Coding, Classification and Reimbursement

A quick review of what is changing with 2020 ICD-10-CM Guidelines

  • 1.  A quick review of what is changing with 2020 ICD-10-CM Guidelines

    Posted 14 days ago
    Hi, this is a very quick review of what is bolded in the Guidelines as a change.

    This review was for SNF residents, so Chapter 15 and 16 are not included.

    2020 ICD-10-CM Guideline changes

     

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    1. Zika virus infections

    1) Code only confirmed cases

    Code only a confirmed diagnosis of Zika virus (A92.5, Zika virus disease) as documented by the provider. This is an exception to the hospital inpatient guideline Section II, H. In this context, "confirmation" does not require documentation of the type of test performed; the provider's diagnostic statement that the condition is confirmed is sufficient. This code should be assigned regardless of the stated mode of transmission.

    If the provider documents "suspected", "possible" or "probable" Zika, do not assign code A92.5. Assign a code(s) explaining the reason for encounter (such as fever, rash, or joint pain) or Z20.821, Contact with and (suspected) exposure to Zika virus.

     

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    5) Other Types of Myocardial Infarction

    The ICD-10-CM provides codes for different types of myocardial infarction. Type 1 myocardial infarctions are assigned to codes I21.0-I21.4.

    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 code I21.A1. Codes I21.01-I21.4 should only be assigned for type 1 AMIs.

     

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    1. Pressure ulcer stage codes

    1) Pressure ulcer stages

    Codes in category L89, Pressure ulcer, identify the site and stage of the pressure ulcer.

    The ICD-10-CM classifies pressure ulcer stages based on severity, which is designated by stages 1-4, deep tissue pressure injury, unspecified stage, and unstageable.

    Assign as many codes from category L89 as needed to identify all the pressure ulcers the patient has, if applicable.

    See Section I.B.14 for pressure ulcer stage documentation by clinicians other than patient's provider.

     

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    4) Patients admitted with pressure ulcers documented as healed

    No code is assigned if the documentation states that the pressure ulcer is completely healed at the time of admission.

     

    7) Pressure-induced deep tissue damage

    For pressure-induced deep tissue damage or deep tissue pressure injury, assign only the appropriate code for pressure-induced deep tissue damage (L89.--6).

     

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    1. Non-Pressure Chronic Ulcers

    1) Patients admitted with non-pressure ulcers documented as healed

    No code is assigned if the documentation states that the non-pressure ulcer is completely healed at the time of admission.

     

    NOT INCLUDED IN THIS ANALYSIS:

    1. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)

    NOT INCLUDED IN THIS ANALYSIS:

    1. Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96)

     

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    1. Chapter 17: Congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)

    Assign an appropriate code(s) from categories Q00-Q99, Congenital malformations, deformations, and chromosomal abnormalities when a malformation/deformation or chromosomal abnormality is documented. A malformation/deformation/or chromosomal abnormality may be the principal/first-listed diagnosis on a record or a secondary diagnosis.

    When a malformation/deformation or chromosomal abnormality does not have a unique code assignment, assign additional code(s) for any manifestations that may be present.

    When the code assignment specifically identifies the malformation/deformation or chromosomal abnormality, manifestations that are an inherent component of the anomaly should not be coded separately. Additional codes should be assigned for manifestations that are not an inherent component.

    Codes from Chapter 17 may be used throughout the life of the patient. If a congenital malformation or deformity has been corrected, a personal history code should be used to identify the history of the malformation or deformity. Although present at birth, a malformation/deformation/or chromosomal

     

    abnormality may not be identified until later in life. Whenever the condition is diagnosed by the provider, it is appropriate to assign a code from codes Q00-Q99. For the birth admission, the appropriate code from category Z38, Liveborn infants, according to place of birth and type of delivery, should be sequenced as the principal diagnosis, followed by any congenital anomaly codes, Q00- Q99.


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    3) Iatrogenic injuries

    Injury codes from Chapter 19 should not be assigned for injuries that occur during, or as a result of, a medical intervention. Assign the appropriate complication code(s).

     

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    3) Physeal fractures

    For physeal fractures, assign only the code identifying the type of physeal fracture. Do not assign a separate code to identify the specific bone that is fractured.


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    4) If two or more drugs, medicinal or biological substances

    If two or more drugs, medicinal or biological substances are taken, code each individually unless a combination code is listed in the Table of Drugs and Chemicals.

    If multiple unspecified drugs, medicinal or biological substances were taken, assign the appropriate code from subcategory T50.91, Poisoning by, adverse effect of and underdosing of multiple unspecified drugs, medicaments and biological substances.


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    Complication codes from the body system chapters should be assigned for intraoperative and postprocedural complications (e.g., the appropriate complication code from chapter 9 would be assigned for a vascular intraoperative or postprocedural complication) unless the complication is specifically indexed to a T code in chapter 19.


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    Z68 Body mass index (BMI)

    BMI codes should only be assigned when there is an associated, reportable diagnosis (such as obesity). Do not assign BMI codes during pregnancy.

     

     

     

     

     



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    Bill Roush, RHIA, BSHI, AHIMA-Approved ICD-10-CM Trainer
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