Knowledge Base Category -

Did You Know?

The way brush biopsy is coded changed October 1, 2017.

Why It Matters?

Prior to 2017 ICD -10 did not have the option to choose Extraction for the Root Operation. At that time, the only option was to select “Excision”.

Definitions of Excision and Extraction:

1. Excision is the cutting out or off, without replacement, a portion of a body part
2. Extraction is the pulling or stripping out or off all or a portion of a body part with the use of force.

Physicians like to use the “brush” technique as it is low risk and the least invasive, but still provides enough cells to the Pathologists to make a diagnosis.

In addition, it is important to note the difference between the two approaches because the physician may obtain a specimen using both Excision and Extraction during an operative episode.

For example, during a Bronchoscopy, the physician may perform a brush biopsy of the bronchus and a transbronchial lung biopsy. To obtain a lung biopsy, tiny forceps are used to remove lung tissue, so this would be coded to the approach Excision. The lung biopsy carries a higher risk because there is a chance a pneumothorax will occur. The endoscopic lung biopsy will also group the DRG to a higher weight, which is another reason for being aware of these two approaches.

What Can I Do?

Review Coding Clinic, 4th Quarter 2017, page 41. Closely review the Op Report documentation and note the root operations used during the procedure.

References

• Coding Clinic, 4th Quarter 2017, page 41
• PCS Coding Guidelines

Did you know?

Did you know that a new code has been created to identify unspecified Depression, NOS, effective October 1, 2021?

Previously in ICD--10, when a provider documented Depression, NOS, it was assigned to Major Depression, Single Episode, code (F32.9); however, only 10% out of 30% of patients that report symptoms of Depression, have Major Depression. Therefore, a new code has been created to capture Depression NOS.

• Depression, Unspecified (F32.A) • Depression NOS (F32.A) • Depressive Disorder NOS (F32.A)

Major Depression, Single Episode, Unspecified and Major Depression NOS is still assigned to code (F32.9).

Why it matters.

You may not be capturing the most accurate severity of illness of the patient.

What can I do?

Read Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2021: Page 9

Question

Do you know when the COVID-19 Public Health Emergency (PHE) will end?

Answer

The COVID-19 PHE declaration was last renewed on January 14, 2022 with an effective date of January 16th (link). When the Secretary of the Department of Health and Human Services (HHS) makes a PHE declaration, it lasts for the duration of the PHE or 90 days but may be extended by the Secretary for as long as the PHE continues to exist. The most recent declaration is set to end April 16, 2022.

Further, in January 2021, acting HHS Secretary Norris Cochran sent a letter to governors across the country to share details about the COVID-19 PHE and indicated in the letter that HHS “has determined that the PHE will likely remain in place for the entirety of 2021, and when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination.”

Did You Know?

The advice from Coding Clinic, First Quarter 2021, page 12 advises that medications prescribed on a “PRN” or “as needed” basis are not considered to be long term drug therapy. This means that Z79, Long Term Drug Therapy would not be assigned for these medications.

Why It Matters?

Coding long term medication use for a drug that is given only on an “as needed” basis would be contradictory to the Z79 code description as it implies continuous use of a drug for an extended period of time.

What Can I Do?

Review Coding Clinic, 1ST Quarter 2021, page 12. Read the medication list, determine the medications to be coded and then look to see how they are prescribed.

Question

Our gastroenterologists rarely state if a patient’s personal history of colon polyps is adenomatous in nature or hyperplastic, or both. Typically, the documentation only reflects that the patient has a “history of colon polyps”. If the physician specifies the patient’s previous colon polyps as being hyperplastic, what ICD-10-CM diagnosis code should be assigned?

Answer

For a personal history of hyperplastic colon polyps, assign ICD-10-CM diagnosis code Z87.19 (personal history of other diseases of the digestive system).

Question

We have a patient that was admitted through the ED with significant shortness of breath and acute respiratory distress, with the CT scan of the lungs showing bilateral infiltrates. The patient tested negative for COVID-19 on admission. The patient was treated for pneumonia and acute hypoxic respiratory failure. However, four days into the stay, a second COVID-19 test was performed and the results were positive. What POA do we assign in this case?

Answer

Due to the many nuances, complexities, and incubation period of COVID-19, we cannot assume that the infection was POA or occurred after admission, based on the date of the test. Any issues relating signs and symptoms, the timing of test results, or findings, should be referred to the provider for the most appropriate assignment of the POA.

References:

• ICD-10 Official Guidelines
• AHA Coding Handbook
• cdc.gov
• Revenue Cycle Advisor / March 27, 2021

Question

Has Palmetto GBA finalized its coverage determination for Cardiac Resynchronization Therapy (CRT)?

Answer

Yes. The coverage determination became effective December 12, 2021 and can be found in Palmetto GBAs’ Local Coverage Article A58821 (link) and Palmetto GBAs’ Local Coverage Determination L39080 (link).

As with most of the other Medicare coverage guidelines, CRT has specific diagnosis codes that must be submitted on the claim to support medical necessity. In addition, the medical record must have documentation of the patient’s QRS duration - reflected in milliseconds - from the EKG, as well as documentation of QRS morphology such as right / left bundle branch block. Check the LCA and LCD for complete coverage requirements.

Did You Know?

The advice from Coding Clinic has changed regarding Anxiety with Depression.

Coding Clinic, 1st Quarter 2021, page 10 advises that Anxiety with Depression should be coded as two separate conditions, unless the physician has documented a link between the two. We are not to assume the linkage. If documentation does link the two conditions together, then F41.8, Other Specified Anxiety Disorders should be assigned.

Please note that this advice has been updated from Coding Clinic, 3rd Quarter 2011, page 6, which previously instructed us to code Anxiety with Depression as one condition.

Why It Matters?

It is important to correctly capture the clinical picture of the admission by coding the correct ICD-10 codes. Also, the Depression codes have been recently revised.

What Can I Do?

Review both Coding Clinics and the Oct. 1, 2021, coding changes with the coding staff.

Question

If a provider has documented diabetes and arthritis, can we code it to diabetes with arthropathy (E11.618)?

Diabetes, diabetic (mellitus) (sugar) (E11.9)

with

arthropathyNEC(E11.618)

Answer

No. Even though the ICD-10 Alphabetic Index has an entry for ‘Diabetes with Arthropathy NEC’, the provider needs to document the relationship between the two conditions; we cannot assume a causal relationship when a diabetic complication is “NEC”.

The “with” guideline does not apply to “not elsewhere classified (NEC)” conditions indexed to broad categories. The specific condition must be linked by the terms “with”, “due to” or “associated with”.

Arthropathy is a general term for any condition that affects the joints. There are many different types of arthropathic conditions that may not be due to diabetes. To link diabetes and arthritis, the provider needs to document the condition as a diabetic complication.

Please be aware of all diabetic NEC complications listed in the Alphabetic Index:

• Arthropathy NEC
• Circulatory complication NEC
• Complication, specified NEC
• Kidney complications NEC
• Neurologic complication NEC
• Oral complication NEC
• Skin complication NEC
• Skin ulcer NEC

References:

• ICD-10-PCS Official Coding Book
• Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2017: Pages 100-101
• Coding Clinic for ICD-10-CM/PCS, Second Quarter 2018: Page 6

Question:

How do we bill mammography services when a beneficiary undergoes a screening and diagnostic mammogram on the same day?

Answer:

According to the MLN educational tool: Medicare Preventive Services (https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html#MAMMO), “if you perform and bill a screening mammogram and a diagnostic mammogram on the same day, use modifier -GG to show a screening mammography turned into a diagnostic mammography.”