Health Information Management

Coding Clinic caveats

HIM-HIPAA Insider, November 3, 2014

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When coders run into a tough coding question, they often look for guidance in the AHA’s Coding Clinic. Coding Clinic is a resource, but it’s not always the final word.

The AHA publishes Coding Clinic on a quarterly basis and addresses questions submitted to Coding Clinic by stakeholders in the healthcare industry.
Coders, as well as payers, use Coding Clinic advice to determine accurate code assignment.
However, Coding Clinic does not provide clinical criteria for establishing diagnoses and has no authority to provide clinical definitions, nor does it replace physician documentation regarding the clinical significance of a patient’s condition.
Coding Clinic does provide guidance on what codes can be reported based on already-documented diagnoses.
Coding Clinic information may still be useful to understand clinical clues regarding signs or symptoms that may be integral (or not) to a condition.
The Coding Clinic editorial staff is not updating past guidance for ICD-9-CM to ICD-10, just like CMS is not transitioning all National Coverage Determinations from ICD-9-CM to ICD-10.
Coding Clinic staff members are only answering ICD-10 questions going forward, but the editors can only answer question that you ask. So if you are practicing (or learning) ICD-10 and something seems wrong or you’re confused, submit a question to Coding Clinic.
They don’t guarantee they will answer your question, but odds are, someone else has the same question. The more questions we raise before implementation, the more information we will have when we start assigning ICD-10 codes for real. Remember, though, that the Coding Clinic editors are new to ICD-10 as well. Some of the answers they publish now may need to be updated as more information becomes available and coders actually use the new codes.
This article originally appeared on HCPro’s ICD-10 Trainer blog.

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