This one I want to bring to your attention because of how important it is to make sure
you’re using the right descriptors.
The diagnostic statement says irritant contact dermatitis due to cosmetics, but the – if
you look at your index, it’d be very easy for you to pick up on the H codes and not
the L code.
What the difference is that irritant.
The descriptor agitate irritant.
That is very important when assigning a code.
I put in a red font here so you can see what I’m talking about.
But I also wanted you to notice, under the L24 category code, there is an “excludes
to” note for dermatitis in the eyelid.
And those are those H codes.
So, since it is an “excludes to” note, that means we could code both the L code and
the H codes if the patient had both conditions.
The dermatitis due to an irritant, and the dermatitis due to allergies.
How a doctor would know the difference, I have no idea.
But, the code book tells us that because of that “excludes to” note, we could code
both at the same time.
Stevens - Johnson syndrome, Toxic Epidermal Overlap syndrome, skin exfoliation 10% of
the body surface.
Sevens-Johnson syndrome, and the erythema multiform disorders are the saddest things.
They are – the patient just has these boil like, and burns and excoriation all over their
bodies and they just suffer tremendously.
In this particular one, there is a – an instructional note that tells us to use additional
code to identify the percentage of skin exfoliation.
So, I wanted to make sure you were aware – once again, we’re going to always look at those
additional codes – use additional code or instructional note, and make sure that we
would code that exfoliation.
Because of the type of disorder this is, that exfoliation is where the body starts to really
– the skin is breaking down, and you got – it’s just peeling, peeling, peeling.
And the percent of body surface area, we give the physician a very good idea of what they’re
dealing with.
So, it’s just important to follow those instructional notes.
This is an example of a pressure ulcer.
Early in the PowerPoint, we coded a non-pressure ulcer.
And I bring this one to your attention because the – we are able to use the nursing documentation
that stages these ulcers when we are coding.
And – I quoted here, the general coding guidelines, 1B14, which is stating that documentation
for BMI non-pressure ulcers and pressure ulcers, code assignment can be based on medical record
documentation for clinicians who are not the patients provider.
You may remember, back when we were coding, BMI or body mass index, we were using the
nurses documentation, the patients BMI.
So, here we go with the skin, the non-pressure and pressure ulcers.
We can also use the nurses’ documentation for the staging, because that is part of our
code selection.
So, I have the pathway here on the right.
You can see how I got those codes and then the rationale we’ll look at on the next
slide, but I did want to bring to your attention this note about – instructional note for
the L89 category.
You are going to code first the gangrene.
Because that’s your most serious thing you have to deal with here.
Gangrene, if you don’t know, is just dead tissue.
And it is – it is not a good thing when you start having dead tissue in these ulcers.
It takes a lot longer for them to heal, to fill back in.
So, here’s the rationale for the previous slide.
The decubitus ulcers are classified as pressure ulcers, and the note at the category L89 indicates
that sequencing.
We just talked about the gangrene first.
Then you pressure ulcer at the hip, looking at – always going to the Tabular, to make
sure you’re selecting the right code when indicating the stage and the laterality.
And then the sacral region, stage two, and the sacral region includes the tailbone and
the coccyx.
Actually, the tailbone technically is the coccyx.
That’s what – the source I was using here made the distinction between these two things.
To me, they’re the same thing.
I wanted to bring this one to your attention because when you start looking in the codebook,
in the index.
When you get to athlo –athlo – or atherosclerosis, it get’s very busy.
And you really have to watch your indentations in the index so that you go to the right one.
And I have – there’s a pathway, on the next page, on the rationale.
I mentioned that the by – bypass graft codes of the extremities are listed first, so you
really have to keep reading down, and watching your indentation, until you get to the leg.
And then you can locate left or right.
Also, at the 170.23, there is an additional code to identify the severity of the ulcer,
and the code first – code first any underlying condition.
So you can see where we – in the previous slide, we did code that atherosclerosis first,
and then our ulcer code.
And it’s telling us that we could use the L97 code as a principle if no underlying cause
had been documented, but because we did have the atherosclerosis documented, they were
going to sequence that first, and the L97 would be the secondary code in this case.
If you have a condition like arterio – or atherosclerosis, of the extremities or chronic
venous hypertension, diabetic ulcers, postphlebitic syndrome, varicose ulcers.
That conditioned – you can assume that there’s a relationship between the ulcers and those.
And those positive diagnoses would be sequenced before the ulcer codes.
Okay, the next one, infection of nephrostomy site, would make a little note here, that
you know that a nephrostomy and urostomy are two different openings into the genital/urinary
system.
The nephrostomy is at the upper part of the kidney, which is the renal pelvis, and the
urostomy is lower down in the urinary system.
It can be a lower part of the kidney, or the bladder.
Both of those created openings are to allow body deterring the urine.
And typically would be done whenever there’s been insult to the kidney, or could be a malignancy.
For whatever reason, the body is not able to enter the urine the normal way; the way
that we would be able to do that.
Would create these stomas or openings in the body that allow us to insert tubes and then,
the urine can be drained from the body.
The kicker here is that you really have to convert that diagnosis of infection to complication
to find this code.
And I would say the more you code, the more you’re going to find out when you read something,
yeah, this – this says infection.
But it means complication because it’s a procedure.
A nephrostomy is a procedure that was done to the body, so it would make sense that it
would be a complication code.
And then when you go – there is no infection to a nephrostomy.
No infection for a stoma.
So, then that would, again, make you consider the possibility of using complication as your
main term, and then going down from the stoma.
And when you finally get to it, there is an infection as a sub term that allows you to
find this code.
Okay, as always, be mindful that the exercises in this PowerPoint do not address all of the
guidelines.
Exam questions will relate to all the guidelines covered in the chapters planned for each week,
not just those guidelines covered in the PowerPoint.
Always follow the assignment schedule with regard to specific Chapter assignments.
If you have any questions, please post them in the discussion board.
I want – me to see that path that you used to try to find the code, and then you can
let everyone share in our discussion.
Thank you so much, and have a good week.