I want us to look at a Coding Clinic. This is a publication, published quarterly
by the American Hospital Association (AHA) and it is for coders
who are doing both diagnosis coding (ICD-10-CM) and procedure coding (ICD-10-PCS).
This particular one is the fourth quarter 2016. You'll notice as you scroll
through, and I've got it enlarged to 163 percent so it would be quite a bit
smaller if you were reading it, but you see that there's going to be changes to
your diagnosis reporting (ICD-10-CM), changes to your procedure reporting (ICD-10-PCS) and a
special section on Heart Assist Devices. It starts off with "New and Revised"
Diagnosis Codes, goes through them alphabetically, then you scroll down and
you find "New and revised" PCS Procedure Codes and they also are listed
alphabetically.We will focus on the diagnosis codes since that's what we're
covering in this class.The last section is "Ask the Editor" where very specific
questions come in from veteran coders asking this AHA body what the right
response should be to a particular scenario. You see here the Zika virus is
included in the diagnoses because that is something relatively new to the
coding world. So I'm going to scroll down to page 4, we're on page 2 right now,
scrolling down to page 4. I wanted to show you too, you notice here the Executive Editor of Coding Clinic is Nelly Leon-Chisen. She is also the author
of your textbook. She does an excellent job of covering everything. I just wish
that the chapters in her textbook matched the chapters in the code book
but they don't. Okay, keep going down to page 4, the
Zika virus. The Coding Clinic tells us that code A92.5 Zika virus disease has been
created to uniquely identify Zika (Fever and Infection) and Zika NOS (not otherwise specified) then goes
into a little bit of explanation or description of what the Zika virus is,
incubation periods, that kind of thing. It talks about how the World Health
Organization thought it was very important to document during pregnancy
because it could cause microcephaly, which are the pictures we've seen on the
news of the babies with the heads much smaller than normal as well as many
other physical problems for these little babies. It reminds us that in all cases,
inpatient and outpatient, we're going to code only confirmed diagnoses based on
the provider's diagnostic statement. The doctor's diagnostic statement that the patient
has been infected by Zika is sufficient. That's an exception to other guidelines
that require that in general, in an inpatient setting, an uncertain diagnosis would be
coded as if it was established but that's not true with Zika. If the doctor
says "probable Zika infection" you do not code it. Yu would only code it if the
doctor says the patient has Zika virus infection.There's a few bullet points to
remind us of that very same thing. So you see how it (Coding Clinic) takes a topic, goes into some
detail explaining about it and this is a way of educating coders. It also is a
standardization so that all coders are coding the same way. If we were coding
differently, there's no way we could compare our data. I also wanted to show
you how it addresses specific diagnoses that are new like
hypercholesterolemia on page 13. I'm going to scroll down to 13. W're on page
6, scroll down to 13 and this is an
explanation of hypercholesterolemia where the Coding Clinic is reminding
us or teaching us that E78.0 Pure hypercholesterolemia has been expanded
to create code E78.00 for Pure hypercholesterolemia, unspecified
and code E78.01 Familial hypercholesterolemia in order
to improve detection and screening in patients with this treatable condition.
Then it goes into some explanation of what a "familial hypercholesterolemia"
would be, how it would be described.
The last thing I will look at is one of the letters to the Editor on page 142.
This is one of the questions for the Editor.The question is -"we have
previously been extensively trained that the diabetic cataract is rare and may
occur with rapid onset in Type 1 diabetes. Coding Clinic for ICD-9-CM which
obviously that was several years ago when ICD-9 was a code set and not ICD-10.
ICD-9 previously informed us that the type of cataract more commonly found
in adult diabetic patients is the age-related cataract which is not
classified as an ocular manifestation of diabetes. The new "With" in quotation marks
guidelines instruct us to link any condition indented under the word "with" to
diabetes. In this guideline, all cataracts in diabetic patients are diabetic cataracts.
Is there a change in understanding of the pathophysiology of the diabetic cataract
and if so, are all cataracts in diabetic patients now considered diabetic
cataracts?" This is a very good question for a coder that's been coding for a
long time. She's now getting mixed messages
from the different Coding Clinics so the Editor's answer is "The advice published
in the (earlier) Coding Clinic dates back to 1985. Based on the revised guidelines and
changes in the understanding of the relationship between diabetes and
cataracts, cataracts in diabetic patients should be coded as "linked"
conditions. Cataracts are considered a major cause of visual impairment in
diabetic patients as the incidence and progression of cataract is elevated in
the patients with diabetes mellitus. Several clinical studies have shown
cataracts develop more frequently at an earlier age compared to non diabetic
patients. So that is the answer. So you see how the Coding Clinic provides
guidance to all coders for how we would code specific scenarios.This is often a
question on the national exam that asks "What publication provides
guidance to coders?" It will be a multiple choice question and the answer
you're going to be looking for is the "Coding Clinic". If you have any questions
about Coding Clinic, please post them in Discussion Board. I encourage you to read
through these. I know they're not going to make as much sense to you now as they
will at the end of the semester but hopefully you can remember to look back
at them. Since ICD-10 (was implemented), our Coding Clinics have
been quite lengthy because there's so much more to look at than there was with
ICD-9-CM.Thanks so much and have a good afternoon.