Although ICD-10-CM and ICD-10-PCS will not be implemented until October 1, 2014, the American Hospital Association (AHA) launched its new AHA’s Coding Clinic for ICD-10-CM/PCS in the fourth quarter of 2012 in response to requests from the coding community. Future issues of the Coding Clinic will continue to include ICD-10-CM/PCS issues in addition to the ICD-9-CM coding questions as approved by the editorial advisory board. This new direction for Coding Clinic will help all coders establish a solid foundation in accurate coding in ICD-10-CM and -PCS.
Following is a brief overview of a few of the ICD-10-CM/PCS coding issues the Coding Clinic addressed.
Acute Exacerbation of Asthma and Status Asthmaticus
Every effort was made to carry over the ICD-9-CM guidelines and concepts into ICD-10-CM. However, in some cases there was a specific change in ICD-9-CM that did not allow the same concept to be incorporated into ICD-10-CM. Coders should not assume that the omission of a specific guideline in ICD-10-CM/PCS means that the advice has changed. Coding of acute exacerbation of asthma and status asthmaticus together is one such case. The ICD-9-CM coding guidelines included guideline I.C.8.a.4, which stated that “it is inappropriate to assign an asthma code with 5th digit 2, with acute exacerbation, together with an asthma code with 5th digit 1, with status asthmaticus. Only the 5th digit 1 should be assigned, only the code for the more severe condition (i.e., status asthmaticus) should be assigned.” This ICD-9-CM guideline includes clinical information and therefore is not appropriate for coding guidelines. In ICD-10-CM when coding acute exacerbation of asthma and status asthmaticus, only the code for the more severe condition (i.e., status asthmaticus) should be assigned. So while the ICD-10-CM guidelines do not specifically state the coding guidance as in ICD-9-CM guidelines, the coding remains consistent—that is, code the more severe condition.
Sequencing of Acute Myocardial Infarction
The sequencing of the I22 and I21 codes depends on the circumstances of the encounter. The Coding Clinic included an important decision tree diagram to walk the coder through assigning the correct code when the patient is admitted due to an acute myocardial infarction (AMI) and when a patient is admitted due to another condition and experiences an AMI during the admission.
Initial Encounter Versus Subsequent Encounter for Malunion of a Fracture
In ICD-10-CM malunion of a closed fracture of the wrist is identified with the seventh character P, for subsequent encounter. Yet according to the Official ICD-10-CM Guidelines for Coding and Reporting, an initial encounter “should be assigned the 7th character for initial encounter for a patient who delayed seeking treatment for the fracture or nonunion.” So how would one code an encounter for a fracture when the patient delayed treatment of the fracture that resulted in a malunion? The fact that this is an initial encounter takes precedence, and assigning the seventh character describing subsequent encounter for treatment of malunion is not appropriate in this case. The correct seventh character assignment would be A, for initial encounter.