The release of Coding Clinic 3^rd Quarter 2017 (effective with discharges which started on July 27, 2017) brought about the following key changes:

ICD-10-CM – Diagnosis Changes

Emaciation

• If the provider documents emaciated or emaciation, coders are instructed to assign code R64 – Cachexia
• For a coder to assign E43 – Severe protein-calorie malnutrition, the provider must document emaciated or emaciation due to malnutrition (it is not necessary to document severe)
• Even though the ICD-10 Index includes “due to malnutrition” as a non-essential modifier, Coding Clinic advises that further research needs to be done if the title of the code suggested by the Index does not identify the condition correctly

Severe Malnutrition

• If the provider documents severe malnutrition, coders are instructed to assign code E43 – Unspecified severe protein-calorie malnutrition
• Only code E42 – Kwashiorkor or E41 Marasmus if these conditions are specifically documented
• Kwashiorkor is a condition caused by severe protein deficiency that is usually seen in poor, underdeveloped countries, it is extremely rare in the US

GI Bleeding Secondary to Gastric Ulcer

• If a patient is admitted with a GI bleed and potential sources of the bleed are found, coders can now assume a cause and effect relationship between the GI bleed and the potential sources of the bleed
• This change is consistent with the revised “With” guideline found in the ICD-10-CM Official Guidelines for Coding and Reporting
• Previously providers were required to document a causal relationship between the GI bleed and potential bleeding sites to assign the combination codes

ICD-10-PCS – Procedure Change

Therapeutic and Diagnostic Paracentesis  

• If a diagnostic and therapeutic paracentesis are performed at the same time, only assign code 0W9G3ZZ – Drainage of peritoneal cavity, percutaneous approach
• The qualifier “X” is exclusively used for diagnostic procedures only
• If the diagnostic and therapeutic procedures use different approaches or samples from different sites, then two codes are required
• This new guidance finally settles the question of how to code a paracentesis that is both for therapeutic and diagnostic purposes
• It is now important to pay close attention if multiple paracenteses are performed to ensure that the correct procedure code qualifiers are assigned
• If the diagnostic qualifier is selected, the DRG will often shift from a Medical to Surgical DRG

Reference

1. AHA Coding Clinic ICD-10-CM/PCS – 3^rd Quarter 2017