinical Documentation Improvement Specialist’s Guide to ICD-10.

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