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0:04 Good morning, or good afternoon, everyone. Before we get started, just a quick sound check. Make sure that everyone can hear me and see my screen. I am by myself today, so, if you can just, in the comment box or question box, just let me know if you can hear me, that would be great.
0:26 OK, awesome, thank you. Alright, so, we’re gonna go ahead and get started.
0:33 Thank you. I guess I should mention that, I do have somewhat of a cold, so I’m actually getting better. So, I apologize in advance for any coughing or clearing my throat? I might have to take a break now and again to take a sip of water. So, but, I guess I should let everyone know who I am. I mean, some of you, I’ve been, I haven’t been here for the last couple of roundtables, but, I just wanna say thank you. Welcome back to Roundtable 152. Thank you for taking your time out of your day to join us today. My name is Janice, to our lucky I’m sorry, X is Health Director of Advanced Education, and today, we’re gonna be discussing fiscal year 20, 23 coding guideline changes. Before we go any further as usual, we have some housekeeping items. First up, I want to mention that next month’s topic has been revised.
1:21 If you haven’t seen it, it was going to be fourth quarter coding Clinic Review, however, we’re changing that to mastering upcoming 2023 NM changes and will, we’ll push fourth-quarter coding clinic review to first quarter of 2002 of next year. So, 2023 of January January of 2023. So just pushing that out just a little bit, you should have received the e-mail last week with the update. If you work for psi X, you should have received the update to the invite, the internal invite, but I just wanted to let everyone know, make everyone that’s on the call today aware of that.
1:58 If that’s something that you’re interested in, again, we’re still going to have the fourth quarter Coding Clinic Review that just basically all the new codes, kind of every summary of all the new codes in that Coding Clinic. And part of that is the new guidelines which we’re discussing today. So we’re sort of discussing fourth-quarter today, anyway.
2:18 So, just wanted to let you know, you’re hearing it here, but it’s also you don’t have to re-register anything. Just the topic has changed the date and time. And everything is remain the same. It’s the same invite. So we’re looking forward to discussing those changes to evaluation and management guidelines and codes, so that we can hit the ground running in the upcoming year.
2:40 So, so, some additional housekeeping items. There are no cola numbers, we always get this question, the format streaming only, so that we can allow a more attendees. Today’s webinar will be available on demand after the live session and will be as accessible through a link that will provide in our follow-up e-mail.
2:58 They are also available on our our, so if you just Google … webinars, that should come right up and bring you to our webinar page.
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3:34 Also, um, be aware that there’s a link in the, in the, in the presentation, as well, but please allow. Please make sure that you’re following the instructions in that link and wait for the presentation to be over.
3:47 Typically, they’re not, they’re not uploaded until after the presentation is over anyway, So you may need to wait a little bit. And, of course, you can download the handouts at any time there in the handout section.
3:57 And I’ll do my best to answer any questions at the end of the session. If we have time, I usually do allow a little bit of extra time to run over at the end, if you want to stay on a little bit longer to make sure I answer those questions.
4:15 So, if you do want to sign up for webinars, as I mentioned, please check out our website. You can just Google … Webinars, and under should take it, take you right to the landing page, scroll down to the bottom of the page, and you can register for any upcoming webinars, including this NM webinar that I just mentioned.
4:38 All right, so let’s get started here, first up, we’ll talk about C M, let me change our slides here, OK, we’re going to be talking about our coding guideline changes. So our agenda for today is our C M guidelines, and then we’ll move to our PCS guidelines.
5:01 OK, so first up, I’m going in order, kind of, as the changes appear in the document.
5:07 So some of these are, could be minor, grammar changes, Some, no, maybe some update.
5:17 But the first one that I noticed was Undercoat Assignment and Clinical Criteria. They did mention in this section, or they did add a particular sentence, if there’s conflicting medical record documentation, query the provider for code assignment, the assignment of a diagnosis code is based on the provider’s diagnostic statement that condition exists. So just a reminder, we shouldn’t be basing our coding based on clinical criteria. It’s up to the provider to establish that diagnosis.
5:44 However, is if there is conflicting documentation, we should be querying the provider, is what they updated that guideline to say. Moving on to our, I think we’re all aware of that, at this point, but just, they did, they did complete that, and add that to the code assignment, clinical criteria guideline, in our general convention in General guidelines section. So, next, we have, before documentation by clinicians, or the patient’s provider, they’ve updated this year after year.
6:12 Please note, the one change that they update it for this year is under Immunization Status. So, last year, they added … and blood alcohol level to this guideline, so that we can take those off of other clinicians.
6:29 Documentation other than the provider. So nursing, et cetera, like we do with BMI, and pressure ulcers and ulcer stages, coma skills, things like that. They’ve added under immunization status. We can now take that from other clinicians documentation. As long as it’s debate that it’s able, the provider should say, the clinician is able to document in the medical record.
6:52 We’re able to take that documentation for under immunization status.
6:56 So, this is actually So, I’m going to stop here for a second and say sometimes we have to look back look back in time to see why they make changes to the guidelines, right? And we’ll see that a lot as we go through this presentation. Sometimes, I’m not able, and if you know, I mean, maybe you’ve been to other presentations maybe by AHIMA, maybe, by the HA, and you kind of know, Sometimes, it’s not always clear, clearly spelled out why they made a change. If you go to, If, you listen to the co-ordination meetings, you may hear some, some discussion, but that’s a six hour meeting, Sometimes, you may. You know, it’s hard to get all that information. Sometimes, it’s hard to find information about why they made changes.
7:36 But I do, I try my best to figure out what what they’re trying to, why they made the change to the best of my ability, based on previous guidance, based on those webinars and things like that. Um, if anyone hears anything else, let me know.
7:54 Coding Clinic fourth-quarter at times, does provide some additional rationale, which I’ve included in the presentation, as it applies.
8:01 So for this one, for under immunization status, this has actually been applicable since April of 2020, or April 21st of 2022. So the HA AHIMA at one point was was keeping up, they’re both publishing these frequently asked coding questions. I don’t think AHIMA is doing it anymore. It kinda disappeared from their page.
8:26 Correct me if I’m wrong, I haven’t been able to find it. The link that I used to use is no longer valid. But on the HA, they’re still keeping up, the last update was back in May, it’s still on their website, so back in April.
8:41 A question was submitted, actually.
8:42 I was, we submitted this question. Would it be appropriate to utilize documentation from clinicians, a nurse, other than the patient’s provider, to determine if a patient’s under immunization status to report the new … code for Cove in 19 could starting April first. Remember, those codes came out in April first. Where are we allowed to code that from other providers? It wasn’t outlined in the coding guidelines, and they tell us, yes, under immunization status codes may be assigned based on a nursing or other clinician documentation where information regarding the patient’s vaccination status can be found. Official coding guidelines, documentation by conditions, other than patients provider, will be updated for fiscal year 20 23. Guideline revisions to include all under immunization status, as one of the exceptions of acceptable conditions, status is documented by clinician, other than the patient’s provider. And I put a link there to see the full list of frequently asked questions. I’m sure at this point everyone’s aware of those frequently asked question pages.
9:36 Remember, they’re part of one of the co-operating parties that makes decisions and provides education to us about how to use codes. And it gives us advice about codes when it’s not clear.
9:49 Cool.
9:53 So, it can either be the doctor, or it could be the nurse, Anyone that’s licensed to document in the patient’s medical record is where we can take that information from.
10:04 OK, so, next up, we have documentation of Complications of Care. So, let me just read the whole guideline and anything in bold. Here is what, what’s new? So code assignment is based on the provider’s documentation of the relationship between the condition in the … procedure, unless otherwise instructed by the classification. The guideline extends to any complication of care. Regardless of the chapter, the code is located in, is important to note that not all conditions that occurred during or following medical care surgery are classified as complications. There must be a cause and effect relationship between the care provided in the condition, For example, A patient has surgery, maybe they have a chronic medical condition that gets exacerbated in. The post-op period doesn’t mean it’s a complication of the surgery. It could just be an exacerbation of the patients’ chronic medical condition, right?
10:49 We want that clear, cause and effect relationship, document it.
10:53 In that case, in order to assign the complication code, they go on to say the documentation must support. This is the new part, that the condition is clinically significant.
11:03 It is not necessary for the provider to explicitly document the term complication.
11:08 So if there’s a cause and effect relationship document, it, this was caused by the procedure. But they don’t specifically say this is a complication of the procedure. That that’s what I’m interpreting this to mean, as long as there’s a cause and effect relationship documented, and they are specifically due to the surgery.
11:25 We can code it to the complication code.
11:27 For example, for example, if the condition alters the course of the surgery as documented in the operative report, then it would be appropriate to report a complication code.
11:37 Of course, query the provider for clarification, if the documentation is not clear, as to the relationship between the condition, and the care, or the procedure.
11:45 And I think this also, again, I mentioned earlier that I kind of look back in time to see kind of why these guidelines were updated or revised or rephrased, because, I mean, every day, I talked to coders, auditors. And you, you can see how people, different people interpret the guidelines differently. You know, some people take it for what it exactly what it says, black and white.
12:08 Some people read a little bit more into the verbiage of how it’s documented, so I think it’s good that they, they update this information as needed to clarify things that may be, you know, not so black and white.
12:27 OK, so next we have, I have some a coding clinic where I think this kind of stemmed from and it’s important when they refer to a previous Coding Clinic that we also refer to that Coding Clinic to have a better understanding of what they’re referring to and this particular Coding Clinic. So they refer to in this intra-operative … Coding Clinic.
12:49 I think a lot of people were a bit up in arms about this, or maybe didn’t understand the intent of this Coding Clinic, because we didn’t refer back to the old Coding Clinic to read through that and see exactly what they were trying to say.
13:04 So I think I can apply this coding, this new, updated guideline, based on this Coding Clinic. that came out in first quarter of 2022. So the question is please clarify the Advice published, encoding clinics? Second quarter 2021 page? eight regarding the inter operable operative … will tear The advice appears to conflict with the official coding guidelines for coding and reporting for documentation of complication of care since the provider explicitly documented that no complication of curd. So we saw in, in that coding guideline where they updated it to say, they don’t specifically have to say there’s a complication, but if there’s a cause and effect related cause and effect relationship documented, that would, that should suffice, right. So let’s keep reading an addition.
13:49 Because the terror occurred during a laparoscopic self, self pengo, oophorectomy, code, Kate, 9172, accidental puncture, and laceration of a digestive system, organ, or structure during other procedures, should have been assigned, rather than K 9971, accidental puncture, and laceration of a digestive system, organ or structure during our digestive system procedure. So the answer, I’m not really too concerned with the K 91 code, because that’s not really what we’re, but they do address it in this Coding Clinic, so we’ll talk about it. The answer is the device previously published, Encoding Clinic, second quarter of 2021 page 8 does not conflict with official coding guidelines for coding and reporting for documentation of complication of care. Since a cause and effect relationship was documented between the surgery and the surreal, Solitaire.
14:31 The guideline was not intended to mean that the surgeons must specifically document the term complication.
14:37 The surgeons, documentation of the … and the subsequent procedure for repairing the terrorists sufficient documentation to report a complication code.
14:46 Furthermore, the term complication does not imply inappropriate inadequate care in or an unplanned outcome.
14:52 Some issues or conditions occurring as a result of surgery are classified by ICD 10 as a complication, whether stated or not, although the surgeon stated the … was unavoidable, it does not mean that the terrorists not a surgical complication.
15:05 For example, a … can range from a small nick requiring no treatment at all, to a major tear requiring removal of a portion of a small intestine.
15:13 Are also Tears alone, do not qualify as a reportable diagnosis, as we, I think we all know. That’s kind of what comes in question. We kind of have to ask ourselves, Should we report the Stirrups Altera? Not a lot of us do have policies and procedures should be Query. Should we leave it off, Et cetera. But in some cases, we have clear. We have clear advice. That’s given to us in our coding clinics, and we’ll get to that in the next upcoming slides. If, however, the degree of the … alters the course of a surgery, I supported by the medical record documentation in the chair should be coded.
15:44 Although not explicitly stated in the Q and A the patient had undergone multiple procedures including assaulting, oophorectomy, Reduction and repair of an incarcerated eventual hernia, with Mesh and Lace of adhesions, the … occur during the part of the surgery to repair the ventral hernia and most of adhesions of the small intestine.
16:00 Therefore, code K 9171, accidental puncture and laceration of a digestive system organ or structure during a digestive system procedure, is the correct code assignment.
16:10 OK, so let’s move on to the next Coding Clinic that they’re referring to in that Coding Clinic is talking about this, this laparoscopic sopping oophorectomy. The surgeon noted and incarcerated loop of small bowed hearing to eventual hernia sack. After take down the bow was discolored with multiple sclerosis tears. Incision was an extended, was then extended. The loop of the bow was brought out the incision and the segment of this are also injury was excised. It seems that are also, tears requiring excision would be clinically significant. However, in this case, the provider documented the injury was inherent to the nature of the procedure.
16:48 OK, we don’t normally remove a loop of bau during herself who sopping oophorectomy and eventual hernia sack repair. So on query, he stated that the … was unavoidable unavoidable during the extensive list of adhesions not an intra-operative complication. Would any bowel injury requiring excision be considered clinically significant and reportable? How is this are also injuring repair bike sizing a small bowel encoded? So we’re going to code the K 9171, accidental puncture and laceration of the digestive system, Oregon for this are also injury of the small intestine, because it altered the surgery, right? They, they nick the bow and then they had to, they had to do. They had to size up portion of the bow.
17:27 Although after query the provider indicate the … was unavoidable is clinically significant, as it required further excision complicating the surgery. Therefore, the decision of the small intestine is coded, assign the following procedure code, extension of small intestine open approach, the decision of the small intestine. And so just in summary, I think that’s why they made that change to the coding guideline. They don’t have to specifically say it’s a complication.
17:49 But if there’s a cause and effect relationship and it alters the course of treatment, then we can, we would still follow our coding encode those as appropriate. Of course, sometimes we still need to query if they are do, are they still are they significant? Sometimes it’s not always clear.
18:07 Hmm? Hmm.
18:11 So this is so this is we can dive deeper into this. I wasn’t planning on diving deeper into this because we’re just talking about the guidelines. But if the physician says it’s inherent to the procedure and they just like did a few sutures, we have other coding clinics on that, right? If there’s just so if it’s just a minor nick and they do a couple of sutures, it’s not considered to be significant and we’re not going to code it.
18:33 Now if it’s a full thickness injury, et cetera, we have other coding clinics that talk about, you know, we can query the provider to see if it’s significant, et cetera, and ask if it’s if it’s if we should be picking that up.
18:47 So we didn’t put them all in here, but we do have other advice, encoding, clinic regarding sir also tears, and I would refer to that. And a lot of, again, a lot of facilities do have policies and procedures about about what you would do and who’s going to review it. So I can’t speak for everyone on this because a lot of facilities have different steps. They take when they have these.
19:09 Because as someone mentioned in the comments, it does trigger a PSI so it is a conversation worth having internally. And I’m sure most of you, I know all the facilities that I work with do have some type of policy in place or someone that’s going to review that. Maybe a liaison, a clinical liaison that’s going to review that. Should it be queried, should it be coded? Is there enough Dakota or should be queried? Et cetera. But this is one example when they have to take out an Oregon or a piece of an Oregon that it’s considered clinically significant and we don’t need to query.
19:47 Hmm, Hmm.
19:49 Good.
19:51 OK, so moving on to our next topic is, Are HIV managed by anti right anti retroviral medication?
20:00 Now, I think there was a misinterpretation of this guideline. However, they added they they added if a patient who was documented HIV disease, they’ve added the other terms that we use. EOP 24, HIV related Illness, or age, as aids is currently managed by anti retroviral medications. Assigned code B 20.
20:20 And in my mind, even though, before they added that, we all know we can’t code B 20, if someone has asymptomatic HIV positive Even if they’re on anti retrovirals, they have to have HIV disease documented HIV related illness documented, or aids documented, right?
20:39 So, if we, if we used all of those, those guidelines, in combination with each other, I think there, to me, there really was, it was more of a typo. But there was some confusion about the intent of that guideline. So, let’s take a look at the, so, there was some clarification before this guideline was updated for fiscal year 20 23.
21:02 They did provide us some clarification back in March, regarding it, history of HIV managed by medication, my facility has interpreted the new HIV coding guideline, one, C one, A two, I, history of HIV managed, by medication, to mean that the, code B 20 HIV disease should be reported for any HIV positive patient, on an anti retrovirals, regardless of whether the documentation states that the patient has never had an HIV defining illness. Whereas, HIV disease, could you please clarify, if this was the intent of the new guideline, and I’ve seen a lot of coders, no code HB 20, just because the patient is on anti retrovirals. And that’s not the case we, based on the guideline or the intent of the guideline. The guideline was to provide guidance that … is appropriate for patients documented with HIV disease on anti retrovirals, and to align with the guidance Publishing Coding Clinic fourth quarter 2020 to 20 20, that clarified HIV diseases, specifically classified to be 20.
21:59 It would, it would not be appropriate to Code B 20 without provider documentation of an HIV related illness.
22:05 Cama HIV Disease or aids.
22:08 A diagnosis of HIV are HIV positive without documentation of HIV disease and HIV related illness or aids, should be assigned to Z 21 asymptomatic human human immunodeficiency virus HIV infection status. However, the provider should be queried for clarification, of course, when the documentation is unclear, if it’s HIV positive or aids.
22:29 HIV Disease and that was also consistent with Advice Publishing Coding Clinic first, Quarter 2019 pages, 8 through 11. And that’s actually a good quarter for those that struggle or find coding HIV challenging. I think over the years, it has gotten a little bit clearer. I know we struggled with an I nine in the beginning of a 10, but I think that that coding clinic, if you need a good coding clinic to read, I would definitely read through Coding Clinic first, quarter 2019. There’s a few different examples. Again, my point of going of this presentation is to discuss the guideline changes. So I don’t have them all listed here.
23:07 But we do have a similar coding clinic but this is regarding asymptomatic HIV positive patients, patient on anti retroviral therapy.
23:17 And I want to refer back to this because it’s kind of, um, a little bit different in the fact that a patient that is asymptomatic can also be an anti retroviral therapy.
23:29 So, whether the patient is asymptomatic has been diagnosed with any HIV disease illness, or related disease, or, I should say, has not been diagnosed with HIV illness or related disease.
23:39 And is taking anti retroviral medication, prophylactically to prevent, then, from progressing to HIV disease. Or aids, how should this case be coded. We’re going to still going to code that says 21.
23:56 OK, next we’re going on that we have a new code for Hemolytic … Syndrome, and we do have an exclusion. So when we have a patient that’s being admitted for HIV related conditions, were typically going to be coding the B 20 encode as our principal diagnosis. But now we have an exclusion or an exception to this guideline if the reason for admission as Hemolytic … syndrome associated with HIV disease. So if we have HIV disease causing Hemolytic … Syndrome, before, we would you know the based on our coding guidelines, we would have coded our HIV disease first.
24:35 However, since the addition of this new code, Hemolytic … Syndrome, we’re going to assign the D 59 31 infection associated Hemolytic … Syndrome, followed by the B 20. That’s one of the exceptions to this guideline.
24:48 And I have some more information coming up on the next slides to discuss regarding this, because it changes a few different guidelines. Next, we also have sequencing of severe sepsis, and I have to say, This is quite rare. I’ve seen it a couple of times over the last 20 years.
25:04 I’m gonna say if you’ve if you work at a Level one Trauma Center, you may see it more often than someone working at a local community type hospital, but it’s still even rarer than. So sequencing of severe sepsis, um, it says, there’s a reminder here, for infection associated with Hemolytic … Syndrome with severe, severe sepsis.
25:26 See guideline one, C one, D nine, and that’s also under sepsis, and severe sepsis with a localized infection.
25:33 Um, the reason is is if we take a look at this sequencing note, they tell us that we should use additional code to identify associated infection code also, if applicable, any associate acute renal failure, chronic kidney disease. If we go to this infection associated … syndrome, we have a use additional code note and that advises sequencing, right?
25:59 So that’s also in the guidelines.
26:01 We would use an additional code, you’d code our D 59 3 1 with an use additional code note for our sepsis, this would be a secondary code.
26:12 So please just make sure if you do come across this, that you’re following any instructional notes. If we go to other types of Hemolytic … Syndrome for example, had a … Hemolytic … Syndrome. It’s a code also no.
26:26 Which, no, we can choose either one, depending on the circumstances of admission.
26:31 And under other Hemolytic You Remixed Syndrome code, first if applicable, any associated covert, 19, et cetera, code, also any additional diagnosis.
26:41 So we want to make sure that we’re, we’re following those instructional notes here for Hemolytic … Syndrome, and that is at MCC. if we’re coding that as a secondary.
26:58 And here is the continuation of the guideline. So Hemolytic Geremek Syndrome associated with sepsis. If the reason for admission as Hemolytic … Syndrome, and that is associated with sepsis, We’re going to assign D 59 3 1 infection associated with Hemolytic … Syndrome as the principal diagnosis. Codes for the underlying systemic infection in any other conditions, such a severe sepsis, should be assigned as a secondary diagnosis. So, we have it noted in our book, and we also have it noted in the guidelines. So, just a reminder about that. Again, it’s somewhat rare in the comments section.
27:29 Let me know if you, um, if that’s something that you see at your facility.
27:38 I know, again, I’ve only seen it a couple of times and in my, in the last 20 years, OK. And then also, the last thing they update, it was the under immunization status.
27:50 So, in order to sign this under vaccinated or partially vaccinated, we need to follow the information on the CDC website that can change from time to time. So if you go to your fiscal year 22 guidelines, that link was actually invalides.
28:04 They did update the link in the 2023 guidelines, So the new link is noted there.
28:11 So if you download a copy of the fiscal year 20 23 guidelines, you will have the appropriate website link take you to that information about what’s considered fully vaccinated versus partially vaccinated.
28:25 OK, so just have a couple of comments. Most people are saying no, they’ve never seen Hemolytic … syndrome being documented.
28:32 So that’s kinda been my experience, too.
28:35 It’s not very, again, probably, seen at me, less than a handful, maybe 3, 3 times.
28:42 OK, so next, we have the neoplasm Chapter, under D In that section they’ve added, see Section one CT, two T secondary malignant neoplasm of Lymphoid Tissue. So if we go to that section, secondary malignant neoplasm of Lymphoid Tissue and this has been I know in I nine, and this is this is why I say I kind of go back in time. We we kind of we also had coding clinics that advise this in I nine, but they didn’t update them. They did recently, but about coding, secondary, Mets using of lymph node of Lymphoid type Neoplasm. So, when I’m in a latent neoplasm of lymphoid tissue metastasizes beyond the lymph nodes, a code from Category C 81 to C 85 with the final character of nine should be a sign identifying extra nodal and solid organ sites rather than a code of for secondary malignant. Neoplasm of the affected solid organ, for example, for … of B cell lymphoma to the lung brain and left adrenal gland assigned code. Assigned Code is C 83 3 9. Diffuse large B cell lymphoma, extra note on solid organ sites instead of our …
29:52 a secondary code from C one to C D five. And we, for those of us that have been coding for a long time, we’re kind of used to this. But it wasn’t in the guidelines until now, so now it’s there also. We have they’ve actually put this an example of this. In. Second quarter of 2021 before, was updated in. The Guidelines in this coding advice was effective of June seventh of, 2021.
30:17 So the question Is a patient with a history of T cell lymphoma. Of? the skin presented to the fever, hypotension and worsening of Skin Lesions a positron emission tomography pet scan was performed, which should multiple metabolically active lesions. that provider diagnose The patient. with recurrent T cell lymphoma involving multiple lymph nodes above and below the diaphragm as well as active lesions in the spleen and skin, with multiple codes be assigned to capture each site involved. What are the appropriate codes for this admission?
30:44 The answer is to assign Code C 84 8.
30:47 A: eight: cutaneous T cell lymphoma, unspecified lymph nodes of multiple sites, because we have above and below the diaphragm we have CD 4 a 7: cutaneous T cell lymphoma unspecified spleen, to capture cutaneous T cell lymphoma, multiple lymph nodes as well as the spleen and the skin lesions are inherent of course to the cutaneous T cell lymphomas We don’t need to capture that separately. But you can see here, there are the guy, this wasn’t specifically in the guidelines, but they did advise us.
31:15 And there’s a bunch of different coding, coding, clinic regarding this and 99. We have this one, an eye 10.
31:22 And so they, they’re doing a much better job, I think, of adding things to the guidelines in IE 10, when they advise something, which I think is great, right? We have the coding advice, and, you know, that, we’re like, well, why are we doing this? It’s not in the guidelines, it was just like, is it truly something that we should be doing? So, they advise it, and then the next when they go ahead and update the guidelines, or adding it to the guidelines for the next year.
31:47 So, I think they’re doing a much better job of that, in my opinion, of, of updating those guidelines year after year, for things that aren’t clear.
31:58 Next, we have updates to the Diabetes section, and this is purely related to the addition of our new code, a new code that we have for injectable, non insulin, anti diabetic drugs. So we have diabetes. And this applies to all of the types of diabetes, and I just put the one example for space.
32:19 But if documentation in the medical record does not indicate the type of diabetes, et cetera, et cetera, they talk about additional code should be assigned from categories, Z 79 to identify the long term, current use of insulin, oral hypoglycemic drugs, or injectable, non insulin anti diabetic drug as follows. So, if the patient is treated with both an oral hypoglycemic drug, insulin both Z, 70, 9 point, for a long term, use of insulin encode disease, 7980, for long term use of oral. Hypoglycemic should be coded or Assigned. If the patient is treated for both insulin in an injectable so like … injectable, non insulin anti diabetic drug, We’re going to assign Z 79 for a long term use of insulin. And they crossed out Z 79, 8, 9, 9 other long term. current drug therapy.
33:05 Z 7980 and added Z 7985, long term current use of injectable, non insulin anti diabetic drug because that is a new code for fiscal year 20, 23. So that’s the main change in this section, is that they are just updating the code.
33:22 Yeah.
33:27 OK.
33:30 Long term use of … or victoza, a GLP one receptor and Agonist with oral anti diabetic Drug. This is from 20 20.
33:41 With an oral anti diabetic drugs, please, please. Also, when you’re looking at older advice, one of the reasons I I put these in here, first Of all, the code has been updated and second of all, The guideline has been updated.
33:55 So, just be, make sure that, when you’re looking at this, assign code, Z, 70, 984, long term use of oral anti diabetic drug, encode, disease 79, 8 9 9, this is going to be updated to Z 79, 85. So, just make sure that you’re, if you’re, you know, you’re not just auto plugging in these codes from the Coding Clinic and also making sure that you’re, that the guideline hasn’t changed.
34:19 So, make sure if, when they are referring to a guideline in the Coding Clinic, that you are referring to the newest guideline.
34:24 This guideline has changed a little bit over the last two years or so, You want to make sure that we’re doing that.
34:34 And here is the list of new codes.
34:38 And you can see here, we have tons of new codes for long term use, of different, Since we’re talking about long term use of drugs, different long term you know immunosuppressants immuno modulator, they give some examples of different long term use of monoclonal antibodies. Long term use of chemo agents, is it alkaline agent? Is it an anti tumor antibiotic?
35:03 Is it, etcetera? Some of these words that came and say.
35:08 And finally, we have our other long term drug therapy. We also have our long term use of injectable, non insulin, anti diabetic drug. And of course, there we have it excludes to that states that, you know, we can code those. If they’re on all three of those, we can code Z 7985. It doesn’t exclude, you know, excludes two means that both of these can be coded right? Long term use of insulin can be coated with Z 79, 85, and Z 79 84, if applicable.
35:46 Next, we have some minor changes with verbiage in this section, selection of codes describing in remission some, some grammar changes there. The main issue, the main change here, was we have new codes for dementia, right? so, some of you may have been on our coding update. Some of you have probably attended other coding updates, but you should be aware that dementia is probably one of the largest number of codes to be expanded for fiscal year 20, 23. We now have to be I mean, let me know in the comments. How has this impacted your coding So far for fiscal year 20 23 because we now have to know the etiology and the severity.
36:23 And of course, knowing some of that stuff can give a CC’s versus not being CC’s and also no the, the adequate manifestation. Right? So, selection of the appropriate severity level requires the providers, clinical judgement and code should be assigned only on the basis of provider documentation of mild, moderate, et cetera. We’re kind of default to unspecified, right, unless otherwise instructed by the classification if the documentation does not provide information about the severity of the dementia, assign the appropriate code for unspecified severity.
36:56 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 only one code for the highest severity level reported during this day.
37:09 I find it interesting that they didn’t state the POA.
37:14 Um, like they do for our, for some of our other codes, That might be a question that some of us have.
37:23 I’m going to assume that the POA is still yes.
37:27 Based on other advice that’s been given. So, this is just a slide from our PR … webinar about the additions this year and this is just a quick good number of codes. This is vascular dementia. We have unspecified severity. We have a ton of new codes. So, vascular dementia, unspecified severity without behavioral dismount dementia, vascular dementia, unspecified severity with agitation. So, this is gonna go on and on for mild, moderate, severe and also different types of dementia.
37:58 So, vascular dementia, unspecified, with, without behavioral disturbance, et cetera.
38:06 And they have seen such a burden.
38:08 You know, the dementia is a very high burden for those effected by the patient. You know, patients with dementia, as well as the patients taking care of patients, providers, and.
38:22 Caregivers that are taking care of these patients, the resources being required for patients that maybe they have, you know, agitation. Maybe the severity level, they want to be able to better track first and identify those stages and the impact of, of those resources and management of those types of patients over time. So, and be able to better track that information.
38:47 So, not all of these are CC’s but, though, with behavioral disturbance, of course, we that was a CC before, will now still be CC, so we have a lot more options available to us.
39:02 I don’t see any comments. I did ask, how has that been affecting a lot more. You see it using a lot more queries for that. So, next, we do have a couple of coding clinics in fourth quarter, Coding Clinic about this. Coding advice. We have new subcategories. It’s actually 69. New codes are recognized for fiscal year 20, 23. I thought it would be very impactful. So far, I’m not seeing any comments.
39:29 We have a couple of questions, here. So, we kind of already talked about this information. But, a question, a patient with known severe dementia due to late onset Alzheimer’s disease and functional quadriplegia is admitted with a Senior Living Facility due to increased agitation and combativeness. Over the past three days, what is the appropriate code is summit for severe dimension a patient with agitation incompatible. We’re gonna assign the … disease with late with late onset, R F zero to C 1 1 dimension, other diseases classified elsewhere severe with agitation. Our code …
40:01 are the are 53.2 may be assigned for the quadriplegia Functional quadriplegia. We also have some additional information about our mild cognitive disorder. Additional codes were, were additional advice was given regarding those? So we have …, oh 6, 7 from mild cognitive neurocognitive disorder, an F 0671 mild neurocognitive disorder, due to known physiological condition. It’s one is with, and one is without behavioral disturbance, so these are to capture mild neurocognitive disorders that have not yet developed dementia.
40:43 And our severe does code to dementia, right?
40:48 So, I just have so, thank you for commenting. We mostly code dementia unspecified, so that might be an area of opportunity for you, right? Because some of those are if we just have dementia, unspecified versus dementia, you know, mild, moderate, or severe with a behavioral disturbance, and there’s a lot more options for the manifestations of dementia. If you take a look at all the codes in the Code book, I highly suggest doing that. That might be a few, that could possibly be a future roundtable to kind of dive into a little bit more depth regarding that. And then I have a couple of other people mentioning we have we have not been querying for specific dementia or severity. Then another person saying that we have been sending a lot of more queries for dementia.
41:36 Then, probably need to pay more attention to the which ones would be C Cs, so I highly recommend that you do pay attention to that. See what documentation you have.
41:45 See if you have some evidence of perhaps some some behavioral disturbances that you can potentially capture, definitely take a look at the code book and see what code what’s available to you.
42:08 It’s OK. Next we have completed weeks of gestation. This was in our pregnancy. This isn’t a pregnancy chapter, and kind of looking back. We do have, prior to this coming out, they did, they did let us know about this in advance. So this was actually applicable before this came out in our guidelines. So an ICD 10 completed weeks of gestation refers to four weeks. For example, if the provider documents 39 weeks and six days, the code for 39 weeks of gestation should be assigned as the patient has not yet reached 40 weeks. And we do have some coding clinics regarding this and second quarter 2022. And obstetrical patient is admitted to labor and delivery for a Plan C section due to breach presentation.
42:55 Provider documents, the gestational weeks at 40 weeks and two days. Is it appropriate to assign 0 48 … post term pregnancy based on the documentation of gestational weeks alone without documentation of post term, or post dates?
43:08 And the answer is, yes, one provider documentation indicates that the patient has over 40 completed weeks to 42 completed weeks, that is appropriate to assign 0 48, 0 … term pregnancy base and inclusion term that’s specifically states. Pregnancy over 40, completed weeks to 42 completed weeks provider does not have to document post term or post states, also assign appropriate codes for Category C 3, 8 weeks of gestation.
43:35 Next, determining weeks of gestation, quite another question was please clarify completed weeks of gestation when assigning codes O 48 O, post term pregnancy prolong pregnancy.
43:47 O 0 O 0 to 1, mister abortion, Oh, 3, 364 maternal care for an intrauterine deaths and ICD 10, the answer in ICD 10 completed weeks of gestation refers to a full week. For example, if the provider documents 39 weeks and six days, 39 weeks of gestation is assigned as the patient has not yet reached 40 completed weeks. When the providers documentation and medical record record indicates the patient’s pregnancy is over 40 completed weeks to 42 completed week so 40 weeks, one day to 42 week, zero days, it is appropriate to assign 0 48 post term pregnancy. If the documentation indicates the pregnancy has advanced beyond 42 weeks, 42 weeks 1 day, it would be appropriate to assign 0481 prolong pregnancy.
44:29 We can code code, oh, 75, 82 onset spontaneous of labor after 37 weeks, but before 39 weeks of gestation and with delivery by Plant C section may be assigned. When with the weeks of gestation of 39 week 0 days up until 38 weeks and sixties.
44:46 Code 0 0 or code of 0 to 1. Mister Abortion refers to fetal death that occurs prior to the completion of 20 weeks, including up to 19 weeks and six days. So, that’s important to note for our abortion codes, MIT maternal care for intrauterine death is assigned for maternal care for intrauterine fetal death after completion of 20 weeks, zero days. So, just to kind of add here, mister Abortion. Once it goes past that that 19 weeks and six days, which is basically a fetal death.
45:19 After that, 19 weeks and six days, it becomes maternal care for intrauterine death instead of the … abortion.
45:28 So when assigning codes for obstetrical conditions also assign the appropriate code from Z 3 8. 3 a to indicate the weeks of gestation. Now I want to point this out that we also have a guideline.
45:38 This doesn’t refer to abortion coding, because because we have, I think they kind of forgot that when they put this in here, they probably should have put it up here. Just a reminder when the weeks of gestation don’t apply to that Z three A, don’t apply to our abortion codes, right? That’s in the guidelines.
46:02 Um, there is a guy so someone is asking about weeks gestation. And please take a look at your guidelines that’s in the guidelines. So Chapter 15 Pregnancy childbirth in the Pure … hemorrhage falling elective abortion. For hemorrhage post elective abortion assign 0046 to later Access of hemorrhage, falling induced termination of pregnancy. Do not assign code 0 70 to 1 other immediate post post-partum hemorrhage, as this code should not be assigned for post abortion conditions. So there can’t be post-partum if they have an abortion.
46:35 And that’s what they’re putting that in the specific guidelines. I wasn’t able to find anything specifically on this, but it also says do not assign a code Z 33 to encounter for elective termination of pregnancy. And the patient experiences a complication, post elective abortion.
46:50 When they have a complication, we should be coding this specific complication code.
46:55 I did there is a specific coding clinic talking about acute blood loss. I thought this would be a good reminder due to mister abortion with retain product of conception to the patient presents at 19 weeks. So if we apply our weeks of Gestation Coding Clinic, they have a fetal deaths prior to 20 weeks, right? So that’s going to be our midst abortion code.
47:16 If they say myst abortion at 20 20 weeks, that’s going to be our intra uterine death code So I just wanted to kind of apply this to the new got the guidelines that we have about completed weeks.
47:29 And that’s, that actually has been, that’s actually in in our code books, but just, you know, now that it’s, we have specific guidance on it spelled out for us. And those of us that have coded for a long time, it was also defined like that in ICD nine.
47:46 Some things were kind of inadvertently left out, I think when they updated the guidelines.
47:53 Some of you, that code a lot of OB probably are aware of some things that were left out, again, that’s outside the scope of this discussion, but I know some of us right decoding clinic about some of those things.
48:03 They, they left out, that could be a whole nother whole nother roundtable. But just kind of sticking on point with what we’re talking about, they say to code the O 0 4 6, delete or access of hemorrhage, falling induced termination of pregnancy.
48:17 And then a D 62 should be assigned as an additional diagnosis. The, the interesting thing about this one, which I thought was a good, this is why I thought it was a good coding clinic, is they said that … anemia resulted from the hemorrhage, which is after the after. The patient. The patient had the intrauterine fetal demise and they had treatment. And they went on to develop this hemorrhage. And the hemorrhage resulted in the Kubler Ross anemia. So we wouldn’t decoding in a chapter 15 code associated with that. They’re not post-partum, right? So I think this has something to do with that guideline. They’re not in a post-partum state. They hadn’t they had an abortion, or, in this case, the … abortion and treatment. So, that acute … anemia resulted from the hemorrhage, not from the actual pregnancy.
49:07 Next, we have our updated Z O five codes. I’m not sure. They put suspected they changed this to suspected diseases and conditions.
49:15 As you can see in the highlighted portions, condition slash disease, I’m not sure. I mean, to me, if I saw condition disease, I kinda think that’s the same thing. But I guess that’s semantics, depending on how you’re interpreting that.
49:29 When …, five, when the patient has document to have signs and symptoms of a suspected problem, do not use the code from Code 0 5, when the patient is documented to have signs and symptoms of a suspected problem in such cases code, the signs, and symptoms.
49:42 I’m assuming the signing symptom would be document really sure the intent of, of why they change that.
49:49 But anyway, we have a couple of coding connex prior to this just talking about giving us a couple of examples.
49:57 New code assignments contained in this issue were effective with April first. So the question is, a newborn delivered with AFCARS of 9 and 9 were monitor for withdrawal due to intrauterine exposure to prescribe and turtles.
50:11 Detects neonatal abstinence syndrome monitoring was done daily. However, urine drug screen was not performed. After five days of monitoring the provider document, the infant showed no symptoms making withdrawal unlikely. So the infant was discharged. So how are we going to code this? There’s no signs and symptoms. They just suspected it, because the maternal, my mom was on this medication. We’re going to assign 0, 5, 8 observation and evaluation of a newborn.
50:36 So if they did have symptoms, we’d be coding the symptoms. We wouldn’t be coding the 0 5, 8.
50:43 Right?
50:44 Or this is the condition, or the disease, based on the guideline.
50:50 And we have another one for newborn observation due to maternal marijuana use. A 39 year old infant was born via spontaneous vaginal delivery. To a mom who had a history of marijuana use and subsequently stopped using when she found out she was pregnant, because of the history of maternal marijuana use a UDS was ordered.
51:06 The infant’s drug screen came back negative and social services, cleared the infant to be discharged home, How should this infants, possible intrauterine and drug exposure be coded assigned 0 5, 8, observation and evaluation for newborn for other suspected conditions? Again, there is no provider documentation indicating the infant had any signs or symptoms or withdrawal, or was affected in any way by the cannabis use.
51:29 So, per the guidelines, categories you a five, we’re going to use encounter for observation and evaluation for newborn and conditions ruled out.
51:39 Next, under dosing, so some of you may recall they did have a coding clinic that came out prior to this updated guidelines, so we’re probably all aware of this, but they updated it to under dosing guideline to take into effect that advice. So, under dosing is, refers to a patient taking less of a medication prescribed, and they’ve added documentation of a change of the patient’s condition, is not required in order to assign an under dosing code. So, if they come in with hype, you know, if they are on a high high blood pressure medication for hypertension. And they don’t have, you know, accelerated hypertension, We can still code this, if the patient is not taking their medication, is what this is saying.
52:17 Regardless, if they have, you know, a change in their condition, documentation, that the patient, is taking less of a prescribed medication or discontinued to prescribe medication is sufficient for code assignment for an under dosing.
52:30 And we have a specific example.
52:33 Are some, somebody, they address this specifically. Well, they give an example.
52:41 About the new codes, I should say, but here’s the under dosing with no change in patient condition. From first quarter 2022, patients stopped taking his prescribe dose of …, after running out of anti hypertensive medication several days ago, The provider documented the patient’s blood pressure was stable, would it be appropriate to assign encode for under dosing of … when there’s no documentation of exacerbation or an issue with the patients chronic hypertension.
53:05 We can still code, 246, 5 X, six, A under dosing, hypertension, and Z 90, 9114, patients, other non compliance with medical regimen, to capture the fact that the patient was not taking the medication as prescribed.
53:19 The under dosing guideline does not preclude the assignment of introducing codes. In the health record, documentation not, does, not specifically state change in the patient’s condition.
53:27 So because of the because it was not entirely clear, they did go ahead and add the fact to the guideline that doesn’t have to necessarily change the patient’s condition, in order to code that.
53:44 This is just in terms of the new code related, we do have some new code. So I put this in here, related to quizzing Adverse Effect of An under dosing of methamphetamines, for time purposes.
53:54 I’m not going to read this but it’s here if you want to know more information about methamphetamines, prescribed, really the only prescribed methamphetamine is desert …, which is precise I prescribed for attention deficit hyperactivity disorder and they still said it’s somewhat rare to be given, um but anyway, there’s some information here that you could have read through.
54:19 Next, again, these are, I don’t know how often we’re gonna see these, if, unless you work for a, maybe for a pediatrician or an internal medicine person, but we have codes for encounter for pediatric to adult transitioning. They added specific guidelines for you. The use of this code should be assigned when a pediatric to adult transition counseling is the sole reason for the encounter, for when the counseling is provided in addition to other services, such as treatment of a chronic condition. If both the transition counseling and treatment of a medical condition or provider doesn’t seem encounter. The codes for the medical conditions treated and the Z 7187 should be assigned. So if anyone’s used using those codes, I don’t think will be seen that if you’re, if you’re coding inpatient, but more of a professional fee area of interest, if you’re interested in more information, there is this Coding Clinic, and then they advise this in the Coding Guidelines.
55:14 They, also, in Chapter 21, added the codes for Z The Z codes, these code should be assigned only when the documentation specifies. the patient has an associated problems. So, they still have to meet reporting criteria. And there was a, let me go cook somewhat of a bit of clarification added to social determinants of health. So, codes describing problems or risk factors related to social determinants of health should be assigned when the information is documented. We’re going to sign as many social determinants. Health coaches necessary to describe all the problems of risk factors. These codes should be assigned only when the documentation specifies the patient had an associated problem, or risk factor. For example, not every person living alone would be assigned code. 0, 60.2 problems related to living alone if it’s not impacting their care.
56:03 Right? If the patient comes in for an asthma exacerbation, it says they, you know, note it to live alone, but it’s not impacting their care. The patient can care for themselves. We shouldn’t be coding that unless maybe the patient needs. Maybe they also have dementia, and they need some, you know, they, they need some additional assistance at home, that might be an issue that we might want to be capturing as a social determinant of health.
56:30 And just some information about the new, the new social determinants of health, since we’re talking about this, the new codes, transportation, and security, and I’m sure you’ve heard about these financial insecurity, and then maternal hardship.
56:44 Hmm, hmm.
56:46 So next we have some time to go over the PCS guideline changes. And there’s not too many here. So I’m going to kind of, we have a couple of minutes left to kind of dive into these. So we have a new guideline for our detachment procedures. I should say this isn’t new, right? They didn’t change anything about this other than adding it to the guidelines previously the New Guideline detachment.
57:10 Used for an attachment were defined in the reference, the ICD 10 PCS Reference Manual manual, when we first would ICD 10 first came out, and that is no longer being maintained. I think the last update was 2016. So they have to add, they had to add it to the guidelines, because it’s not documented anywhere else other than the, the, the reference manual. So it’s kind of hard to find that information. So it’s now the definitions for our detachment procedures are now officially in the official coding guidelines. So there’s nothing new here. We should all be following this. This is, I took put the actual, to, the whole guideline is new to the guidelines, but it’s not new to us, right? So if you’re wondering why, why is this new? It’s not really new to us. We should have been following this anyway.
57:58 The qualifiers they talk about this encoding Clinic 2017 and it also originally published in the ICD 10 definition manual.
58:08 So I couldn’t fit everything on there, but here is a quick definition from that Coding Clinic, as outlined.
58:19 So I don’t really have much to go over other than noting that it’s now in the guide in the coding guidelines.
58:25 And we did do, I believe, we did do a roundtable on this if you need more information, you can search our roundtables and watch the recording if that’s something that you would like more information on.
58:36 Next, propose. I have proposed change there, it’s actually finalized. I forgot to update that proposed, right there.
58:44 So, um, the current guideline prior to fiscal year 20, 20, 23. If a procedures performed in a continuous section of a two or body part code, the body part corresponding to the anatomical most proximal closest to the heart portion of the jugular body part. So, a tubular body part can refer to also the intestines, right?
59:05 But if you go and look at the example, the referring to a lesion involving a artery, a continuous section of an artery, So that wasn’t the intent of the guideline, it’s really, the intent of the guideline was for vascular procedures.
59:19 So they went ahead and updated that guideline to for B 401 C to say vascular procedure. If it’s a singular vascular procedures, performed a continuous section of an arterial venous body, part code, the body part value corresponding to the … most proximal closest to the heart portion of the arterial venous body part.
59:39 It wasn’t meant to me like intestinal like esophagus.
59:46 Say they put a stent in the esophagus and and the small bowel. No, that wasn’t the intent.
59:53 The intent was to, you know, was specifically to mean a lesion involving a continuous section of the arterial or venous body part and they did come out with a clarification on this back in the first quarter of 2022. So we should all be aware of this. Again, we saw this coming and they they did go through through and tell us that they are going to update the guideline for fiscal year 20 23 revising or clarifying that guideline to say terms vascular in arterial and venous.
60:27 So that was back in Effective with March changes, And there’s some other examples. For example, since the updated guidelines for coding and reporting specifies tool, or body parts this guideline apply to any to lower body parts and service, esophagus stomach large and small. intestines know, the intent was to only apply to vascular creature, such as arteries and veins Now, other tubular organs, such as a soft target stomach, large and small intestines.
60:53 And I put I did put the other coding clinics that were, that were associated with this. Again, it’s not it’s kind of outside the scope of the change, but you can read those if you’re interested. And finally, in guideline B one, B 61 A, they also revised the revised the words an event, document it.
61:15 To the example given for a complication nessus, necessitating, both insertion and removal of a device before the end of an operative procedure, again, I really don’t see.
61:25 I mean, I don’t really see the difference.
61:28 I mean, the old guidelines set in size is inadequate, or a complication occurs, Um, or, and it says inadequate or an event documented as a complication occurs.
61:38 It kind of seems to be the same.
61:43 I don’t really see much of a difference there, but I guess it’s semantics.
61:49 So, anyway, I have some references here for you, linked to the guidelines. If you haven’t already downloaded them, you can get an electronic copy. I use them a lot to do search my guidelines instead of kind of manually paging through them.
62:02 I think it’s a lot easier to find things, but if you need more information, it’s here.
62:08 So, I’m gonna end it here but I will stay on to answer some additional questions. And address some comments. You can download your CEU certificate, or you can wait for the e-mail, but it’s in the handout. So I highly recommend in downloading your handouts.
62:23 Um, you can download it there and please give us a little bit of time to get that uploaded.
62:28 You have two weeks from today to download the CEU, before the link expires, and we won’t be re issuing CEUs after that point.
62:37 Again, please allow time after the webinar for us to upload dystrophin ticket, Um, attendance details login, provided to credential sponsors. Upon request. By downloading the CEU, you are affirming your attendance for the entire session. If you should have any issues, you can e-mail us, but, again, if you could just wait a little bit before e-mailing us, we do note that sometimes we may have to do some corrections, and when we get noted of that, and we fix it. I always try to check that as well, and psi X employees, please refer to the Yammer Roundtable group for additional guidelines as well.
63:13 OK, so, I do have some questions and comments that I do want to address. I know we are a couple of minutes over. But I do want to just someone did make a comment about your remixed syndrome.
63:26 Um, let me go back. I think that was the last comment.
63:31 So just to be clear, there is some information. I highly recommend doing a little bit of research on her Hemolytic … Syndrome, which was it’s different than being your …. So if someone has end stage renal disease, they are said to be your remix, Ope Build-up of those toxins in the body, because they don’t have the kidneys can filter out the waste. So that would be different then than hemolytic arena, you, remix syndrome. So please be careful with assigning that code. You remix syndrome is not the same as Hemolytic … Syndrome. And I do have information on that slide, and where you can do a little bit of more research, A quick Google search, which should give you enough information for basic understanding. But I have to say it’s very rare, very rare occurrence that you’ll see that.
64:16 Um, OK. So I have one person say they did actually see Hemolytic … Syndrome recently.
64:27 I don’t have the code book in front of me. Um, there was a recent coding clinic about like linking alcohol abuse with anxiety. They have to specifically link that I don’t.
64:39 I don’t have the book in front of me to see if the with guidelines also relates to dementia with anxiety. I don’t have that up in front of me.
64:50 We can probably address that. I probably should do a whole, whole, probably, a whole webinar on dementia and other associated disorders. I actually don’t have that up in front of me right now. It’s a bit out of scope, but I think that’s actually a great question, and I’ll mark that down to address in the future. I’ll definitely be looking that up.
65:14 Um, if anyone happens to know, offhand, please feel free to respond.
65:24 Do we assume that I have another question. Do we assume that dementia with anxiety is linked? Again, I don’t have that up in front of me, but I can get back to you guys about that.
65:37 Good points.
65:41 About making sure that we’re checking out. So another comment about the width rule.
65:55 Yeah. I don’t know off hand. I have to look that up. I have a couple of comments about that. I know, again, I did, I did come out with something with the alcohol dependence with anxiety. We can’t assume that relationship. I don’t know what that information is off hand without do kind of diving a little bit deeper into that. That’s a great questions, great questions on that, guys.
66:15 Um, thank you for bringing that up.
66:24 This is frequently not coded correctly based on audits. And what do you, which, which, sorry, I didn’t see when you mentioned that.
66:31 Tracy, if you can just add a little bit more of what you’re referring to there, I kind of missed when you, when you said that, if you’re still on.
66:40 So, does under dosing apply if they can’t afford the men. Afford the medication? Yes. We now have our, you know, financial, you know, non compliance due to finances.
66:56 So, a question about, um the link to register for upcoming CX: Rabbit Roundtables: You get the easiest way to do this.
67:03 We do have a website, it’s on, it’s actually WWW psi X health dot com front slash resources front slash webinars, but you can also find it just by Googling psyops webinars and it should take you right to the page and then you can go ahead and register for the upcoming events.
67:25 Again, another question about CEUs.
67:28 There’s a link in there in the documents that you can download and or you will receive a follow-up e-mail.
67:43 For the continuous tubular body part how would a carotid endarterectomy be coded if done on a common external, and internal carotid they did address that. In the Coding Clinic, it’d be coded to the well, it’s also based on the coding guideline most proximal to the heart, so we would code it to the common carotid. because that’s most the closest to the heart right if we take a look at the anatomy.
68:07 Mmm hmm.
68:11 For There isn’t an app for coding guidelines, but you can go ahead and download them from the CMS website.
68:19 If you don’t have access any other way, most of us have access via or are standalone encoder or we have a copy in our book. But if you need a free copy, you can always find it at the CMS website. I have it listed in the references. It’s, I have a section listed as guidelines, and you can go ahead and download the CM guidelines, You can also just Google PCS guidelines, 20 23 or CM guidelines. it should take you right to the page.
68:48 You’re welcome.
68:56 I’m like, if someone’s saying that the C, The C U is not correct. That’s because it’s not uploaded yet. So like I said, you, please make sure you give us a little bit of time. When the webinar’s over, we’ll upload that. So just give us a few minutes after the webinar.
69:10 Um, wait. And or wait until tomorrow to kind of double check that.
69:20 So someone’s asking for a webinar encephalopathy. And we actually did have a webinar, I forget the exact webinar, you can look in the recordings. But that’s actually probably one that should be readdress since we’ve had a lot of changes in that section. So thank you for that topic.
69:35 Oh, thank you, Tracy. So, Tracy was saying that we see a lot of coding errors based on undergo saying, I agree with you on that. Make sure that you know if a patient is not taking a medication as prescribed that you’re coding it. And also sometimes we also see errors encoding that as adverse effect versus under dosing when they’re taking less of a medication. So make sure that you understand that, and that’s usually newer coders. Make sure that you’re, you understand the difference between under dosing and an adverse effect.
70:10 If you’re not sure if a small sir also tear is a complication, it’s not documented, you may want to query for the significance, right. There’s, there’s guidance that’s provided in Coding Clinic on similar scenarios, and the advice is, I believe off hand, I always have to look at them, is to query if it’s not clearly documented as a complication.
70:32 If it’s, you know, if it’s minor, I probably wouldn’t be coding it.
70:42 Lot of comments about the CEU. As mentioned, please wait for us to upload it.
70:48 We wait for the webinar to be over traditionally to upload it so that people aren’t downloading it before listening to the whole, whole webinar.
70:59 I’ll take note of that HCC, Someone’s asking for HCC as a topic.
71:11 OK, this is it off topic but I’ll answer it and then I think I’ll end here. MD documents, coagulant, apathy due to Coumadin was told not to code this based on prior CC. So, we’re not going to code the hemorrhagic disorder. I think this is where you’re going with it. The hemorrhagic disorder due to X X extrinsic anticoagulants, because there’s no bleeding right? So we wouldn’t be coding that, we can’t code that unless there’s hemorrhage. That code specifically says, hemorrhages due to due to an anticoagulant.
71:44 It’s possible to code the elevated INR, if it’s outside extremely outside the range. But the patient yet yet hasn’t had some type of bleeding. Sometimes we have to use that. That’s in the coding handbook, if you want more information on that, they give that example.
72:04 Yep, So, um, and there’s a couple of coding clinics at different examples, depending on how it’s documented. I’m not sure exactly how it’s documented in your case, but I would definitely the coating handbook does have some good examples in there, and also coding clinic does have some good examples. Depending on the documentation. You may be coding coagulation disorder just depends.
72:32 Um.
72:42 If you do, I guess, I’ll make a comment. In the roundtable group, if you do work for … about where we do have a question about coding clinics. I’ll make a comment about that in our Yammer group.
72:57 All right. Take care, everyone. Thank you so much. Thank you. For those that stayed on for additional questions. I have noted a couple of topics that you would like to see encephalopathy, dementia related to the width guideline, some HCC might be a topic.
73:18 So I’m writing that down. But take care. Have a great rest of your week. And until next time.
73:25 Aye.