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0:02 Everyone, and welcome to Roundtable 148.
0:06 Once again, credits you guys for taking time out of your day to join us sect which was a few minutes.
0:12 Though we have over 2200 registrants.
0:15 So quite a crowd assembled here today.
0:19 Second, Vice President of Coding Education and continuous Improvement for psi X is a dream division. It’s my pleasure as always, to introduce today’s speaker, DNS to our liking.
0:29 Today, Janice going to enlighten us about some proposed rule highlights for fiscal 2023 inpatient prospective payment system.
0:41 Um, it’s really cool.
0:42 Going off script here a little bit, that we get the benefit of a rule in using it or we were to a kind of gives us a pretty good read on what to expect in October, so that way, when October comes out October first, we’re not kind of caught off guard.
1:01 Boy, anything unexpected. So.
1:06 That excites me at least. Some housekeeping or no call numbers, the format streaming only.
1:14 Sure.
1:15 Today’s webinar will be available on demand after the live session and will be accessible through a link that will provide, then a follow up e-mail will be sent out this afternoon.
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1:46 That’s an absolute during the webinar you can download the handouts and enter any questions you have.
1:52 Janice will answer any questions at the end of the session. Using a little bit longer.
1:57 Run out of time, and I’ll get to your question, Janice. We’ll do our best to follow up afterwards.
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2:18 We understand if we’re doing a good job here, and also helps us understand if there’s anything we can help you or your organization with.
2:24 So, that is the opening statement, Janice. I’m done. So, over to you.
2:32 All right. Thank you, Scott.
2:35 So, as Scott mentioned, we are, I have, I have, we’re going to be talking about just the proposed rule. But, mainly, just the new codes.
2:43 I’m going to touch base a little bit on some of the C Cs. MCC, which kind of ties into the IPS and then also some of the Guideline updates.
2:54 And we’ll definitely dive into this more as we get closer to October, September, October. So, just our Agenda, the proposed … codes, again, the highlights, I’m not going over every single new code. The proposed PCS codes, and PCS guidelines, I do want to make a note here about the PCS codes. So initially, when I was putting this presentation together on the file that they, that’s on the CMS website, there’s only about 50, some codes, 54 code, something like that.
3:26 But there’s actually 300 and some codes that are being, that will be in the final rule, or even even more than that, in the final rule, but those weren’t in the file. So today, I’m going to be focusing on just the ones that were in the file. I was able to locate another file. Actually, I was, I spent a lot of time searching for it. I’m like, I was there 300 and some new PCS codes, and they’re not in this file. So I was able to find it, but it was actually just a few minutes before, you know, an hour or so before this call. So I didn’t have a chance to add those, but I I’ll kind of read off some of those when we get to that point. So I just wanted to make note of that. Um, if you’re wondering, you know, if I mentioned there’s 50 some new codes, and there’s actually 300 listed on the summary before we officially get started. And, of course, all of this information is subject to change based on the final rule.
4:12 They do always make changes, not a lot, but there are a substantial number of changes as we get to the final Rule. So first up, we’re going to be talking about CM changes.
4:27 And this when I say, oh, there’s 1179 newseum codes. This does include the new codes that came out on April first are covered are covered updates, you have 288 deletions and 28 revisions. The focus of today’s presentation is going to be on the new codes and a lot of the deletions and revisions have to do with expansion of codes and things like that.
4:50 I do want to also State that I mean, it’s always good to look at the index and tabular agenda. They call it the agenda because it just shows the things that are new.
5:02 And these don’t always have to do with, they could just be, these have to do with more the revisions to codes they might have revised the code title, they might have revised how this How things were indexed, and we’ll talk about a couple of those. Those things as we go through the presentation, but I highly recommend looking at those, they change might change the excludes OneNote and excludes to note. And we see a lot of that stuff being addressed encoding clinic as the year goes on. And they kind of updated in in the index when the new code schema come out in the new, the new for the new year. So, I do want to recommend I do have a link to the guidelines.
5:39 Any downloads if you do want to take a look at the agenda: I am not talking about that today, but it’s always something we should be looking at as well.
5:48 Not just the new codes, because they do change other things in the index and tabular that may not relate to those new codes.
5:58 OK, So, first up, we have, and I should, I should probably start off by saying, I’m not going to be Reading.
6:06 No word for Word, what’s on the slide? There’s more information here that I’m going to be talking about. Um, it’s more for your reference.
6:13 This information does come from the co-ordination meeting information.
6:21 So, I won’t be reading it, but word for Word. I’ll just be highlighting some of the changes for this year and why these changes are happening.
6:28 And you can more, you can have these for your reference, if needed, if you need more information about some of these codes.
6:37 So, I just wanted to say that if you’re, you know, we obviously only have an hour, so I can’t go over that much detail as highlighted on the slide, but I will discuss some of these things in a little bit more detail. So, first up, we have kind of like what we have with recurrent C diff. We have recurrent Volvo, vaginal, Candida …, or a yeast infection.
6:59 When we think about these types of infections, they’re typically treated over the, with treat, treat it with over the counter medication. But there are a group of women that develop these more recurrent infections that are that are more severe in nature and are more resistant to treatment. So they want to be able to capture this and capture the prevalence, and be able to, to do a little bit more research and come up with more treatment options for these types of cases. So we do have expansion of the Code for Candida …
7:40 to include acute Kansas, candid ISS, and chronic kinda Diocese, of the *****, and ******. And as you can see there under Chronic, it does include recurrent.
7:53 Next up, we have Hemolytic … Syndrome, now we do have a current code for this. However, they are expanding this code to take into account different types of Hemolytic … Syndrome. And we do see this. I mean, you went actually, we don’t see this quite that often, but the one that I typically kind of when I’ve come across this in in in medical records is in combination with our gastrointestinal infections, like E coli and things like that.
8:22 But they are expanding it to take into account. As you can see, this is just a little snippet of some of the code additions on the the right hand side of your screen, and you can see there. Please take note also when you’re reviewing these codes, and of course, we’re gonna go through these as we get closer to implementation. But you can see there we have under D 59 3 1 infection associated, Hemolytic … Syndrome, we have use additional code notes, and we do.
8:50 I should have put a guideline alert on this slide because we do have a new guideline in relation to this, this code expansion, Hemolytic Geremek Syndrome, But you can see there we have use additional code note under D 1932. We have a code also note.
9:05 Then under D 59 3 9, other Hemolytic … Syndrome, Atypical Hemolytic … Syndrome, or Secondary Hemolytic … Syndrome it says Code first if applicable. Any associated …, complication of transplant, kidney liver and heart could also any applicable hypertensive emergency malignant, neoplasm, SLE, or systemic, lupus, or any adverse effect of a drug.
9:31 So we have to make sure we’re also following our use additional code notes or code any instructional notes Code. First nodes depending on the type of hemolytic … e-mail it hemolytic … syndrome.
9:47 So we just want to keep in mind and they they’re not just we don’t just see hemolytic … Syndrome with our our gastrointestinal infections but we do see them. We say see atypical cases.
9:59 Also, we have genetic type, um, also other types of infection, not just GI infections. Again, those are probably the most common. And where I’ve actually had a code Hemolytic … syndrome, but also other types of infection like chicken pox or influenza. And as you can see, we also have coven being added to that list as well.
10:22 Then other types of secondary, atypical, hemolytic yermak syndromes include, you know, due to chemo, for example.
10:33 Next up are Heparin induced thrombocytopenia. So, we already have a code for heparin induced thrombocytopenia. They’ve expanded this to include other types, non immune. So, we’re going to need, we need to look for greater specificity, going forward, to Type one, Type two. So, non immune, versus immune, mediated versus other. And I thought this was interesting spontaneous heparin induced thrombocytopenia syndrome without Heparin exposure. I’m like, how do you have Heparin induce thrombocytopenia without heparin exposure?
11:10 So, I thought that was a bit interesting, and they do go on, I’m talking about that in the documentation or in the information they supply.
11:20 Me see if I can find it. I just thought that was really interesting. They talk about, they have clinical features of the syndrome, or the … of Heparin induced thrombocytopenia as the same mechanism, but they, they just call it spontaneous, …, syndrome, so, not going into too much detail there.
11:40 Um, but, it’s been known to have the patients are known to have this kind of a similar syndrome without actually being exposed to Heparin.
11:53 So, it kind of doesn’t make an entire sense to me, but prior to do a little bit more research on that one, I’ve personally never seen it documented, OK.
12:06 Next, this is, this is one I definitely want to talk about. We have acute and chronic metabolic acidosis. And we’ve actually seen some of these things. Last year when we talked about the actual maintenance meeting, and typically, so these things are discussed a year or two sometimes even years, five years in advance of them actually becoming codes. So, we did talk about this a little bit. Last year they had an update.
12:32 This acute and chronic Metabolic acidosis they had to update. Some of the includes notes excludes notes. They didn’t make 100% sense, But they do want to start tracking this, you know, different types of acidosis. We currently code we have one code for acidosis. We have E 78, 7.2. So now, we’re gonna They’re gonna be expanding that to unspecified, which includes lactic not an iOS metabolic MLS. But please note, there’s also a code off, also, if applicable respiratory failure with hyper ….
13:06 And then we, as we make our way down, we have acute metabolic acidosis and includes acute lactic acidosis. We have E 8 7 zero point twenty two chronic Metabolic acidosis, which includes chronic lactic acidosis, and it also says code first underlying etiology, if applicable.
13:22 Now, I do highlight on this slide that under E 8 7 zero point two nine, Other acidosis, it does include Respiratory acidosis, OS, but if we have acute respiratory acidosis documented, look at that X that. That note there.
13:38 It says to code J 96 oh 2 are, know, A, we can code acute respiratory acidosis, I should say. We have an excludes to note there with J 1602, which is hyper katnic, respiratory, Acute Respiratory Failure with ….
13:56 And if you Index acidosis, which I kind of, I’m not sure if it should be excludes to note, because if you Index acidosis respiratory acute in the new index it does take you to acute respiratory failure with hyper cap nia.
14:13 Also, if you index, so, Scott, this might be a big change.
14:18 If you Index acidosis respiratory chronic, it does index to chronic respiratory failure with hypercar Remember.
14:29 So that’s an interesting change. Again, I don’t know if it should really be an excludes to note if it is in if we go to the index in an index, if we have Exclude inclusion notes. So that’s something I’m going to be looking out for in the final rule to see if there’s any changes based on any public comment.
14:47 Right now, that’s how it’s listed in the agenda.
14:51 So I think that’s a little bit interesting, looking at the Tabular versus looking at the, the, the index.
14:57 It’s a little bit different, so, there’s more information there on the slide about, it was actually the Reno Guys or girls.
15:08 The renal physicians, I should say, that submitted this. They want to be able to better track different types of acidosis and as they relate to mortality, clinical evaluation and treatment plans, because chronic acidosis when it’s a complication of chronic kidney disease, is associated with an increased risk of progression of disease and also death. So, that’s kind of how this, this kind of came about.
15:33 Expansion of, of these acidosis codes. Now, we also talked about this previously. The dementia stage of severity, behavioral, and psychological symptoms, I just have a sample, obviously, I can’t fit. This is one of the largest number of expansion of codes. I couldn’t obviously include all of them on the slide, but, in summary, I did want to say that they’re adding severity, so mild, moderate to severe and different types of behavioral and cycle psychological symptoms to dementia. So, that includes vascular dementia, dementia and diseases classified elsewhere. An unspecified dementia. So, for anyone that’s looking at documentation improvement this might be an area that we focus right. These are going to be all C Cs.
16:14 Most of them are going to be C Cs. So, when we have You know, right now, we can’t really capture a lot of these behavioral disturbances separately. We have. So, for example, we have vascular dementia with unspecified severity. It’s further broken down into without behavioral disturbance.
16:34 With this, with unspecified severity without behavioral disturbance but there they have psychotic disturbance or mood disturbance and anxiety.
16:44 And you can see that there with behavioral disturbance, unspecified severity, and you can see all those inclusion terms. Major neurocognitive disorder, I know I’ve seen this in the documentation That does code to dementia, and that would be included in those code assignments. We also have a use additional code note for the wandering on. They actually deleted that. We have our vascular dementia, unspecified severity with agitation, and so forth.
17:09 So if you could think about how these codes are set up, we’re going to have vascular dementia with mild severity, moderate severity with severe severity, and they’re going to also have that for our dimension diseases classified elsewhere, and are unspecified dementia are, you know, we’re going to have our with other behavioral disturbance and you can see there use additional codes to identify wandering and vascular dementia is going to be under the behavioral disturbance categories.
17:38 That would include a behavioral disturbance and then we also have unspecified severity with psychotic, disturbance, and so forth.
17:46 When listening to, um, when listening to the initial meeting commentary, they did say if they’re if there’s components of different types of behavioral disturbances, that we can capture them separately.
18:06 Just like we do with diabetes, with neuropathy, nephropathy and angiography. So, I’ll be looking out for if they make any additional changes, to see if they’re going to be all inclusive codes or if we can pick those up, You know, say they have psychotic disturbance and a mood disturbance. Would we be coding for 152 and F 0153? So, I’ll be looking for more additional commentary to be published as the, as we get closer to two implementation.
18:39 Next, now, this is, to me, not the biggest change. Substance use unspecified in remission. They’re really making these changes to be in line with all of the other code changes that we have in the chapter. So, as we all know, we have a lot of changes to the substance use category.
18:59 The guidelines last year, not really, but we really shouldn’t be using those unless they’re clinically significant in some way.
19:08 So, they have, they are adding in remission codes for substance used to be consistent across all Code category, so, they’re adding them to all of the use codes. Alcohol use, unspecified in remission, opioid use, unspecified and remission and so forth.
19:27 Across all of our are use cases.
19:34 To be consistent and allow tracking of those types of things. Again, I don’t know how often we’re going to be coding these as per our guidelines we don’t typically code use unless it’s somehow I’m thinking more foresight cases than anything.
19:50 Next we have postural, ortho static … syndrome or pots and I know I’ve seen this quite a bit. It was coding to like other arrhythmia, I think it was I 49. 8 other specified cardiac arrhythmia, There’s actually more to postural, ortho static tachycardia syndrome than just arrhythmias.
20:11 It is considered an autonomic nervous system disorder that can severely cause disability and impaired quality of life. I’ve actually seen, I don’t know how many of you are into social media. I’m assuming most of you are but I’ve seen a lot of of those influencers talk about their experience with. This comes up on my feet at least. With this put the pot syndrome and how it affects their life. It can be very debilitating. And that’s why I mean and this is why it’s kind of in my on my mind and why I wanted to share this one. I think it’s more prevalent than they probably think of They think because there is no specific code. If you think about that.
20:52 This coding to I, 40, 98, this is probably something that’s probably, you know, something that’s no affecting more people than they think.
21:03 So I’m glad that this code, we now have a specific code for … syndrome. And interestingly enough, it was actually it’s been recorded back in medical which literature back to the Civil War. And they used to call it different things.
21:18 To cost a syndrome, irritable heart, soldier’s heart, Civil War Syndrome, and things like that throughout history. And it said that infectious diseases are one of the most common triggers for the onset of pods.
21:32 There’s more information here. So of course, as with most of these codes, the reason they usually come out with new codes is to be able to track those better research, medical, you know, utilization impact, and other types of research.
21:49 And there’s actually a lot of interest in the pot’s research from other government agencies and other academic centers in the United States, so.
22:06 OK, so, next, I, this is another one, I mean, they talked about this being in.
22:12 Going, I think, going back to 2011. I think, this is an I nine, a code for chronic fatigue syndrome.
22:20 This was talked about in CNN meetings all the way back since 20 11, so, quite a long time.
22:27 We finally have a code for chronic fatigue syndrome. I mean, there’s a few different codes here. Or, you know, as we think about chronic fatigue, it just goes to our 5382, it’s very generic. Um, there’s no way to chronically track different types of chronic fatigue syndrome.
22:47 Specifically, ME, which is my logic and several of my, my litas or chronic fatigue syndrome. You can see there. Those are both terms listed under G 9332.
23:01 It could also have effects on health care resource planning, someone that just fatigued versus having the syndrome. They want to be able to better researched this condition, making accommodations for people in disability benefits. They also revised the code title to include initially it was it was just post viral syndrome but they wanted to revise that to include post viral and related fatigue syndromes as they’re not all precipitated by a viral infection.
23:34 So both the terms Emmy, …, and cephalon My Latest and Chronic Fatigue Syndrome. Both of those terms include viral and non viral causes of those syndromes, and a lot of times, we think of chronic fatigue syndrome, or at least I do, I kind of, you kinda see that a lot with Epstein Barr Virus. But we can see there, they also added a use additional code if it’s due to post covert 19, if we have that chronic fatigue syndrome related to our post covert 19 condition.
24:14 Next we have chronic angina, … or … refractory to medical and interventional therapies. I’m a lot of expansion here. If you think about all of our, you know, … of native arteries on different types of graphs: transplant, et cetera. We have a large expansion of codes here to include all of those those options for refractory angina.
24:38 And the thought is, is that this is a major public health concern as we have no pain patients living longer.
24:47 They’re becoming, you know, they don’t have any additional therapies, angioplasties, or bypass surgeries that are able to control their disease at this point.
24:59 Maybe they’ve progressed to the point where they just are on medical management. Maybe they don’t qualify for other types of therapies and refractory. In this sense, they define it as chronic condition, greater than three months characterized by angina. in the setting of C D, which cannot be controlled by any biomedical therapy, optimal medical therapy, angioplasty, bypass. And we’re reversible myocardial ischemia has been clinically established to be the cause of the symptoms. They don’t have any other options, or if they do, they’re very limited.
25:33 So this makes treating these patients very challenging. So they want to be able to track this information.
25:40 So these are being implemented for 2023 or proposed, I should say.
25:47 Finally, we have a code for malignant, Pericardium, Fusion. So they’ve expanded this Code category To include malignant, Pericardium, Fusion and diseases classified elsewhere, It says Code first, Underlying neoplasm. And then we have our other, of course, because they expanded the Pericardium Fusion Code, they had to create another code for other Pericardium Fusion.
26:12 Again, there’s more information on the slide. But we see this in, you know, breast cancers, lung cancers, and other types of neoplasm, malignant, melanoma, leukemia, or lymphoma. Um, they want to be able to better track this and not be coding these two secondary neoplasm like we have with lymphoma. Technically, we don’t have secondary sites of lymphoma.
26:35 So we now have a way to capture this correctly without coding a secondary neoplasm.
26:45 Hmm.
26:47 Trying to change the slide here OK. Next up mitral annulus Calcification. I know I’ve seen this a lot.
26:54 And then if you have a cardiac cardiothoracic unit, you’ve probably seen this calcification document at probably quite a bit. We now have a specific code for our calcifications.
27:12 That can be chronic in nature degenerative increases with patients age.
27:17 It has higher risk factors in patients with chronic kidney disease or cardiovascular risk factors. It has increased risk of mortality and cardiovascular disease.
27:31 They want to be able to track this better, has significant risks and complexity.
27:37 And they’re looking at different types of surgeries such as the trans catheter or mitral valve replacement as an alternative to patients with this mitral annulus calcification who are poor candidates for surgery. There’s currently no way to really capture this. So they want to be able to capture this. So they are creating these codes.
27:58 Our non rheumatic mitral valve annulus classification, it also includes an OS and they also have could also notes to code also the mitral valve insufficiency or stenosis.
28:11 So that we can better capture that condition.
28:18 Next we have … point is a form of ventricular tachycardia, I’m sure you’ve seen this in the documentation. It can be fatal.
28:29 So they want to be able to, you know, to capture this. But rather to ventricular tachycardia, or to sword, to sword, to sword, to point.
28:39 Separately, to be able to Track This and look at research reporting, just reduction strategies, other types of drugs that they can use to treat the condition.
28:52 So, they are expanding that to include no unspecified, other specified, and to soared to point. To start at the point, I should say sorry if I mispronounced that. Trishaw Du point and I’m not doing it with a French accent. I have a horrible French accent, but it comes from the French.
29:15 So they want to be able to capture that better for those reasons. So expansion there.
29:23 A lot of times we just see unspecified, right?
29:28 But they do, on occasion, will, will say, other types. Now, I guess this should be another.
29:33 This is a huge number of codes, probably another somewhat big deal. I don’t know how often. we have.
29:40 All of the specificity With our aneurisms, but, of course, if you see who propose this Id Score, We, they do a lot of the implants or create a lot of the implants for our aneurism repairs. And a lot of those devices can be dependent on where that anatomy is located and where, what’s involved, the type of aortic aneurism and does it involve in dissection, Does it involve a rupture. They also want to be able to capture the clinical presentation and provide more utility for clinicians.
30:14 So what they’re gonna be, they’re taking into account here is where is the a or where’s the dissection or rupture locate it.
30:23 These are just examples. We have thoracic aorta and we have abdominal aortic ruptured without rupture.
30:30 And as you can see there, they drill that down even further. Is it dissection of a or ascending aorta dissection of aortic arch dissection of descending, thoracic aorta, or unspecified. And as you go through all of the codes that are available, you will see that same kind of pattern.
30:50 And of course someone that has a dissection, it’s a terrine they order.
30:55 And also, the most feared aortic dissection is one that affects the ascending aorta due to the potential for coronary ischemia. So they do. They definitely want to be able to track these better and be able to know so we can report them better and also again in terms of severity clinical presentation.
31:17 And being able to capture that specificity.
31:23 The saint, we’re not shown in the slide. We also have, there’s also new codes being, you know, create it for things.
31:31 For the throughout, the Rocco, abdominal aorta. Um, you could see here Juxta Reno and I know I’ve seen this type of specificity in the documentation.
31:40 So, just more document specificity will have to look for when coding these next.
31:47 Now, this isn’t that common, I have seen this before, is our enka associated vasculitis.
31:55 It is a group of autoimmune diseases that can affect our blood vessels.
32:02 We have three main types, including government, granuloma, …, with Poly and …, I know I’ve seen that formerly known as Wegner, …, as an affiliate Granuloma choices with Poly and …. Church strauss syndrome, or microscopic Poly Angie itis MPA. We also have other types, including drug induced vasculitis, in Reno Limited vasculitis.
32:25 So we do have a code for to capture the actual vasculitis code. And we haven’t excludes, to note there, to capture the specific type.
32:34 So we’re gonna encode the M 30.1, with the I 7782, to capture the actual vasculitis code, in addition to that Wagner’s, Turk strauss, et cetera.
32:49 one of the things they did point out was that if this is caught early, it’s very treatable. If not, it’s generally not highly survivable. So they definitely do want to get more information on this type of disease, and be able to track it better.
33:11 Next up, we have transfusion associated Disney. I’ve actually never seen this document. Let me know in the comments if you have It’s a kind of Along the same lines is our transfusion associated circulatory overload or taco or trolley transfer, transfusion related acute lung injury.
33:28 It’s, it can’t be specifically, um, classified as taco or trolley.
33:38 It is a type of pulmonary complication post transfusion that they want to be able to capture. It’s, you know, these can these transfusion related adverse effects are one of the top?
33:50 I guess the top third reactions with transfusions and they account for 65% of the fatalities, So they do want to be able to capture this information. Again, I’ve never seen this document, let me know.
34:08 I don’t see anyone saying they’ve seen it documented, but it’s something to look out for in the documentation. That’s actually how the definition they provide is transfusion associated dyspnea is a complication that that can’t be classified to taco or trolley.
34:25 I’m sure we’ll get more information on it as we get closer to implementation, usually our third or fourth quarter coding clinic, they give a lot of information in that section. Now, this is a code we probably all been waiting for. So as we all know, in ice or for those of us that coded in ICD nine, we had a specific code or a unique code for hepatic encephalopathy.
34:48 It kind of lumped into our a paddock coma, PSE code, et cetera, and it was included in all types of hepatic failure and we didn’t have a specific code, but we were able to capture it.
34:59 Now, we have a patent in ICD 10. It’s the manifestation of hepatic coma is captured, and is included in the various cause of headache failure but we don’t have a specific way to capture hepatic encephalopathy. It kind of just indexes to the type of hepatic failure.
35:15 So, in order to capture, um, specific hepatic encephalopathy is actually, they say the reason they’re adding this code is so it can harmonize with ICD 11 reporting because we do have a specific code in ICD 11 for paddock encephalopathy. They also want to be able to code this for research and clinical purposes. So I think they missed out on how many years. So in 20 15, 7 years of data, because we weren’t able to capture this code. So just note that we do have a separate code for a paddock encephalopathy.
35:51 That will be forthcoming. I do. There’s also a code note to unearth Lyme disease. And please note, this hepatic encephalopathy does not include a paddock coma. We still have, as you can see, we have been excludes one note there, for all the codes, in that code, also note that are with coma.
36:10 So if it’s with coma that, we wouldn’t be coding a paddock encephalopathy separately that’s the most severe form of hepatic encephalopathy. So we wouldn’t be coding that separately.
36:25 OK.
36:30 Next. We also have a code for rib fractures due to cardiopulmonary resuscitation. So this came about this was asked by the AHRQ. So if you’re concerned with core measures, PSI six, we have an excludes note for … pneumo thorax that could reasonably be expected to involve entering into the pore space cases involving rib fractures. Performance of CPR should be excluded from PSI six because … would be unexpected outcome in this coding clinical setting. This exclusion has been historically accomplished using S codes, but because coding clinics advice, we can no longer excluded from they can no longer exclude it from PSI six. They are requesting new codes to specifically identify thoracic fractures due to performance of CPR. And we shouldn’t be using S codes, right?
37:20 If it’s a, if it’s due to a medical procedure, it’s not due to trauma as codes are for trauma, right? We’re asked to and sine M 90, 689, It’s actually, that’s our current coding or coding M 9689, other intra-operative and post procedural complications and disorders of the musculoskeletal system. We will have new codes for specific so Fractured ribs tournament thorax and we have specified specific codes there. So we have a fracture of Sturm associated with chest compression and CPR.
37:50 one read multiple ribbs flail chest and then other fracture associated with chest compressions.
38:00 Next we have contrast induced nephropathy. We have a specific code for this. Again, I’m not gonna go over everything on that slide but just know that we’re gonna be having a specific code for Contrast Induce Nephropathy and 14.11 instead of just our other drugs, medical, and biological substances. And please note, it says excludes to acute renal failure. So we can code both of those conditions. Make sure that you also take a look at the other the acute renal failure currently. It sits as a, I believe, it’s a code also note. So, the sequencing.
38:39 It’s going to be dependent on the circumstance of admission. I think people get lost in the Coding Clinic. They do not advise sweet sequencing in the Coding Clinic. They just say, How do you code contrast induce nephropathy with acute renal failure?
38:52 So you have to be careful with how you interpret that. Make sure that you’re checking your your includes notes excludes notes, any all of your other notes that are available in the codebook.
39:06 This is probably going to be more impactful, I mean, I guess inpatient, but also outpatient eissa code, a lot of these in the outpatient setting a greater specificity. I already see this on our, our audits coders, missing specificity for the endometriosis sites. We’re going to have to be on the lookout for, not only more additional sites. We’re gonna have sites for things like you know.
39:32 The pleura endometrial was just of the Pleura, but we’re also going to have to look for the depth. So is it superficial or deep? There’s a large number of codes in this category. That’s why I wanted to talk about it today. A huge number, a huge number of codes in this category for expansion. On the specificity of endometriosis, do we have that currently have that level of specificity?
39:58 I’ve never seen deeper, superficial documented, So it might be something that we have to, you know, kind of work on in terms of documentation improvement.
40:08 Let me know in the comments if you’ve seen depth documented in your specific documentation.
40:19 Next we have fetal anomalies. So they they wanted to expand. So currently we just have a code for maternal care for suspected central nervous system malformations in the fetus.
40:30 It includes all types of central nervous malformations. So there’s a large number of expansion in this category to take into account specific types of fetal anomalies in this area.
40:43 So a genesis, you know, for example, and syphilis seel hydrocephalus, spina bifida when it when the patients seeking maternal care for these conditions.
40:55 And we used to have these codes in I nine, the specificity, and now we have, we’re going to have the specificity in ICD 10, as well.
41:07 Moving on, and we’ve talked about this before, as well, the type, the apnea of newborn expansion of different types of acne of newborn. More information will be out on this about, you know, what to look for with these different types. I mean, I know we’re from a coding perspective, we’re not clinical, so we’re looking at the documentation. But just to give you a general sense of the different types central cessation of breathing effort, we have obstructive Airflow obstruction. Usually at the pharyngeal level. We have mixed a central apnea that is directly followed by an obstructive apnea apnea premature Chert Charity, which includes developmental disorders caused by immaturity or neurological or mechanical function of the respiratory system. And there is a lot more information they supplied. Again, I don’t have time to go through that now, but just know, we’re going to be looking for specificity with the type of apnea.
42:00 So, as you can see there on the slide, some examples, primary sleep apnea of newborn, other apnea, obstructive apnea, unspecified, mixed apnea, and other acne of newborn, which I know we see these in our newborns. There’s a couple of other codes that are part of that, also part of this proposal.
42:24 one of them is that, when we have that, when they go home, with the monitoring devices, and the monitoring device goes off, but they actually don’t, Dash had nothing wrong. So there’s actually a code that was suggested. It will get to that in a little bit. Observation for suspected condition not found.
42:49 And then they also have a new code that’s coming out for risk for suffocation if the parents sleep with their baby. That’s another code that as was also part of that.
43:03 As well. Next, we have Atrial Septal on Atrial ventral septal defect. Now these are very the problem with the current code.
43:09 It’s very non-specific and multiple, the patient, the baby or the patient can have multiple birth defects and they’re all captured with the same code they could have. Let’s say a PFO and they can also have, I mean, I don’t know if this, maybe they have a coronary sinus defect.
43:26 Um, so we’re not able to capture those separately. So for registries, congenital anomaly registries they rely, they do rely solely on, are mainly on our ICD 10 codes. And with these limitations, they really can’t differentiate between the different types of atrial septal defects and atrial … defects. And if you’re coding these, um, you probably have seen this for the different types of repairs that they do for separate atrial septal defect, depending on where they’re located, it can be quite. That can be quite different depending on the location of the Septal defect. So there, they have the inability to research the specific or track the specific types of congenital anomalies because we only currently have one code that captures all of these anomalies.
44:13 So the cute 2111 Code.
44:17 So, the expansion, as you can see, we have quite a bit of expansion with unspecified, we have, second, um, atrial septal Defect, pick PFO, coronary sinus, atrial defects, superior, sinus, venous, et cetera and different types.
44:34 Atrial, Atrial ventral canal defect, et cetera.
44:43 Yeah.
44:44 So someone’s just making a comment that it’s always a concern for the congenital registries, the ASD versus ….
44:55 This is actually another great one. Oops. It skipped ahead.
44:59 Intracranial injury with unknown loss of consciousness.
45:03 So sometimes we we see they see patients who present with injuries that are coded to intracranial injury present without a clear history of loss of consciousness. We probably see this a lot. The current default is with loss of consciousness of unspecified duration, which implies the patient had a loss of consciousness, which may not be the case.
45:21 So, in order to better track these patients, this is actually proposed by the American Academy of Pediatrics.
45:28 They wanted to add a new code to track unknown loss of consciousness when we don’t actually know if the patient lost consciousness or not. So this is just a sample of the codes, but you can see concussion with loss of consciousness of 30 minutes or more of unknown consciousness.
45:45 An unspecified duration, so now that those codes have been expanded, and that’s been that’s been expanded across all of our traumatic brain injury codes. So I think that will make it a little bit easier, in some cases. Maybe not. We’ll see as we implement those codes.
46:03 The documentation isn’t always clear, or they actually don’t know if the patient actually lost consciousness. So this is going to be a code that we’re going to be using for those types of injuries. Next. We have poisoning adverse effect and under dosing by methamphetamines now. Initially, the proposal was just for poisoning by methamphetamines. And the reason they wanted to start tracking this right now it’s tracked under.
46:28 Unfed amines, Um, as you can see, it’s an inclusive term under unfed amines, which it’s actually a different in terms of tracking methamphetamines, illegal use of methamphetamines. It’s very important. They want to start tracking because there has been a tenfold increase in more turbidity, and mortality in the United States, and this is provisional overdoses. Deaths due to methamphetamines. So they want to be able to track this better, so they did create the poisoning codes during that maintenance.
47:00 Meaning they didn’t mention, one of the Doctors on the call did mention there is one methamphetamine drug that is legal that’s used to treat ADHD and narcolepsy, that does contain methamphetamine. So they also are expanding this code category. You can see there, we have reasoning codes. But, we also have adverse effect and under dosing those are probably going to be rarely used, right? Because, how many patients do you have? They said, it’s very this deck.
47:28 So, just so, I don’t even know how to pronounce that D S O X and a Y N Dexter’s in Des Susan, does Susan …, I don’t know, something like that.
47:42 It’s probably, I’ve never seen it, but those are, that’s a drug that’s used to treat. And she actually said on the call that that’s actually not a very common drug to prescribe for those conditions, but it is, it is approved to be used. So they did create a code for the adverse effect and under dosing.
47:58 So they did, they did come out with those as well. So they updated that.
48:04 Here is that code I was talking about in terms of the apnea. I’m sure we can also code this for other types of monitors. But when babies go home with, this is the main reason they created this, when a baby goes home for, you know, with a monitor, and it goes off, and they bring the baby in, and there’s actually nothing wrong, They don’t find anything. So, we have a code for Encounter for observation for suspected conditions related to home physiologic monitoring device, which was ruled out.
48:30 So, encounter for observation for apnea alarm without findings, obviously, if they have findings you’re going to code, they’re going to code the apnea or bradycardia or the sleep apnea, et cetera.
48:40 But, we do now have a code, too.
48:42 Report that.
48:47 And then, next, of course, social determinants of health has been a big issue, a big deal over the last couple of years. They’ve expanded the codes to include transportation insecurity, financial insecurity, and maternal hardship.
49:01 So, additional codes there.
49:07 Um, then, personal history of non compliance. They’ve expanded the codes here.
49:17 Then, also, this is part of the proposal that we just talked about.
49:28 With, sorry, I wasn’t gonna say, in terms of the maternal, the pediatric, the Academy of Pediatrics, this is part of one of those proposals, were their talk, they wanted to make sure that we can capture caregivers non compliance, because some patients, maybe they’re too young, maybe they’re, they have, they’re disabled, maybe they’re elderly, and maybe they’re not getting care. They need because of the non compliance of their caregiver, not necessarily because the patient themselves are non compliant. So, we have expansion of those, because I think that will also help us. A lot of times, you’re left to kind of work with a, with a, you know, other other category here.
50:14 Then, a lot of expansion for our long term use of drugs, so it’s, we probably pick these up quite a bit. We’re going to have, You know, it’s increasingly, you know, increasing number of patients are on these types of drugs, so we have long term use, you know. If you’re a transplant patients do 79, 621 and you’re on ….
50:36 That’s something that we have a space we’re going to be having a specific code for a lot of the.
50:42 You know, the different chemotherapy drugs, you know, we have the history of chemotherapy agents but we also, now it will be having codes for long term use of chemotherapy therapeutic agents.
50:53 We see patients such as, you know, patients being on chemo for you, know, 12 cycles or, you know, maybe a yearly basis or we see there the methotrexate, we see that for other types of not necessarily Cancer. So we have other expansion of codes.
51:10 You’re also The one I really wanted to point out here, was the long term we’re currently using other long term drug therapy for non insolent anti not injectable, non insulin anti diabetic drugs. We’re going to be having a new code for Z 79, 85, long term use of injectable, non insulin anti diabetic drugs. So, expansion there of the codes for our diabetic drugs.
51:35 Just something to look at.
51:40 We also have other immuno modulators, immunosuppressant drugs.
51:47 That, you know, monoclonal antibodies.
51:50 So, more drugs here as well, on this next slide.
51:57 And finally, other concepts that we’re not gonna have time to discuss today, that I don’t think are as impactful.
52:05 Um, maybe some of them are to you if it’s something, you know. But, there’s here just so, you know, von Willebrand disease, we do already have a code for that. It was expanded some of these other are very rare diseases Gref disorder. We have one code there: limb, girdle, muscular dystrophy.
52:23 Lumbar, Lumbo sacral, Annulus fibers defects muscle wasting atrophy of the back. We have slip, We have expansion of the slip up or for moral. *****, stable versus unstable. Foreigners disease of the ******, and Volvo is smo seal one code there. We have our EMR Tomer, Tumor Syndromes, Primary Blast Injury.
52:42 If you’re working with veterans, you’ll probably see that those are due to blast injuries like bombs and stuff. We have a huge number of codes in the external causes of morbidity codes for E bikes. I know I see those in my neighborhood in and around town. So a lot of new codes for, we always have a lot, a ton of new codes, an external causes of morbidity, chapter. They are related to the expansion of codes for, you know, E bike and pedestrian E bike and animal, E bike, and a car, etcetera. We also have expansion of encounter for pediatric to adult transition counseling. We have, there’s the risk of Suffocation smothering under another while sleeping, that has to do with, you know, sleeping with your baby.
53:29 You’re at a greater risk for the babies at a greater risk for certification. And then we also have additional codes for history of cryptic, congenital anomalies. A ton of codes there. And history of certain conditions are rising the perinatal period, so they’re just history codes. But if you want to take a look at them, feel free. There’s a great number of expansion there to look at.
53:48 If that’s something that your facility is concerned with just to know Will we will be talking more in detail about that once we talk about the the other the codes for as we get closer to October. So I’m not going to read this list. But you can see the additions to the MCC list, things that you’d expect, the hemolytic … syndrome, the dissection or rupture of the aneurisms Contusion of the brain with, the, with the unknown loss of consciousness, primary blast injuries as well.
54:23 See, see, there’s a ton of codes in this list. Are von Willebrand Disease or acidosis, our vascular all of our vascular diseases with or agitation, disturbances, mild, unspecified, all the way to moderate and severe. So, just unspecified, without any, you know, just unspecified to very unspecified type, or without any of these things aren’t CC’s but with these behavioral disturbances and mood disorders, They do land in the CC list. And, again, this is the proposed rule. This may change, and you can see the huge number of codes here.
54:59 Our refractory angina codes are also on this list.
55:04 Then our Pericardium, fusions, R V tax, the transfusion of student associated dystonia, are fractures of the chest, um, then our sleep apnea is of the newborn. And I think that’s about it.
55:21 Oh, we have more, or eight, ASTS, some of those additional traumatic brain injury codes, less severe.
55:33 codes, are also on the CC list, um, and that’s it for our highlights first, ARR, C M, So I’m going to go into the CM guidelines.
55:45 They’ve added a couple, couple of things here, code assignment and clinical criteria, if there’s kind of under the 8019 code assignment, clinical criteria, they said, if there’s conflicting medical documentation, inquiry the provider. So some semantics there, I think we know that.
56:01 So, we had a coding clinic came that came out earlier, I think it was in second quarter. about, can we code off of other clinicians, documentation for under immunization status. The answer was yes. They went ahead and added it to the guidelines.
56:22 Documentation of Complications of care, I know there are some. There are some newer coding clinics that came out. They added some additional verbiage here.
56:31 There must be a cause and effect relationship between the care provided in that condition and the documentation must support that the condition is clinically significant. It is not necessary for the provider to explicitly document the term complication.
56:44 For example, if the condition alters the course of surgery as documented in the operative report than it would be appropriate to report a complication. So, for example, the Coding Clinic talks about they, you know, made a laceration of the bow they had to remove the bow. Didn’t specifically say that was a complication, but because they had to remove the bowel, it’s considered a complication.
57:05 So I think that’s why they, they, they added that to that, to clarify the guidelines there, obviously you want to clear cause closet cause and effect relationship. If we’re not sure if that it’s significant, like, if they just have a minor tear and they just did a suture there, and they don’t listed as a complication. That might be something that we need clarified.
57:28 They’ve added some guidelines regarding HIV.
57:33 For Hemolytic … Syndrome, I’m an exception. There’s actually it’s going to be further on, but if they put it in chapter one, more in the chapter specific one guidelines, and exceptions to the guideline. If the reason is for is admission for hemolytic … syndrome associated with HIV disease. Assigned code D 59 3 1.
57:52 Followed by B 20, that’s one of our exceptions, our new exception for coding, our HIV related condition.
57:59 So that’s going to be a new change. However, how often do we see Hemolytic geremek syndrome? I hardly ever see it.
58:06 So I’m not sure how impactful that’s going to be HIV.
58:09 So, I know everyone, know there are some misinterpretation of this guideline Last year.
58:14 They’ve updated their guidelines so we’re all clear The patient was documented with HIV disease. They, they defined what HIV disease or was in the previous guideline.
58:24 Um, however, they’ve added HIV related illness or aids to make it more clear, which thank, thank, I’m glad they did.
58:32 They did come out with a coding clinic explaining that if a patient is documented HIV disease HIV related illness or aids is currently manage an anti retroviral, we can assign the B 20 encode, Z 7999 for other long term you.
58:47 So, if they just have HIV positive, that’s not the same thing, right?
58:53 They have to specifically say HIV disease, HIV related illness, or aids.
58:57 Now, we do see patients that are HIV positive on long term use of drug therapy, which I wish they would have added that there, to make it complete and concise.
59:05 But it would still be appropriate. We still pay to see those patients on long term drug therapy.
59:15 They added under sepsis, no major changes here. I think we’re all waiting probably for sepsis three to be incorporated. I don’t think that’s ever going to happen. But we have for infection associated hemolytic … syndrome with severe sepsis.
59:30 Um, that’s being added here, see the guideline for 1 C 1 D 9, and we’re getting to that Hemolytic … Syndrome associated with sepsis. If the reason for admission as Hemolytic … Syndrome, that as associate with sepsis we’re going to assign D 59 3 1 infection associated, Hemolytic geremek Syndrome, as the principal codes for the underlying systemic infection and other conditions. Such a severe sepsis should be assigned as a secondary diagnosis.
59:58 And again, I see a lot of people asking questions. I know as much as you guys do, until they publish more information.
60:07 Or, obvious, they, they will, in court at Coding Clinic, fourth-quarter.
60:11 They don’t always give us all the information with the, the proposed rule. I’m assuming there’ll also be more information with the final rule, as well.
60:20 Also, the CMS website does have additional information, and in that, in that, about these different conditions. This was just the highlights section. So I didn’t include all that information.
60:36 Under immunization.
60:40 They just add it. If you notice, if you went to this link in the current guidelines, they link takes you nowhere, So they updated the link here, you can actually go to the website now and find the correct information about what constitutes fully vaccinated.
60:58 That’s the updated link.
61:05 Then we have some guideline updates regarding secondary neoplasm of lymph lymphoid tissue. So, when an malignant neoplasm of lymphoid tissue metastasizes beyond the lymph Nodes A code from Category C C one to C D five, the final character of nine should be a sign identifying extra nodal on solid organ sites rather than a code for the secondary neoplasm of affected solid organ. So, for example, for Mets of B cell lymphoma to the long brain and left adrenal gland, we’re going we’re going to assign C 83 3 9. Diffuse large cell B cell lymphoma, extra nodal, and solid organs sites.
61:41 I think that’s a little bit different than some of the guidance that’s been given in coding clinics, recently.
61:53 Because we have new codes for an injectable, non insolent diet, antibiotic diabetic drugs, they had to update the guidelines. So just some minor changes here. The guideline remains the same.
62:04 They just updated the code because we have a new code for our injectable, non insulin into diabetic drug. And I just put the one guideline here. But it affects all types of diabetes, not just, you know, type two.
62:21 In some changes, they’ve added a specific guideline for dementia.
62:27 Some minor, also in remission, they added they have a new codes, they had to update this dementia, they added a new specific guideline. We have our dementia codes, based on the base of etiology and severity selection. of the appropriate severity required providers, Clinical judgement encode should be assigned only on the base of provider documentation.
62:50 Unless otherwise instructed by the classification, if the documentation does not provide information about the severity, assign the appropriate code for unspecified.
62:58 If a patient is admitted to an inpatient acute care, hospital or other inpatient facility setting with dementia at one severity level and it progresses to a higher severity level, assign one code for the highest severity level reported during the stay.
63:11 So we have some clarification on that.
63:15 They’ve added some information about completed weeks of gestation. We have that encoding clinic second quarter as well.
63:23 We also have hemorrhage following elective abortion. Guideline added, so for hemorrhage, post elective abortion, assign code, oh, oh, 0 4 6, Delete, or excessive hemorrhage do. Not assign zero point seventy two other immediate post-partum hemorrhage, as this code should not be assigned for post abortion conditions.
63:41 Post-partum post abortion or are different, right.
63:44 Do not assign code Z 33 to encounter for elective termination of pregnancy when the patient experiences a complication post elective abortion, say, clarified that guideline.
63:57 We have use of 0 5 codes, some minor, some minor verbiage changes there.
64:05 Suspected diseases and conditions, instead of just conditions, they added diseases.
64:12 Under dosing, they added, we have a coding clinic on this. Documentation of a change in the patient’s condition is not required in order to Senate and reducing the fact that they’re taking less of a prescribed medication.
64:23 We can go ahead and assign the under dosing code, is enough to assign that code.
64:31 And we already, we do have a coding clinic on that. We have a new code for pediatric adult transition counseling. They added a guideline on that. I’m not sure how often we’ll see that unless you have a pediatric clinic.
64:42 And then social determinants of health.
64:46 They’ve added additional verbiage here, assign as many … codes as necessary, describe all the problems are risk factors. These codes should or should be assigned only when the documentation specifies that the patient has an associated problem or risk factor. For example, not every individual living alone, So, I could be living alone, but that doesn’t necessarily impact my care, right? I’m not disabled or not, you know, anything like that.
65:11 For example, it doesn’t affect my care, maybe it does affect my care.
65:15 Maybe I need a ride, because I can’t get to the hospital myself, but maybe I’m undergoing some type of therapy, and I can’t get to the hospital, I need a ride. Maybe that would be an instance of where it would be impacting my care. So we shouldn’t be using coding, … codes, social determinants of health codes, just to code them. They should be impacting the patient’s care in some way. So they clarified that in the guideline as well.
65:41 Let me see, I think I’m not going to get to our PCS, I’m probably gonna have to do another presentation on this. It’s here for your review. Again, I mentioned earlier in the presentation that in the file there is only a handful, 50, some codes. If we take a look at the summary, there’s actually 3331 codes, and I couldn’t find them. I finally found them, they’re not in the original file. I don’t know why they weren’t in that file.
66:09 But just to quickly, we do have these the additions are here. You can go through this, if you wish.
66:16 Um, and I do. We do have some coding guideline updates, as well.
66:24 Again, I’m out of time. So I’m going to just quickly talk about these gods sorry. The proposed changes.
66:32 Oops.
66:34 Is going on with my slides. I think there’s a ghost.
66:39 We have a new guideline. This isn’t something new, but they’ve added it to The, guidelines are Detachment Procedures of Extremities.
66:46 We had the Qualifiers Published Encoding Clinic. We also have them in the definition the ICD 10 Definition Manual when ICD 10 first came out so it’s nothing new to us. We’re already using these definitions but they put them in the, they actually put them in the guidelines. So, I’m not going to spend too much time here, but again, this is something we already should be utilizing.
67:05 They actually added it to the guidelines proposed changes. We had a coding clinic on this, so we should already be aware of this.
67:13 ARR before one seek guideline, they said tubular body part for continuous section of a tubular body part.
67:21 It actually should referring here to, if a procedures performed on a Venus or vascular body part, they didn’t mean all body parts like like the colon. So they’ve updated that verbiage to just, say, our tiered, arterial, venous body part. I mean I’ve highlighted there the differences and we’re probably all aware of this. We’ve had a couple of coding clinics on this coding clinic first quarter. I highlighted there. If you need more clarification again Just to highlight the changes here. Um, it took me a while to figure out what they actually changed in this guideline. I read it, like 100 times. I’m like, What did they change in this guideline? So this is a device guideline.
67:59 Um, I think this has to do with the complication. So they change. For example, the device size is inadequate or an event documented as a complication occurs for the removal and insertion of that device for before it used to say, for example, the device size it is inadequate or a complication occurs.
68:20 So, I mean, I guess, though, explain what the difference there is, it kind of sounds the same to me. I don’t know, anyone in the comments?
68:29 Has any insight into that, let me know? They don’t really, with PCS changes, they don’t really give us that detail.
68:38 So they did change the verbiage just a little bit, I’m sure someone else can interpret that differently than me, but it kind of sounds the same.
68:47 And all that document, all the packets that I used, all the information. You can just Google the co-ordination meeting packets and get a lot more information about each of these codes. And this is where I found the information.
68:59 As a re as a reminder, you can download your CEU at this point. If it’s up, give us a minute to upload it, or you can wait for the e-mail. You have the link here. I get tons of e-mails about this. I didn’t get the e-mail. We do provide the link at this point during the presentation. So if you wait a little bit, you can use that link that’s provided there and download your CEU. You have two weeks to download it from using that link and, or using your e-mail that you get. The reason we do that is because some, sometimes your organization will block the e-mails. So we want everyone to be able to download that, so we provide it in the webinar packet.
69:38 For more information, for six employees, please also refer to the Yammer Group, I have a ton of information in their questions, and more information about, about the, our process.
69:53 So I will stay on for a couple of minutes, and answer any questions. I did go over, and I apologize, I did not get to PCS.
70:04 So thanks everyone for attending our webinar.
70:10 Right.
70:14 I do, but someone asking, asking a question about aortic tears. Um, if it’s if it’s traumatic and in nature, I believe there are probably is.
70:23 Without knowing off the top of my head, I probably can probably just go to injury of a vessel or injury of aorta and there probably is a code for a laceration or tear of.
70:35 it might.
70:35 It’s probably a very generic code, I’ve actually never code aortic traumatic, aortic tear before. So I’m just, I’m assuming I’ve coded like traumatic tears of the carotid artery, for example, and there is a a code for that.
70:52 OK, so another question is does does Does TA, Did it D or transfusion associated dysphonia decoded I’m trying to, does that have to specifically be document it, sorry. I’m trying to understand or transfusion associated just me or be coded. if documentation says … secondary to transfusion or related … and a similar wording. That’s a good question. I mean, if they say distinct due to transfusion as at the same thing, I don’t know.
71:21 That would be something that we have to seek clarification on or is it a specific condition? I would be looking out as it currently stands without more information I’d probably looking out for that be looking out for transfusion associated somehow linking it to the transfusion but that’s actually a good question. You might want, you know, we could probably submit that for clarification.
71:54 If they are resolved by discharge, would you still be coded for the newborn coding codes or much? Sure. Are you talking about the apnea codes? I’m not sure which codes.
72:08 Yeah, if they’re treating a condition and, you know, sometimes those babies are here for a very long time, I would still be coding them if they’re treating them, you know, if they meet any of the secondary reporting guidelines.
72:24 Question about CEUs. I have this slide up on the screen right now that you should be able to see with the link.
72:30 It’s also in the handouts.
72:31 You can download it and use that link. I do ask that, you know, sometimes it’s not always there, right, immediately. So you might have to wait a couple of hours before it so that they can the marketing going to get it, upload it.
72:46 Just a comment about the social determinants of health codes, those are good codes.
72:54 That’s a good question. To what define? I mean, we know that. What defines long term use?
73:00 12 weeks or cycles of chemo, does that qualify? as long term use? I mean, they get it, inpatient gets it once on one day, or over a period of 24 hours, let’s say. And then they don’t get it for three weeks.
73:13 Um, that’s a good question.
73:17 Hopefully they defined that for us.
73:19 I’m assuming that would be an example of long term use. Because that’s the prescribed method is every, you know, every two weeks or every three weeks, over a period of weeks.
73:32 That’s a great question, though.
73:36 Someone’s asking a question about post term gestation is 40.6 weeks considered post term. Coding Clinic just came out with a coding clinic in that second quarter coding clinic, I believe. And they say, yes. It’s considered post term.
73:50 It looks like the person, the asset left already.
73:56 So with social determinants of for living alone, if a patient has to go to sniff, instead of home that constitutes coding.
74:05 So obviously, for that one, you’re gonna wanna look to see if it’s impacting their care. Are they going to? a stiff because they live at home, and they can’t care for themselves? I would say yes, then we should be coding that.
74:15 I was just using an example of, you know, a healthy person is cut maybe they’re a healthy person is coming into the hospital for an appendectomy, let’s say, you know, otherwise healthy individual. They’re coming in for an appendectomy in the Care manager notes. It says the patient lives alone. That’s not really impacting their care, right? Like they’re just going home with normal care. So they say we’re not We shouldn’t be coding it in that sense, but if it’s impacting their care and they have to go to a sniff, because they live alone, that would be an example of impacting their care.
74:43 They, they need web, you know, dressing changes in the patient can’t change it themselves, so they need to go to a nursing home.
74:53 So, a question about the proposed MCC deletion, I usually don’t talk about that. If there is something significant on there, I would, but the proposed MCC deletion list is based on the codes that were expanded?
75:05 Um, so, for example, um, me, Go to that list.
75:13 So, if we have an expansion of a Code category, they deleted the old code and the new code is still on the MCC list, I didn’t see any change in terms of codes that were C Cs that are now MCC, or vice versa.
75:35 Before, let me go before one. See.
75:43 So that’s, it pertains to any procedure that’s performed in a continuous section, it doesn’t matter if it’s open or closed. So, I don’t believe it doesn’t say anything about the open or closed state of the procedure. So if we have a lesion, they do an open endarterectomy of the carotid artery, it involves a lesion involving the internal and the common carotid that lesion is one lesion that extends from the common to the internal carotid. We’d still be coding it to just common carotid.
76:09 There’s coding clinics on that as well, if you need more detail on that.
76:15 Um, so it doesn’t matter if it’s an open or percutaneous procedure.
76:27 OK, so, let me go back to that, Let me see if I can quickly bring up the CC list, just so you can see what I’m talking about.
76:39 OK, so, this is available on the CMS website, um, silvana Villain Brands Disease, for example, was expanded.
76:46 So, we have it’s delete it from the CC List acidosis was expanded so it’s deleted from the CC List. Vascular dementia with Behavioral Disturbance. We have a greatly expanded code set there. So, those. So, as you can see, all of these codes are being deleted because we have expansion of the codes and the same as it can be said for the SEC, for the MCC list. So these are the only MCC delete it.
77:09 And as you can see, these were expanded for fiscal year 20, 23. So these are the only ones being deleted.
77:20 I hope that answers your question.
77:25 All right. I don’t see any other questions. None, a lot of questions today. If you do have any other questions, feel free to reach out. And thank you so much for attending. I appreciate it.