Blog, Revenue Integrity, The Hospital Finance Podcast®

Coding Clinics from 2023 Webinar [PODCAST]

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In this episode, we’re pleased to welcome back Kristen Eglintine, Coding Manager of Revenue Integrity Services at BESLER, to give us a glimpse into BESLER’s next webinar, Coding Clinics from 2023, on Wednesday, January 10th at 1 PM ET.

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Highlights of this episode include:

  • Background on Coding Clinics
  • What Coding Clinics are used for
  • Guidance on a code or clinical condition
  • What Coding Clinics will be covered in the webinar

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Kristen Eglintine, Coding Manager of Revenue Integrity Services here at BESLER. In this episode, Kristen will give us a glimpse into BESLER’s next webinar, Coding Clinics from 2023, that we’re hosting on Wednesday, January 10th at 1 PM Eastern Time. Welcome back and thank you for joining us, Kristen.

Kristen Eglintine: Well, hello, Kelly, and hello, everyone. Thanks for having me back. I’m excited to be here.

Kelly: Well, great. Well, let’s go ahead and jump in. So, as I mentioned, BESLER has an upcoming webinar, Coding Clinics from 2023. Coders, CDI specialists, HIM, auditors, etc., have heard of Coding Clinics, but some of our listeners may not know about them. Can you provide some background on Coding Clinics?

Kristen: Absolutely. So, we all know Coding Clinic as a quarterly publication by the American Hospital Association or referred to as AHA’s Central Office. The AHA’s Central Office serves as the official U.S. clearinghouse on medical coding for the proper use of ICD-10-CM and ICD-10-PCS coding systems, and Level 1 HCPCS for hospital providers, and then certain Level 2 HCPCS codes for hospitals, or physicians, or other health professionals. Since 1984, the AHA Central Office began publishing quarterly what they call the AHA Coding Clinic for ICD-10-CM and ICD-10-PCS and the AHA Coding Clinic for HCPCS. Again, those are updated terms based on the year. So, in 1984, it was ICD-9, but we are now ICD-10. Even though the AHA publishes the publication quarterly, they have a formal cooperative effort between AHIMA, the CDC, and CMS for recommendations on revisions or modifications to the classification system.

Kelly: Thank you for that explanation. Kristen, can you elaborate how and what Coding Clinics are used for?

Kristen: Yeah, so they are wonderful. AHA’s Coding Clinic for ICD-10 provides expert guidance that supports coders, auditors, and insurers with their coding matters. The coding advice, again, is in a quarterly publication. And this delivers insights to educate providers, coders, insurers, again, and others in the field on the proper use of the ICD-10 codes. Coding Clinics answer questions on code assignments or sequencing of codes. And it also serves as a current reference on regulatory and other requirements for reporting diagnostic and procedural information from medical records. So, to take all of that and put it in really simple terms, Coding Clinic provides coding guidance. Here’s a couple of examples from Coding Clinic, quarter one of 2023, of that.

So, the publication is in a question and answer format. From quarter one of 2023, the question came in, and it was describing a nephrologist’s documentation of chronic kidney disease, G4A3. And they were asked if this description is sufficient to assign a code for stage 4 CKD. Sequencing guidance was also provided in that quarter one Coding Clinic for an encounter in which an end-stage renal disease patient, so someone has ESRD, and they presented with fluid overload and required emergent dialysis. That’s always a tricky one for coders. So having something in writing from Coding Clinic on that is very helpful for all of us. They also touch on the reporting of uncertain diagnoses, which can differ depending upon the setting. So if there is, from the inpatient setting discharge documentation, that states, “Liver mass pending pathology,” Coding Clinic provided some advice there, as well. The central office receives hundreds of requests for coding advice a month. In order to ensure that you receive a definitive response to your coding request, they ask that you read and adhere to some published following do’s and don’ts prior to the submission of your request. And then, coding advice is provided based upon specific medical record documentation submitted for each coding request.

Some of the do’s and don’ts are they ask that you do not submit questions without supporting medical record documentation. They have an FAQ section that you can refer to for more information on that. Requests submitted without medical record documentation may be returned unanswered. They ask that you do not submit any documentation that contains PHI. They don’t want physician names. They don’t want hospital names. They do say to submit questions that relate to the application of specific coding guidelines. And they say do submit questions regarding specific advice previously published in Coding Clinic. So that’s just a very small sampling. There’s many more do’s and don’ts to follow as you submit a question for Coding Clinic.

Kelly: Wow, thank you for all that great information, Kristen. As some of us likely know, coders rely on the alphabetic index, the tabular list, official coding guidelines, and AHA Coding Clinic advice for reporting the correct diagnosis or procedure code. Does one resource trump another?

Kristen: Yeah. So, Coding Clinic is the approved resource to update and clarify the use of ICD-10 codes. Their advice is not optional. Coding Clinic takes precedence over guidelines. And CMS had an affirmation of this. So, they, in their Federal Register, volume 74, so way back from August of 2009, actually, they affirmed that Coding Clinic is the official source of coding information.

Kelly: Well, that’s very good to know. Is there any way as coders, we can know if there’s a Coding Clinic guidance on a code or clinical condition that we’re trying to report?

Kristen: Yes. Generally, in the tabular, under a code description, there is a reference to AHA Coding Clinic, the year, the quarter, and sometimes even the page number is provided. And this tells us coders that the guidelines may not provide the most updated advice and to reference that Coding Clinic. The same goes for encoders. Today more than ever, I’d say coders must possess an understanding of anatomy and terminology, coding guidelines, and Coding Clinics to report the most accurate codes. And it is the coder’s responsibility to be aware of this tool and know how to use it. Coding Clinic is generally provided to you from your employer. However, if it isn’t, you can purchase it directly from AHA.

Kelly: Very good to know. And from all that you’ve said, I’m beginning to understand the importance of Coding Clinics, I think. So, what Coding Clinics will you be covering on the webinar?

Kristen: So, healthcare workers, we’re busy. Whether you’re a coder or you’re a CDI specialist, a validator, or an HIM manager, staying on top of Coding Clinics is of the utmost importance. However, it can be difficult with our day-to-day responsibilities. So, we have put together a webinar that will highlight some of the more important Coding Clinics from 2023. We’ve chosen six in total from different quarters. Starting with the first quarter, two questions came in, and they were related to sequencing of a GI bleed and the associated etiologies. The first describes a situation in which a patient is admitted with acute blood loss anemia due to a GI bleed. And the second one describes a slightly different scenario. Here, the patient has acute blood loss anemia and was admitted to rule out a GI bleed. So those are two questions that we’re going to be going over from the first quarter. We’ll also touch on the end-stage renal disease and fluid overload issue from the quarter one, as well. From quarter two, we’re going to go over diabetes with dysautonomia, orthostatic hypotension syndrome. And then from the third quarter, we’re going to touch on acute kidney injury and acute-on-chronic right heart failure and diastolic heart failure with improved recovered ejection fraction.

And then in addition to discussing the question and the answer, we will dive into the clinical condition that is the subject of the Coding Clinic. We’ll touch on the code assignment of that clinical condition, and then provide any critical knowledge needed to understand the Coding Clinic better. And then while I have just stressed the importance of knowing and understanding Coding Clinics, I will also add that it is just one resource for accurate coding. So, at the end of the webinar, we’ll also address some common coding tips and best practices, such as principal and secondary diagnoses, and the procedures coded to make sure everything was sequenced correctly and nothing was missed. We’ll touch on coding conventions and guidelines. Were they followed? We’ll give some examples on sequencing, combination codes, exclude OneNotes, etc. We’ll also touch on, does AHA Coding Clinic advice support and not contradict any other coding concerns? Are unspecified codes assigned where the documentation was more specific? Does something need to be changed there? Can you get more specificity than the code you’re reporting? Present on admission indicators, we’ll touch on the importance of that, and then the discharge disposition.

So that gives you a little bit of a picture of what we’re going to be going over on Wednesday, January 10th. I’d like to thank everyone for joining us today. This podcast is just an introduction to our upcoming webinar that would greatly help any coding professional. The webinar is scheduled for Wednesday, January 10th, at 1 PM Eastern Standard Time. And I strongly encourage and invite everyone to attend for a more detailed review of coding guidelines and Coding Clinics from 2023. Thank you, Kelly.

Kelly: Wow, thanks, Kristen. You guys are going to cover a lot of content in that webinar. And just as a reminder, I know she said it quite a few times, but the Coding Clinics from 2023 is presented live on January 10th, 2024, our first one of the year, at 1 PM Eastern Time. Thanks again, Kristen.

Kristen: Thank you. Have a great day.

Kelly: Thank you. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

[music] This concludes today’s episode of the Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.


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