How to decode ICD-9 mysteries |
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So your coders are busy coding their 389th radiology report ofthe day and they come across a complex ICD-9 coding issue in the report that they are not sure how to code. What should they do? The first resource for ICD-9-CM coding questions should always be the American Hospital Association (AHA) Coding Clinic for ICD-9-CM. The AHA Coding Clinic is a quarterly publication that provides answers andclarifications for all kinds of ICD-9-CM coding questions. The publication isproduced and sold by the AHA, but is sanctioned by the following organizations:
Given that both CMS and NCHS, the organizing group that maintains andupdates the ICD-9-CM codes every year, have given this publication theirblessing, the Coding Clinic is the source for coding clarifications for allcoders, not just facility coders. The following are some common, and sometimes confusing, radiology issues tobe on the lookout for, along with reference information to learn more throughthe Coding Clinic: Trauma – Did you know that if the reason for the radiologyservice is specified only as “trauma” that coders cannot code it as an injuryand should instead assign V71.4 (observation following other accident). Vol. 23 No. 1, first quarter, 2006. Consistent with – Language such as “consistent with”,“compatible with”, “indicative of”, “suggestive of” and “comparable with” areprobable or suspected conditions that cannot be coded in the outpatientsetting. Instead, coders should code the condition to the highest degree ofcertainty for the particular encounter, using indicators such as signs orsymptoms or other positive findings in the medical report. Vol. 22, No. 3, third quarter, 2005 Coronary artery disease – You would think that a diagnosisof coronary artery disease would be coded 414.00 if the physician does notspecify whether the disease was in a native artery or graft. However, thedisease is presumed to be in a native artery if there is no mention of coronaryartery bypass graft (CABG) and 414.01 would be coded. Code 414.00 if there isknown history of CABG and the physician does not document whether the graft ornative artery is diseased. Vol. 14, No. 3, third quarter, 1997 Bilateral occlusion and stenosis of precerebral arteries –There are individual codes for disease of the basilar artery (433.0x), carotidartery (433.1x) and vertebral artery (433.2x).There is also a code for“multiple and bilateral” precerebral artery disease (433.3x). Many codersassign 433.3x when there is bilateral disease in the carotid, vertebral orbasilar arteries. While that is a correct code, it should be assigned as thesecond code. Code 433.0x, 433.1x or 433.3x should be assigned first to specifywhich artery is affected, 433.3x should be assigned to indicate the disease isbilateral. Vol. 23, No. 1, first quarter, 2006 Carotid occlusion with stroke – Just because a patient has had a stroke, andalso has carotid artery disease, it is not appropriate to code 433.11. Theradiologist must document causality; that the carotid artery disease caused thestroke before the fifth digit of “1” can be coded. Without that documentation,433.10 and 434.91 would be coded. Vol. 12, No. 2, second quarter, 1995 By Jean Stoner, CPC, RCC, PCS, Lead Subject MatterExpert NLP |