AHA Coding Clinic 4th Quarter 2017 – Key Highlights

Coding Clinic 4th Quarter 2017 (effective with discharges starting October 1st) included the FY 2018 ICD-10-CM/PCS codeset updates (see article here), Official Guideline revisions, and question and answer coding guidance. Below are the key highlights:

Severe Sepsis Coding Guideline Change 

  • Physicians must document the relationship between sepsis and organ dysfunction to code severe sepsis
  • It is also appropriate to code severe sepsis when the provider documents “severe sepsis”
  • The Official Coding Guidelines were revised to reflect this (changes in bold)
    o …when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”).
    o For conditions not specifically linked by these relational terms in the classification or when a guideline requires that a linkage between two conditions be explicitly documented, provider documentation must link the conditions in order to code them as related.
  • The “with” guideline does not apply to the coding of severe sepsis

To ensure severe sepsis is captured accurately always make sure explicitly linking documentation is included in the medical record (e.g. “Sepsis with AKI”, “respiratory failure due to sepsis”, “SIRS due to pneumonia with respiratory failure)

Omitting ICD-10-CM Codes 

  • According to Coding Clinic, it is “not appropriate to develop internal polices to omit codes automatically when documentation does not meet clinical or diagnostic criteria”
  • Coding Clinic recommends that facilities “develop policies for querying providers for clarification to confirm a diagnosis that may not meet particular criteria”
  • “If after querying, the attending physician affirms a condition in spite of certain clinical parameters not being met, the facility should request the physician document the clinical rationale and be prepared to defend the condition if challenged in audit”

This guidance will surely lead to even more queries being sent to providers. It is more imperative than ever for CDI and medical staff to work together to ensure documentation is clear, consistent, and supported in the first place to avoid queries after documentation is already in the chart. Long gone are the days when coders were just instructed to “code what was documented.”

New Intestinal Obstruction Codes 

  • Intestinal obstructions now have subcategories for partial, complete, and unspecified obstruction
  • Postprocedural intestinal obstructions are now grouped to DRGs 390/391/392 – GI Obstruction, they were previously grouped to 395/394/393 – Other Digestive System Diagnoses
  • All the new intestinal obstruction codes are designated as CCs

The new codes are listed below:

  • K56.5- (Intestinal adhesions (bands) with obstruction)
     K56.50 – Unspecified (CC)
     K56.51 – Partial obstruction (CC)
     K56.52 – Complete obstruction (CC)
  • K56.6- (Other and unspecified intestinal obstruction)
     K56.600 – Unspecified (CC)
     K56.601 – Partial obstruction (CC)
     K56.609 – Complete obstruction (CC)
  • K56.69- (Other intestinal obstruction)
     K56.690 – Unspecified (CC)
     K56.691 – Partial obstruction (CC)
     K56.692 – Complete obstruction (CC)
  • K91.3- (Postprocedural intestinal obstruction)
     K56.30 – Unspecified (CC)
     K56.31 – Partial obstruction (CC)
     K56.32 – Complete obstruction (CC)

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