Today we're going to look at Chapter 17 in the Coding Handbook.
Chapter 17 corresponds to Chapter 3 in our code book.
If we think of anemia three ways, it helps us to know how to code it.
There's blood loss anemia.
There's anemia caused by factors that influence red blood cell production.
And there's anemia that caused by the red blood cells being destroyed by an illness
or a disorder.
It's a good idea for you to review not only the PowerPoints that have been created by
the author of the textbook, but also these podcasts that I am giving you because it's
additional information not found in the textbook that I think supplements what
she has said and helps you better understand what the highlights of the text are.
I have a couple of slides here about coding from the documentation just to remind you
as a coder or future coder that acute blood loss during surgery is not necessarily a complication
and you don't code that as a complication unless the physician has identified it as
such.
And just because someone gets a transfusion during surgery is not an indication to you
as a coder that you should be coding anemia.
If you notice on a lab report that it certainly looks like someone has anemia, you don't code
from that (lab report)
If you think you have sufficient evidence to ask a doctor if a code should be included,
then you would have a query.
But you do not, as a coder, have that freedom to code (from a lab report).
And don't forget that anemia due to chemo is not the same as aplastic anemia due to
chemo, which is coded to a specific D61.1 code.
Our first exercise, Exercise 17.2 #3, post hemorrhagic anemia due to acute blood
loss following the perforation of a chronic bleeding duodenal ulcer.
So I have here, on the right, your pathway for how
you're going to get to these codes.
So let's take a look at the Alphabetical Index.
We're in anemia.
We go down to post hemorrhagic acute, D62.
And we look up D62 in the Tabular and we see acute hemorrhagic anemia.
Note that the code's Excludes 1 (note).
The patient cannot have acute hemorrhagic anemia and anemia due to a chronic blood loss.
Two different things.
So you're always going to be very mindful of your Excludes 1 or Excludes 2 or any
instructional notes.
Instructional notes are usually in a red font to get your attention at the beginning of
the category.
In finding our second code, we're in the Alphabetical Index under ulcer, duodenal with acute chronic.
I think we're going to look at chronic with
hemorrhage and perforation, K26.6.
So we're going to look now.
And we're in our Tabular K26.6 chronic or unspecified duodenal ulcer with both hemorrhage
and perforation.
So let's look at another exercise.
This would be exercise 17.3 #4, pancytopenia related to methotrexate therapy for rheumatoid
arthritis, initial encounter.
Just as a clarification or maybe something you don't know, if a patient is taking a medication
as prescribed, that's an adverse effect.
If a patient were taking more of something than they should be, than was prescribed,
that is a poisoning; and if a patient is not taking as much as was prescribed that's an
under-dosing.
So those are three different columns under the T codes that we need to be mindful of.
Okay.
Here is our pathway.
Pancytopenia, drug induced gives us D61.811.
If we go to the Table of Drugs and Chemicals, looking up the substance methotrexate, we
get the T45 code, and then we look up our rheumatoid arthritis.
That gives us an M06.1.
I'm sorry, M06.9 code.
I'm not going to go back and forth as much because I think as you have become more familiar
with the code book, I don't think I need to do that.
And we can spend more time on actually learning information that leads us to the right code.
Here is our next code, Exercise 17.5 #9.
Acute gastritis with hemorrhage, exacerbated by heparin therapy, initial encounter.
As I'm thinking of it, I am trying to give you, in the diagnosis, the type of encounter,
whether it's initial, subsequent or sequela.
In the real world in the medical record you would be reading the information and you would
be determining from the information if this was an initial encounter or a subsequent encounter
or we're treating this sequela.
But for the purposes of learning to code early on, I'm just going to give you that information
as part of the diagnosis.
So looking at our pathway in the right column, we have gastritis acute with bleeding.
Gives us K29.01.
And then because the patient is on heparin, we know we have to go to the Table of Drugs
and Chemicals and look up the adverse effect code for heparin.
And that gives us the T45.515A.
Here's an exercise not in the Coding Handbook.
As you know I like to give you some of these so that you have additional information that
helps you use the code book in a different way, perhaps than the Coding Handbook has.
In this diagnosis, the patient is treated for folate deficiency due to triamterene.
And triamterene is used as a diuretic for the treatment of hypertension.
So you're going to have to code the anemia, the T code for that drug, the adverse effect
of that drug, and the patient's hypertension.
And I take you here through some of the rationale, the pathway.
But I want to bring to your attention something that's different in this case.
When you're in the Alphabetical Index, think of the Alphabetical Index as getting you "in
the neighborhood" of the right code, but not necessarily "in the right house".
You have to always go back to the Tabular to find the code that best matches your documentation.
So if we were in the Alphabetical Index under anemia, folic acid, we would get this D52.9
code.
But then when we go to the Tabular I want to show you what happens.
So you see where the Alphabetical Index took us to the D52.9 code.
But we know that this patient is on a drug.
So really, this should be the right code, a drug induced folate deficiency anemia, and
this tells us, an instructional note (tells us) to use
additional code for adverse effect to identify the drug with the 5th or 6th character "5".
Some of the other codes we've looked at have not given us this additional instruction right
here for the 5th or 6th character.
So we're going to look up the adverse effect of this drug to see which T code works for
us.
So we're in the Table of Drugs and Chemicals, looking for triamterene,
and here it is.
And we want the adverse effects.
And here we go.
I believe it's that column.
Let's just double check ourselves.
The next to last column is adverse effects.
So, triamterene, T50.2X5.
And then the 7th character is our initial encounter.
And hypertension is as simple as I10.
So this is just a very good example and a reminder
to us that the Alphabetical (Index) gets us in the
neighborhood.
It might not get us in the right house.
So we always want to be very careful and always, always check the Tabular.
Here's another exercise not in the Coding Handbook, and it's just a reminder that you
would not code additional blood loss from a heart surgery unless the physician has documented
that this patient has a post hemorrhagic anemia because of all the blood that was lost during
this surgery.
Here's another exercise not in the Coding Handbook.
The patient has anemia and chronic kidney disease stage four.
We would go through these pathways and note that when you get to D63.1 in the code book.
There is an instructional note to code first the underlining chronic kidney disease.
So that helps us know how we would sequence these codes.
So the N18.4 would go first, and then the D63.1.
Next exercise not in the Coding Handbook, the patient is admitted for treatment of anemia
associated with an acute monocytic leukemia.
This is one that we've already done in our (Chapter) 29, but I just wanted to give you
another reminder that when anemia is due to malignancy
and a focus on this treatment is for the anemia, the focus is for the management of the anemia
due to the malignancy, according to our guideline we would code the malignancy first and the
anemia next.
If the patient was treated for anemia caused by chemo there's a guideline specific to that.
We would put the anemia first, then the cancer, then the adverse effect of the chemo.
So the order is different depending on how the patient is being treated and the guideline.
The guideline is what really guides us.
And in the previous slide this is how we got to the bladder cancer in the Table of Neoplasms.
And this is how we got to the adverse effects code for the chemo.
Chemo is coded as antineoplastic.
There's one we haven't coded yet.
The patient is being treated for aplastic anemia due to radiation for the cerebellum
or brain cancer.
The cerebellum is part of the brain.
So in the Table of Neoplasms you're going to
see it as brain as your primary term or main term,
and cerebellum as a sub term.
We have the aplastic anemia due to radiation has a very specific code.
And we know from our guideline exactly how to code this.
When admission is from management of anemia due to the radiation and the only treatment
is for the anemia, the anemia is sequenced first, followed by the code for the neoplasm
and code Y84.2 for the adverse effect.
Y84.2 is what's called an "External cause code"
and some hospitals do not report that.
But because it's in our guidelines I think I would report it until I'm told not to.
And the last thing I want to say is about studying for exams.
Always, always be mindful that the exercises we cover in the PowerPoints do not address
all of the information in the Coding Handbook, but your exam questions will relate to all
of that information and in the applicable guidelines that are covered in the chapters
for each week.
So you're always going to follow your assignment schedule with regard to which chapters are
assigned each week and which chapters will be covered on the exams.
Thank you, and I will see you next time.