FY 2017 IPPS and 2016 Coding Clinic – Top 7 Changes Coders and Physicians Need to Know About

The 4^th Quarter 2016 Coding Clinic and 2017 Inpatient Prospective Payment System (IPPS) final rule includes the most significant changes since the partial code freeze began on October 1^st 2012. Below is a list of the key changes that occurred to the codeset effective October 1^st, 2016.

1. Diabetes is automatically linked with subterms
   • Conditions listed under the subterm “with” should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the condition is unrelated and due to some other underlying cause besides diabetes.
   • Osteomyelitis has been added as a subterm under diabetes.

2. Hypertension and heart disease are automatically linked

• The classification assumes a relationship between hypertension and heart involvement and hypertension and kidney involvement as these conditions are linked with the term “with” in the Alphabetic Index.
• These conditions are coded as related in the absence of provider’s documentation explicitly relating them.

3. There are three new hypertension codes
   • Hypertensive urgency – I16.0
   • Hypertensive emergency – I16.1 (CC)
   • Hypertensive crisis – I16.9 (CC)
   • Physician Education Opportunity
     • Ensure physicians are documenting urgency, emergency, or crisis.
     • Malignant and accelerated hypertension no longer have unique ICD-10 codes; they are coded as unspecified hypertension when documented.

4. Pressure ulcers that progress require two codes
   • If a patient is admitted with a pressure ulcer at one stage and it progresses to a higher stage, two separate codes should be assigned: one code for the site and stage of the ulcer on admission and a second code for the same ulcer site and the highest stage reported during the stay.
   • The higher stage should be reported as not present on admission.
   • Physician Education Opportunity
     • To reduce compliance and quality scoring risks ensure all clinicians are aware of the new coding rules for pressure ulcer staging.
     • Ensuring accurate staging at the time of admission is now even more important.

5. Coma scale codes can be used for non-traumatic conditions
   • The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition.
   • Assign code R40.24, Glasgow coma scale, total score, when only the total score is documented in the medical record and not the individual score(s).
   • Physician Education Opportunity
     • To accurately capture patient acuity, ensure physicians are documenting Glasgow coma scales for patients with both traumatic and non-traumatic conditions (especially in the ICU).

6. Control root operation definition has changed
   • The root operation Control is defined as, “Stopping, or attempting to stop, postprocedural or other acute bleeding.”
   • If an attempt to stop postprocedural or other acute bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.
   • Example: Resection of spleen to stop bleeding is coded to Resection instead of Control.

7. Coronary artery procedures now identify arteries rather than sites
   • The coronary arteries are classified as a single body part that is further specified by number of arteries treated. One procedure code specifying multiple arteries is used when the same procedure is performed, including the same device and qualifier values.

Related Links

1. American Hospital Association “AHA”, Coding Clinic, 4^th Quarter, 2016
2. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2017-ICD-10-CM-Guidelines.pdf
3. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2017-Official-ICD-10-PCS-Coding-Guidelines.pdf