Hi, this is Cindy.
I'm going to go over a few of the exercises from Chapter 7 in the Coding Handbook.
I won't go over all of them but I want to do a couple with you, so that you can
understand more and more how to use the Code Book, how to look up codes,
how to apply the Guidelines when you're assigning a code
and what I'm expecting from you on the exercises in the future, which you
will submit.
I will be toggling between this PowerPoint that I've created and the Code
Book.
The Code Book has the document camera on it and I'll try to make it as smooth as I can.
It isn't always as smooth as I would like it to be.
We'll start with exercise 7.1, # 1, which is Influenza with Gastroenteritis.
If we go to the Tabular, we're going to find
Influenza as our main term and then it will be indented
one level, "with", indented another level "gastroenteritis".
So, when you are looking for the pathway in the Answer Key for the exercises
that you will complete in this class this is how you will see
the way the Alphabetic Index looks.
Now I'm going to toggle to, here's our Code Book, and you see Influenza
"with" - "gastroenteritis" - J11. 2
So now that we have that code, we're going to go to
the Tabular and find J11.2 and what I've learned is moving the Code Book
and not the camera is the best way to go.
And, here is J11.2 "Influenza due to unidentified influenza virus
with gastrointestinal manifestation", so that is
the first one.
After you have found a code, before you assign that code, I want you to
be able to look at Guidelines and know how a certain Guideline might
guide you to selecting the right code.
The Guideline that I think addresses this particular exercise
is "Assign only the combination code when that code fully identifies
the diagnostic conditions involved or when the Alphabetic Index
so directs."
And, that is Coding Guideline 1.B.9 Let me go back to the Code Book just to be
sure everyone's on the same page.
When I'm talking about Guidelines, I'm talking about the Official Coding Guidelines
and under General Coding Guidelines which I mentioned,
it started with Roman numeral I.
This is where I get that from.
This is the one (I), and then you go to "B" which is your General
Coding Guidelines Here's "B", and then "9" is your Combination
Code here. So when you are, my suggestion is before
you start completing your exercise that you would read through the Guidelines
for a specific chapter, then look at your exercises, and, after you have
selected the codes, go back to the Guidelines just to make sure you're not
missing anything before you assign that final code.
Ok, the next one is exercise 7.2 #3
"combined spinal cord degeneration with anemia due to
a dietary vitamin B12 deficiency" The main term in this diagnosis is the degeneration.
Sometimes students ask me, "How do you know what the main term is?"
Well, you just start looking it up.
Just start looking up words, and if you don't find what you need with one term then go to
a different term until you find what you need.
I know that this one is degeneration.
Then "degeneration" is your main term, "combined" is your first sub-term, "with anemia-
due to dietary vitamin B12" 'D' fifty-one point three (D51.3).
You notice there's two codes here?
The first code is your etiology code, the second is your manifestation code.
So, let's go to the document camera and you see "degeneration" here
"combined spinal cord" - "with anemia" "due to dietary vitamin B12" and there's the
two codes.
We're going to look up both of those codes D51.3 and G32.0
D51.3, "Other dietary B12 dietary anemia..."
So if you wondering where is that "Other" what's that referring to?
Well, up above here, we talk about anemia "due to intrinsic factor deficiency", "anemia
due to selective vitamin B12 malabsorption problems",
"Transcobalamin II deficiency", which I've never heard of but there you go.
And, D51.3 is "Other dietary vitamin B12 deficiency anemia."
I said "D51.3" and I really shouldn't be saying that because someone, there may
be many characters in a code so I really should
be saying D51 "point", 3. or D61 "dot", 3.
However you prefer to refer to that dot or that point.
So, I will correct myself and say I should have said D51 "point" 3,
That would be your first code and then G32 is your
next code.
We'll look back here in the "G's".
And here is G32.
Right here, "Other degenerative disorders of the
nervous system and diseases classified elsewhere" And, you notice that this is called an Instructional
Note "Code first underlying disease" which we did
when we had our codes.
We had that "D" code first, that's the anemia.
You see here's some examples.
You code first your underlying disease then this code - G32.
Codes that have this phrase, "in diseases classified elsewhere", those
can never be used as a primary or a principal diagnosis.
They're always going to be a secondary diagnosis.
So let's go back and now let's look at what
Guidelines would work best.
And, this one is what I've selected.
Coding Guideline 1.A .13 and this is when "Certain conditions
have an underlying etiology and multiple body system manifestations
due to the underlying etiology" and this convention requires that underlying condition be sequenced
first followed by the manifestation.
This is what I've done and this is where I've quoted that Guideline.
The next diagnosis is "Diabetic neuralgia due to type 2 diabetes 'mellitus'
however you prefer to say that.
-Patient on insulin" I've heard it pronounced both ways.
I'm not sure which is correct.
I typically say 'mellitus' but whatever, I know what you mean.
We know, or you will know, from finding your diabetes codes
in the Alphabetic Index that they are classified by type
so, you can see here on the pathway Diabetes - type 2 - with - neuralgia takes
you to E11.42. So, let's go to
our Alphabetic Index and you see here "I", "M", "N"
Go all the way to the top, "diabetes type 2"
"with" - neuralgia E11.42.
I also want to bring to your attention, see my little note over here, this
is note I made when I was reviewing a Coding Clinic from
the first quarter of 2013 and the instructions were to code type 2
diabetes with ketoacidosis as E13.1-
Why is in here?
Because this was something that I noticed in Coding Clinic
that I had seen in some medical record documentation.
So to be sure that I didn't forget that this is how we'd
been instructed to code this, I put a note right here in these "with"
diagnoses here.
So, in future publications of ICD-10, ketoacidosis is going to go in here, right
in here, and it'll be identified or the coder will
know to use E13.1.
So, we're back to our code E11.42.
We're going to find that code in our Tabular.
Come over here...
E11.42 "Type 2 diabetes mellitus with diabetic polyneuropathy"
You may say polyneuropathy is not one of the words we were looking up.
No it isn't, but neuralgia is, and neuralgia is right here.
Whenever you see a descriptor under a code, it's just telling you
this is another way that you might see this expressed in a documentation
and is the same code E11.42.
Let's go back.
And we want to look at a patient on insulin.
We haven't coded any with the "Z" codes yet.
It's a good idea to not be afraid to start looking for codes even if it's outside
the chapter we're studying.
We're going to find long-term. So in our Alphabetic Index we're going to
look up long-term as our main term - drug therapy
- insulin Z79.4.
So, when we go over here
Long-term use go down until you get to insulin.
Z79.4.
Take that code, go all the way back to the back of the Code
Book to "Z" codes and all the way in the corner over here
we see, oops, here we go, long-term use of insulin
Z79.4.
So we know that those two codes are correct for this particular
diagnoses.
Neuralgia due to diabetes, patient on insulin.
Here's the Guideline that I've chosen to go with this
particular diagnosis, and that would be the combination code,
Coding Guideline 1.B.9, which is the same one we had used earlier.
So you know what I'm expecting when I say "pathway" this is what we're looking
at, when I say "rationale" this is what I'm looking at.
In this case it was a Guideline it could have been an
instructional note, or something like that.
The next diagnosis is "subacute and chronic pyelonephritis"
and I have a little note here to remind you that unless the index with the Tabular
indicates otherwise that the term "acute" and "subacute" are coded the same.
Our pathway, we're going to find the main term
of "pyelonephritis - acute" and "pyelonephritis - chronic", so we'll take
that we will go to the Alphabetic Index
we have "pyelonephritis" -I'm having trouble with that word today.
"acute" - is N10 - and "chronic" N11.9.
And you see how "acute" and "chronic" are at the same indentation level, that's
important.
You'll see that in the Guideline when we talk about it.
It's going to mention terms being at the same indentation level.
Now we'll go back in the Tabular and look up our codes.
Be sure we've got the right code.
Here is N10 and even though they use different words, our word is right here.
We know that this is the right code of the "acute pyelonephritis"
and then we come for chronic we're going to choose this one because
"not otherwise specified" (NOS), the codes above here talk about
specific places where the obstruction or inflammation might be.
Our documentation didn't give us any of that.
We're going to choose this less specific N11.9 code
for this diagnosis.
Now let's see what did I chose for the Guideline and it would be this one—Coding Guideline
1.B.8 "If the same condition is described as both
acute (subacute) and chronic, separate subentries exist in the Alphabetical
Index at the same indentation level, you code both and sequence
the acute code first."
Which we did.
We put our acute code N10 first, then our chronic code, N11.9, second.
Now of course if you were reading medical documentation
this would just be a phrase in a larger volume of documentation whether is was a History
and Physical, Discharge Summary, Operative Report, whatever it might be.
As you're learning to code we just give you these "oneliners", but little by little as you
become more comfortable with the Code Book, I will be giving you longer
exercises so you get used to reading medical record documentation and
knowing which terms need to be coded.
Next on we're going to look at is "cervicitis."
Okay, for "cervicitis" the diagnosis is "acute" and "chronic"
Our pathway is "cervicitis" as our main term, and "acute" and "chronic" on the same line
N72.
When we look at that in the Code Book you can see what I'm
talking about.
Here's "cervicitis, here's acute, here's chronic.
Both conditions have the same code "N72".
We'll look up that code and it's right here,
"inflammatory disease of the cervix uteri" N72.
Notice this "use additional code".
If we had been given the organism responsible for this
infection, or inflammation, we would code that and it would be somewhere in
this (B95–B97) category but we weren't given that
so in this case we don't code that.
Ok, that's what I'm going to do so far for Chapter 7 exercises.
I will do a second: Part 2 in the next recording.