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Q&A: Complication codes versus condition codes

CDI Strategies, June 11, 2015

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Q: When I started as a CDI specialist, I learned that when a complication code, such as 999 or 998 series, happens to be the reason of admission, along with another condition also contributing to the admission, the complication code takes precedence over the other condition code. Is this correct, and is there any written guidance like an AHA Coding Clinic for ICD-9-CM/ICD-10-CM/PCS that discusses this? 

A: First refer to the code set’s alphabetic index and tabular list guidelines related to sequencing, with notes that instruct us to code first or code also. There is instruction within the Official Guidelines of Coding and Reporting as to how to interpret the directional notes found here. For example: “Section I. Conventions, general coding guidelines and chapter specific guidelines.”

Coding Clinic also gives us guidance, however, there is a hierarchy for which piece of guidance supersedes the other. First follow the instruction within the index and tabular list (coding conventions) as these are the highest, followed by the Official Guidelines of Coding and Reporting, and lastly the Coding Clinic advice.

The Official Guidelines of Coding and Reporting, related to this subject in particular states in “Selection of Principal Diagnosis- Section G:”

Complications of surgery and other medical care. When the admission is for treatment of a complication resulting from surgery or other medical care, the complication code is sequenced as the principal diagnosis. If the complication is classified to the T80-T88 series and the code lacks the necessary specificity in describing the complication, an additional code for the specific complication should be assigned.

Thus, your understanding of how these should be sequenced is absolutely correct, and now you are able to state where you accessed this instruction.

Editor’s Note: Laurie L. Prescott, RN, MSN, CCDS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, and CDI Education Specialist at HCPro in Danvers, Massachusetts, answered this question. Contact her at lprescott@hcpro.com. For information regarding CDI Boot Camps visit www.hcprobootcamps.com/courses/10040/overview.

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