IPPS Code Updates for CDI Staci Josten BSN RN CCDS Director UASI CDIUR Services stacijostenuasisolutionscom Amanda Suttles BSN RN CCDS Supervisor UASI CDIUR Services ID: 908223
Download Presentation The PPT/PDF document "2020 MS-DRG, ICD-10-CM and" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
2020 MS-DRG, ICD-10-CM and IPPS Code Updates for CDI
Staci Josten, BSN, RN, CCDSDirector, UASI CDI/UR Services staci.josten@uasisolutions.com
Amanda Suttles, BSN, RN, CCDS
Supervisor,
UASI CDI/UR Services
Amanda.suttles@uasisolutions.com
Slide2AgendaIntroductions and OverviewDiscussion of 2020 MS-DRG changes with CDI tip recommendationsDiscussion of 2020 IPPS changes with CDI tip recommendations
Discussion of 2020 ICD-10-CM updates with CDI tip recommendationsQuestionsuasisolutions.com | 2
Slide3Benefits of Being Familiar with Code UpdatesCoding is the basis of clinical documentation improvementUnderstanding coding fundamentals will assist in knowing what to look for in regards to incomplete documentation
Awareness and exposure to code updates promote understanding of the yearly changes for our coding colleaguesComplete training for FY 2020 ICD 10 CM updates:https://uasisolutions.com/insights/uasi-training-for-fy2020-icd-10-cm-updates/Complete training for FY 2020 ICD 10 PCS updates:
https://uasisolutions.com/insights/uasi-training-for-fy2020-icd-10-pcs-updates
/
Complete training for FY 2020 DRG updates: will be added soon
uasisolutions.com |
3
Slide4FY 2020 MS-DRG
Changesuasisolutions.com | 4
Slide52020 MS-DRG Changes2 new MS-DRGs:MDC 5 Diseases and Disorders of the Circulatory System
MS-DRGs 319 & 320: Other Endovascular Cardiac Valve Procedures with MCC and without MCC2 deleted MS-DRGs:MDC 11 Diseases and Disorders of the Kidney and Urinary TractMS-DRGs 691 & 692: Urinary Stones with ESW Lithotripsy with CC/MCC and without CC/MCC
uasisolutions.com |
5
Slide62020 MS-DRG Title RevisionsMDC 4: MS-DRG 175: Pulmonary Embolism with MCC
or Acute Cor PulmonaleAllows codes “with acute cor
pulmonale
” to code to DRG 175 while previously they required an MCC be added to group to that DRG.
MDC 4: MS-DRG 207: Respiratory System Diagnosis with Ventilator Support >96h
Previous title included, “ …or Peripheral Extracorporeal Membrane Oxygenation (ECMO)”
ECMO (
venoarterial
and
venovenous
) were both removed from this DRG and added to MS-DRG 003
MDC 5: MS-DRG 266 & 267: Endovascular Cardiac Valve Replacement
and Supplement Procedures
with MCC and without MCC
Added procedure codes describing
transcatheter cardiac valve repairs (supplementation)These were moved from MS-DRGs 228 & 229 (Other Cardiothoracic Procedures with MCC and without MCC)
uasisolutions.com |
6
Slide72020 MS-DRG Title Revisions (cont.)MDC 5: MS-DRG 291: Heart Failure and Shock with MCC
Previous title included, “ …or Peripheral Extracorporeal Membrane Oxygenation (ECMO)”ECMO (venoarterial and venovenous) were both removed from this DRG and added to MS-DRG 003MDC 5: MS-DRG 296: Cardiac Arrest, Unexplained with MCC
Previous title included, “ …or Peripheral Extracorporeal Membrane Oxygenation (ECMO)”
ECMO (
venoarterial
and
venovenous
) were both removed from this DRG and added to MS-DRG 003
MDC 11: MS-DRG 693 & 694: Urinary Stones with MCC and without MCC
Previous title included, “ …without ESW Lithotripsy”
The accompanying DRGs (691 and 692 “with ESW Lithotripsy”) were deleted due to data showing a decline in
inpt
cases reporting urinary stones and an ESWL procedure
MDC
18: MS-DRG 870: Septicemia or Severe Sepsis with Mechanical Ventilation >96 Hours
Previous title included, “ …or Peripheral Extracorporeal Membrane Oxygenation (ECMO)”ECMO (venoarterial and venovenous) were both removed from this DRG and added to MS-DRG 003
uasisolutions.com |
7
Slide8Pre MDC 2020 MS-DRG ChangesPeripheral ECMOFY 2020
the assignment of the 2019 ICD-10-PCS procedure codes for peripheral ECMO move to the same MS-DRG as the predecessor code for open (central) ECMO procedures: MS-DRG 003.
uasisolutions.com |
8
CDI
Tip:
All ECMO patients now go to DRG 003
Slide9MDC 1 Diseases and Disorders of the Nervous System Extracranial Procedures 2020 MS-DRG Changes
Insertion of Feeding DeviceRevision:Any PDX in MDC 1+Insertion of Feeding Device into Stomach, open approach (ODH60UZ)
=>
MS-DRGs 040-042 (Peripheral, Cranial Nerve & Other Nervous System Procedures with MCC, CC or without CC/MCC)
*These procedures were previously grouped to MDC 23 and will show a RW increase of 2.112 for 042, but a RW decrease of .5616 and .0665 for 040 and 041 with the change.
However, with the movement out of DRGs 981-983, targeting for back end review may improve.
uasisolutions.com |
9
Slide10MDC 4 Diseases and Disorders of the Respiratory System2020 MS-DRG Changes
Pulmonary Embolism3 codes will group from MS-DRG 176 to 175 with higher severity and noted title change:I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute
cor
pulmonale
I26.09 Other pulmonary embolism with acute
cor
pulmonale
uasisolutions.com |
10
CDI
Tip: If you have a PE, look for s/s of acute
cor
pulmonale
which will give you a MCC
Slide11MDC 8 Diseases and Disorders of the Musculoskeletal System and Connective Tissue 2020 MS-DRG Changes
Knee procedures and InfectionAdditions:MS-DRGs 485, 486 and 487: Knee Procedure with PDX of Infection with MCC, CC and Without CC/MCCA54.42 Gonococcal arthritis A18.02
Tuberculous
arthritis of other joints
M00.9 Pyogenic arthritis, unspecified
M01.X61 Direct
infection of right knee in infectious and parasitic diseases classified elsewhere
M01.X62 Direct
infection of left knee in infectious and parasitic diseases classified elsewhere
M01.X69 Direct
infection of unspecified knee in infectious and parasitic diseases classified elsewhere
M71.061 Abscess
of bursa, right knee
M71.062 Abscess
of bursa, left knee
M71.069 Abscess of bursa, unspecified knee M71.161 Other infective bursitis, right knee M71.162 Other infective bursitis, left knee M71.169 Other infective bursitis, unspecified knee
uasisolutions.com |
11
CDI
Tip:
Septic arthritis will code to M00.9 (Pyogenic Arthritis). This does not equate to Sepsis. Be alert for s/s of Sepsis.
Slide12MDC 8 Diseases and Disorders of the Musculoskeletal System and Connective Tissue 2020 MS-DRG Changes
Knee procedures and InfectionDeletions:MS-DRGs 485, 486 and 487: Knee Procedure with PDX of Infection with MCC, CC and Without CC/MCCM86.9 Osteomyelitis, unspecified
T84.50XA Infection
and inflammatory reaction due to unspecified internal joint prosthesis
T84.51xA Infection
and inflammatory reaction due to internal right hip prosthesis
T84.52xA Infection
and inflammatory reaction due to internal left hip prosthesis
T84.59XA Infection
and inflammatory reaction due to other internal joint prosthesis
T84.60XA Infection
and inflammatory reaction due to internal fixation device of unspecified site
T84.63XA Infection
and inflammatory reaction due to internal fixation device of spine
T84.69XA Infection
and inflammatory reaction due to internal fixation device of other site
uasisolutions.com | 12
CDI Tip: Acute
, Chronic,
Subacute
,
and other Osteomyelitis
remained. Review
for possible
DM- this will take it to the diabetes DRGs
Slide13MDC 9 Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast 2020 MS-DRG Changes
Bone Excision and Pressure UlcersRevision:PDX of Pressure Ulcer+Procedures describing excision of sacrum, pelvic bones and coccyx (below)
=>
MS-DRGs 579-581 (Other Skin, Subcutaneous Tissue and Breast Procedures with MCC, CC and without CC/MCC)
These procedures were previously grouped to MDC 23 and will show a RW decrease of .3823 to 1.5159 with the change.
However, with the movement out of DRGs
981- 983, targeting for
back end review may improve.
uasisolutions.com |
13
ICD-10-PCS
Description
0QB10ZZ
Excision of sacrum, open approach
0QB20ZZ
Excision of right pelvic bone, open approach
0QB30ZZ
Excision of left pelvic bone, open approach and 0
0QBS0ZZ
Excision of coccyx, open approach
CDI Tip: This takes the procedure out of the DRG unrelated to principal which should reduce targeting.
Slide14MDC 10 Endocrine, Nutritional and Metabolic Diseases and Disorders 2020 MS-DRG Changes
Lower Extremity Muscle and Tendon ExcisionRevision:Specific DM PDX (see list below)+Procedures describing excision of lower extremity muscles and tendons (below)
=>
MS-DRGs 622-624 (Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Disorders with MCC, CC and without CC/MCC)
These procedures were previously grouped to MDC 23 and will show a RW decrease of .5351 to .7265 with the change.
However, with the movement out of DRGs 981-983, targeting for back end review may improve.
uasisolutions.com |
14
ICD-10-CM
Description
ICD-10-PCS
Description
E11.621
Type 2 Diabetes Mellitus with Foot Ulcer
0KBN0ZZ
Excision of right hip muscle, open approach
E11.69
Type 2 Diabetes Mellitus with Other Specified Complication
0KBP0ZZ
Excision of left hip muscle, open approach
E11.628
Type 2 Diabetes Mellitus with Other Skin Complications
0KBS0ZZ
Excision of right lower leg muscle, open approach
E11.622
Type 2 Diabetes Mellitus with Other Skin Ulcer
0KBT0ZZ
Excision of left lower leg muscle, open approach
E10.621
Type 1 Diabetes Mellitus with Foot Ulcer
0KBV0ZZ
Excision of right foot muscle, open approach
0KBW0ZZ
Excision of left foot muscle, open approach
0LBV0ZZ
Excision of right foot tendon, open approach
0LBW0ZZ
Excision of left foot tendon, open approach
Slide15MDC 10: Endocrine, Nutritional and Metabolic Diseases and Disorders 2020 MS-DRG ChangesInsertion of Feeding Device
Revision:Any PDX in MDC 10+Insertion of Feeding Device into Stomach, open approach (ODH60UZ)=> MS-DRGs 628-630 (Other Endocrine, Nutritional and Metabolic OR Procedures with MCC, CC and without CC/MCC)
These procedures were previously grouped to MDC 23 and will show a RW decrease of .1883 to .8127 with the change.
However, with the movement out of DRGs 981-983, targeting for back end review may improve.
uasisolutions.com |
15
Slide16MDC 11 Diseases and Disorders of the Kidney and Urinary Tract 2020 MS-DRG Changes
Basilic Vein Reposition in Chronic Kidney DiseaseRevision:Any PDX in MDC 11+Procedures describing the reposition of the
basilic
vein (below)
=>
MS-DRGs 673-675 (Other Kidney and Urinary Tract Procedures with MCC, CC and without CC/MCC)
These were previously grouped to MDC 23 and will show a RW decrease of .0051 to .9274 with the change.
However, with the movement out of DRGs 981-983, targeting for back end review may improve.
uasisolutions.com |
16
ICD-10-PCS
Description
05SB0ZZ
Reposition right basilic vein, open approach
05SB3ZZ
Reposition right basilic vein, percutaneous approach
05SC0ZZ
Reposition left basilic vein, open approach
05SC3ZZ
Reposition left
basilic
vein, percutaneous approach
Slide17MDC 11: Diseases and Disorders of the Kidney and Urinary Tract 2020 MS-DRG ChangesColon Resection with Fistula
Revision:Any PDX in MDC 11+Resection of sigmoid colon, open approach (0DTN0ZZ)=> MS-DRGs 673-675 (Other Kidney and Urinary Tract Procedures with MCC, CC and without CC/MCC)
These were previously grouped to MDC 23 and will show a RW decrease of .0051 to .9274 with the change.
However, with the movement out of DRGs 981-983, targeting for back end review may improve.
uasisolutions.com |
17
Slide18MDC 21 Diseases and Disorders of the Digestive System2020 MS-DRG Changes
Peritoneal Dialysis Catheter ComplicationsRevision:8 procedure codes (below) describing the removal, revision and/or insertion of new peritoneal dialysis catheters (or revision of synthetic substitutes)+
a PDX of Peritoneal Dialysis Catheter Complication
=>
MS-DRGs 907-909 in MDC 21 (Injuries, Poisonings & Toxic Effects of Drugs).
These
were previously grouped to MDC 23 and will show a
RW
decrease of .3184 to .5124 with the change.
However, with the movement out of DRGs 981-983,
targeting for
back end review may improve.
uasisolutions.com |
18
Slide19MDC 23 Factors Influencing Health Status and Other Contacts with Health Services 2020 MS-DRG Changes
R93.89: Abnormal findings on diagnostic imaging of other specified body structuresMoved from MS-DRGs 302 & 303 (MDC 5) to MS-DRGs 947 & 948 (MDC 23).
uasisolutions.com |
19
CDI Tip: Be
alert for query
opportunities to define what the abnormal finding might be and move
into a more appropriate DRG
Slide20FY 2020 IPPS Changes
Discussionuasisolutions.com | 20
Slide21FY 2020 IPPS Proposal and Final RuleThe FY 2020 Inpatient Prospective Payment System (IPPS) proposed rule, clinical advisors recommended changes in severity level designation for almost 1,500 ICD-10-CM codes. However, following the publication in April, many commenters expressed concern with the proposed severity level designation changes overall and recommended CMS conduct further analysis prior to finalizing any proposals.
The final rule, published in August, contained only 5 CC deletions and no MCC deletions, where the proposal had 537 CC deletions and 145 MCC deletions.It also amplified operating payment amounts 3.1% for acute care hospitals under IPPS taking part in Hospital Inpatient Quality Reporting and meaningful EHR.
https://acdis.org/articles/news-fy-2020-ipps-final-rule-published-ccmcc-downgrades-postponed
uasisolutions.com |
21
Slide222020 IPPS ChangesThe IPPS Final rule also moved codes in category Z16- Resistance to antimicrobial drugs from a Non CC status to a CC designation.
uasisolutions.com | 22
CDI Tip: Resistance to antimicrobial drugs is now a cc.
Slide232020 IPPS ChangesZ16 Example (Chapter 21: Chapter Specific Guidelines with Coding Examples)
Z16 Resistance to antimicrobial drugsThis code indicates that a patient has a condition that is resistant to antimicrobial drug treatment. Sequence the infection code first.Penicillin resistant streptococcus pneumoniae meningitisG00.1 Pneumococcal meningitisZ16.11 Resistance to
penicillins
Explanation: the status Z code is used to describe the presence of a drug-resistant organism that most likely altered how the meningitis was treated.
uasisolutions.com |
23
CDI Tip: In
these cases you would query the MD for the meningitis
specificity, as well as the resistance if it
is not
documented.
Slide242020 IPPS Changes5 CC deletions according to the IPPS final rule:
uasisolutions.com | 24
Deletions
Code
Description
Explanation
D81.3
Adenosine
deaminase
[ADA] deficiency
Expanded into four codes:
D81.30, D81.31, D81.32, D81.39
I48.1
Persistent atrial fibrillation
Expanded into two codes:
I48.11, I48.19
Q79.6
Ehlers-Danlos syndrome
Expanded into five codes:
Q79.60, Q79.61, Q79.62, Q79.63, Q79.69
Q87.1
Congenital malformation syndromes predominantly associated with short stature
Expanded into two codes:
Q87.11, Q87.19
T67.0XXA
Heatstroke and sunstroke, initial encounter
Expanded into three codes:
T67.01XA, T67.02XA, T67.09XA
CDI Tip:
With the expanded codes, it provides a greater need for clarification.
Slide25FY 2020 ICD-10- CM
Chapter Changesuasisolutions.com | 25
Slide262020 ICD-10-CM: Chapter UpdatesChange Summary:
The ICD-10-CM code changes contained in the FY 2020 Rule Tables revealed 273 new codes, 21 codes deleted30 code title revisions
uasisolutions.com |
26
Slide27Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
AdditionGlucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive genetic metabolic abnormality caused by deficiency of the enzyme G6PD. This enzyme is critical for the proper function of red blood cells. When the level of this enzyme is too low, red blood cells can break down prematurely (hemolysis). When the body cannot compensate for accelerated loss, anemia develops.
Currently
, ICD-10-CM coding for patients with G6PD deficiency defaults to D55.0 Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency. There is no unique code to identify the majority of individuals who do not have anemia, but are at risk.
uasisolutions.com |
27
Slide28Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism Addition (cont.)
The original adenosine deaminase deficiency (type 1), which causes a severe combined immunodeficiency commonly referred to as SCID due to ADA deficiency. Adenosine
deaminase
2 deficiency was relatively recently discovered, researchers suspect that it may not be a rare disease. It is characterized by abnormal inflammation of various tissues and current research is trying to determine whether it may underlie other forms of
vasculitis
and stroke whose causes are now unknown.
Despite
the similar terms used to identify these disorders, they are quite different clinically. The gene involved in the original ADA deficiency is on chromosome 20, while the gene involved in ADA2 deficiency is on chromosome 22.
uasisolutions.com |
28
CDI
Tip:
The unspecified diagnosis is a CC as well as but these are clinically different. A query is appropriate for specificity
Slide29Chapter 9: Diseases of the circulatory system changeOther Types of Myocardial Infarction
Type 2 myocardial infarction (myocardial infarction due to demand ischemia or secondary to ischemic imbalance) is assigned to code I21.A1, Myocardial infarction type 2 with the underlying cause coded first. Do not assign code I24.8, Other forms of acute ischemic heart disease, for the demand ischemia.
If
a type 2 AMI is described as NSTEMI or STEMI, only assign I21.A1. Codes I21.01-I21.4 should only be assigned for Type 1 AMIs.
*We were previously instructed to “code also”*
uasisolutions.com |
29
CDI
Tip
:
Potential query opportunity for cause of Type 2 MI. Previously instructed to “code also”
Slide30Chapter 9: Diseases of the circulatory system Additions
Subsegmental pulmonary emboli (SSPE) can be detected with CT, but studies have suggested that the optimal clinical treatment for these may differ from other pulmonary emboli (PE).
uasisolutions.com |
30
CDI
Tip
:
The PE without acute
cor
pulmonale
is a MCC when secondary.
Slide31Chapter 9: Diseases of the circulatory system Additions (cont.)
Longstanding persistent atrial fibrillation is persistent and continuous atrial fibrillation lasting longer than one year. Persistent atrial fibrillation describes cases that do not terminate within seven days, or that require repeat pharmacological or electrical cardioversion. Permanent atrial fibrillation is persistent or longstanding persistent atrial fibrillation where
cardioversion
is not indicated, or cannot or will not be performed.
Chronic
atrial fibrillation may refer to any of persistent, longstanding persistent, or permanent atrial fibrillation - use of one of those more specific descriptive terms is preferred
uasisolutions.com |
31
Slide32Atrial Fibrillation Documentation
Atrial fibrillation without any further specificity will code to “I48.91 Unspecified atrial fibrillation“ which is not a CC.
2020 Alphabetic Index
Chapter
9: Diseases
of the circulatory
system Atrial fibrillation discussion
uasisolutions.com |
32
Fibrillation
- atrial or auricular (established) I48.91
(Non-CC)
-
chronic I48.20
(CC)
-
- persistent I48.19
(CC)
-
paroxysmal I48.0
(Non-CC)
-
permanent I48.21
(CC)
-
persistent (chronic) (NOS) (other) I48.19
(CC)
-
- longstanding I48.11
(CC)
CDI
Tip:
Possible Query Opportunity:
Always clarify specificity of Atrial Fibrillation to capture the most accurate type.
Slide33Coding Clinic 2nd Qtr 2019: Chronic Persistent A fib
Question: A 68-year-old man with a history of hypertension, chronic obstructive pulmonary disease and coronary artery disease (CAD) was admitted to the hospital for evaluation of atrial fibrillation (AF). While in the hospital, the patient’s AF was controlled using antiarrhythmic drugs. The provider’s final diagnostic statement listed “Chronic persistent atrial fibrillation.” Since there are unique codes for both chronic and persistent atrial fibrillation, which code is more appropriate I48.1, Persistent atrial fibrillation, or I48.2, Chronic atrial fibrillation?
Answer:
Assign only code:
I48.1, Persistent atrial fibrillation, as the principal diagnosis.
Rationale:
Persistent
AF is an abnormal heart rhythm that continues for seven days or longer, or that requires repeat electrical or pharmacological
cardioversion
.
Chronic
atrial fibrillation is a nonspecific term that could be referring to paroxysmal, persistent, long standing persistent, or permanent atrial fibrillation.
Since
code I48.2 is nonspecific, code I48.1 is a more appropriate code assignment
Pg
3
Coding Clinic 2
nd
Qtr
2019: Types of A Fib
Chapter 9: Diseases of the circulatory system Atrial fibrillation
discussion
uasisolutions.com |
33
Question
:
In
the Alphabetic Index, the different types of atrial fibrillation all appear at the same indentation level under “Fibrillation, atrial.” If a provider documents various types of atrial fibrillation, such as chronic, persistent, and permanent, would separate codes be assigned for each type of atrial fibrillation?
Answer
:
Assign
only one code for the specific type of atrial fibrillation (AF), since some of the terms are less specific, such as chronic AF, and some of the different types of AF cannot clinically occur at the same time.
For
example, if the provider documents both chronic and persistent AF, assign only code I48.1, Persistent atrial fibrillation. Persistent atrial fibrillation typically may require repeat pharmacological or electrical
cardioversion
and does not stop within seven days.
Longstanding
persistent atrial fibrillation is persistent and continuous lasting longer than one year.
Permanent
atrial fibrillation is longstanding persistent atrial fibrillation where
cardioversion
is not indicated or cannot be performed.
Pg3
Slide34DVT/Thrombophlebitis
In the past there were no specific codes to capture thrombophlebitis or thrombosis involving the peroneal vein or calf muscular branch veins.
Location
Chapter
9: Diseases
of the circulatory
system DVT/Thrombophlebitis Discussion
uasisolutions.com |
34
Slide35Chapter 9: Diseases of the circulatory system DVT/Thrombophlebitis Discussion (cont.)
uasisolutions.com | 35
CDI
Tip: G
ood
practice to clarify with the physician greater specificity
for these ICD 10 codes, many times it
impacts the
DRG/SOI/ROM
Slide36Assessment: Thrombophlebitis
ThrombophlebitisPainRedness
Warmth
Swelling
Palpable blood vessel
Fever
Treated with compress and/or
meds
Assessment
: DVT
Chapter
9: Diseases
of the circulatory
system
DVT/Thrombophlebitis Discussion (cont
.)
uasisolutions.com |
36
Deep Vein
Thrombosis
Pain may or may not be present
Redness
may or may not be present
Warmth may or may not be present
Swelling may or may not be present
Palpable vessel may be absent
Fever may be absent
Treated with anti-coagulants/blood
thinners
Slide37Chapter 12: Diseases of the skin and subcutaneous tissue Additions
Deep Pressure InjuryDeep Tissue Pressure Injury (DTPI) is now defined as “intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. ““
Deep tissue injury”
had been indexed
to “ulcer, pressure,
unstageable
, by site. However,
unstageable ulcers can ONLY be Stage 3 or 4, by definition and if slough or
eschar
is removed, a Stage 3 or Stage 4 pressure injury will be
revealed”, according to the Agency for Healthcare Research and Quality (AHRQ).
Dissimilarly,
deep tissue injury may
go away
without
any loss of tissue. Also, ischemia and pressure can combine to cause these deep tissue injuries.
https://www.aapc.com/blog/47931-coding-deep-pressure-induced-tissue-damage-in-fy2020/
uasisolutions.com |
37
Slide38Code
DescriptionCC/MCCL89.006Pressure-induced deep tissue damage of unspecified elbow
N
L89.016
Pressure-induced
deep tissue damage of right elbow
N
L89.026
Pressure-induced
deep tissue damage of left elbow
N
L89.106
Pressure-induced
deep tissue damage of unspecified part of back
N
L89.116
Pressure-induced
deep tissue damage of right upper back
N
L89.126
Pressure-induced
deep tissue damage of left upper back
N
L89.136
Pressure-induced
deep tissue damage of right lower back
N
L89.146
Pressure-induced
deep tissue damage of left lower back
N
Chapter
12: Diseases
of the skin and subcutaneous
tissue Additions (cont.)
uasisolutions.com |
38
Code
Description
CC/MCC
L89.156
Pressure-induced
deep tissue damage of sacral region
N
L89.206
Pressure-induced
deep tissue damage of unspecified hip
N
L89.216
Pressure-induced
deep tissue damage of right hip
N
L89.226
Pressure-induced
deep tissue damage of left hip
N
L89.306
Pressure-induced
deep tissue damage of unspecified buttock
N
L89.316
Pressure-induced
deep tissue damage of right buttock
N
L89.326
Pressure-induced
deep tissue damage of left buttock
N
L89.46
Pressure-induced
deep tissue damage of contiguous back, buttock and hip
N
Code
Description
CC/MCC
L89.506
Pressure-induced
deep tissue damage of unspecified ankle
N
L89.516
Pressure-induced
deep tissue damage of right ankle
N
L89.526
Pressure-induced
deep tissue damage of left ankle
N
L89.606
Pressure-induced
deep tissue damage of unspecified heel
N
L89.616
Pressure-induced
deep tissue damage of right heel
N
L89.626
Pressure-induced
deep tissue damage of left heel
N
L89.816
Pressure-induced
deep tissue damage of head
N
L89.896
Pressure-induced
deep tissue damage of other site
N
L89.96
Pressure-induced
deep tissue damage of unspecified site
N
Slide39Chapter 17: Congenital malformations, deformations and chromosomal abnormalities Additions
Ehlers-Danlos syndrome is a life- long progressive condition that has a major impact on the lives and daily function of most living with EDS. There are about 13 specific types of EDS and the most severe in presentation and the only one associated with early mortality is vascular (vEDS
).
Specific
ICD-10-CM codes for the most common and severe types will be of value to the patient and the clinician.
uasisolutions.com |
39
Code
Description
CC/MCC
Q79.60
Ehlers-
Danlos
syndrome,
unspecified
CC
Q79.61
Classical
Ehlers-
Danlos
syndrome
CC
Q79.62
Hypermobile
Ehlers-
Danlos
syndrome
CC
Q79.63
Vascular Ehlers-
Danlos
syndrome
CC
Q79.69
Other Ehlers-
Danlos
syndromes
CC
CDI
Tip:
Although the unspecified diagnosis will give you a
cc, the most common and severe types are pertinent to the clinical picture so
a query is appropriate for specificity
Slide40Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified: Additions
Cyclical vomiting syndrome is described by episodes of severe vomiting that have no identifiable cause. Episodes can last for days or hours and alternate with symptom-free periods of time. Cyclical vomiting syndrome may or may not be related to migraines. Cyclical vomiting not related to migraines now will be assigned to R11.15. Code titles in subcategory G43.A have been modified to include the phrase “in migraine”.
Pyuria
was
indexed to code N39.0, Urinary tract infection. There is
now a code
for reporting
pyuria.
uasisolutions.com |
40
CDI
Tip:
Pyuria
should be clarified if clinical indicates support UTI.
Slide41Prior to the 2020 changes, there was only one code for orbital bone fractures.
Now there are specific codes to identify orbital fractures including left or right. Depending on the description it may be a MCC, CC, or Non CC
Location
Chapter
19: Injury
, poisoning and certain other consequences of external
causes Orbital Roof/Wall Fracture Discussion
uasisolutions.com |
41
CDI Tip: Be
alert
for orbital roof/wall fractures during MVC
and altercations (assault
). Review radiology for a query opportunity if a fracture is noted but the physician has not documented.
Slide42Chapter 19: Injury, poisoning and certain other consequences of external causes: Additions
7th Character Definitions A – Initial encounter, closed fracture K – Nonunion B – Initial encounter, open fracture G – Subsequent encounter, delayed
D – Subsequent encounter, routine
S
–
Sequela
uasisolutions.com |
42
CDI
Tip: Be sure you know when it happened (initial) and open/closed. If not, clarification is needed.
Slide43Chapter 19: Injury, poisoning and certain other consequences of external causes Additions
Exertional Heat Stroke (EHS) is the most severe form of Exertional Heat Illness. Unlike classical or passive heat stroke, which typically develops over days and occurs in hot environments, Exertional Heat Stroke can develop within hours, and often in healthy individuals undergoing strenuous activity in hot, humid environments. There was no ICD-10-CM code to specifically identify Exertional Heat Stroke.
The
lack of specific coding has been cited by researchers as an impediment to analysis. The clear differentiation between EHS and other heat related illness is a necessity in evaluating all current and future treatment modalities.
uasisolutions.com |
43
CDI
Tip:
These
additions are related to heatstroke which adds specificity. All of these are cc if they are initial encounters.
Slide44BMI (Z68)=2019
Z68 Body mass index [BMI]Note: BMI adult codes are for use for persons
21 years of age or older.
BMI pediatric codes are for use for persons
2-20 years of age.
These percentiles are based on the growth charts published by the Centers for Disease Control and Prevention (CDC).
BMI (Z68
)=2020
Chapter
21: Factors
influencing health status and contact with health
services
uasisolutions.com |
44
Change to the tabular notes
Z68 Body mass index [BMI]
Note:
BMI adult codes are for use for persons
20 years of age or older
BMI pediatric codes are for use for persons
2-19 years of age.
These percentiles are based on the growth charts published by the Centers for Disease Control and Prevention (CDC).
CDI
Tip:
BMI code for adults now starts at age 20. Prior to the 2020 changes the adult BMI code started at age 21
Slide45Questions and Discussionuasisolutions.com | 45
Slide46ReferencesAcdis. (2019). FY 2020 ipps
final rule published, cc/mcc downgrades. CDI Strategies, 13(33). Retrieved from: https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/reference_list_electronic_sources.htmlAmerican Hospital Association. (2019). Coding clinic: Second quarter: Chronic persistent a fib.
Pg.3.
American Hospital Association. (2019).
Coding clinic: Second quarter: Types of a fib.
Pg.3.
Optum
360, LLC. (Eds.). (2019).
2020 DRG expert- volume I: A comprehensive guidebook to the classification system using the
icd
- 10-cm and –pcs code sets
. Unknown:
Optum
360, LLC.
Optum
360, LLC. (Eds.). (2019).
2020 ICD-10-CM Expert for Hospitals: The complete official code set. Unknown: Optum 360, LLC. R Dustman. (2019, July 24). Coding deep pressure-induced tissue damage in fy2020. [web log]. Retrieved from: https://www.aapc.com/blog/47931-coding-deep-pressure-induced-tissue-damage-in-fy2020/https://uasisolutions.com/insights/category/coding-tips/
uasisolutions.com |
46
Slide47UASI at a Glance
uasisolutions.com |
47
Headquarters:
Founded:
Clients:
Team:
Charts handled annually:
Solutions:
Experience
Management: 22 years of HIM experience;
11 in CDI
Coding staff: 8+ years
Quality
97% accuracy in coding
100% target for accuracy, certification and meeting industry standards
Reliability
32+ years in business
40 clients in US News & World Report best regional and honor roll hospitals
Culture
People-centric, team-driven culture
High employee satisfaction
20% new hires referred from current employee
Industry-leading average employee tenure
Cincinnati, Ohio
1986
200+ hospitals/health systems nationwide
450+ employees, including AHIMA/AAPC-certified coders, HIM and clinical documentation specialists
3.75 million coded; 200,000 audited
Coding Services, Coding Reviews, Clinical Documentation Improvement, Revenue Integrity, HIM Solutions, Strategic Consulting