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Coding Clinic updates for first quarter 2017 [PODCAST]

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Hospital_Finance_Podcast smallIn this episode, Kristi Morris, Director of Revenue Integrity Services at BESLER, discusses Coding Clinic updates for the first quarter of 2017.
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Mike Passanante: Hi, this is Mike Passanante. And welcome back to the Hospital Finance Podcast.

Today, I’m joined by Kristi Morris who is the Director of Revenue Integrity here at Besler. And Kristi has joined us to talk about some recent updates to the AHA Coding Clinic for the first quarter of 2017.

Welcome to the podcast, Kristi.

Kristi Morris: Thank you! Thank you for having me on again.

Mike Passanante: We love having you!

So today’s podcast, it’s a little different for our listeners who have been with us for a while. We recognize that as part of revenue integrity, accurate coding is extremely important to ensure both optimal reimbursement and compliance.

And so, what we’re going to do today is walk through some of the highlights that our Revenue Integrity Team took from this recent Coding Clinic.

It’s going to sound a little bit technical. Don’t worry about that. If you need the details, you can go up to our website in the shownotes and read them there. But we’re going to go work through this material. We’re going to make it entertaining for you I hope. And we’ll hopefully convey some great information to you.

So, with that, Kristi, I’m going to turn to you with my first question. And that is:

Is the coding of the Impella device impacted by the number of hours left in the patient?

Kristi Morris: No. The Impella device should be coded regardless of the number of hours that is left in the patient.

Now, the codes for the insertion of the Impella device which is 02HA3RZ is the insertion of the External Heart-Assist System into the Heart, Percutaneous Approach;

And then we have 5A0221D which is the Assistance of the Cardiac Output Use Impeller Pump Continuously;

And then, lastly, we have the code 02PA3RZ which is the Removal of the External Heart-Assist System from the Heart, Percutaneous Approach. And this one would be used for the removal of the Impella device.

Mike Passanante: Should gross hematuria be assigned as principal diagnosis for a patient with a known history of prostate cancer?

Kristi Morris: Well, based on previous guidance that was provided in the Coding Clinic of the 2nd quarter 2010 located on page three, it was recommended to sequence gross hematuria as a principal diagnosis in a patient with a known history of prostate cancer.

Now, ICD-10 Code R31.0, which is gross hematuria, falls under chapter 18. Now, chapter 18 is Symptoms, Signs and Abnormal Clinical & Laboratory Finding Not Elsewhere Classified.

Now, today, it is recommended using Guideline 2A in which it describes that codes for symptoms, signs and ill-defined conditions from chapter 18 are not to be used as a principal diagnosis when related to a definitive diagnosis that has been established.

Now, based on this guidance, the malignancy code will be assigned as a principal followed by the hematuria code. This is impactful since sequencing the prostate cancer as a principal diagnosis would regroup to MSDRG 724 which is a higher weighted DRG.

Mike Passanante: Pivoting over to knee replacements, when coding a total knee replacement, is the patella part of a total knee replacement or does it have its own body part value?

Kristi Morris: Well, when coding a total knee replacement, the patella is part of the total knee replacement. So there is no additional code necessary to capture the replacement of the patella.

Mike Passanante: And in a patient that is treated for chronic obstructive pulmonary disease and pneumonia, which code should be assigned as a principal diagnosis?

Kristi Morris: Well, in third quarter 2016, we received guidance recommending the sequence J44.0 which is Chronic Obstructive Pulmonary Disease with Acute Lower Respiratory Infection as the principal diagnosis followed by a code J18.9 which is Pneumonia (Unspecified Organism).

Now, that was based on the instructional note using additional codes to identify the infection, now under code J44.0 which is a Chronic Obstructive Pulmonary Disease with Acute Lower Respiratory Infection.

However, the instructional note at code J44.0 (which, as I’ve mentioned before, is the Chronic Obstructive Pulmonary Disease with Acute Lower Respiratory Infection) would not apply to aspiration pneumonia and/or mechanical ventilator associated pneumonia.

Aspiration pneumonia is considered an inflammation of the lungs which is caused by the inhalation of a solid or a liquid matter rather than by an infection.

Now, in the case of a mechanical ventilator associated pneumonia, the ICD-10 code for ventilator-associated pneumonia does not fall in the respiratory infection codes.

Code J95.85, ventilator-associated pneumonia, is under the section titled IntraOperative and Post-Procedural Complications and Disorders of the Respiratory System Not Elsewhere Classified.

Consequently, the sequencing of both conditions would depend on the circumstances of the admission and not the instructional note.

Mike Passanante: When a patient with asthma and chronic obstructive pulmonary disease is admitted for chronic obstructive pulmonary disease exacerbation, is the asthma automatically exacerbated?

Kristi Morris: No, asthma is not automatically assumed as exacerbated. A query would be needed to clarify if the asthmas is exacerbated. This is important since as the asthmas exacerbated is a CC (which is a complication or comorbidity) and it could impact the MSDRG.

Mike Passanante: Are mini-thoracotomies considered open or percutaneous?

Kristi Morris: Mini-thoracotomy is minimally invasive. However, it is still considered an open approach.

Mike Passanante: Okay. And how should we code body mass index or BMI falling between 19.1 through 19.9?

Kristi Morris: That’s a good question. Coders have struggled with this for a while. Now, since code Z68.1 is for a body mass index of 19 or less, and the next code Z68.2 is for body mass index of 20 through 29, coders were unsure as to which code to report in cases where the body mass index fell between 19.1 through 19.9.

Now, with the guidance that we just received, we’re guided to use code Z68.1 which is body mass index 19.0 or less for an adult, which is a complication or comorbidity, and this could impact your MSDRG.

Mike Passanante: How do we code a manual reduction of umbilical hernia?

Kristi Morris: There is actually not a code to report a manual reduction of umbilical hernia.

Mike Passanante: Okay.

Kristi, how do we report a type 2 myocardial infarction?

Kristi Morris: According to the American Hospital Association, a type 2 myocardial infarction is marked by non-ST elevation and occurs secondary to cardiac stress due to causes such as ischemia resulting from a supply-and-demand mismatch, without artherosclerotic plaque rupture, but with myocardial necrosis.

Now, code I21.4 would be assigned as a T2 MI.

Mike Passanante: Kristi, do you have any final thoughts for our audience?

Kristi Morris: Yes. Staying informed on Coding Clinic updates can have a substantial impact on your provider’s coding accuracy. Now, ensuring that all procedures and conditions are captured appropriately will not only increase accuracy, but also ensure revenue integrity.

Every quarter, there are changes and there are clarifications that are released. Timely review and education is vital to your organization being proactive and ensuring that changes are implemented correctly.

Mike Passanante:  Kristi, thanks for that, and thanks for all of that great information today.

For additional resources, you can visit And if you have any thoughts on the content of this episode or anything around the Hospital Finance Podcast, feel free to drop us a line at We’d love to hear from you.

Kristi, thanks so much again.

Kristi Morris:  Thank you. I appreciate it. I always enjoy being on.



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