AHA Coding Clinic 2nd Quarter 2018 – Key Highlights

Coding Clinic 2nd Quarter 2018 (effective with discharges starting June 6th)

Below are highlights from the latest release:

Diabetes Combination Codes – Not Elsewhere Classified (NEC)

  • As previously noted in Coding Clinic, 2nd Quarter 2016: Page 36, The subterm “with” in the Index should be interpreted as a link between diabetes and any of those conditions indented under the word “with”
  • For example, physician documentation does not need to provide a link between the diagnoses such as diabetes and chronic kidney disease to accurately assign code E11.22, Type 2 diabetes mellitus with diabetic chronic kidney disease
  • This link can be assumed since the chronic kidney disease is listed under the subterm “with”
  • These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated and due to some other underlying cause besides diabetes
  • For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions to code them as related
  • However, the exception to this rule is for conditions listed under “diabetes” that are NEC (e.g. neurologic complication NEC, skin complication NEC)
  • For example, if a patient is admitted with diabetes and cellulitis, coders cannot not assume the cellulitis is a complication of diabetes
  • Even though “skin complication NEC” is listed under diabetes, coders cannot assume all skin complications are related to diabetes based on the “NEC” classification
  • Conversely, if a patient is admitted with a “foot ulcer”, then it is assumed to be due to diabetes unless otherwise specified by the provider
  • For example, coders should assign E11.353 (diabetes with other skin complications) when diabetes is linked to a skin condition such as cellulitis using acceptable linking terms such as “with”, “due to” or “associated with”

Diabetes with Peripheral Angiopathy

  • Coding Clinic notes that E11.51 – Diabetes with diabetic peripheral angiopathy includes conditions such as peripheral arteriosclerosis, peripheral vascular disease and peripheral arterial disease

Carotid Artery Stenosis and Transient Ischemic Attack (TIA)

  • Coding Clinic advises coders not to code TIAs when due to carotid artery stenosis
  • There is an “Excludes1” note under category I65 – Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction that prohibits assigning codes in G45 -nonspecific precerebral artery insufficiency (which includes TIAs)
  • Even though TIA’s are present, since they are after study found to be due to carotid artery stenosis they are not coded
  • Generally, symptom codes from chapter 18 (e.g. R05, cough) are not coded when the underlying cause is found (e.g. cough due to pneumonia), so even though TIA (G45.9) is not a symptom code, it is not coded because of the excludes1 exception

Substance Use

  • Substance use such as opioid and marijuana should not be coded unless there is an associated physical, mental, or behavioral disorder documented by the provider
  • For example, provider documentation of “recreational marijuana use” should not be coded since there is no associated disorder noted

Osteoporotic Fractures – Traumatic vs Pathologic

  • Coding Clinic recommends that providers are queried for patients with a history of osteoporosis who sustain a fall resulting in a fracture as to whether or not the underlying cause of the fracture was due to osteoporosis or was non-osteoporotic (due to trauma)
  • Coders should not assume that fractures resulting from trauma in patients with osteoporosis are pathological in nature
  • If the provider indicates the fracture from a fall is due to osteoporosis more so than the trauma, a code from category M80 should be assigned
  • Per The Official Guidelines for Coding and Reporting, Section I. C. 13. D. 2. state “A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal healthy bone.”

Traumatic Subdural Hygroma

  • Subdural hygromas should be coded as G96.0, cerebrospinal fluid leaks (which is a CC)
  • Per Coding Clinic, a subdural hygroma, also called traumatic subdural hygroma, is a collection of cerebrospinal fluid in the subdural space that can occur following head injury, other possible causes may include but are not limited to congenital anomaly, neurologic surgery, and chronic subdural hematoma

Intra-Aortic Balloon Pump (IABP)

  • According to Coding Clinic, the IABP is not classified as a device, nor coded as a device in ICD-10-PCS and therefore should be coded by using the root operation “Assistance”
  • See Coding Clinic issue for examples of how to code IABP’s


  1. AHA Coding Clinic – 2nd Quarter 2018
  2. AHA Coding Clinic – 2nd Quarter 2016

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