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0:02 Everyone, and welcome to Round table 154, fourth quarter Selected Coding Clinic Review.
0:09 Want to say?
0:12 Thank you for joining us for her, for the, for the first roundtable, 2023, and we hope that you join us for the rest of them. If you’ve been tracking with this roundtable from the beginning, then, you know that initially scheduled in December, but shifted to today to accommodate a roundtable on 20 23 NM changes. So thanks for your patience with that. You thought it was important to get that out before the person here.
0:37 So now, here we are. With today’s topic with me today are actually I’m wipers more like it is Janet …
0:46 director of Advanced Education per se E term Division. My name is Scott …, I’m the Vice President of Coding Education.
0:54 And continuous improvement here, EDFacts help. Address some housekeeping real quick. First of all, no column numbers.
1:01 I guess I could probably stop saying this at some point. The format is streaming only. That could allow us to accommodate the large number of attendees that we’ve had in the past couple years. Today’s webinar will be available on demand after the live session, and will be accessible through a link that will provide in.
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2:22 Please take a minute to answer the straightforward questions. It’s really useful to us to understand if we’re hitting the mark here. So, thanks again for your attention, and let’s get underway. Take it away, Janice.
2:34 Thank you so much, Scott. So, as Scott mentioned, I will be discussing fourth-quarter Coding Clinic Review. Obviously, we can’t talk about every single coding clinic, and typically, fourth-quarter Coding Clinic is about all of the new codes, so this is kind of a refresher.
2:53 Of refresher of a lot of the codes that you’ve probably been seeing over the last couple of months. Maybe some things that we need to talk about, in terms of the guidelines. Just kind of an overall refresher, I tried to hit the hot topics, or the topics that we’ll see more. I try not to focus on the little things that we probably see once a year. I’m just over exaggerating there. But I try to pick those topics that we see on a regular basis to cover today.
3:19 OK, so this is just a little bit of agenda, of some of the things that we’re going to be talking about. And you can read that there on the slide, but Acute and chronic metabolic acidosis, contrasts Induce nephropathy. We have malignant, Pericardium, fusion intracranial injury, with unknown lost consciousness, and so on.
3:37 And we’ll talk about those as we go through through the agenda.
3:46 OK, so first up and this is a CC Alert so on the slides, I tried to put some of our new CCS or expanded CC’s acidosis is always a CC.
3:56 But now, we have new codes to account for acidosis, unspecified, accute Metabolic acidosis, chronic Metabolic acidosis, and other acidosis.
4:09 And Scott, do you mind muting yourself. I think there’s a little background noise coming from your end.
4:19 I don’t know if it’s be unmuted, but it doesn’t show that your mood. Muted. Sorry.
4:26 OK, so, maybe it’s me, let me just double check my connection here.
4:34 Do you, do you hear it on your end, Scott?
4:39 I don’t, actually.
4:41 Yeah, just here, it’s a little fuzzy.
4:46 I don’t know.
4:50 All right. OK, so, getting back to our acidosis codes.
5:00 And we have some, you know, some expansion there and they talk about, I mean, one of the main drivers for this was from the the, from the Kidney Doctors, Right? They wanted to better track mortality rates with, for our chronic metabolic acidosis associated with chronic Kidney disease. And in looking at those codes, they decided to expand in other areas as well. So, the first question here, encoding clinic is, I mean, it’s a pretty basic example, we’ll talk about a little bit of a few of the other changes in the upcoming slide. But a 58 year old man with Stage four chronic kidney disease presents to the renal clinic, the provider known at Chronic Metabolic acidosis progressive decline and Kidney function. The patient was prescribed oral sodium bicarbonate and advice to follow up in two weeks. What are the appropriate code assignments? So, we’re gonna code the Chronic Kidney Disease followed by the Chronic Metabolic acidosis as an additional diagnosis.
5:57 So, the next thing I want to point out and you probably are all aware of this at this point.
6:02 But, if you take a look at acidosis in the Index, actually I want to talk about a couple of things here. I didn’t highlight the other one, but this just came up in conversation in the last few weeks. The first thing is, if you take a look at acidosis, we have respiratory acute. You can see that codes two, J 1602, which is a respiratory failure code, right?
6:22 And chronic goes to … J 96 1 2. So, if we have acute or chronic respiratory acidosis documented, it does coach the respiratory failure codes.
6:37 Um, so just be cognizant of that. I think that is a query opportunity. Potentially, I know we probably, we probably already have the the respiratory failure documented, but please note, the O two and the, or that the fifth digit of two is for hyper ….
6:57 So, you can see there in, in the lactic acidosis, metabolic acidosis so if they have lactic acidosis, or Metabolic acidosis, and it’s not Respiratory acidosis. You can see here, it says code also if applicable or the type of respiratory failure.
7:13 Um, also, I mean, some of these include, includes, you know, these these notes, so you can still code this.
7:20 Also, if you look at Other acidosis, if they have Respiratory acidosis NOLS, there’s an excludes to know, um, with acute respiratory acidosis and chronic respiratory acidosis, I think they need to do.
7:35 No, a little bit of re work on these excludes two notes. I think they’re a little bit confusing, but we’ll see if you have any questions about Coding acidosis. For example, if you have a respiratory and metabolic with respiratory, you know, Acute Respiratory acidosis, but they also have alcohol aosis, can we code? Is it appropriate to code the 874 and the J 96 0 2. They didn’t address every possible scenario here, and I know when they were having a conversation on the Maintenance Committee meeting, they were getting a lot of ton of questions on this. So, I don’t know if they work through all the kinks on this, but just know that if you do have respiratory acidosis or chronic respiratory acidosis than it does now index to acute respiratory failure with hyper company.
8:23 The one other thing I wanted to talk about for acidosis, this is sort of unrelated, but related, is that, if you take a look at acidosis, we see an assumed relationship here, because we because of the width guideline, which includes with or in type one diabetes, so it does go to ….
8:44 I just wanted to point that out.
8:45 I saw some, some comments about in type two diabetes.
8:51 I would just be very careful because sometimes the patient has acidosis, and they’re clearly not an …, they don’t have hyperglycemia, and it’s really related to another, maybe dehydration or some other. Maybe they’re coming in with COPD exacerbation. So that might be another query opportunity. We don’t want to just be coding D K A, for every patient that has Diabetes With acidosis, that’s my opinion. I know there’s an esteemed relationship there and type one diabetes but, a lot of times, you can clearly tell the patient’s not in … There’s absolutely no documentation of that that might be a query opportunity for clarification of of acidosis if it’s not clear in the documentation.
9:35 OK, so, I have another slide.
9:39 Where are you have J 9602, you have Acute Respiratory acidosis. I don’t so Someone’s saying there’s an excludes OneNote. Whereas the excludes one, no. I only see an excludes to know.
9:55 But, anyway, so, we have Acute Respiratory acidosis is listed under J 96. Oh, so, just, I’m just showing other aspects of the code book. We also have J 96 1 2, Chronic, which includes Chronic Respiratory acidosis. Again, this isn’t actually, I don’t know if it’s, maybe it’s not large enough. This is an excludes to note here.
10:20 OK, so moving on, we’re talking about dementia stage of severity, behavioral and physical symptoms. This is a C C when we have physiological symptoms. So they expanded our codes or we have our codes classified by type, which we’ve always had, but they’ve added severity, and they’ve also added additional behavioral disturbances. So, I think this is another area of focus for docking better documentation. I know the doctors do document this, and we’re going to have a whole roundtable on up come in the next month or two on dementia.
10:54 So, I’m not going to spend too much time here, but just know that we should be looking out for the severity. This is coming up on our recent audit findings as a theme, we’re missing perhaps the severity, and more often we’re missing the behavioral disturbances. So, definitely take a look at the CAD new code categories.
11:15 We have behavioral disturbances psychotic disorders, mood affective disorders, agitation, anxiety, combativeness. Those are conditions, are responsible for driving patient care with patients and dementia.
11:31 So, those are things that we want to be looking at. The question that they, they threw in here. As 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 are the appropriate code assignments for severe dementia? And they say to code the G 30.1.
11:54 Alzheimer’s disease with late onset, an F zero to C 1 1 dementia and other diseases classified elsewhere severe with Agitation. Encode our 53.2.
12:11 OK, OK, so great question came up about, Can we code advanced dementia too severe and we’re going to talk about that when we get to the coding guidelines? Is there a way to index advanced dementia to severe? Is going to be my first question and we’ll get to that answer in just a second or my I guess it’s more of my opinion but I think there’s enough in the guidelines to make it.
12:39 I guess I’ll be basing my opinion based on the guidelines, so we have, this is just a sample of what’s in the codebook for vascular dementia. We have as you can see, unspecified severity, they broke this all out, vascular dementia without behavioral disturbance, Unspecified severity, without behavioral disturbance, we have psychotic, disturbance, mood disturbance and anxiety.
13:02 It also includes major neuro cognitive disorder, They created another code from mild neurocognitive disorder, that’s a separate slide. Of course, we can still code the wandering and this is, this is kind of consistent across all of the expansion of codes in this category.
13:20 We have again, unspecified severity, and they put different terms in here. We have verbal or physical behavior such as profanity, shouting, threatening anger, or aggression, combativeness. So that’s one of the terms that we saw on that Coding Clinic.
13:34 Answer vascular dementia, unspecified severity with aberrant motor behavior, such as, restlessness, rocking pacing, exit seeking, etcetera.
13:43 So, we definitely want to review our codebook, and make sure that we’re kept, we were aware of all the possible behavioral disturbances because all of these codes, whether they’re regardless of the severity level, if they have a behavioral disturbance, it, it does impact. It gives us a CC. Does it, the severity of this point Is an impact causing an impact with our, with our reimbursement?
14:11 Maybe in the future, well, right now, it’s really the behavioral disturbances that are driving that.
14:18 We also have a new code for our mild cognitive disorder due to known’s physiological condition to create with or without behavioral disturbances.
14:28 So that’s another just, you know, if we just see mild neurocognitive disorder documented, we’re going to be looking out for those behavioral disturbances as well.
14:39 OK, so here’s the guideline, I’m going to address the questions regarding advanced dementia.
14:45 But the guideline says, The ICD 10 CM classifies dementia, categories, F 0 1, 2 and 3. on the basis of the etiology and severity. Unspecified, mild, moderate, or severe selection of the appropriate severity level requires the providers, clinical judgement and code should be sign only on the basis of provider documentation as defined in the official guidelines for coding and reporting, unless otherwise instructed by the classification. If the documentation does not provide information about the severity of the dementia, we’re going to assign the appropriate code for unspecified severity, so I think that answers. another question that I received about, What if it’s not documented. I’m assuming you’re talking about the severity. I’m not sure. But if it’s not severity isn’t documented we can just go with unspecified severity. Also, if a patient is admitted to an inpatient care, hospital or other inpatient facility, setting that with dementia, one severity level, and it progresses to a higher severity level, assign one code for the highest severity level, report it during the stay.
15:44 Um, so, going back to our Advanced Dementia, I don’t think that’s class.
15:49 That’s classified in classified in the index or any of the documentation that they provide it to us, from Coding Clinic or in the Code book. I wasn’t able to find advanced anywhere.
16:04 I don’t know, let me know if you guys did.
16:07 I would be looking for mild, moderate, or severe.
16:10 You can always query that, or, and, or we can, you know, if you have specific documentation of that, you could probably submit that to Coding Clinic as they are one of the co-operating parties for clarification, if, if advanced, meets one of the definitions of mild, moderate, or severe.
16:29 We had a similar coding clinic recently about the severity of obesity, class 1, 2, or three. They did give us, we can’t index that, as, you know, specifically. But they did tell us that, you know, class three is considered morbid, but the other ones we can’t, you’d have to query for more specific information. I’m just using that as an example.
16:48 So I can’t make a, kind of, a, uh, assumption here, unless I can index the term, or they provide more information about the definitions.
17:04 OK, that is a good question, though. We see a lot of advanced dementia being documented, Again, I would, I would submit that for clarification, but at this time, I wouldn’t assume that it’s severe.
17:18 Again, that’s my opinion.
17:21 Next, we have pots. And we’ve probably see this a lot in, in the documentation. We, prior to this, we were coding it to very generic code in the cardiovascular system. It’s actually an autonomic nervous system disorder.
17:35 So now we have a specific code for that, G 90 point a.
17:41 So they talk about, we, we’ve talked about this in the past, and are, are RCM update, call, and other things are proposed new code. So I’m not gonna go into depth about there’s information on the slide that you guys can read if you’re interested, or if you haven’t, you heard my spiel yet about it. But to get to the question here from Coding Clinic, a patient was admitted with symptoms of fatigue, palpitations, and breathlessness. During the diagnostic workup, the patient’s symptoms were associated with standing upright, the blood pressure remains stable, however the heart rate went up upon standing, and that’s a, that’s a lot.
18:16 What I’m seeing when I’m seeing patients are people that have this condition, they’re mainly talking about that, their blood pressure heart rate going up.
18:26 You know, they’re showing it on their watch And it shoots up from, you know, 70 to like 150 and, you know, it starts causing symptoms. And a lot of, a lot of people are, have it, you know, we see it more now. I think also in the setting of … is a long term a long haul symptom.
18:46 So we have they tell us to assign a G 90 point a postural, ortho static type tachycardia syndrome and no addition. Additional code is assigned for the tachycardia as its inherent to the diagnosis of pots. So if you’re wondering, Do we code that tachycardia separately? The answer is, no.
19:13 Yeah, next we have post-viral, and I think that and related fatigue syndrome, I think we’ve been waiting on a code for this. I mean, when I code it, when I started coding, we, we, we’ve been, I think we’ve encoding this to fatigue forever.
19:27 Kind of, you know, this chronic fatigue syndrome, there has never really been a good code for it. But I think this, they kind of push this forward when when covert became an issue, and they finally came out with a specific code for chronic fatigue syndrome, also known as post-viral fatigue syndrome.
19:47 A lot of times we see this in relation to Epstein Barr virus, for example.
19:55 But it’s also known as my logic and cephalon, my litas, AKA chronic fatigue syndrome. It’s a chronic multi system disease. So, now, we have a specific code, G 9339 as a sign for post bacterial fatigue syndrome post, infectious fatigue syndrome, and other types of fatigue syndrome.
20:15 So, we now have specific codes also for G 93 3 post firearm related fatigue syndrome, and we’re going to use additional code for additional post covert 19 condition, G 93 3 1 post-viral fatigue syndrome, G 93 3 2, which includes chronic fatigue syndrome, et cetera, and then G 93 3 9.
20:40 So, we have a greater expansion, and more options for coding this.
20:49 Next, refractory and angina pectoris. This is also a C C actually. I believe all of the codes in this category with refractory angina, and I do see refractory angina, document it.
21:02 Maybe not on a regular basis but I do.
21:04 It’s known to be a chronic condition are defined as being a chronic refractory, angina. It’s usually irreversible ischemia lasting more than three months.
21:15 It’s not controlled by medication, PCI or Cabbage, and it can be very challenging to for treatment options, for patients with this refractory, angina pectoris. So they might, the patients may be unsuitable for PCI or cabbage and, you know, we’ve all seen those patients where the patient is kind of out of options.
21:37 And they’re treating them for this angina.
21:41 They want to be able to capture this and precisely code. It.
21:44 There are they do kind of have some treatments, new technology that may be available to these patients.
21:54 The question is a patient with a history of CKD status first quadruple, coronary artery bypass, and multiple coronary interventions, including angioplasty, what’s done, presents to the ED with severe chest pain, the provider documents, chronic refractory engine of …, and refers the patients or cardiac specialists. How should this encounter be coded?
22:12 We’re going to sign I 25, 702.
22:15 Atherosclerosis of coronary artery bypass grafts unspecified with refractory angina, pectoris as the first listed and assign the Z 70 to 98 6 1 coronary angioplasty status as an additional code.
22:29 So, they’re giving us very basic examples here, but just showing showing the decoding clinics that were published in the fourth quarter.
22:38 They’re just a kind of an overview of the things that we see that we’ve seen for updates in 20 23. Reminder about fluorophore, malignant pleural effusion. I don’t know why I eat the malignant plural, fusions, the malignant per pair cardio fusion.
22:59 Um, yeah, the malignant, Pericardium Fusion, the malignant plural, fusions, the malignant A site is I’m not sure why we do have coders missing the fact that there is a code first note here.
23:12 So, code first, the underlying neoplasm so, just to I really wanted to point highlight. That is that’s the major issue. I see, I don’t think we’ll have an issue with assigning when apparel parent cardio fusion codes.
23:23 But we now do you have a specific code for malignant Pericardium fusion, It is a very serious complication of advanced neoclassic disease, and they want to be able to track that.
23:37 So the question is a patient with lung cancer presented to the emergency room with complaints of dry cough, shortness of breath sharply, erotic chest pain, and was admitted following work up The provider diagnosed? Pulling it Pericardium, Fusion? Perry … was performed with placement of a drain. What are the appropriate diagnosis code assignments for this admission?
23:55 We’re going to assign See 34 9 oh, malignant Neoplasm of unspecified part of Bronchus and assign Code 131, 31 malignant, Pericardium Fusion and Diseases classified elsewhere. And, again, even if we weren’t aware of this Coding Clinic, our code book does say to code first the underlying Neoplasm. So we have the Coding Clinic. We also have our code book advising us of the sequencing.
24:20:00 Next, we have Hemolytic … syndrome, before we get started, I know you may have heard me say this before, depending on what presentations you’ve heard.
24:29:00 But I want to make a note here that Hemolytic … Syndrome is not the same as a patient being your remix or having Uremia. I have seen coders.
24:40:00 Potentially assign this code, Hemolytic … Syndrome because they were documented as being your …, or you are had uremia from underlying kidney disease. Hemolytic … Syndrome is a specific rare disease that affects the kidneys and Blood clotting mechanisms of the affected people. Typically we see this.
25:02:00 With Shingo toxin producing bacteria, falling in E coli infection, you know, those raw meat ground meat infections that we see from time to time. It is a condition that does affect the blood and blood vessels so it results in the destruction of blood platelets, so we see thrombocytopenia. A low blood, blood, red, low red blood cell count, so anemia, and kidney failure due to damage to the tiny that the vessels of the kidneys and other organs may also be affected, such as the brain or heart.
25:34:00 Know, by the damage to small blood vessels, in contrast, Uremia, or geremek, is just referring to erase level of urea, or nitrogenous, waste products, or compounds, or waste products that are normally eliminated by the kidneys.
25:53:00 So it’s not the same as Hemolytic … syndrome that produces thrombocytopenia, anemia, and kidney failure.
26:01:00 So just be careful with that, because Hemolytic you Remix Syndrome isn’t MCC. You may have other opportunities for your … if they’re, you know, end stage renal disease or if they have, you know, metabolic encephalopathy, etcetera.
26:16:00 Due to that you remix, Uremia or you remix state.
26:23:00 Janice Did you want to say something, Scott? Maybe how’s the audio is over.
26:30:00 Yeah, I muted you. It was I heard you typing and stuff so I just muted you know. Sorry about that, everybody else. It’s OK.
26:38:00 A little bit about H U S real burgers.
26:42:00 It’s It’s not very common, and, you know, where it seems like in a pediatric population.
26:49:00 So, not always kind of know when to look for things and consider your audience, so to speak, when you’re, when you’re coding this more likely to see these in the kind of the population.
27:03:00 They did create actually other codes, a typical HSUS.
27:10:00 No triggering events such as chicken pox. You know, usually, typically think that with children, influenza can also trigger. We also a pregnancy. I mean, these, I’ve never seen some of these before. We have genetic causes, et cetera.
27:25:00 So, the example they give is a patient was admitted with hypertension with chronic kidney disease stage three, and a typical HSUS.
27:33:00 So what is the correct code for a typical helium Hemolytic … syndrome? I’m surprised I didn’t give them more common scenario of the the E coli example.
27:42:00 But anyway, we’re going to assign a D 1939 other hemolytic you remixed syndromes for a typical Hemolytic … Syndrome.
27:50:00 We’re gonna assign I 12.9, with stage one, stage 1 through 4, and then an 18.3 chronic kidney disease. I’m assuming that somewhere in that documentation, they also have hypertension.
28:04:00 It wasn’t, or, don’t know, it was stated in there. OK, I miss that. It was synced with hypertension.
28:09:00 OK, so, we have a very basic example here: please note: the Sequencing: we do have guidelines about sequencing, so let’s take a look at that.
28:19:00 On the next slide, pay attention to your code Also notes use additional code notes, right, we have code also notes and use additional codes. Advice, you know, use additional code notes. Advice, sequencing, we have code first notes that advises sequencing. Code also notes, we want to pay attention to this. If not, we also have our guidelines that talk about sequencing as well.
28:45:00 It’s a little bit strange. You know the advice that they gave us about sequencing of Hemolytic … Syndrome, But the first section where it’s noted is with sepsis. So if the reason for admission as Hemolytic … syndrome that is associated with sepsis. we’re going to sign D 59 3 1 infection associated, Hemolytic … Syndrome, as the principal diagnosis, for an encode the underlying systemic infection. And another conditions, such as severe sepsis, should it be assigned as a secondary diagnosis.
29:13:00 Again, as Scott mentioned, this is very, very rare, occasion.
29:18:00 We’re not going to see this on a regular basis, but should you come across this, we should be aware that there is a coding guideline on it, and we have to follow our sequencing rules for that. It’s a little bit strange, we’re not used to sequencing, you know, maybe with a complication in sepsis, but usually we’re sequencing sepsis, or maybe they’re coming in with multiple things.
29:37:00 But typically, you know, in most cases, sepsis is probably going to be our principle unless the patient is pregnant or something. We do have some exclusions. But you know, in general, speaking, generally, we don’t really see something that Trump’s a sepsis code on a regular basis. So just keep that in mind. They also when we’re in the sequencing of severe sepsis, they say to see the specific coding guideline for infection associated, Hemolytic … syndrome, and the same with sepsis, or severe sepsis with a localized infection. They also tell us to see the specific guidelines for Emily you, remix syndrome associated with sepsis.
30:19:00 Selection of an HIV sequencing of HIV codes, so patients admitted for HIV related conditions. If a patient is admitted for an HIV related condition, the patient diagnosis should be B 20 human immunodeficiency virus, followed by any additional codes for all reported HIV related conditions.
30:37:00 An exception to this guy now, guidelines. If the reason for admission is Hemolytic … syndrome associated with HIV disease. Assigned Cody 59 31 infection associated, Hemolytic you, Remix Syndrome followed by B 20, so I do have a comment that someone made.
30:53:00 That they’ve coded it three times from inpatient adults, secondary to chronic kidney disease. I personally hardly have ever seen it. I probably can’t go to maybe 2 or 3 times in my entire coding career. I don’t know.
31:07:00 Maybe you’re, you’re out of the norm, there, but it’s something I, personally, haven’t seen a lot of over the years. And when I have seen it, it was typically in children. So, you know, it is.
31:20:00 So when, as someone mentioned, they’ve seen it more in adult patients, secondary, chronic kidney disease.
31:27:00 So just throwing that out there, If anyone else has seen it, let me know in the comments where you’ve seen it, or if you’ve seen it. If it’s something that you see on a regular basis, let me know.
31:37:00 Maybe, maybe it’s more common than we think, But they do state, it’s rare. I’m assuming that’s based on data.
31:45:00 So next, we have expansion. I don’t know. We have expansion of aortic aneurysms and dissections.
31:55:00 You can see quite a few changes to, or additions, with specificity for … or Aneurisms, and you can guess, who want an expansion here.
32:07:00 Some of these are M C Cs.
32:11:00 Know the dissection the ruptured options are going to be or MCC’s and actually Gore you know, the company that makes our aneurism repairs.
32:22:00 And here’s in repair devices.
32:25:00 We’re actually the the people that more of these codes specifically are submitted this proposal.
32:35:00 So you can see a ton of new codes in that category. So specificity, I’m already seeing audit findings where we’re missing specificity of the, the aneurism.
32:44:00 So if you’re using kak, you might have to train your cat to get the greater specificity or, et cetera. Just be looking out for that specificity in the documentation, again, Rupture dissections.
32:57:00 Those are the things that impact your severity, but we want to always coat to the greater specificity that we, that we can write.
33:08:00 Mmm hmm.
33:11:00 Next We have … are tachycardia, they’ve expanded this to distort the disorders to points and my French accent is horrible. So please forgive me for the pronunciation there. So, we haven’t Tricolor tachycardia unspecified, we have I 47 to 1 for Disorders Sadie’s de points. I don’t know, Scott, you can correct. My pronunciation of horrible. And then we have I 47 to 9 other ventricular tachycardia for other types of …. These are all CC’s nothing, changes there. It’s still going to be SCC.
33:49:00 What we’re going to say, Scott, Sorry.
33:52:00 I think whatever that was doing the.
33:54:00 Yeah, I PPS of the presentation, I said, Just don’t say ….
34:00:00 Maybe that’s why I said it. Is what it is. I didn’t say French either. I think this … is what they call it. It’s, it’s, I think. That’s why I said that. I think they got stuck in my head to her. Saudis the point. Is that the way you say it?
34:17:00 It’s infrequent enough that I was talking to a physician’s assistant in the ER and ask them about this.
34:26:00 He said, I’ve seen it, and typically when they see it in the ER setting, to actually print out the EKG and kind of show it around.
34:34:00 Because it’s kind of rare, and they want people to be able to recognize it when they see it, because for distinct, remote EKG, prospective, So.
34:42:00 Yeah, I’ve definitely seen it a couple of times thinner.
34:47:00 I don’t know if I’ve seen the abbreviation though.
34:49:00 It’s a large uppercase, T, D, Small, D, and P, so that’s another thing that we can learn from this slide as well.
35:00:00 They also talk about it being typically an adverse effect of anti-psychotics, anti medics, anti eurythmics, or even electrolyte abnormality. So they do have a code or code also a use additional code for to identify the substance. So, if you’re wondering why that’s there, it is commonly a complication of, of some of those medications.
35:25:00 Someone’s laughing, they’re saying, That’s how you laugh out loud. That’s how you say it.
35:28:00 Thank you, Scott, you’ve got that stuck in my head, it’s like when you can’t pronounce aluminum. And so and start saying it wrong and then you start saying it wrong.
35:40:00 Anyway, so moving onto hepatic encephalopathy. I know we’ve all been waiting for this code for awhile, but I do want to talk. I did have a question that came up from a discussion on hepatic encephalopathy. Internally. So I wanted to see how everyone is addressing this, you know, a true roundtable discussion about a paddock encephalopathy and I’ll get to that in just a second. But just to briefly talk about this, we do now have new co a new code for her paddock encephalopathy.
36:09:00 Do you not uniquely identify it? We were coding it to what? Kids paddock failure due to this, whatever specific cause.
36:17:00 So, if it was alcoholic hepatitis C, chronic hepatitis C, we’re cutting it to happen like chronic hepatitis chronic paddock failure without Colma, unless they specifically said with coma.
36:33:00 But they talk about hepatic encephalopathy. It’s a specific type of encephalopathy that occurs when liver disease causes toxins to build the patient’s blood. And, of course, when we’re seeing this in the documentation, we’re, you know, patient has liver disease and we still see a high level of ammonia in the in the blood, and that’s typically when we see them documenting that they have had against philosophy. Maybe they’ve changed and mental status.
36:57:00 Other symptoms include anxiety, cognitive impairment, issues with balance and muscle twitching impaired thinking. We changes sleep problems and in slapping. Anyone know the word specific medical term for for that? Let me know in the comments. There are treatments such as antibiotics, that slow stop bacterial growth and medications that can reduce the ammonia levels or you remove the toxins from the body.
37:22:00 However, if the underlying cause of the liver disease is not treated the toxins continue to build And patients with advanced, a paddock encephalopathy, lose consciousness and go into a coma That’s another I don’t really see, have had a coma documented a lot. Usually, I just see hepatic encephalopathy. But the new code will allow, for coding A paddock encephalopathy specifically. Now the one thing I want to mention here is that there’s different stages of paddock encephalopathy.
37:46:00 So this doesn’t include, as you can take you, take a look, at the inclusion terms here, hepatic encephalopathy, without coma porter portal, systemic encephalopathy.
37:58:00 So without comb, this includes, without comment, once we go to you say, it says, also code, also the underlying liver disease.
38:07:00 And you can see, without Comas listed in all of these options, there’s an excludes one note that if it does, if it’s a paddock encephalopathy, with coma, we’re going to code the acute subacute, a paddock failure with coma. So once it progresses takoma, we’re no longer going to code this case 7682. Because there’s an excludes one note here.
38:30:00 OK, good, so Asterix, this is another term for hand flapping. I actually have it down here that was just a little pop quiz. That’s typically what you’re gonna see a medical term being used in the documentation for ham flapping.
38:45:00 So I just wanted to, kind of a pop quiz there.
38:52:00 But one of the conversations, or one of the questions, I thought, this is a great question, and again, in the comments, let me know what you guys are thinking or what you’re doing at your facility. But we have coding a recent coding clinic from 20 21 talking about toxic metabolic. This is toxic.
39:06:00 It’s called toxic metabolic encephalopathy, and hepatic encephalopathy, from first quarter of 2021, where they talk about a patient having non alcoholic hepatitis cirrhosis, nash, complicated by hepatic, encephalopathy, and diabetes, and altered mental status. The patient was admitted for full workup and they are diagnosed with toxic metabolic encephalopathy, secondary acute on chronic A paddock encephalopathy. So, now that we know, well, when we code hepatic encephalopathy, we’re coding. It’s a disco the K 7682 code, which isn’t a CC or MCC but are toxic encephalopathy isn’t MCC? So what are you guys doing in that instance?
39:51:00 are you querying your cases for toxic metabolic encephalopathy? It does go on to say that week. It is appropriate to code the acute subacute hepatic failure without coma, in the case 72 10, chronic capac failure without coma and the … 92 toxic encephalopathy.
40:10:00 So, I was just wondering, what everyone’s doing are you quarrying for that? You know, obviously, if they’re presenting with hepatic encephalopathy, we’re probably using it as the principal diagnosis, unless they’re being admitted for multiple causes.
40:23:00 In most cases, we probably are using it as the principal, but again, there are instances where they just have chronic encephalopathy and it might not be the reason for admission. So, I just want to see your thoughts on that. Or what are you guys doing with with when they’re presenting with acute and chronic hepatic encephalopathy and you have an opportunity for querying for toxic metabolic encephalopathy or you quarrying every case are there? Is there any references about, you know, the difference in the two? They basically, just say, if both are documented, that we can code both.
40:56:00 Um.
41:00:00 I have one person saying, Yes, I do. I do ask that. I am assuming you’re meaning you query for that. Anybody have any clinical criteria?
41:09:00 Um, just kinda trying to roundtable this. I’m not sure of the correct answer.
41:16:00 Are kind of what the best practice is for, for this, when it’s not specifically documented?
41:25:00 They are not the same condition. Yes.
41:28:00 So I have one person saying, Yes, we would query. Yes. I know they’re not the same the same.
41:33:00 But what would prompt the query, um, is kind of where I’m getting from. So the encephalopathy that curves with liver failure is metabolic in nature formed from toxins generated within the body, not from external toxins. When the provider documents both the toxic metabolic we can assign the G 92 8 and then also, we can assign the deliver deliver, this was liver failure.
41:58:00 But now that we have a specific code for hepatic encephalopathy, can we, we can assign, definitely, sign of both. But the question is, what if it’s not documented you are you guys quarrying for that?
42:10:00 Um, and what are the clinical how would what prompts you to submit a query?
42:16:00 Because there’s gonna be a lot of cases that we can potentially query for toxic and toxic metabolic encephalopathy, Right? So what is your prompt for that?
42:30:00 Theoretically, can be queries on every single Patrick encephalopathy case is kind of my question.
42:44:00 OK, so depending on the circumstance of it, I’m just reading a comment depending on the circumstance of admission TMA due to GMC in the paddock and suffered due to other conditions.
42:53:00 So I don’t have the coding clinic up, so I can’t show you, but there is a specific one about coding that we can both or if the T M E is due to the liver failure or due to a peck encephalopathy, we are allowed to code both.
43:10:00 It’s not conflicting documentation. They’re just saying that the hepatic encephalopathy is causing toxic metabolic encephalopathy.
43:25:00 Um.
43:32:00 OK, so, just a comment from somebody I ask when they have more than one etiology or risk factor, for instance, if they have acute hepatic encephalopathy and also maybe alcohol. Hypo … brain swelling pneumonia, OK?
43:47:00 So, someone’s mentioning it or if maybe if the emergent levels are high. So, I think most people that have some form of attic encephalopathy that’s like one of the key indicators.
43:58:00 That they have a paddock encephalopathy, I’m not sure about that one.
44:06:00 So just just a conversation. Let me still continue with your question.
44:10:00 Your comments, I’ll read them as time allows here, but I just thought that was a good question. And I wanted to reach out to everyone and see what kind of how you’re handling that.
44:23:00 OK, moving on to our next code, we did have a coding clinic about this. I don’t have the Older Coding Clinic since we now have specific codes for this.
44:34:00 But they had to come up with something because it was impacting core measures. So we have rib fractures due to chest compression, and cardiopulmonary resuscitation.
44:44:00 We have a new code for fracture of ribs, associated with compression of the chest.
44:50:00 Um, to get to, to specifically identify fractures, due to poor performance of CPR. So we have fracture of sternum with chest compression fracture of one rib.
45:01:00 Fractures of ribs flower chest, the chest compression, other fracture associated with chest compression and CPR. Some of these are CCS and some of these are empty Cs. I have a whole list coming up. I think, the one with Flail Chest is one of the MCC, that’s just off the top of my head.
45:20:00 They wanted to aid in tracking and reporting.
45:22:00 Also, one of the indications was also, because of the core measure that it was affecting, so the question is, this 89 year old female patient presented to the Hospital for cardiac workup, became hypertensive and unresponsive following a cardiac cath. The patient’s pulse was non palpable in cardiopulmonary resuscitation was initiated. The patient suffered multiple rib fractures due to chest compressions, and palliative care was consulted. What did the diagnosis code assignments for the for fractures due to CPR, we’re gonna assign 96 8 3 multiple fractures of the ribs, associated with chest compressions and cardiopulmonary resuscitation for the rib fractures. External cause codes from chapter 20 is not assigned because the external cause isn’t and intent are included in 96 8 3.
46:07:00 OK?
46:10:00 Next, we have oops, I skipped a slide here.
46:13:00 We have contrast induced nephropathy, they just expanded these codes so that we have more specific codes so we had drug induced nephropathy. Now we have a specific code for contrast induced nephropathy.
46:26:00 The question here is a six year old female with diagnosed with AKA. Due to acute tubular necrosis, secondary contrast Nephropathy, what are the appropriate code assignments for acute kidney injury, due to acute jugular necrosis secondary to contrast Nephropathy? Please note that they are not advising sequencing right here. They’re not seeing the patient was admitted with this. This is probably a second, You know? They don’t say it happened during the stay. A lot of patients are actually already admitted when they develop this. I just want to point something out in just a second.
46:54:00 We’re going to assign codes and 17 point O acute kidney failure, and end 14.11, they’re just telling us the codes that are assigned specifically for contrast and induce nephropathy with ….
47:08:00 I’m gonna argue here, you can see, this is, this would be a correct. We have an excludes to note at, which means we can code both codes under and 14.11. So we can, if they’re excluded from, there’s an excuse to note, meaning they can both be coded.
47:24:00 But please note, under and 17, there’s a code also know, right, So code also note, a code also note associated with the underlying condition doesn’t advice sequencing.
47:35:00 We can, we can choose, based on the circumstance of admission.
47:39:00 So I just want to throw that out there, that there is a code, also note there, for code, also, the underlying associated condition. Again, this isn’t a lot of times, they’ll say, assign this as the Principal Diagnosis. In this case, they’re not saying, this is specifically why the patient was admitted. They’re just saying, the patient has this condition. What code should be assigned?
47:57:00 So just be careful with, with sequencing when it doesn’t advise sequencing.
48:06:00 Again, most patient patients are probably already hospitalized. They underwent a cat scan, or an NGO, and then they’re being, admit it, or not being admitted. They’re developing … during the hospital stay. So in most cases, it may be a set, it’s going to be a secondary diagnosis.
48:22:00 But there are instances where we do see patients maybe being admitted from an outpatient basis. Maybe they had a cat scan, et cetera.
48:31:00 And there are an outpatient cardiac cath and they’re being admitted for the …. So just be careful with with sequencing of that, Again.
48:41:00 based on the circumstance of admission, you can probably go with With either one again, it’s going to depend on the circumstance of admission Janice. Yep.
48:52:00 This real quick back to the field testing is, we’ll test is the only MCC and the Yeah, I have the slides coming up in the: At the end, just.
49:01:00 Yeah, we’re citizens forever, but, thank you. I thought it was just, I knew, I knew one of them or two of them are that makes sense, because that’s the most severe.
49:14:00 Um, new codes for I just wanted to point this out reminder. I did, I do see coders missing these so if they’re there, they’re seeking care for maternal care for suspected fetal anomalies. They’ve greatly expanded these categories. So chromosomal anomalies, facial cardiac pulmonary gastrointestinal, so if they suspect the baby has an anomaly, and they’re doing a workup.
49:39:00 Previously we just had codes for certain central nervous system malformations such as spina bifida hydrocephalus.
49:47:00 So they want to be able to track this better and allow for different, different tracking of these conditions, so they’ve greatly expanded this code category. Again, I have seen quite you know, not quite a few, but I’ve seen some mrs. here with when a patient’s presenting for further workup of a Suspected fetal anomaly for specific condition. So we this is just a sample of the codes. But you can see here on the left, where they’ve they’ve expanded this.
50:18:00 Next, we have this is another great topic. I’ve seen a lot of Georgi changes recently about loss of consciousness. We do have a new code for intracranial injury with unknown loss of consciousness, which we greatly probably need it because a lot of times, they don’t know if they lost consciousness or how long they’ve lost consciousness.
50:39:00 So, we have specific codes. We have great expansion of these codes for all of our traumatic injuries. Some of these are CC, some of these are MCC is ever, again. I have a whole list at the end of our new CC’s a new MC Season. You could probably pick out the ones that are ….
50:59:00 In this case, you know, contusion of the brain. Things like that.
51:04:00 Traumatic cerebral edema, are probably MCC easier.
51:10:00 Also, they were expanded to we have our new codes for a primary blast injuries of brains, which that’s going to be due to war, and things like that.
51:17:00 We might have some other instances where we’re using blast injuries, but for the most part, that was mainly created for veterans and, and, and things like that.
51:29:00 Are patients presenting with war injuries?
51:34:00 So, the thing I want to talk about is our duration of loss of consciousness. And let me go to the next slide.
51:45:00 Often, patients will present with injuries that are classified as Category six intracranial injury, without a clear history of loss of consciousness. Previously these codes defaulted to codes for loss with loss of consciousness of unspecified duration. However, this implied the patient had a loss of consciousness, which may not be always, which might not always be the case. The creation of these new codes will allow for better tracking of patients in which class of consciousness is either unknown or not specified. I want to make a note here, This is, we’re having we’re seeing a lot of errors in DRG assignment. Not just for with unknown loss of consciousness but for brief loss of consciousness.
52:22:00 They’re saying the patient actually had a brief loss of consciousness or they had unknown versus no loss of consciousness. Just be very careful with your loss of consciousness, code coding. I put a coating note here, unknown loss of consciousness. So if they specifically don’t know, if they lost consciousness groups to MS DRG 82, this is 284 Traumatic stupor and coma greater than one hour with or without CC or MCC. Similar to loss of consciousness of unknown duration.
52:52:00 So it’s still groups to that DRG whether we use unknown loss of consciousness or unknown duration. However, if it’s died, documented as no loss of consciousness or brief loss of consciousness, we’re gonna go to … with less than one hour.
53:08:00 And I’m seeing we’re finding that quite a bit, that those are coded incorrectly.
53:12:00 This is kind of a little note outside of this Coding Clinic that it’s something that we’re seeing quite a bit and you really want to be careful with your assignment of your loss of consciousness code because it can impact your DRG assignment.
53:27:00 So the question that they gave us was, a patient with a history of dementia presented to the emergency room following a fall. Although the patient was alert when the family, family of the patient found her on the floor, they were unsure if there was any loss of consciousness. The patient was diagnosed with both subarachnoid hemorrhage and a subdural hemorrhage. The physician was queried regarding whether there was loss of consciousness.
53:47:00 With the fall and the provider stated they could not verify if there was any loss of consciousness, what is it, appropriate, six character. We’re gonna assign SO 6, 6, X, A traumatic Iraq annoyed with loss of consciousness of status unknown and then traumatic, subdural, loss of consciousness, unknown. And of course, we can assign the unspecified, fall, et cetera.
54:08:00 Categories in six intracranial injury include a six Character A which describes unknown or unspecified loss of consciousness.
54:22:00 And of course, we have new codes for methamphetamines. This is actually, you know, we all know, right?
54:28:00 You know, if we watch the news, or, you know, just, you know, in our in our communities, This has been over the last couple of years, or probably more than a couple of years, just, you know, it’s been an increased use. They want to methamphetamines. It’s highly addictive.
54:48:00 Know, they want to be able to better track this. It was I think it was just going to end Fetid means within Fetid means are different than methamphetamines.
54:57:00 There is one Desert …, which is a message said, I mean that’s prescribed by the FDA. It’s one of the Oh, that’s why they added the adverse effect code, but there’s really Oh, that’s the really the only drug that’s used out there for its use for ADHD. So we’re probably not going to be using adverse effect of methamphetamines very often.
55:19:00 But they did have to add that because we do have one drug that falls into the methamphetamine category, but we do have a couple of questions here. A patient presents to the ED after experiencing convulsions use admitted to using a large amount of math while getting high with friends the patient, the provider diagnose methamphetamine overdose so we can code that to poisoning.
55:40:00 Convulsions and then the other specific stimulant use unspecified. So, we all know the guideline for using use codes, right? In this case, they have their link there.
55:52:00 They came in with a poisoning due to use of a drug, so that in this case, it would be appropriate to code the use. The use code.
56:02:00 Next, we have a question, a patient prescribed at … for attention deficit disorder. Experienced rapid heart rate, The provider states, the rapid heart rate was an adverse effect. So in this case, we would assign the tachycardia followed by the adverse effect.
56:22:00 So, just so I’m just going to quickly stop and talk about this. A patient has lost consciousness, but did not mention the amount of time, do we use status unknown or unspecified?
56:33:00 I, personally, would probably query if, in some cases, depending on what you have documented, but if they specifically don’t know that the, if they’ve lost consciousness, we have the unknown loss of consciousness if they don’t tell us the amount of time, they know they lost consciousness. They didn’t tell us the amount of time you can use the unspecified code, but you may, you know if it’s if there’s some suggestion that it’s brief in nature.
57:01:00 No.
57:12:00 You may want to ask if they know the length of time, but it does default to with if they did lose consciousness, with loss of consciousness of unspecified duration.
57:15:00 They don’t give a specific time period.
57:21:00 We would only use unknown if they, they don’t know, for sure if they lost consciousness.
57:25:00 Yes.
57:38:00 Here’s our list for our additions to the CC MCC, lest we can see our hemolytic … syndrome, or dissections and ruptures of aneurism or flail chest is on there.
58:10:00 Are contusions of the of the brain traumatic hemorrhage of the brain, pleura blast injuries of the brain, brain, etcetera. Some of these we didn’t talk about today vascular dementia and you can see all the severity levels are on here that What’s, what’s creating the SEC is if they have with agitation psychotic, disturbance, mood disturbance, anxiety, etcetera. Those are what’s giving Making it an SEC. I do see quite a few missed behavioral disturbances.
58:30:00 They have agitation combativeness they give them, you know, how dull, etcetera, I do see that missed quite a bit on, on audits or reviews where we’re finding that here’s a full list of dementia. Diseases classified elsewhere, unspecified, dementia, and then are mild cognitive disorder.
58:58:00 With behavioral disturbances also on that list Are angina codes. Refractory angina codes are also NRCC list, are v-tech codes. Some of these were already on our C RCC list, because of the expansion there. They just added new codes. Are fractures of the sternum, those other codes, and not seep due to CPR on the CC list instead of the MCC list?
59:09:00 And these other codes we didn’t really talk about. But there, you can see all the codes that are on the list here.
59:23:00 And we’re, we’re, we’re almost out of time here. I have a couple of slides on PCS concepts. There’s this coding clinic is quite lengthy. It’s hundreds of pages.
59:28:00 A couple they do give some.
59:41:00 Some some very basic examples about the appropriate use of codes. Quickly, we have drainage of perron pharyngeal space and retrovir pharyngeal space.
1:00:15 For the patient was admitted for incision and drainage of a large power pharyngeal abscess, the procedure was performed endoscopic way using a flexible fiber optic laryngoscopy. So what is that correct PCS codes? So they didn’t have an option for via natural or artificial opening, or natural via via natural or artificial opening endoscopic under neck, which is the body part where each were, were told to use for pharyngeal and retrofit and Joel space. So they’ve added they added their approach values there in that table.
1:00:18 Ambulation, … of prostatic artery.
1:00:28 So, just like we have with uterine artery, this is for control of will not control including blood flow to the prostate.
1:00:36 Control would be control right unless they did something specifically like occlusion.
1:01:13 In this case, the patient has BPH causing symptoms of …. They present it for bilateral prostate artery embolization during the procedure. Are very common for moral artery was calculated with the contralateral left internal iliac artery, and multiple attempts were made to calculate the left breast prostate artery. Despite the effort, the left prostate artery could not be successfully calculate it. Subsequently, the right internal iliac artery was selectively calculated, and both spheres were instilled into the right prosthetic artery. When stagnant flow is identified within the right prostate artery, imaging showed complete occlusion with preservation of its fiscal branches.
1:01:19 So what is the appropriate code for prostate artery?
1:01:27 And polarization, we’re going to code occlusion of the artery with inter luminal device for the … spheres.
1:01:52 So you can see here, different Foley catheter in the sticks are via the artery, whatever artery they’re using, the stick that catheter in. The, you can see, kind of see these … spears or microspheres being injected into these arteries to include them try to get a good picture there, but you can see what’s going on there that we’re going to code?
1:02:03 Or Occlusion, Prosthetic Artery left. I mean, in this case, it’s percutaneous, and then we have intra luminal.
1:02:08 We have options for right and left as well. Whoops.
1:02:12 Right left.
1:02:16 We have our new codes for litt therapy.
1:02:31 This is probably one of the greatest expansion, one of the greater expansions, they moved it from the radiation therapy to our destruction codes. It’s really not a radiation procedure. It’s really a destruction procedure.
1:02:57 So they’ve moved, move them or deleted them from the radiation table and reclassify to the medical and surgical section. It’s already a procedure that we probably seem to thermal therapy rather than radiation. It’s, you know, heat is generated by laser probe to destroy tissue. So for it, we should no longer be looking for those in the radiation therapy section there in the destruction Tate there now. And the destruction tables.
1:03:10 This is another good one. I’m actually almost done here. We have ultrasonic surgical aspiration. They created this extraction of central nervous system and cranial nerves body part first cerebellum.
1:03:21 They created this for the they actually created this last year, I think, that for previous year but they had to add the body part for cerebellum for this. Kinda trying to ultrasonic surgical aspiration.
1:03:25 And there is a coding clinic on this from 2021.
1:03:29 That tells us we should be using.
1:03:30 Extraction of brain.
1:03:39 In this case, they said Extraction of brain Open Approach for the kava chon ultrasonic surgical aspiration.
1:03:48 But now we have a more specific body part for cerebellum if applicable. I do want to note that I do see this kusa device are.
1:04:01 Kevin Trying to ultrasonic surgical aspirate are being used in other areas of surgery. So I guess I want to throw out a question to everyone. Are you using extraction for the … devices used in other areas of surgery?
1:04:08 For example, I’m using, I see them doing coosa aspiration of spinal cord.
1:04:23 Um, spinal cord tumors, for example, I’m trying to think of some other examples. I’ve seen it quite a bit this this device being used where they kinda suck out the tumor pieces piecemeal.
1:04:28 Using that aspirate are the River River comes to mind.
1:04:32 What’s that liver, OK.
1:04:36 Um, I forget the other one that I saw.
1:04:55 We have God, I can’t remember I know it was It was the spine, but in the in the encoder that I was using, they didn’t actually didn’t give me, and if I typed in Kusa, they actually didn’t give me an option, unless I went to, I had to specifically had to go to extraction So I just want to point that out. I know that’s kind of outside the scope of this.
1:05:17 This presentation, because we’re just talking about the coding clinics, but I’m just throwing that out there as a, you know, a little bit of additional information about the Kusa device. I’m seeing that quite frequently and usually the doctors are saying, Who’s a CUSA? They’re not spelling out kava. Tron ultrasonic surgical aspirated they’re just saying Kusa in the in the doc in the dictation.
1:05:20 Um, introduction of beaune substitute.
1:05:31 Um, they put an option for open or added an option for open in percutaneous endoscopic. We just had percutaneous before. So, I wanted to add that.
1:05:39 And introduction of other therapeutic monoclonal antibody if you’re not already using it. I think this is my last one.
1:05:45 Yeah, Know, we have this disco’s you know, we have our codes for …
1:06:16 and Neil Plastic conditions. But what about if it’s a monoclonal antibody for for something other, For example, is … for C diff. That’s not neo plastic, and it’s not covert related, So, how would we code that? So, we do have a code. I had a couple of questions. I think this actually came out earlier, but I had a couple of questions about this. We do have an option for other therapeutic monoclonal antibody if it’s not for Neo plastic condition, and it’s non covert related.
1:06:20 So, I just wanted to point that out. They also delete it.
1:06:30 In Section X, they removed the bins Ben, as Bez low tox a mob monoclonal antibody for this imply.
1:06:40 Because now, we have a specific code for other therapeutic monoclonal antibody. So, I just wanted to point that out, because I did have a couple of questions about this recently.
1:06:42 And, finally, I did have a question about CEUs.
1:06:50 We always provide the link at the you can see that on my screen right now. And on the handouts, at the end of the webinar, you have the link to download your CEU.
1:07:09 This is, if you for some, whatever reason, you’re not getting our follow up e-mails, you always have the link to download, the CEU, please allow a couple hours before you check that. Typically it’s up there within the hour.
1:07:20 To download that, just give us a bit of time to get it uploaded and you have two weeks from today to download your CEU before that link expires.
1:07:24 And as Scott mentioned in the beginning of the presentation, we did have an issue with the attendee list.
1:07:48 We’re working on getting that attendee list, know, working with IT or their IT with goto Webinar’s IT to get, for some reason, it didn’t track the attendees. So we’re working on that. And will let everyone know, but again, you have a copy. We always provide this link at the end of the webinar so you should be able to download the CEU without waiting for that e-mail.
1:07:53 I just wanted to point that out. Hopefully you’re staying until the end of the webinar.
1:08:18 But anyway, All right. That’s all I have for today. Everyone. Thank you so much. I know I went a little bit over. I appreciate you staying on until the end, Thank you so much, and I will stay on for questions. If anyone has any questions, and you, you’re willing to stay on for questions.
1:08:20 Thank you, everyone. Thank you.
1:08:32 Yeah.
1:08:37 Um.
1:09:04 I’m not sure if the current one is uploaded. I’m right now. That might be from the last webinar.
1:09:13 OK, so, I’m assuming someone had a question about I was taught unless the patient had a heart cath to determine if the … involve the Native Artery or the cabbage to code the cat.
1:09:30 C A D as unspecified Well, we know it’s Native, I’m assuming that I know what Coding Clinic you’re talking about. I think there might have been more documentation in that Coding Clinic that they didn’t give us.
1:09:43 I’m assuming, so we’ll probably write to them and ask for clarification, but I know what you’re talking about, They didn’t specifically say what vessels were involved.
1:10:19 OK, I’m assuming the submission, the submission that the, the person submitted did include that information.
1:10:22 Mmm hmm.
1:10:36 That’s OK, Amanda.
1:10:41 Thank you, everyone.
1:10:48 All right. I don’t see any more questions. Oh! wait, I do see a question.
1:11:12 Nancy will be talking about that on the note on the dementia webinar, but the answer to your question is, Yes, we would, We would follow that guideline.
1:11:14 Yes.
1:11:15 All right, I don’t see any more questions, so I’m going to sign off. But thanks again for staying on.
1:11:25 Have a great day.