Hi, it’s Cindy, recording Part 2 of the Chapter
7 Handbook Exercises review.
I remembered after I closed Part one that I did not go over the guideline that would
be applicable in the case of acute and chronic cervicitis.
Each unique ICD-10-CM code may be reported once for an encounter.
So this applies to bilateral conditions when there are no distinct codes identifying laterality
or two different conditions, which is true in this case of acute of chronic
cervicitis.
Two different conditions classified to the same ICD-10-CM diagnosis code.
So in other words you only report it once and that's Coding Guideline 1.B.12.
Alright so now we’ll go to the next one.
And this is brain damage following cerebral abscess seven months ago.
Exercise 7-7 #3.
Looking at our pathway, "damage" is our main term.
Under Main is our sub term and it is non traumatic, because
it’s an abscess, it’s an illness.
It’s not an accident or a brain injury in the sense of someone being hit in the head
or sustaining a head injury in an accident.
So G93.9 is our code for the brain damage and then for the abscess we're actually going
to look up "sequela".
So let’s move to our document camera and here’s damage, brain, non-traumatic, G93.9.
So if we turn to G93.9 G93.9
It’s a very general code.
G93.9 disorders of the brain unspecified.
As unspecific as that diagnosis or that description is, it’s the best you’re going to do in
this category.
So G93.9 is correct for brain damage.
It’s the sequela of the abscess that’s most important to us.
So were going to go back and look up sequela.
Oh it’s the very first one, I’m making this too hard.
Ok.
Sequela of Abscess G.09.
What’s interesting about this and if I have the author of the text with us I would be
asking her this question.
Because it looks like abscess intracranial or intraspinal conditions in G06.
The sequela of those would be G09.
Now it may be that these are not exclusive.
There could be other sequela because our code was not G06.
Okay, so just a case in point.
Sometimes you do wonder how the author got the answers that she got and that’s ok to
question.
I can tell you when I give you an exam or an exercise, I will be able to defend to you
why I choose the answers I choose and that’s what I want you to be able to do as a coder.
Be able to defend why you selected a certain code.
So here’s our sequela code, G09.
Let’s go back in the tabular to G09.
Sequela of inflammatory diseases of the central nervous system and since the brain is considered
to be part of the central nervous system, this is the right code.
Again here is the same situation where I would be questioning this author because it says
G09 is to be used to indicate conditions whose primary classification is to G00 through
G08 as the cause, themselves classifiable elsewhere.
The sequela include conditions specified as residual.
So this part I still question a little bit but this part we have right.
Code the first condition resulting from the sequela of the inflammatory diseases.
So the first condition we coded was the brain damage and then here’s our sequela code.
So that might be something I will look through the Coding Clinics to see if I see any clarification
on that.
But that’s an example of where a coder might read something, have a medical record that
he or she is coding and send an e-mail to the Coding Clinic and ask for clarification.
That’s a good example.
Every day you learn something new right?
Now I want to talk about which guideline is applicable in this case and this is the one
I chose.
The coding of the sequela generally requires two codes, sequenced in the following order.
The condition or nature of the sequela is condition
first and sequela code is sequenced second.
Which is what we did here.
Our next exercise is 7-7 #12, borderline hypothyroidism.
And if we look up hypothyroidism in our index it is E03.9.
So let’s go there.
To our index and you can see.
Here is your hypothyroidism and were looking to see if there is a classification for borderline
hypothyroidism.
And there is not.
So this is or it doesn’t seem to be our code, so were gonna go back here and find
our code.
E039 and it is just hypothyroidism, unspecified.
This myxedema is a word that you occasionally see in the medical record documentations,
so just be aware of that word.
While I’m thinking of it, if you’re ever looking for a word or you run across a word
in the medical terms that don’t know.
I want to show you how you might find that word.
If you go into the address bar and type myxedema, put a colon after myxedema.
Swelling of the skin and underlying tissues giving a waxy consistency typical of patients
with underactive thyroid glands.
So myxedema is more of a condition because of hypothyroidism.
But just think of this sometimes when you’re looking up a quick medical term.
If you just go into your Google search engine, type in your word, put a colon after the word
and search, you get your definition.
And if you want to hear its pronouncement, you just hit this little megaphone.
Myxedema.
Isn’t that neat?
I use this tool probably at least once a day.
Looking up a word or it’s usually medical terms, because the medical literature is always
growing and no matter how much you know, new terms are coming on the horizon as well as
new medications, new chemicals being used in different chemotherapies.
So it’s just a good idea to use this as a search engine tool.
Alright, just wanted to show you that while I was thinking of it.
So back to borderline hypothyroidism.
Here is the guideline for that.
If the provider documents a borderline diagnosis at the time of discharge, the diagnosis is
coded as confirmed.
And this would be inpatient obviously.
Unless the classification provides a specific entry and we’ll go over that in just a few
minutes.
Borderline diabetes.
There is a code for borderline diabetes and this particular guideline is coding guideline
1.B.17.
And here’s that borderline diabetes that we were mentioning.
It is code xxxx but in the Alphabetical Index, it's
borderline, under that it's diabetes, under that is R73.09.
So if we go to the Alphabetical Index, our main term is borderline, and here’s diabetes
R73.09.
Someone brought to my attention, a professional coder brought to my attention
that if I’m using the main term borderline, there are five conditions (in the Index).
So it’s probably a good idea, if you’re going to be coding for a living, that when
you would see the term borderline in the documentation that you would know that it’s only for these
five conditions that there is a unique code for borderline.
Otherwise, that coding guideline applies, where borderline is not even considered in
your diagnosis.
You would just go to that main term.
So here we go R73.09, when we go back in the Tabular and look up R73.09.
We see it right here, so-- no, that's not right.
R73.09.
Here we go, R73.09 other abnormal glucose.
Prediabetes is one of those terms, so this is how borderline diabetes.
It’s not an E-code, which many of the diabetes codes are.
It’s rather an abnormal lab, an abnormal symptom code.
In this case, abnormal glucose.
And back to our guideline.
It’s the same guideline we used in the previous exercise but this one is related directly
to the borderline diabetes.
If the provider documents a borderline diagnosis at the time of discharge, the diagnosis is
coded as confirmed unless the classification provides a specific entry, for example borderline
diabetes.