Here's another example that's not in the code book, and it's a pregnant patient.
And I'm not going to get into this too deeply because to me, the OB, the coding of pregnancy
and pregnancy related conditions is one of the more difficult chapters in the ICD-10-CM
code book.
So we're not going to spend a whole lot of time on it.
But I just wanted to make you aware that there is a very specific guideline that relates
to a pregnant patient having the malignant neoplasm.
You will learn when you get to this chapter, it's Chapter 15 in the code book, that
the week of gestation is always reported for any patient in the hospital who is pregnant.
At the very beginning of the Chapter 15 codes, there is a little table that tells you
how the weeks correspond to the trimester.
And week 29 is the third trimester.
So that Z3A.29 is her weeks of gestation.
I know I'm jumping ahead, but that just explains to you where that comes from.
There's no guideline about that that I'm aware of is in the code book that gives you that
direction.
There is a guideline for malignant neoplasm in a pregnant patient.
And this tells us to use the (letter) O. That's not (the number) zero.
The O9A.113 code.
The O9A category is at the very end of Chapter 15 in the code book.
I'll show you that in a moment.
So we're going to use that code as our principal because chapter 15 codes, the pregnancy
or OB codes, always are (the) principal (diagnosis).
They're always the- I shouldn't say "always".
They're most often your principal.
There's very few instances where they're not.
And then we're going to identify the cancer.
That our C50.912.
And then of course our Z code indicating our weeks of gestation.
The Table of Neoplasms, if you look up breast, you get the C50.9-, (the dash) meaning additional characters
are needed.
We're going to assign that character with her "left" breast being those extra characters.
And, let's see.
I'm not going to spend much time looking up this pregnancy code because that will come
later.
I just want you to just primarily be aware of that fact that there is a guideline specific
to the malignant neoplasm in a pregnant patient.
Here's another exercise not in your coding handbook.
The patient is admitted for a pathological fracture of L4-5 initial encounter due to
bone cancer.
Treatment during stay will focus on the treatment of the pathological fracture.
That documentation is important because our coding guidelines tell us that the sequencing
is dependent on the focus of treatment when you have a pathological fracture due to a
neoplasm.
Your pathway is here on the slide. "Fracture,"
"Pathological is your main term with sub-terms due to neoplastic disease, vertebrae.
Takes you to M84.58.
When you go to theTabular, you see that there's a 7th character needed.
We know the initial encounter is our 7th character.
So we need a placeholder "x" in the 6th character position.
That indicates the pathological fracture.
It's the principal (diagnosis) because our focus of treatment during this encounter is the treatment of
that pathological fracture.
And the cancer is there because that's the reason why he has this pathological fracture.
Here's another example, the same example.
However, this time the focus is on the bone cancer, not the fracture.
So all we would do is invert our codes.
So now our cancer diagnosis is our primary (principal) code, and the vertebrae fracture, T56 fractures,
are the secondary code in this case.
And here's another exercise not in the Coding Handbook that's very common in the hospitals,
and that is when you have anemia associated with a malignancy.
If the patient is admitted for treatment of the anemia associated with acute, monocytic
leukemia, you're going to sequence the malignancy as the principal (diagnosis), followed by the code for
the anemia as your secondary code.
And here I have the pathway's primary (main) term is anemia or main term is anemia, -in, which
can also mean due to or with, neoplastic disease.
Remember that terms in parenthesis are non-essential modifiers.
It wouldn't have to say that, but it might say that.
Then your acute monocytic leukemia in the alphabetical index, leukemia is your main
term with sub-term acute monocytic.
And that takes you to C93.0.
Additional characters are needed.
You look up the C93.0 in your tabular and that gives you your 5th character "0" (zero)
I'm not going to spend as much time going back and forth between the alphabetical index
and tabular unless I get more questions because these podcasts just get so long.
I'm trying to be a little more efficient with that.
The next exercise not in the coding handbook is the patient is admitted for treatment of
anemia cause by chemotherapy for the treatment of bladder cancer.
We have a guideline that directly addresses anemia associated with chemo.
And here we go.
It's coding guideline 1.C.2.c.2.
When the admission is for management of anemia associated with an adverse affect of the administration
of chemo or immunotherapy and the only treatment is for the anemia, the anemia code is sequenced
first, followed by the malignancy codes and the adverse effect code.
So we see the T45.1x5 is already given to us as one of the codes that we're going to use.
We also have the anemia code here.
And here's your code for bladder cancer.
So here's your anemia code.
The pathway is anemia due to anti-neoplastic chemo, D64.81.
Note the "Excludes 1" note.
Anemia and neoplastic disease and anemia due to anti-neoplastic chemo are two different
things, two different codes.
Table of Neoplasms, using that for our bladder cancer. we see in the malignant primary column,
C67.9 is the code for the bladder cancer.
And if we were looking up, we have been given in our guideline the T45 code, but I also
want to show you it is in the Table of Drugs and Chemicals.
If you look up "anti-neoplastic" under the substance column and then your adverse (effects) column,
you find this.
I think we'll go to the code book and look at that one.
And I have it highlighted in my book because I look at it quite often.
Go back up here.
Here's your substance.
And all the way over here is your "adverse effect" column.
It's the next to last column.
So we're going to go back down to anti-neoplastic.
Anti-neoplastic.
We're not given a specific (type of) chemo this person is using.
So we're going to go across here to your adverse affect column.
And this is where our guideline gets that T45.1X5 as the adverse effect code.
T45.1X, adverse affect of anti-neoplastic and immunosuppressive drugs.
Seven characters are needed.
One, two, three, four, five, six, and our seventh character would be our encounter,
which in this case is initial.
Just as a reminder of this, we go to the front of this chapter.
This is Chapter 19.
And if we go to the very beginning of our T45 category, we see instructional notes here,
the appropriate 7th character has to be added to each code for category T45 with "A"
being our initial encounter, "D" a subsequent (encounter), and "S", (representing a ) sequela (of a condition).
Our medical record documentation told us it is initial encounter.
So our 7th character is "A" for this T45. code.
One last thing I want you to be mindful of
the exercises in the PowerPoints don't address all of the guidelines.
However, our exams can address all those guidelines.
So please don't just study what we're doing in our exercises, but study all the guidelines,
knowing when you might apply them.
Follow your Assignment Schedule with regard to the specific chapter assignments through
the semester.
That way you can stay on top of it.
If you have any questions, please post your questions in the discussion board and I will
attempt to answer it for everyone.
And I hope you have a good day.
Take care.