It is very important to stay current with the latest coding guidance from official coding resources. Coding Clinic, published by the American Hospital Association (AHA), has released Fourth Quarter 2016. There are six key takeaways from this issue:

  1. Diabetes and Osteomyelitis: Previously, the official coding guidelines for this combination stated that ICD-10-CM would not assume a relationship between these two diseases. This advice has changed as of October 1, 2016. The ICD-10-CM Index has osteomyelitis listed under diabetes subentry of “With.” This change means that there is an assumption of the relationship between diabetes and osteomyelitis.
  2. Lewy Body Dementia: The correct coding for Lewy Body Dementia is G31.83 and F02.80. The Excludes1 Note under F02.80 prohibiting the assignment of G31.83 has been deleted with the October 1, 2016 update.
  3. Present on Admission (POA) Indicator for Progression of Ulcer: If the pressure ulcer stage worsens, report two codes for the pressure ulcer and its stages. The POA indicator for the initial stage present on admission should be “Y.” The POA indicator for the stage that was not present on admission should have “N” as the indicator. This guidance is unfamiliar, as the same diagnosis will be reported twice with only the seventh character differing.
  4. Readmission Post-Myocardial Infarction (MI): If a patient who is within four weeks post-MI is readmitted for another condition, such as exacerbation of chronic obstructive pulmonary disease (COPD), the MI is still reported. The patient is probably still taking cardiac medications so the MI code is still current because the MI is within the four-week window. Remember, ICD-10-CM changed the active MI timeframe to 4 weeks rather than 8 weeks that was used for ICD-9-CM.
  5. Supervision of High Risk Pregnancy: The conditions of elderly primigravida or elderly multigravida are not reportable on an inpatient visit. These conditions are intended to be reported for high-risk pregnancies during the prenatal period. If the patient delivers without problems, then the principal diagnosis will be O80.
  6. Use of X-Ray to Determine Site of Pain: If the provider only documents “Pain” on the order, the site that is being evaluated may be used as the specific site of the pain. Coding Clinic states to also report the findings of the X-Ray.

We will continue to learn more about the classification of conditions under ICD-10-CM. Remember that after 36 years of ICD-9-CM, there were still questions asked about that classification.

I imagine that the questions will continue for ICD-10-CM.

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