Health Information Management

ICD-10-CM offers a new twist on complications: Codes that act as their own CC or MCC

HIM-HIPAA Insider, May 5, 2014

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A diabetic patient is admitted with gangrene. The physician does not specifically link the diabetes and the gangrene, but also does not document any other potential cause of the gangrene. Should you code both conditions?

 
In ICD-9-CM, coders can assume a cause-and-effect relationship between the diabetes and the gangrene as long as the physician does not document any other causes of the gangrene (Coding Clinic, First Quarter 2004, pp. 14-15).
 
That guidance allows coders to report the gangrene, which is a CC, even if the physician does not state that the gangrene is due to diabetes. "Physicians are not always good at documenting cause-and-effect relationships," says Jennifer Avery, CCS, CPC-H, CPC, CPC-I, AHIMA-approved ICD-10-CM/PCS trainer, senior coding instructor for HCPro, a division of BLR, in Danvers, Massachusetts.
 
Coders cannot report the combination codes for diabetes and a complication, such as osteomyelitis, gangrene, or renal failure, unless the physician specifically documents the relationship between the diabetes and the condition, adds Christina Benjamin, RHIA, CCS, CCS-P, an independent coding and education consultant in Jesup, Georgia. Per Coding Clinic, Third Quarter 2008, p. 5, the phrase "diabetes with [a certain condition]" satisfies this requirement.
 
Continue reading "ICD-10-CM offers a new twist on complications: Codes that act as their own CC or MCC" on the HCPro website. Subscribers to Briefings on Coding Compliance Strategieshave free access to this article in the May issue.



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