Now I’d like to go through a couple of exercises that are not in your Coding Handbook because
I think they're good practice for reading a
little bit more than one line and asking the questions that you have to ask to know how
to code diagnoses.
In this scenario a sixty-year-old female patient has a shortened right leg tibia
that is of unequal length compared to her left leg.
The deformity of her right lower extremity is a result of the fact that she
had acute poliomyelitis when she was three years old.
So what is the residual condition in this case?
The residual condition is the deformity of the right tibia that is an unequal
length compared to the left tibia and the deformity is the result of a sequelae.
The deformity is the result or the sequelae of the past
polio that she had as a child.
So that past polio infection would be coded as a sequela.
So in our path way, we begin with the main term deformity, next term limb, acquired.
In other words, it was not something she was
born with.
If she had been born with that shortened length, that would be congenital.
Acquired, unequal length, short sight is the Tibia.
Takes us to code M21.76 -, that dash meaning we need an additional character.
So first let’s start with our alphabetic index.
We start with deformity and we go down until we get to limb.
Here’s limb, go over another indentation and were looking for unequal
length.
Here we go, unequal length.
Short site is, we know from our literature, it is
the tibia and here’s the tibia M21.76- both
the dash and this little black box with the white check mark mean additional character(s)
(needed), character or characters are needed.
So we then go our tabular.
Unequal limb length acquired tibia and fibula.
You notice that this category code right here is for the tibia and the fibula
but we also notice that a 6th character is needed, 5 characters are given, a 6th
character is needed.
So we're going to read through these subterms and codes until we
get to what we want and in this case the first one is what we want.
It’s her right tibia.
So our full code is M21.761.
The next thing we have to look for is the sequelae of the polio.
So that is going to be the main term sequelae, sub term poliomyelitis
B91.
So let’s go to our alphabetical index, in here we are under sequelae.
We’re going to go all the way to the P’s, poliomyelitis
B91.
So now we’re going to go back in your tabular to B91 and it’s a very simple in
this case code.
Sequelae of poliomyelitis.
So B91 is the correct code in this situation.
I want to bring to your attention here though this little Excludes 1 note.
If you remember, Excludes 1, you cannot use both the B91
and the G14 code.
So you would have to examine your documentation and be sure that your coding
the right thing.
If your doctor has documented post-polio syndrome, that is a different diagnosis
than sequelae of poliomyelitis.
So just kind of be aware of that.
So back to our problem here.
We have added our 6th character of "1", because we’re
talking about this patient’s right tibia and we have our sequela code from B91.
And which coding guideline helped me with that?
Coding guideline I.B.10, which is just as simple as the coding of a sequela generally
requires two codes.
The first code is the condition or the nature of the sequela, which in our
case was the shortened leg length on the right tibia and the sequela code B91 is the second
code.
So your guideline gives you sequence then advice, not advice but a rule, a sequencing
rule and tells you which goes goes first.
Here’s another exercise, not in your Coding Handbook, that I just want to talk about because
it is important and it helps you to know that for the most part, 99.9% of the time you’re
only going to use physician documentation when you're coding.
But there’s a few situations where you are allowed to use the documentation
from other providers of care because their documentation is more specific.
And this is the case that I’ve chosen to illustrate
this.
The physician is saying the thirty-six-year-old female is admitted for bariatric surgery with
a right heel ulcer.
Her admitting diagnosis is severe obesity due to excess calories and
a right foot ulcer.
If you only had that information to go by, you could not gauge the depth or
the stage of that right heel ulcer, which is important
in the situation of ulcers for many reasons, not the least of which are "present on admission"
diagnoses which we talk about as you become more familiar
with coding in hospitals.The hospitals have to report what a patient comes in with,
what stage of an ulcer, for example, they come
in with and if that ulcer gets worse, (a payer) (like) Medicare's not going to pay for something
that happens in a hospital that the patient didn’t come in with.
So in this case the staging of an ulcer is very important.
It’s also a more complete documented record when
the patient’s BMI, body mass index, has been documented and the dietician, as a normal
part of his or her role, is going to document the patient’s BMI on his or her report.
And the nurses are going to document what stage a pressure ulcer is.
So we know from the guidelines that we can use this documentation.
(We use) dietician documentation for the BMI and the
nursing documentation for the stage of the ulcer.
And here’s the full guideline that helps us know that.
It’s Coding Guideline 1.B.14 for the body mass index or BMI, the
depth of non-pressure ulcers--this should be 'non'
pressure ulcers.
Code assignment may be based on medical record
documentation from clinicians who are not the patient’s provider since this information
is typically provided by other clinicians.
And as I mentioned earlier the dietician often documents the BMI, the nurses often pressure
ulcer stages.
However, the associated diagnoses with these conditions such as a patient’s
being overweight, obese, or having a pressure ulcer
must be documented by provider.
So yes you’re going to be able dig deeper in these specific
cases but you don’t get your diagnosis from those cases.
So here’s our final codes and I just wanted to go through these with you.
Obesity severe.
Ok we're going to go to the Alphabetical Index, here’s obesity, we go down to severe and
it’s E66.01.
Notice also morbid E66.01, those words are sometimes used interchangeably
and also the doctor did mention it was due to excess calories.
Which again is the same code, E66.01.
So then we go to our Tabular look up E66.01.
E66.01 morbid or severe obesity due to excess calories.
So that is the correct code for the obesity.
Go in our Alphabetical Index, we're under ulcer,
pressure.
I’m looking for stage three, stage one, stage two, stage three, heel, L89.6-
the dash, meaning we need more characters and
also that little icon, the black box with white check mark.
We need more characters.
So let’s look up L89.6 in our tabular, and here we are, stage one, stage two, we need
stage three.
Let’s go to the next page.
Okay, pressure ulcer of the right heel stage three, L89.613,
I think that would fulfill our need for more characters.
Yep, that’s it right there, L89.613.
And back in our Tabular, body mass index, forty or greater Z68.42 is BMI in the
range of 45 to 45.9.
So that is the correct code right there.
Alright that’s all I’m going to show you for Chapter 7.
Please work through those exercises.
You do not submit the exercises from the Handbook.
Let’s also remember that in week two there is exam one.
Exam one covers Chapters 1 through 7 in the Coding Handbook
and that includes the ICD-10 guidelines and conventions.
If you have any problems or questions about other exercises in Chapter 7. you
can post them in the discussion board or contact me personally and I will walk you through
how to get those answers.
Thank you so much, Have a good week.