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ICD-10 CM and ICD-10 PCS Coding Scenarios

ICD-10 CM and ICD-10 PCS Coding Scenarios. Presented by Kay Piper, RHIA, CCS AHIMA Approved ICD-10-CM/PCS Trainer MoHIMA ICD-10 Task Force member SSM Healthcare St. Louis-Network Coding Educator Developed by: Angela Talton, MBA, RHIA, CPC, CPC-H SSM Health Care- St. Louis

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ICD-10 CM and ICD-10 PCS Coding Scenarios

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  1. ICD-10 CM and ICD-10 PCS Coding Scenarios Presented by Kay Piper, RHIA, CCS AHIMA Approved ICD-10-CM/PCS Trainer MoHIMA ICD-10 Task Force member SSM Healthcare St. Louis-Network Coding Educator Developed by: Angela Talton, MBA, RHIA, CPC, CPC-H SSM Health Care- St. Louis Regional Epic Product Specialist-HIM

  2. ICD 10 CM Warm ups The next few slides are designed to get you acquainted with looking up codes using your ICD-10-CM code books.

  3. ICD-10-CMSigns and Symptoms What is the ICD-10-CM Code for Dysuria?

  4. Answer R30.0

  5. ICD-10-CMSigns and Symptoms What are the ICD-10-CM Codes for Severe vertigo, left temporal headache and nausea?

  6. Answers • R42 • R51 • R11.0

  7. ICD-10-CMSigns and Symptoms What are the ICD-10-CM Codes for Generalized abdominal pain due to pancreatitis versus cholecystitis?

  8. Answers • R10.84 • K85.9 • K81.9

  9. ICD-10-CMENDOCRINE What are the ICD-10-CM Codes for Diabetes: Uncontrolled or Poorly Controlled, Inadequately Controlled ? Type 1 Type 2 Secondary

  10. Answers • R10.65 • R11.65 • R13.65

  11. ICD-10-CMENDOCRINE What are the ICD-10-CM Codes for Diabetes? • Gestational • In Childbirth • In Pregnancy, Pre-existing

  12. Answers • O24.419 • O24.429 • O24.31- O24.81 Specified NEC O24.01- Type 1 O24.11- Type 2

  13. Guideline 15.a.3 Delivery • Whenever delivery occurs during the current admission, and there is an “in childbirth” option for the obstetric complication being coded, the “in childbirth” code should be assigned.

  14. Guideline 15.c Pre-existing conditions versus conditions due to the pregnancy • Conditions in certain categories • Prior existing vs. Pregnancy-related • It is acceptable to use codes specifically for the puerperium with codes complicating pregnancy and childbirth if a condition arises postpartum during the delivery.

  15. Antepartum, In childbirth, puerpereal conditions • Antepartum hemorrhage O46.9- • Thromboembolism O88.2 • .211-.219 In pregnancy—report which trimester • .22 In Childbirth • .23 Peurperium • Complications of Puerperium O90-O99 • Postpartum Acute Renal Failure O90.4 • Postpartum anemia O90.81 • HIV O98.7 • .711-719 In pregnancy • .72 In Pregnancy • .73 Complicating Puerperium

  16. Group Exercise Find the ICD-10-CM Codes for the following Sign and Symptoms • Flushing and sleeplessness due to premature menopause • Toxic diffuse goiter with goiter crisis [thyrotoxic storm] • Hypokalemia • Hypercholesterolemia and endogenous hyperglyceridemia • Mitral valve stenosis with congestive heart failure

  17. Answers • E28.310 • E05.01 • E87.6 • E78.2 • I05.0 I50.9

  18. Group Exercise A patient with compensated congestive heart failure on Lasix began to have extreme difficulty in breathing and was brought to the emergency department, where he was found to be in congestive failure. Because it was felt that an impending infarction was possible, a percutaneous transluminal coronary angioplasty (PTCA) was performed, but the patient went on to have an acute inferolateral infarction.

  19. Answers • I21.19 • I50.9

  20. What is STEMI?

  21. ICD-10-CMSigns and Symptoms Easy stuff, right? Now let’s try procedures!

  22. ICD-10-PCS Below knee amputation, right leg at distal* tibia and fibula *Documentation Opportunity

  23. Answer: detachment—cutting off all or a portion of the upper or lower extremities 0Y6H0Z3 Qualifier: • 1 High--at proximal portion of shaft • 2 Mid--at mid portion of shaft • 3 Low--at distal portion of shaft of tib/fib • Tip: Body System always = X Y Anatomical Regions • Guideline B2.1a

  24. http://www.cms.gov/Medicare/Coding/ICD10/2013-ICD-10-PCS-GEMs.htmlhttp://www.cms.gov/Medicare/Coding/ICD10/2013-ICD-10-PCS-GEMs.html

  25. ICD-10-PCS Percutaneous mechanical thrombectomy, left brachial artery

  26. AnswerExtirpation—taking or cutting out solid material from a body part 03C83ZZ • APPROACH: Percutaneous = puncture or minor incision • Tip: Body System 3 Upper Arteries = Above Diaphragm • Guideline B2.1b

  27. ICD-10-PCS Cystoscopy with intraluminal dilation of bladder neck stricture

  28. AnswerDilation—Expanding an orifice or lumen of tubular body part 0T7C8ZZ • Approach: Via Natural or Artificial Opening • Endoscopic reach and VISUALIZE • But NOT to aid in performance (assistance)

  29. ICD-10-PCS Open revision of right knee replacement, with removal and exchange of the polyethylene patellar component

  30. Answerrevision—correcting, to the extent possible, a portion of a malfunctioning device or the positions of a displaced device 0SWC0JZ • Device—Polyethylene is J Synthetic Substitute

  31. ICD-10-PCS Reopening of thoracotomy site with drainage and control of postoperative hemopericardium

  32. AnswerControl—stopping, or attempting to stop, post-procedural bleeding 0W3D0ZZ • Approach: Reopening thoracotomy = open

  33. ICD-10-PCS Pheresis of hematopoietic stem cells, single episode

  34. AnswerPheresis—Extracorporeal separation of blood products 6A550ZV • System = 6 Extracorporeal Therapies • Pheresis: Procedure in which the blood is filtered, separated, and a portion retained, with the remainder being returned to the individual. • Only one Body System = A Physiological

  35. ICD-10-PCS Open excision of acoustic neuroma with computer-assisted magnetic resonance imaging

  36. AnswersExcision—cutting out or off, without replacement, a portion of a body part • 00BN0ZZ • Body System—NERVE • Acoustic = 8th Cranial Nerve

  37. AnswersOTHER PROCEDURES—METHODOLOGIES WHICH ATTEMPT TO REMEDIATE OR CURE A DISORDER OR DISEASE • 8E09XBH • System = 8 Other Procedures • Tip—Use alphabetic index until code is familiar

  38. ICD-10-CMDiagnosis and Procedures Find the following codes: Dx: Chronic epistaxis, severe, recurrent Px: Anterior and posterior nasal packing

  39. Answers Diagnosis Code: R04.0 Procedure Code: 2Y41X5Z

  40. ICD-10-CMDiagnosis and Procedures Dx: Morbidly obese patient with a BMI of 39 Px: Laparoscopic gastroplasty with gastric banding Hint: Root Operation is Restriction • Partially closing an orifice or the lumen of a tubular body part • Alphabetic index key word “Banding”

  41. Answers Dx: • E66.01 • Z68.39 Px: 0DV64CZ

  42. Outpatient Surgery Cases A patient was brought in for surgery of a mature, symptomatic cataract in the left eye and primary open angle glaucoma. The patient is scheduled for an external trabeculectomy and phacoemulsification. Hint: Root operation • Trabeculectomy is BYPASS—altering the route of passage of the contents of a tubular body part

  43. Answer Diagnosis Primary open angle glaucoma H40.11x0 Unspecified cataract H26.9 Procedure Bypass left anterior chamber to sclera, percutaneous approach 08133Z4 Extraction of left lens, percutaneous approach 08DK3ZZ

  44. Trabeculectomy “New drainage passage allows fluid from inside the eye to drain to the outside of the eye, bypassing the trabecular meshwork, the clogged drainage passages present in people with glaucoma.”

  45. Outpatient Surgery Cases A patient with left lung infiltrate on X-ray and subsequently had left pleural effusion. Thoracentesis and bronchoscopy with brush biopsy of lung were performed.

  46. Answer Diagnosis Pleural effusion, not else classified J90 Abnormal findings on diagnostic imaging of lung R91.8 Procedure Drainage of left pleural cavity, percutaneous approach 0W9B3ZZ Excision of left lung, via natural or artificial opening 0BBL8ZX

  47. Observation Case A 32 year old woman was admitted for observation for possible intracranial injurydue to her car colliding with another car while driving to work. She suffered bruises on her upper back and abrasions of the skin of the upper left arm. The bruises did not appear to need treatment and the abrasions were swabbed with disinfectant and Neosporin was applied. The intracranial injury was ruled out. Hint: She had no head injury signs/symptoms of head injury

  48. Answer Observation examination and observation following transport accident Z04.1 Contusion of unspecified back wall of thorax S20.229A Abrasion of left upper arm S40.812A Car driver injured in collision with other type car in traffic accident V43.52xA

  49. Break

  50. Inpatient Coding Scenarios Find the Diagnosis and Procedure Codes A woman with chronic right upper quadrant abdominal pain was admitted for possible pancreatitis after two episodes of vomiting clear fluid. Pain medications were started and nasogastric tube was placed for drainagewith intermittent suction. The NG tube was pulled three days after admission and the patient was discharged to follow up with her physician in one week.

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