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3:25 I’m sorry. I’m on my on my own today. I didn’t realize I had myself music mute it. It’s not technical difficulties. It’s just that I didn’t unmute myself.
3:36 So, can everyone hear me now?
3:43 OK, thank you, I had myself muted into places I didn’t realize, I didn’t unmute myself. Sorry, so, I just wanna welcome everyone again to our roundtable 145. Thank you for taking your time out for today to join us on the webinar. My name is Janice, who are lucky I am … Health Director of Education and today we’ll be revisiting Covert coding, including Changes effective for Visits, occurring On or after April first. Somehow, housekeeping items as usual, there are no cola numbers, the format streaming only, to allow additional attendees. I had some concerns about maxing out. We’re nowhere near maxing out for streaming only so you don’t have to worry about that. Today’s webinar will be available on demand after the live session and will be accessible through a link that will provide in our follow-up e-mail, which will be sent out this afternoon. Please make sure that you opt into our e-mails, they are coming from coding roundtables, that socks health dot com. Make sure that they’re on your Safe senders list for any reason, you’re not able to, …
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5:09 During the webinar, of course, you can always download the handouts at any point during the webinar. I will also spend some time at the end of the webinar, going over question as questions as time allows.
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6:05 Just as a reminder, we do have a quick survey at the end of the webinar if you can take a minute and just answer those quick questions for us so that we can do better in the future. Again, thank you for today. Just thanking you in advance, We’re gonna get started. And again, I apologize, I didn’t unmute myself. And for anyone that that’s attending this meeting, this is I have a couple of questions already about a piece. A APC CEUs. This is a this is a Hema only.
6:36 So, that’s a moot point at this point.
6:40 If you’re a sax employee, again, please check out the Yammer page.
6:45 Alright, so let’s get started. Everyone should just let me know if you can’t see my screen, but you should be able to see it at this point. I’m on my own today I don’t have Scott here, so I Rely on you guys to let me know if there’s any issues with that.
7:02 Mmm hmm, Let me just get myself sorted here, OK?
7:11 No, I was just getting myself sorted, guys.
7:16 OK, thank you, everyone can see.
7:21 Alright.
7:23 Um, So, our agenda for today is we’re going to start with the April first 2000 to covert updates, most of us are probably aware of these already. But we’re gonna talk about some of the challenges that we have with … encoding. I’m obviously not gonna go over every covert guideline, but there are some some items that are still kind of a challenge or things that we’re seeing on our QA, whether it’s internal or external. That we’re going to discuss as it relates to symptoms integral to …. General guideline refresher as they relate to challenges that we’re seeing. Obviously, I’m not going to read every single guideline in that section. We have some covert scenarios that I wanna go through and then talk about, talk about, at the end, talk about history of covert and post covert Conditions, and I think a lot of those issues are not really understanding when to use those codes. I think it’s more of a documentation issue. So, we’ll kind of talk about that And kind of I’ll give my advice and you guys can offer your advice, as well.
8:22 So, let’s get started.
8:29 OK, so first up, for our April first updates, we have three new codes. Obviously, one of those is because due to expansion, and we’re going to have ongoing updates on April first, in the in the future, as well, not just this year. If you want to see more information, you can check out the link that I provided in the slides. I do have some of that information within the slide deck, but there’s definitely more information at that link provided in the slide deck. This is for also information that was also provide it in first quarter, 20 22 Coding Clinic. Obviously, it says with effective with discharges, March 18th, but these codes don’t didn’t go into effect until April first, date of service or discharges.
9:15 Um, if it’s an outpatient or discharge date of, I should say, so our codes are Z 2083, so under immunization status has been expanded. And we have three new codes to identify these. So Z 2810 we have unvaccinated. For coven 19. We have Z 28311, partially vaccinated for covert 19, and then we have Z 28, 39. And that’s basically due to expansion, other under immunization status, And they give us some information, and they also updated the official coding guidelines for the appropriate use of these codes.
9:51 So, from Coding Clinic, first, quarter 2022.
9:57 The question is, a patient presents to the physician’s office for an annual checkup, and as noted to have received the first dose of a two dose regimen. Madonna Cov at 19 vaccine, but has not received the second dose. How should the patients under immunization status for Cove it’d be reported?
10:13 So we’re going to assign is E 28311 for partially vaccinated for coven 19, since the patient received first dose of a two dose regimen. And that’s our current advice on or after April first, for coding under immunization status. We do have prior advice, so if you’re still coding, other charts will talk about that in a second.
10:32 And here’s our updated are updated guidelines for April first. These are from our fiscal year 22 guidelines, but they did published new guidelines. So if you need a copy of the updated guidelines for April first, you can go to the CDC website. Also you can go through your encoder and go to references that way to download a new copy. If you have a paper book. And you need a new copy: essentially this is the the update related to how to use these codes under immunization status. So it says Code Z 2810 unvaccinated for coven 19 May be assigned when the patient has not received at least one dose of any …
11:10 19 vaccine um.
11:13 Code 02831.
11:16 Partially, vaccinated for coven 19 may be assigned when the patient has received at least one dose. Of a multi dose coven 19 vaccine regimen, but has not received the full set of doses necessary to meet the CDC definition of fully vaccinated in place at the time of the encounter. So, obviously, as this gets updated, we will need to go to the CDC to see what their, their recommendation is, and they provide that in the information.
11:49 OK, so prior advice, indicated that we shouldn’t be using Z 28 if the patient has an under me as an easy under immunization status. For encounters with the provider documents, the patient has not been immunized Against coven 19, They told us that the Z 28 3 code would not be appropriate for this purpose. There is currently no ICD 10 code available to identify lack of immunization against …, so that’s prior to April first.
12:21 So, guys, someone is saying that the link takes you to no resource found. You might need to copy and paste the link. If it’s not working for you, it should work. It’s not my link.
12:30 I didn’t, it’s provided by the seat. It was provided by Coding Clinic, so it should work, I’ve tested them. Just copy and paste it if it’s not working for you.
12:43 Here’s some additional links for the PCS codes that are now available. We have nine new procedure codes. Initially when they first came out, I think they had seven, and then they came out with two more.
12:55 So if you had some older advice, if you had some older, prior to the update, I think it was, I forget when they updated the information, I think it was in February.
13:06 They added additional codes to that, to the new codes that were coming out in April. So, there, I think, I believe, initially, there were seven, and now there’s nine.
13:16 And, again, there’s links here, again, if it’s not working for you, try copying and pasting it.
13:21 To get, to use that, utilize those links for whatever reason. Maybe it’s your settings on your computer.
13:31 Um, hmm, hmm, hmm, hmm.
13:36 So, we have the curve at 19 vaccination vaccine administration. So we afford new procedure codes created for covert 1009 Vaccine, as shown. two codes were created for vaccines described as a third dose, and two codes were created for vaccine described as booster.
13:49 So if we’re seeing patients getting, obviously, that emphasis for inpatient, or if you’ve report C PCS codes, I am assuming that some I know some places report these for outpatients at times. So we have four. New Procedure codes are created for coven 19 vaccines. To codes, again, were created for vaccines. Describing is a third dose, and two codes were created for vaccine described as booster. So we have X W 0 1 3 V 7 introduction of coven 19 vaccine, dose three. And she subcutaneous tissue. Percutaneous approach new technology we have X W 0 1 3, W seven.
14:32 Introduction of coven 19 booster into sub cutaneous tissue, percutaneous approach, new technology. We have X W 0 to 3 V 7 introduction of covert 19 vaccine dose three into muscle percutaneous approach. So obviously, you can see, depending on the dose. And if it’s document as a third dose or a booster.
14:52 It’s gonna depend on which code you’re using. We also have introduction of covered 1009 vaccine booster into muscle, percutaneous approach, new technology than they give us some additional information obviously, about how to use them. I’ll use these codes. So a covert 19 vaccine booster shot as an additional dose of the vaccine given after the protection provided by the original shots. As you can decrease over time. The CDC recommendations for covert 19 booster vary based on the vaccine received the patient’s age and the time after completion of the Primary coven 19 Vaccination Series. For example, At press time, the CDC recommends boosters for all patients 12 years and older, who received the Pfizer Bio Nano Tech vaccine at least five months after completing their Primary coven 19 Vaccination Series. Please refer to the CDC’s website.
15:38 For their Current Recommendations for coven, 19 Boosters, as Guidance is evolving.
15:42 A covert 19 third dose refers to any additional vaccine dose administered to people who with, with, moderately moderate early or severe compromised immune systems. To improve the response to the initial vaccine series, The term third dose can be used to refer to an additional dose of the two dose vaccine regimens, but the term additional dose may be used to describe doses given to individuals who received the Johnson Johnson and Johnson Single Dose Vaccine. That may also be eligible for another dose based on their immune systems code, assignment should be based on the documentation. So we’re going to assign the code for kudos to, if it’s document as the second dose, the code for dose three, if it’s document as the third dose, and the booster code, if it’s just documented as a booster.
16:30 OK and then we have some new codes for new therapeutic substances.
16:34 So this first one first MMR, Fussed, Tim and Timid to nib. I can’t even say it is actually for adult chronic immune thrombocytopenia. It was a request for Emergency Use Authorization. And it was approved and we have different codes.
16:54 Introduction of fuss, Tim, two nib. Into mouth, so an oral medication.
17:00 Then we have the inertia artificial opening, so upper GI, and then lower GI Via natural artificial opening.
17:09 In that section, you can see we have different devices. And I have all of them listed, I just show you the next slide for the next strokes.
17:17 So, we also have, on the next slide, we have takes a Vinay mob and still gave him I’m sorry, From a pronunciation there, those are tongue twisters.
17:30 These are new monoclonal antibodies for pre-exposure prophylaxis of coven, 19 and adults and Pediatric individuals’.
17:41 So these are for individuals who are not currently infected with … and who have not had a known recent exposure to an individual infected with sars, cov it to, and who have moderate, to severe immune compromised due to the medical condition. or receipt of immunosuppressive medications, Or treatments, and may not be mount. Amount an adequate immune response to cope in 19 vaccination, Or whom vaccination with any available coven 19 vaccine according to their approved authorized schedule, is not recommended to the history of severe adverse reaction, severe allergic reaction to the … vaccines or covert 19 Vaccine components.
18:14 And one doses administered, at two separate consecutive intra-muscular injections and a single code would be reported for the full dose. And we have X W 0 2 3 X 7 4.
18:26 This quick tip: Does anyone know how we know a drug is a mono … clonal antibody just by looking at the name of the drug?
18:47 Anybody?
18:48 So, a quick tip here, if it ends in, …, may be we know. it is a monoclonal antibody. So, if you think about how they name drugs, I’ve always wondered how they named drugs, and how why some drugs and an M a B.
19:04 So, if we look at monoclonal antibody, you can see these end, an MA B is for monto. We know it’s a monoclonal antibody.
19:16 So, good. So, I see some people are are that are typing it now. There’s a bit of a delay, so, it ends in mob, right?
19:24 So, if it ends in mob, um, it’s a monoclonal antibody.
19:34 We also have a new code that was created for other new monoclonal antibodies, coven, 19 Treatments that are administered inter muscularly. That may be come available and we do not yet have a unique code for. So, introduction of new technology, monoclonal antibody into muscle, percutaneous approach, a new technology group seven. For administration of other monoclonal antibodies used to treat neoclassic conditions rather than coven 19? We’re going to see our three E E, zero table.
20:00 So, these this new code is for new technology monoclonal antibodies for …. For other monoclonal antibodies used to treat neoclassic conditions, we want to see 3 E 0.
20:16 Please, keep in mind, I don’t, Some of you are having questions, they are all great questions. I don’t know the answers to all of these questions, so, these are newer codes that just came out. So, I know as much, pretty much as much as you guys do, based on the information that they’ve, they published.
20:34 So, if you have specific questions, I’ll try to answer some of them. But if you do have specific questions, I would direct them to Coding clinic co-operating parties to answer them, because I don’t know. I know, again as much as you guys know.
20:49 So that’s, that’s it in terms of the new codes.
20:54 Obviously we may need some more advice depending on what we’re coming across in the documentation, and again, I do recommend, I can give my opinion, but it may not always be correct. So I do recommend reaching out to the co-operating Parties and or, you know, some like Coding Clinic to help aid in answering those questions so you have official advice to those questions.
21:17 Next moving on. Symptoms, Integral to Covert. So, I’ve Seato seen a lot of issues with coding coding, symptoms integral to Covert.
21:26 So, I want to stop here and talk about what are signs and symptoms of … versus manifestations of …, So let’s have a discussion here.
21:37 What are signs and symptoms of covert versus manifestations of covert?
21:59 Anybody?
22:04 Hmm, hmm, hmm, I’ll wait for about NaN, and then I’ll move on.
22:11 OK, so we have one person says, fever, cough, fever versus. so cough fever. Cough is a symptom. Manifestation would be pneumonia.
22:22 Shortness of breath would be a sign or symptom.
22:25 OK, good, so Manifestation, um, short of breath, fever, vomiting, diarrhea, those are all symptoms, OK, good. So let’s see does diarrhea, nausea, and vomiting, fever, chills, cough, fever I’m just reading everyone’s comment, loss of taste and smell, Koff aches and pains, OK.
22:46 Respiratory Failure.
22:49 Manifestation signs and symptoms are integral manifestations or additional diagnosis. I’m just reading. Some comments that we have here, cough muscle aches.
22:58 Does everyone?
23:01 So, yeah, everyone, you can, you can comment in the question box.
23:06 So for those, maybe you haven’t been on the call before that, that’s what the question box is for if I ask any questions.
23:15 OK, so and then we have manifestations of covert which could be something a little bit more definitive right, MI, a stroke, viral ….
23:30 Millimeter, high fever, cough, nausea and vomiting or symptoms, sore throat would be a symptom, OK.
23:37 OK, great anemia could be another manifestation signs and symptoms or symptoms manifestations are not signs and symptoms such as pneumonia, OK, good. So I wanted to kind of briefly just talk about that, so it seems like we’re on the same page, we’re signs and symptoms are, you know, things like fever, cough.
23:55 They can be symptoms, signs of other conditions not just covered, But as you can see, as I lists, kind of read off those signs and symptoms, there’s a ton of different signs and symptoms for …, right?
24:06 There’s also a ton of different manifestations of covert and not every patient presents the same, right?
24:13 We have many different presentations. If you think about all the … cases that you coded, we may have seen an asymptomatic patient. We may have seen a patient that just had fever, or we may have seen a patient that just had cough and shortness of breath, but they didn’t have any man, a specific manifestations, such as pneumonia or acute bronchitis, or viral and a write us. They could have just had those symptoms signs, and symptoms of cope it. So, how are we dealing with coding these? There’s so many different manifestations of …, and, I think this is, we’ve seen a lot of coding errors on this and I think it kind of went unrecognized.
24:49 So, I wanted to make sure that I talked about this, I’ve been talking about it with, with our coders, different education calls that I’ve had with our clients.
25:01 But I wanted to kind of get this out there, I think a lot of people have missed this updated advice about coding signs and symptoms with covert versus coding manifestations of covert, and this is back in August 27th, 27th of 2021. It was also published Encoding Clinic.
25:19 This is from, you know, the here, it’s published on The …
25:23 website, um, it’s, et cetera. So you can find it in many different places was actually published on the co-operating parties websites, before it was publishing coding clinic, but you can get it in both places, regardless. So the question is, initially, when this, initially, when this first came out, we were told not to code the signs.
25:43 And symptoms that were respiratory in nature, as those were covered, was primarily of respiratory condition, or condition.
25:51 And we were told not to code the respiratory conditions separately.
25:57 So the question was updated in August. So I’m just going to read the question and answer. And we’ll talk about it. So when a patient is diagnosed with coven 19, we understand that signs and symptoms are not manifestations and would not be coded separately. We also understand the guideline one slash … states that signs or symptoms that are routinely associated with disease process should not be assigned as additional codes, unless otherwise instructed by the classification. When a patient is diagnosed with Covert 19, presents with both respiratory signs and symptoms, for example, shortness of breath, cough and non respiratory signs and symptoms, gastrointestinal problems, dermatological, or Venus sufficiency issues: may the non respiratory signs and symptoms, or conditions be coded separately since they are not routinely associated with corporate 19.
26:43 The answer is, people infected with … 19 may vary from being asymptomatic to having a wide range of symptoms and severity. Therefore, for coding purposes, signs and symptoms associated with Kobo 19 may be coded separately unless the signs and symptoms are routinely as soon as it with a manifestation. So, they’ve changed it a little bit. Originally, it was: it was routinely associated with a respiratory, you know, if it was a sign of symptoms associated with the respiratory condition, we weren’t assign it separately.
27:10 Um, so, they give an example. For example, cough would not be coded separately if the patient had pneumonia due to cope in 19 as cough as a symptom of pneumonia.
27:18 So, on the same token, a patient may just have Coff, right? What if they don’t have pneumonia?
27:24 So, essentially, this is how I’m reading it, is that we can encode the Coff with covert 19 if they don’t have a man or a specific manifestation if all they have is cough without documentation of acute bronchitis for example, or URI, etcetera.
27:40 Additional coding of signs and symptoms not explained by the manifestation, would provide additional information on the severity of disease.
27:47 As we can see, and as we talked about, you can see all the different signs and symptoms that may or may not be, or may not be there for a patient, we, again, kind of summing up what everyone was saying, loss of taste and smell. Loss of, you know, you know, or I should say diarrhea, shortness of breath, cough. There’s so many different manifestations. Maybe they don’t even have respiratory symptoms. Maybe they just have a fever or maybe they just have skin issues or maybe they, I mean, you guys know, you guys could probably put it a ton of different covert cases.
28:18 Not every patient presents to see, do we have a lot of patients that present with respiratory signs and symptoms, of course.
28:26 So I think this was a bit overlooked, um, when they updated this, this question, because I do see it still see a lot of incorrect coding for this. We see a lot of missed. And we’ll go, I do have some examples coming up. You’ll see, we’ll go over. I’ll save that for when we go through those examples on an upcoming slide.
28:46 So, you guys can kind of cheat because the next slide has the answers, But, see, if you know, please, even if you’re you’re cheating, you cheat and go to the next slide, we still need to talk about those. So, hopefully, you’ll kind of follow along before we get to those answers.
29:03 And, of course, we have our Coding guidelines for symptoms. Integral to or Not Integral to Disease process.
29:08 Typically, we don’t routinely associate, you know, assign a symptom. You know, we don’t assign abdominal pain with gastroenteritis, right, because that’s a disease or condition or sign in symptom that’s integral to a disease process.
29:21 Um, Conditions that are not integral to the disease process, we can assign as additional codes, right? We have this in the General Coding Guidelines. You know, typically we also think about the skyline in the sign and symptom chapter, but we want to remember that it’s also in our General Coding Guidelines conditions. Like glucose, I chose this isn’t a sign and symptom.
29:40 It’s not in the sign and symptom chapter, but it is a, it is a symptom of infection, so we’re not going to code that separately.
29:45 So it’s located in both those sections for that reason, and then asked they go on to say that definitive diagnosis codes should be sequenced before the symptom code. Sign are symptoms that are associated routinely with the disease process, should not be assigned as additional codes, unless otherwise instructed by the classification. So typically, we’re not going to assign their signs and symptoms. But in some cases, we can code, assigned it something. We want to make sure that we’re checking all of our excludes notes, things like that.
30:14 Sometimes we have to do a little bit of research, should I be coding this separately, et cetera.
30:19 And sometimes we have, we kind of can go to our Coding Clinic. They are one of the co-operating parties. And we kind of get some advice about what we should be doing. So it’s not specifically in the guidelines as of yet. But to me either clarifying this and saying, going back to that frequently asked question, and saying that we can go ahead, encode the signs and symptoms so that we can adequately capture what’s going on, what’s going on with this patient with covert, just because we have so many different presentations for coven. And, to me, it makes sense. Someone may argue that, you know, shortness of breath or cough is integral to …, is an integral for every patient with covert. Someone can argue that every patient with …
31:01 presents differently, depending on the scenario.
31:11 Millimeter.
31:13 OK, so I’m gonna go through, I’m not going to read our general coding guidelines, word, for Word. They’re all here.
31:19 I’m going to touch on some pain points are challenging coding guidelines that I’ve come across over the past few months.
31:29 Again, I’m not going to be coding, reading these word for word.
31:32 Of course, I always recommend reviewing refering to your guidelines on a regular basis.
31:38 We obviously can’t remember every little detail of a coding guideline and maybe some of us can, I know, I can’t.
31:46 Maybe I have an idea of the guideline, but I do. I do think that’s a lacking. Something that’s lacking for coders is referring to the guidelines on a regular basis.
31:58 So, I definitely, you know, keep my guidelines up and out and refer to them on a regular basis and you know, just to double check myself when I’m kind of doubting and doubting myself.
32:11 Know, some guidelines that you use every day are kind of stuck in your brain and you know them, maybe it’s something that we just don’t understand. So, I think we’re so good with, I think we’re finally good with exposure to covert 19.
32:22 So, If we have coming in with actual or suspected exposure for coming in for covert testing, at Z 28 2 2, so contact with an assist suspected exposure to …, the coding, the screening for covert 19, I didn’t see that they did not update this yet for us to use the Z 1152. They did tell us in that they did tell us that coding guidance will be updated as new information concerning changes. The pandemic status becomes available. It’s obviously becoming endemic. But they haven’t made that change that, or flip the switch that year, that year there.
32:57 They haven’t flipped the switch yet, for us to code to Z 152 for screenings for covert 19. So we’re still using our Z 2082 codes. Just wanted to stop there, in case anyone thought that, maybe, perhaps.
33:11 That we’re going to be flipping the switch here on April first. It’s still, it still reads the same, in our coding guidelines, so it’s not yet. We’re not flipping that switch yet.
33:23 Then we have our signs and symptoms without a definitive diagnosis of coven 19.
33:28 So, we have our patients presenting with cough, they’re doing a covert test.
33:35 We encode that cough and the Z 2082, obviously. If it comes back positive for covert that’s going to work, we’re going to code are covert code.
33:50 We have our, I don’t really see too many issues with asymptomatic individuals who test positive for … 19. If you are seeing that.
33:58 Please let me know, we can, I can add a comment history of covariance follow-up visits for covert infection not really seeing too much or encounter for antibody testing. I don’t really see issues there. The the issue, with personal history of covert is, is really coders coating history of covert versus current coven, versus sequela of covert. And we’ll talk about that more in the next, upcoming slides.
34:24 Could only confirmed cases of cov it, obviously, even if we have a negative test, but they’re confirming that the patient has covered confirmation, does not require documentation of a positive test. I know we have some payer stuff that says you should have a test on file, but based on the guidelines, And that’s what we’re going through today, is the guidelines, um, if you want to know, you can obviously state your what you’ve experienced, if you wish, and the comments sections, about having a actual covert test on file in the chart.
34:57 If they confirm that the patient has covered, we can coded as coven. Obviously, if it says possible, probable or inconclusive, we’re not going to assign OU 71. I don’t really see again too many issues here.
35:11 In terms of sequencing of codes, this is where I see a lot of issues and we’re going to spend some time talking about this in the upcoming slides. So, when covert meets the definition of Principal Diagnosis, code you, 71, … should be sequence first, followed by the appropriate codes for Associated Manifestations, except when another guideline requires that certain codes be sequenced first, such as Obstetric Sepsis or Transplant Complications, So I’m gonna throw this out here to set this covert If a patient has covert, does it have to be the Principal Diagnosis?
35:41 Yes. No.
35:45 I know this might seem like a basic question, but this is where I have a lot of see, a lot of errors. If they have, if we see a patient presents with cobra, does it always have to be the principal or first listed diagnosis?
36:04 No, OK. So we’re going to talk it through some different scenarios.
36:12 And go from there.
36:13 that data that’s upcoming in the next couple of slides, so bear with me. But we have some exceptions, right?
36:20 We have, if a patient presents with sepsis in coven, we have to follow our sepsis guideline. Off, obviously, if the substance is POA, if the patient is pregnant, we have our pregnancy guidelines. If the patient has, you know, a lot of pneumonia and due to covert, we have to follow our transplant complication guideline.
36:39 Um, Sometimes we see patients that come in for something unrelated to covert in the Incidentally test positive for ….
36:48 Would covert be the reason for admission if they’re asymptomatic, I’m talking about inpatient admission.
36:55 Remember, we wanted to look at the thrust of treatment. So if they’re not receiving any inpatient treatment for the cove, it’s not going to be our Principal diagnosis. I see a lot of errors here.
37:04 What is the reason for admission, What bought the bed for that patient?
37:08 You really want to think through that process and say, OK, what did they do for cov? They just gave them cough medicine.
37:13 They wouldn’t be admitted for cough medicine, right? That would be an outpatient encounter.
37:22 So, you really want to think through that. Also, I see a lot of questions regarding if it’s respiratory manifestations versus non respiratory manifestations, obviously they kind of list out, initially when kovac first came out with a lot of respiratory manifestations. We have our covert code sequence first followed by are, Manifestations, of course, we have those exceptions. We have sepsis, OB, et, cetera.
37:47 We want to make sure that we’re cross coding your 7 1 first. If that’s the reason for admission followed by whatever respiratory manifestation they have, of course we also have scenarios where they don’t have respiratory manifestations or maybe they have a combination of respiratory a non respiratory manifestations. If we have a non respiratory manifestation of …
38:06 and the reason is for the non respiratory manifestation of covert, we’re still going to assign the … 71 as our principal or first listed diagnosis. This is where I see a lot of questions.
38:16 We will have some scenarios coming up just to talk through.
38:21 And then, of course, we have our guidelines related to multi system Inflammatory Syndrome. How many?
38:27 I mean, I haven’t seen too much of much of this. How about anyone, if anyone want, has any comments.
38:33 You can put that in the comments section about, but I haven’t really seen too much about multi system Inflammatory Syndrome in the documentation, at least in my experience. Maybe you every once in awhile, but it’s not something that I see on a regular basis. So I haven’t seen too many errors on MIS. Now, post covert condition again, I think this is also, I don’t think it’s that we don’t know how to Code Post coven conditions. I think it’s more the documentation. That’s driving us a little crazy as it really is a sequela of … current active infection. We’re going to talk about that more in the upcoming slides as well.
39:11 Um, so just inter, I have a couple of people saying that they’ve never seen it MIS. They’ve had one case of MIS, and a child. And most people are saying they rarely rarely see it, or if they do see it, it’s just in children.
39:28 OK, OK, and then, we have our new guideline for under immunization, for Koven 19 status and we went over that in the previous slide, but, again, I put it in this section just for completeness sake. So, let’s go. We also have our Cove in 19 infection in pregnancy and childbirth, and I know there’s a few unanswered questions about pregnancy. Please submit those for official advice.
39:53 I have my own opinion again, on those, on some of those scenarios that aren’t addressed in the guidelines. But the more people that write in, into them, into the, into coding clinic or the co-operating parties, the more the better answers we’ll get into more timely manner.
40:10 Um, again, not too many issues with pregnancy, encoded birth process or community acquire that sometimes, we have to query for that.
40:22 And, if it’s covered, if it’s, you know, community acquired or birth process, that might be a query as well. So, again, that’s not really the pain points I’m seeing on my review in the comments, if you, if it’s one of your pain points, just let me know and we can address that at the end.
40:40 So, kind of tying this all back to why I asked the question, Covariates symptoms versus manifestations. So, we have a patient, and let’s go through this, this kind of exercise to tie all of our discussion back to what we just talked about. So, Asymptomatic …, what is going to be your code? You don’t have to give me the exact code, you can give me the description. I know it’s going to take too long decode all this out, but we have asymptomatic … that’s pretty easy, right? You’re 7 1, we’re just going to code ….
41:11 And that’s going to show us that the patient has covered without symptoms. A patient was diagnosed with acute cough, due to covert, what are we going to assign for that?
41:32 Mmm hmm.
41:34 So, I have most people just saying, for, OK, so, patient was diagnosed with acute cough due to …. Most of you are saying, just, you’re gonna assigned the Corvette, I have 1 or 2 of you saying that you’re going to assign the … plus cough. More of you are saying covert plus cough, OK, good. So, we don’t have a specific manifestation.
41:53 So, we’re, for this second one, we’re going to assign the … plus acute cough to show that the mate the manifestation or the sick or I should say the symptom of covert was the call if we don’t have any specific manifestations, but we do have the symptom of acute costs. OK, so next we have patient has a loss of taste and smell. The final diagnosis on this one was covert positive.
42:21 Are we going to assign just the covered code? Are we going to assign the covered code and the symptom code?
42:40 OK, good, so we’re going to assign this covert code followed by this, the symptom, the symptom of loss of taste, and smell, this answers on the next slide. I don’t remember the exact code off the top my head, but we’ll get to that patient presents with diarrhea due to covert. What about this one?
43:07 Diarrhea, due to covert.
43:19 OK, so I have one person saying, … plus the viral viral gastroenteritis. I have diarrhea, coven, plus diarrhea.
43:28 So, so, good, some of you seem to kind of get, kind of get my little kind of a trick question here. But if you index diarrhea viral, it will take you to viral enter right us. And we’ll go through that on the next upcoming slide, So that’s a bit of a trick question.
43:45 For those of us that may have coded that quite frequently, we know that diarrhea virus will co index to viral enteritis Obviously, we’re going to sequence the covert code first, right? Covert, followed by the Viral Enter, right us. Based on sequencing roles there, regardless if it’s a respiratory manifestation or not, the diarrhea was due to …. We’re going to assign the covert first, followed by the end to write code.
44:11 Next, we have patient presents with cough and found to have acute bronchitis due to …. So, are we going to sign the signs and symptoms and the acute bronchitis And the …, what are we going to do for this one?
44:37 OK, good, so for the next one, we’re not gonna assign the cough, right? Because we have a manifestation cough is a common manifestation or sorry, cough is a common symptom of acute bronchitis, so we’re not going to assign the cough separately. We’re going to assign coven followed by the manifestation of covert and it’s acute bronchitis, OK? So, patient is admitted with … pneumonia patient that was thought to have elevated liver function, tests due to covert.
45:10 What about that one?
45:16 OK, Yeah.
45:28 OK, so good, so we’re going to code the covert. We’re going to code followed by the pneumonia followed by the elevated Lefties Elevated … isn’t a manifestation or symptom of anything keep saying sorry, I keep saying manifestation so cool elevated LF Ts isn’t We don’t have a specific manifestation indicated on that line right here.
45:49 So, let’s take a look at the next line patient admitted with sepsis due to covert pneumonia found to have elevated Lefties It should sorry, that’s a it should say left He’s I think that auto correct it there due to acute hepatitis due to Covert Are we gonna assign the elevated LF Ts in this scenario?
46:10 Know, right, because we know the cause of the elevated LF Ts is acute hepatitis that’s integral, that symptom is integral to acute hepatitis.
46:20 Then what does it the only symptom patient has covalent their only sign or symptom is elevated liver enzymes?
46:38 OK, so for the second to last one, we’re gonna assign the sepsis first, right, Followed by …, followed by the coven Pneumonia.
46:47 Followed by the acute hepatitis code, The sepsis was present on admission. So that’s going to be, that’s going to be our principal. That’s one of the exclusions to our sequencing.
46:59 Then if the only the only symptom they have with … is the elevated liver enzymes, we’re going to code kogod followed by our elevated liver enzymes.
47:10 OK, so here’s the answer key we have, we talked about this asymptomatic covert, we just have the covert. We have patient diagnosed with acute cost due to covert. We have our covert followed by I.r.q. Cough, again, just to sum up, we don’t have a specific manifestation here. So we’re going to assign the costs.
47:26 Next, we have patient has a loss of taste and smell, the covert positive that’s the only sign or symptom that they have coded, we’re going to code the are 43 8 for loss of taste and smell. Patient presents with diarrhea. Due to …, we have our, our covert code followed by the 8 oh 8 3 9 other viral enteritis.
47:47 Of course, our Kobe is still the Principal Diagnosis, right. We’re gonna assign any additional manifestations as a secondary diagnosis patient, presents with cough and found to have acute bronchitis due. To …. We’re going to assign our covert code first followed by acute bronchitis.
48:04 Patient admitted with covert pneumonia, thought to have elevated liver function, tests you to covert. We’re going to have psi, sorry, I missed, I have a typo there. We have your 71 followed by J 12 82 pneumonia due to corona virus disease. And, we should also be coding the symptom of elevated liver function tests. I’ll fix this in the final draft.
48:24 Copy and paste issue. Sorry about that. So, a patient admitted with sepsis due to covert pneumonia, found to elevate, have elevated arrestees due to acute hepatitis due to …, we’re going to assign our other specified sepsis. That’s another issue that I see is coders, coding, unspecified sepsis. If they have covered sepsis, We’re going to code 840, 189.
48:43 We have our …, 71, R J 12, 82, and then R B, 17.8, other specified acute viral hepatitis. And we’re not going to assign the are 74, 8, in this particular case.
48:57 And it depends on the liver enzymes that are elevated. If it’s trans am the eidos, we have a specific code for that. if it’s …. We have another a different code for that. This is just non-specific.
49:09 So we would assign, in that case, that’s the only manifestation of …. We’re going to assign the R 74 8.
49:23 Yes.
49:26 OK, so let’s go talk kind of dive a little bit even deeper into Cove some kovats scenarios.
49:33 These are real coding questions, and I want to get everyone’s take on them.
49:40 The question that I have on this case before we walk through it is should PE or … for this encounter because Cove is without respiratory manifestations.
49:50 So this seems to be kind of a theme with a lot of the questions that I get. If there are non respiratory manifestations, does that mean that we can’t use covert as our principle?
50:01 And I think that kind of stems from the fact that the PD X goes to a respiratory DRG if we use coven it as our If we use covered as our principal diagnosis.
50:12 However, based on coding guidelines, what does everyone think our answer is going to be? Let’s just take a look at the documentation.
50:20 This is just a synopsis, but just to kind of get our, the thought, our thoughts going and kind of give a quick scenario, the patient was admitted from 1 18 to 126. Upon arrival to the ED, the patient was found to have bilateral feet … and sudden involuntary movements jerking, of upper bilateral limbs, hence, neurology was consulted.
50:40 The chief complaint is weakness, and with lethargy and weakness also has jerky movements and family curious of Parkinson’s disease, presenting to the ED with increased weakness and fatigue for the last four days. She also notes decreased appetite and tremors to her hands and feet. She was hospitalized three weeks ago with encephalopathy. She takes input will Pfeiffer depression. She just stopped taking her lunesta, denies fever, headaches cough and other acute symptoms. No other known modifying factors. The hospital course was complicated by Bilateral PE. Patient was initiated on Heparin Drip EEG, abnormal due to try basic waves, which could be seen in neuronal dysfunction from toxic metabolic causes, Patient has covered 19 positive, which is most likely the etiology or for Maya CONUS. Emitted emitted once 18 to 126 patient with covert positive test results, patient did not require oxygen. Therefore, not a candidate for … or … zone. Patient was a-fib rail without any chest pain, shortness of breath, headache, or fever.
51:39 Workup positive for sars cov at two. Pieces coven 19 Positive, which is most likely the etiology of or my CONUS CTA chess with incidental finding a bilateral PE’s, hospital course was complicated, bilateral, PE’s, patient was initiated on Heparin drip show. So, what is everyone’s thoughts on this?
52:02 Let me go kind of go back up here and see what everyone’s thinking.
52:06 So, covert as the … followed by …, as long as the Uncertain Diagnosis President on discharge, PE, secondary. Covered is the … or secondary monoclonal was prompted the admission and after study it was a tribute to covert non respiratory manifestation. So, it looks like we’re kind of on the same page here, that the reason for the admission was the Maya Colonus.
52:27 Again, This is a quick synopsis and they were happened to find, happened to happened to found to be PE, have incidental PE’s. It wasn’t really the reason for admission.
52:37 It was found after admission, um, even though even so, it’s probably the PE is probably most, probably due to the Cove in 19 2, although it’s not stated.
52:49 So, that would, you know, that kind of throws a little bit of a, you know, if we had to consider that. We can also consider, you know, a query if that was the only thing that came in, and we weren’t sure if it was due to … or some other issue the patient has. But in this case, they’re linking their presentation to The Cove it. It’s a non respiratory manifestation, it’s not sepsis or camp complication of a transplant, our OB patient. So we’re still gonna go with …, as our PD X in this case. So not, again, I’m gonna re-iterate this not because just because someone present has positive …
53:24 on admission doesn’t mean that we have to use as the Principal Diagnosis, But in this case, they’re presenting symptoms were attributed to coven.
53:32 And after study, that was the cause of their presentation.
53:40 OK, so, let’s go to the next scenario OK, this is another scenario regarding requesting a PBX, opinion patient is diagnosed with … with positive covert test, no respiratory signs, and symptoms are found. Patient underwent one treatment upfront doesn’t mirror, and was discontinued due to increased creatinine level, patient diagnosed with acute renal failure. With acute critical necrosis, encoded associated Nephropathy patient then underwent a tunnel that in multiple dialysis sessions, renal, an infectious disease consultations were done patient with was treated with … Zone for covert infection. Would you still Code 0 7? 1 is the PBX if so DRG has mapped to 177 respiratory infection and inflammation with MCC even though there is no respiratory symptomatology.
54:26 So what does everyone’s thoughts on this?
54:28 Again, it’s a similar question along the same vein as the previous question.
54:47 OK, good so covert is still the PDA X. I mean I put this up here just to see the difference in relative weights.
54:54 The relative weight, and you know, we’re not this isn’t how we’re only going to make our, our PD X decision here. We’re making our PD X decision here based on coding guidelines, right? And we’re not gonna just optimize to optimize, we’re looking to say, OK, they were admitted for HAI and … after study this AKA I was thought to be due to covert.
55:17 They are hard to find, to have covert associated nephropathy.
55:21 So, based on our coding guidelines, you can also take a look at the code book and say, Use additional code which advises sequencing, right? We’re gonna use additional codes to identify pneumonia or other manifestations. It’s not just respiratory, manifestations, but if we were to go back to our coding guidelines, regardless if it’s a respiratory manifestation or a non respiratory manifestation with, you know, obviously we have those exceptions, sepsis, obie, et cetera.
55:45 Know we’re still going to code covert as the Principal diagnosis followed by our manifestations, which, in this case, happened to be, AKA with acute cortical necrosis, we have our ….
55:54 We have our, I thought that covert associated Nephropathy would code to N 0 8.
56:03 It includes … disorders and diseases classified elsewhere, so it includes nephropathy as well, so I thought that would be a good code to capture that covert associated nephropathy. So even though it’s mapping to our DRG 7277 respiratory infection and inflammation, that is still the correct DRG assignment that obviously MS DRG assignment.
56:27 In this case, for this, this scenario.
56:38 I have another case, so, someone was saying, oh, I didn’t see there was an association. We have another case.
56:45 Well, before we get to the other case, we do have some, other, if you’re no questioning yourself about, you know, it’s a non respiratory condition. We do have other coding clinics, and frequently asked questions, that talk about maybe the patient was had some underlying skin failure. This isn’t a respiratory manifestation, but we have a, you know, your, 71, and we have micro, no skin failure due to underline coagulate empathy and microvascular changes due to … 18. We’re still going to code your 71, followed by R D 68, 8.
57:19 In this case, and then … Inflammation of coven 19, associated with …. Euro 71, followed by D 68 8. So, we still have some other, you know, if you’re still on the fence about that, we still have some. Definitely use your references and say, OK, if I’m falling on my coding guidelines we have, I’m definitely going to be coding covert in this case, as our Principal diagnosis.
57:40 So, let’s take a look at another, um, a couple of other scenarios, so patient presented to the ED due to abdominal pain, found to have a PD kath related peritonitis and with an adhesion.
57:52 So, they’re on parity parity, peritoneal dialysis. And they’ve, they’re coming in for peritoneal dialysis, catheter related peritonitis and adhesions. They took them to the OR for lists of adhesions. The patient happened to also test positive for covert in 19 Documentation states The patient is asymptomatic … infection. My question is, would Cove in 19 … based on CC Sequencing Up Coding coven 19 Code?
58:27 And, this is where we see issues were coders are coding Cove in 19 as our Principal Diagnosis, when it’s not the reason for admission. So, the reason for admission wasn’t Cove at 19. They actually have asymptomatic Cove at 19. We’re not going to assign covert 19 in this particular case, as our principal diagnosis. You want to be make sure that that’s why they’re being admitted.
58:50 They receive inpatient care for cov at 19 for us. Just sign that as the Principal Diagnosis.
58:56 The specific Coding Clinic Reference, when a peak coding 19 meets the definition, so it says, it has to meet the definition of principle or first listed code, you’re 71, If it does, then we should sequence at first. Obviously, we have some other guidelines like obstetric sepsis or transplant complication. However, if Kobe does not meet the definition of principle of first listed, no developed after admission, in this case it was asymptomatic. Then you’re 71 can be used as a secondary diagnosis. So we still have issues and questions. On this scenario, I have another one.
59:28 This is a little bit longer.
59:30 Would you link the AQI to co Vid In this account, when the discharge summary saying came to the ER with symptoms from … infection and blood test showed acute, worsening of renal failure. So they came to the ED with symptoms of covert, but the blood tests showed acute renal failure worsening of acute renal failure nephrology documents. It’s likely associated with some hypoglycemia from his recent illness, Possibly a further progression of his underlying disease, cannot be ruled out. The patient at a tunnel cath, So my DRG options are 177,673. So, this patient was admitted with AKA I. they have Stage four chronic kidney disease, hypertensive, renal disease. They also have IGA nephropathy, this was the patient was already being evaluated for kidney transplant. They recommended IV fluids with Bicarb Trend Creatinine in urine output Avoid never toxins hold … there, on Cove in 19 Airborne isolation, Supportive care with anti tough serves. No pneumonia on chest X-ray saturating well does not qualify for any treatment at this time.
60:29 We see the nephrology progress notes here listing their bun and creatinine. You can see it trending up there. Acute deterioration is most likely associated with some hypo … from his recent illness. Possibility of further progression of his underlying disease cannot be ruled out.
60:46 Discuss with the patient that he needed renal support with dialysis initiated during this hospitalization. He consented. Tunnel dialysis catheter was placed. First dialysis was, given unto eight IGA nephropathy biopsy proven on 25, 2010, …, treat it medically in emergency room, et cetera, et cetera. Covert infection. No pneumonia. On the Chest X-ray, he has received coven 19 vaccine, but has not yet received the booster. Or symptoms are dry and sore throat, not relieved by ….
61:19 So what does everyone’s thoughts on this?
61:23 Do you see any link to The Cove, it should cov, it’d be the Principal Diagnosis.
61:43 OK, so most people are saying the HAI is what prompted the admission.
61:49 Do we know if the …, There is a note in that says, maybe it’s due to his recent illness, but it doesn’t say it’s, it’s due to his recent illness, it says, hypo Alenia. So maybe the patient wasn’t eating and drinking enough, and that’s what led to his acute deterioration. We have more documentation, actually.
62:07 So it goes on the list, AKA ….
62:10 He does have an IGA Nephropathy hospital course, you know, after study, he presented to the hospital for Covitz, I mean the ED for covert symptoms, but he was admitted for HAI. So they go on to say He has underlying IGA nephropathy biopsy proven. He’s developed progressive deterioration in his kidney function, and now has chronic kidney disease, Stage four.
62:36 Etcetera, he is, hospital course, he had AKA on chronic kidney disease due to Ivy GA Nephropathy. Heed the patient has advanced kidney disease due to IGA, Nephropathy, came to the ER with symptoms from covert and blood test, showed acute, worsening of real function. Prior to the submission, he was in the process of trying to get evaluated for kidney transplant neurology, nephrology. Sorry, nephrology was consulted and recommended tunnel, dialysis, catheter, inserted dialysis. The patient was started on dialysis in. The hospital and Outpatient Dialysis was Arranged coven. 19. He has no evidence of Pneumonia. He did not require any treatment Specific for coven 19, He remained in covert isolation. So it does look like he has covert. He’s actively infective with. Covert. He does have some thrombocytopenia possibly related to is … Acute, covert infection. So, we, obviously, we’re obviously going to be coding yo 71 now, Whether or not we’re coding your 71, is the Principal Diagnosis, is what’s in question. So, in my opinion, I don’t see enough documentation here to say that the AQI was due to coven.
63:35 So, you can query this or you can decide to say, Is this due to covert is this Judith progression, I mean, based on the discharge summary, I would probably not querying It looks like it’s it’s progression of his kidney disease from IGA Nephropathy. If there’s some additional documentation, of course, this is just a quick synopsis of the chart and you’re questioning on whether or not this is actually due to …? Then you can query, right.
63:59 And I think I see that being one of the, the larger the biggest issues with coding …, when we’re, not sure if the covert is causing the presenting symptoms, when they’re non respiratory in nature.
64:16 If there’s some confusion there, I mean, you could query, right? I mean, that’s kind of I don’t have time to go through our history versus Sequoia, but it kind of ties in to what I was talking about.
64:27 And this in that example is if we’re not sure we can query to confirm, is it?
64:34 Know, is it due to covert, is it not due to … for that? It is still an active infection. They’re still saying it’s an acute infection.
64:41 We just don’t know if the, AKA, I think AKA was the reason for admission, they’ve really had no other symptoms of …, there’s some mild symptoms, so they would probably wouldn’t have been admitted for that, but if the HAI was due to …, then, than it would be a possible principal diagnosis. Based on the discharge summary, again, they’re saying it’s progression of his HAI. Chronic kidney disease, IGA nephropathy on my read, but I can see, you know, there’s some hints here, and there, that it may be due to his recent covert.
65:10 They don’t specifically say that, but, um, the thought process may be due that it’s due to coven.
65:17 So, again, history of cov it.
65:23 Current …, those are things that I see as being one of our largest Bauer barriers at this point to accurate coding is the documentation. But let’s take a look at this one last case. I think we’re over time at this point. So if you need to go, you can leave, I’m going to finish this case and I’m going to end it here.
65:46 If covert is still considered current would be, it would be our only MCC per below. I’m reading the history of Covert or should I query to confirm since original quarantine was for 14 days. So this was a real example, tested positive for covert approximately 10 days ago and 14 day quarantine at a hotel, has significant clot burden throughout the SVG that we’re not able to completely clear. I wonder if this is due to recent covert infection.
66:11 The next progress No coven 19 Virus Infection tested positive 10 days ago So I’m kind of looking to see, do they still haven’t have the current covert infection? Is that acute infection?
66:22 They say, has been without symptoms for greater than five days. Therefore, contact precautions are not needed.
66:28 Discharge diagnosis: acute MI left heart cath with findings of thrombolytic occlusion of SVG to the … and then into the posterior lateral branch. Possibly also with a small segment to the …
66:37 status, suppose angioplasty, Thrombectomy and TPA, coven 19 virus infection tested positive 10 days ago out of the 5 to 10 day quarantine period. So to me, I’m reading that says, non non infectious.
66:49 So I’m going to be coding this, as either a history of or sequela, that thrombolytic.
66:55 Um, am I is, due to the old covert infection, they’re not currently infective. They say they’re out of the quarantine period, They’re not in isolation. So to me, that’s saying that they’re no longer infective if they’re not on contact precautions. So again, we really want to scour that documentation and determine, is this really a current covert infection?
67:19 Is it a history of, is it a …, And I think, again, that’s where I think the biggest challenges in the documentation. Sometimes. When I review charts with coders, I can find that information. Sometimes it’s not clear. So a lot of actually, I should say at least 50% of the time it’s not 100% clear if the patient is still actively infective.
67:37 But some of the things, what are some of the things that you guys look for as a group to determine if if something is an active covert infection or not?
67:54 In the setting of a positive test, we know they have a positive test.
68:01 And I have many more scenarios. We obviously don’t have time for all of the scenarios. And they were addressed encoding Connect. So what I’m going to recommend is, as a team, individually, as a team, I know we have a lot of organizations that come come on this call together. You can talk about these scenarios. And follow and go over these in detail about, you know, are these late effects Sequoia codes are these history of codes. There’s different scenarios and we’ve talked about these scenarios actually in a previous roundtable.
68:36 So, there’s more discussion on these, And I’ve, I probably, I’ve gone over these, probably quite a few times already, but there are different answers to these questions about, no, if they do, still have a positive test to be coded as, you know, pause it, Do we code it as a current infection? A history of, for example, this patient, we’re still positive, But they’re saying they’re non infectious, so we’re not going to code it as a current covert infection. We’re going to code it as the 86, 1 6. So definitely review these.
69:13 And again, I don’t really think it’s that we don’t understand the guidelines when we get these wrong, I think it’s more the documentation, and not being able to tell if it’s an Active coven infection or not.
69:24 OK, so going back to my original question about, how do you guys determine if it’s an active infection or not? So, yes, of course, you’re gonna look, I kind of gave it away a little bit, but, active treatment. So, are they on resume or are they on … zone? I mean, they could be on steroids for you know post infectious?
69:46 Things too, are they on isolation are they on contact precautions?
69:59 Oh!
70:13 We have, I actually have a, you know, long haul Kobe. There’s actually a guidance on that already So is it still current covert infection versus is it Sequoyah of …?
70:26 You know, we all have these different scenarios.
70:32 But it really comes down to documentation.
70:36 To me if you’re unsure, we’re going to ask for clarification. If it’s viral shedding, we have guidance on that. If it’s long haul Covert, we have guidance on that. If we’re not clear, if it’s an active infection, we need to ask for clarification. A lot of times, as mentioned, you can kind of tell by, you know, is it active treatment? Is, are they still in isolation? Do they say they’re not no longer infectious? But they’re treating I don’t know the sequela of cardiomyopathy due to …. Are they working them up for a transplant? Because they have this end stage heart failure, Are they, you know, et cetera?
71:09 It obviously can dramatically change your coding, whether you use covert as your Principal Diagnosis, if you use, as, you know, as it, even as a secondary diagnosis. Is it a late effect of, you know, is it versus a late effect versus the history of the can affect our MRC or G assignment acreage report? No effect reporting.
71:30 So, there’s a lot of things to consider, and I think it’s a lot of a lot of information. That’s a lot of documentation issues. This is what I’m kind of seeing when I’m looking at cases with coders. I think a lot of us understand the guidelines, and it’s more about getting to the bottom of it. Is it still an active infection, or not?
71:54 OK, so I’m gonna end it here, with our scenarios.
71:59 Again, these additional scenarios, we’ve talked about these on previous roundtable’s, I’m having a request to go over different other Items for coven, we can I can obviously take note of that.
72:10 And we can potentially discuss that in third quarter. So I’m gonna write these down. So third quarter, this is actually a very hot topic or it’s been a hot topic for, I guess, the last two years. So long haul. Cove Ed is one of the topics, as I mentioned earlier in the presentation, at the start of the presentation. Please wait to this presentation is over to download the CEUs. They need to upload the new CEU after the presentation is over. So the timing you may need to wait a little bit to download that CEU.
72:46 So let me get spend a little bit of time on questions.
72:53 OK, so we use … due to the exposure guideline for being in a pandemic, but was wondering, would it be appropriate to start using the screening covert code now? so they didn’t. So, as I mentioned earlier, in the presentation, they didn’t change that guideline as of April first, so I’m going to say, no, we should can still consider. We should still be following the current guideline of for screening our testing, and using the Z 28 2 2.
73:17 And I do have a couple of typos that I need to fix, so I wrote that down. So you can, when you get the e-mail, you can download the updated copy.
73:25 Um.
73:29 OK, so I have long Additional discussion of Long Haul coven. I wrote that down.
73:38 OK, so, what about weakness ambulatory disfunction did a long haul covert so that sounds like a …, right? I mean, if you guys want to add your opinion, if they are coming in for?
73:50 I have to search. I think I have something on that in here.
73:55 I have to find it. I kind of went all over the place here in this section.
74:01 Um!
74:05 Here’s a pie. The Critical Illness Myopathy. OK, so here’s a recent updated coding guidance, and this is the frequently asked question.
74:13 So, Post … syndrome, they have generalized weakness and lack of appetite. How are we going to code this so updated? October first, 2021, we’re going to code the symptoms followed by the … 99 code for the post … syndrome. assuming that it’s when they say long haul, covert in this sense, it’s no longer infectious covered. Obviously, if it’s infectious …, we’re still going to code the U of 71. That’s going to be dependent on your specific documentation.
74:52 OK, so if they have a positive covert tests, don’t we always need to code it as current. So I didn’t get to that, so that’s, that’s all in this section.
75:02 So do we, I mean if anyone wants to answer that, do we always code positive if we just have a causative test and they say no longer infectious date. We have advice that says that because they say it’s no longer infectious. We’re not going to code it as cope as yo 71, So there’s a few different scenarios in this guidelines. I recommend reading your frequently asked questions from AHIMA, the HA, your coding clinic, they, they published this back in, and I think, August of 2021.
75:31 And some of these are effective October first, as well, but based on the new codes that we had come out, but they addressed a lot of these questions that you’re asking in these questions.
75:47 Millimeter.
75:50 Oh, that’s another good point. So going back to the acute renal failure is it a is it a sequela of the …? I think in that case, they said it was still cute Corvid.
76:05 Someone mentioned that in one of the, it says, Z 18, 3 10, that’s just a typo.
76:10 So, if you see a typo, it should be 2, 8, not 1, 8.
76:17 Um.
76:27 Yes.
76:30 I see.
76:38 I have someone just reiterating the abnormal findings for symptoms. Although categories are 70 through our 97 in Chapter 18 are provided for coding non-specific and findings is really appropriate to assign one of these codes for an acute inpatient hospital stay. There signed when the physician has not been able to arrive at a definitive related diagnosis enlisted abnormal finding itself as a diagnosis and to the condition meets that. Obviously it has to meet the definition.
77:04 We have guidance for covert about coding the Manifestations separately to show, you know, the specific symptoms of ….
77:16 But thank you for sharing that, So if they have a positive covert test in the ED and they less positive covert test, we can obviously code positive covert if that’s all the documentation we have, you can code your 71.
77:36 I don’t know, I’m not sure some of some people are.
77:42 I’m not sure this is way too long. If you guys have a specific scenario you want me to address, you’re going to have to send me an e-mail.
77:50 Some of these are very long synopsys’s I can’t read. Read the whole thing through this question and answer.
78:05 My employer always makes the assumption of Coville wasn’t treated, that we would have coded that AKA in the AKA scenario, mean, they did treat the HAI independently. But as Judith Covert, I mean, how are they going to, I mean, there’s different treatments for different manifestations of covert. So, I’m not sure I 100% agree with that. If they’re saying, it’s coded related than, and they’re treating it with dialysis. And I would still be coding that coded as the principal diagnosis.
78:45 So, a guess someone mentioned, I just it was a typo, guys, for that covert with pneumonia and elevated Lefties, I accidentally left it off when I was copying and pasting it.
78:54 So, like I said earlier, I’ll fix that.
79:00 All right, so I’m going to end it here. If you have specific questions, you’ll have to e-mail me, I will take the suggestion to do another one of these addressing posta … syndrome, long haul covered in the future.
79:16 For time purposes, I do have to end it now, However, Um, so, again, if you do have a question that I didn’t get to, please, please let me know. Um, but I, again, thank you for everyone for attending, and we’ll talk next time. Thank you so much. Take care. Bye.