April 19, 2022

Explain combination coding and multiple coding. Give an example of each in your response.Use your own words when writing your post. The reference

Explain combination coding and multiple coding. Give an example of each in your response.Use your own words when writing your post. The reference at the bottom of your post should appear as follows:

Reference

Carol J. Buck, Saunders. Step-by-Step Medical Coding, by Carol J. Buck, Saunders

CHAPTER 6

CHAPTER-SPECIFIC GUIDELINES (ICD-10-CM CHAPTERS 11-14)

Slide ‹#›

Diseases of Digestive System, Chapter 11

K00-K95

Unspecified GI hemorrhage, K92.2

Combination codes with hemorrhage

Example: K57.21, Diverticulitis of large intestine with perforation and abscess with bleeding

Slide ‹#›

The categories are sequenced in a manner that follows the path of the digestive system from the mouth to the anus, beginning with disorders of the teeth.

For a hemorrhage to be reported active bleeding is not necessary; however, documentation must support the fact that active bleeding has occurred.

Diseases of the Skin and Subcutaneous Tissue, Chapter 12

L00-L99

Also codes to report conditions of the:

Nails

Sweat glands

Hair

Hair follicles

Slide ‹#›

Chapter 12 describes diseases or conditions of the Integumentary System.

Does the integumentary system only include the skin? (No)

What else is included in the integumentary system? (glands, nails, hair and hair follicles)

What are the two glands that are covered in the integumentary system? (sweat and sebaceous)

Infections

Using additional code before L00 directs coder to report the infection with B95-B97

Slide ‹#›

If there isn’t a combination code to describe the diagnosis (cellulitis) and cause (staph infection), then both of these diagnoses would be coded out to fully describe the condition.

Pressure Ulcers

Stage 1: erythema (redness) of skin

Stage 2: partial loss of skin (epidermis or dermis)

Stage 3: full thickness loss of skin (up to but not through fascia)

Stage 4: full thickness loss (extensive destruction and necrosis)

Slide ‹#›

Pressure ulcers develop when the circulation is decreased to that area of the body.

Pressure ulcers are graded and reported based on:

Depth of the ulcer

Categorized in stages

Diseases of the Musculoskeletal System and Connective Tissue, Chapter 13

M00-M99

Most codes specify:

Site: Location on the body

Laterality: Right, left, unilateral, bilateral

Some codes include “multiple sites” such as:

M15.-, Polyosteoarthritis including multiple sites

Slide ‹#›

Chapter 13 describes diseases or conditions of the bone, joints, and muscles.

A medical dictionary will always be a handy tool to use when there are medical terms that you may not know. For example, dorsopathies.

Infectious Arthropathies

M00-M02

Direct infections

Invades synovial tissue

Invades the joint

Invasive organism has been identified

Indirect infections

Reactive: Microbial infection identified but not in joint

Postinfective: Microbial antigen present, but not constant and no evidence of multiplication

Slide ‹#›

Pathological Fractures

Also known as (AKA): Spontaneous fracture

Fracture reported in addition to underlying condition responsible for fracture

Never assign a code for a traumatic fracture and pathological fracture of same bone

7th character indicates treatment plans, such as A for initial

Slide ‹#›

The 7th character A (initial encounter) is assigned as long as the patient is receiving active treatment for the fracture.

Other 7th characters:

D (subsequent) is assigned when all active treatment is completed

G, K, and P are assigned subsequent, nonroutine encounters

S is assigned for a sequela

Osteoporosis

M80 and M81

Systemic condition that affects bones

Fracture sustained with trauma that would not usually cause a fracture

Site is not a component of codes

Category M80, Osteoporosis with current pathological fracture

Age and other osteoporosis codes

Category M81, Osteoporosis without current pathological fracture

Slide ‹#›

Osteoporosis is a systemic condition

Meaning all bones of the musculoskeletal system are affected.

Male genitalia (N40-N53)

Female genitalia (N70-N98)

Breast (N60-N65)

Urinary System (N00-N39)

Kidney stones are most common disorder reported from this chapter

N20, Calculus of kidney and ureter

Diseases of the Genitourinary System, Chapter 14

Slide ‹#›

Osteoporosis is a systemic condition

Meaning all bones of the musculoskeletal system are affected.

Conclusion CHAPTER 6

CHAPTER-SPECIFIC GUIDELINES (ICD-10-CM CHAPTERS 11-14)

Slide ‹#›

CHAPTER 7

CHAPTER-SPECIFIC GUIDELINES (ICD-10-CM CHAPTERS 15-22)

Slide ‹#›

Pregnancy, Childbirth, and the Puerperium, Chapter 15

O00-O9A

Any condition that occurs during pregnancy, childbirth, or puerperium is a complication

Unless physician documents it neither:

Affects the pregnancy

Is affected by the pregnancy

Slide ‹#›

Chapter 15 codes are never used on the record of the newborn.

Coders may find it helpful to code the mother’s and baby’s records at the same time.

Conditions documented on the birth certificate may appear on the newborn’s record but not the mother’s record.

Additional documentation to support coding may have to be obtained from the physician.

Sequencing Priority

Chapter 15 codes have sequencing priority of codes from other chapters

Z33.1, incidental pregnancy state, is reported if the physician documents incidental status

Chapter 15 codes are only for mother’s record

Never newborn’s record

Slide ‹#›

Routine Prenatal Visits

Routine outpatient prenatal visits with no complications = Z34 category code

First listed

Routine high-risk prenatal visits = O09 category code

First listed

Slide ‹#›

Outcome of Delivery

Outcome of delivery

Z37 category code

Only reported once

On mother’s record

Slide ‹#›

Category Z37, Outcome of delivery, can be assigned as an additional coding to the mother’s record.

An outcome of delivery code should be included on every maternal record when a delivery has occurred.

Trimester and Time Periods

Majority of codes, final character indicates trimester

Trimester calculated from last menstrual period (LMP)

First trimester: less than 14 weeks 0 days

Second trimester: 14 weeks 0 days to less than 28 weeks 0 days

Third trimester: 28 weeks 0 days until delivery

Peripartum = last month of pregnancy to 5 months postpartum

Postpartum = immediately after delivery to 6 weeks after delivery

Slide ‹#›

The unspecified trimester code should rarely be reported.

Ectopic Pregnancy

Fertilized ovum implants outside the uterus

Reported with category O00, based on:

Location of pregnancy

Such as: ovarian or tubal

With or without intrauterine pregnancy

Complications associated with ectopic pregnancy:

Report category O08 code

Slide ‹#›

Hydatidiform Mole

Tumor of the placenta

Secretes hormones

Report with category O01

Report complication with category O08

Malignant, report D39.2

Slide ‹#›

Secretes hormones: chorionic gonadotropic hormone, GGH.

Hypertension in Pregnancy

Pre-existing hypertension that complicates the pregnancy, delivery, or the five-month period after birth, Category O10

First-listed code

Slide ‹#›

Secondary code is assigned to report hypertensive heart disease or hypertensive chronic kidney disease.

Fetal Conditions

Category O35 and O36 report fetal abnormalities that affect the care of mother

If fetal abnormality does not affect care of mother, do not report O35 or O36

Slide ‹#›

When surgery is performed on the fetus, report a diagnosis code from category O35, to identify the fetal condition.

Surgery performed in utero on the fetus is reported on the obstetric encounter.

Diabetes Mellitus in Pregnancy

Type 1 = little or no insulin is produced

Controlled with insulin

Report long-term use of insulin

Type 2 = too little or the body cannot use the insulin that is produced

Controlled with diet, medications, and/or insulin

May report long-term use of insulin

Gestational diabetes develops in 2nd or 3rd trimester in patient who did not have diabetes prior to pregnancy

Do not report long-term use of insulin

Slide ‹#›

Poorly controlled diabetes mellitus during pregnancy can lead to serious complications for both mother and fetus.

May result in miscarriage or stillbirth.

Certain Conditions Originating in the Perinatal Period, Chapter 16

P00-P96

Chapter 16 codes only on newborn’s record

Category Z38 reports live-born according to place of birth and type of delivery

First listed

Does not report congenital malformation, deformities, or abnormalities

Rather report with Q00-Q99

Slide ‹#›

Whose record are Chapter 16 codes never reported on? (Maternal)

Chapter 16 codes can be reported throughout the life of the patient, if the condition persists.

Congenital Malformations, Deformation, and Chromosomal Abnormalities, Chapter 17

Q00-Q99

May be a first-listed or secondary diagnosis

Sequence as secondary diagnosis with category Z38 code on initial birth record

Reported whenever condition is diagnosed

Congenital = born with

Physician must document abnormality

Slide ‹#›

An anomaly is an abnormality of a structure or organ.

Congenital refers to an abnormality with which a person is born.

The term perinatal applies only to the baby, and postpartum applies only to the mother.

Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, NEC, Chapter 18

R00-R99

Sign = objective evidence of disease

Symptom = subjective observation

Report symptoms only when no more definitive diagnosis is available

Example: Pt complains of pain in the right lower quadrant. Diagnosis states acute appendicitis.

Do not report symptom of pain

Slide ‹#›

Signs and symptoms codes are used for encounters until a definitive diagnosis can be made.

No specific diagnosis can be made after investigation.

Signs and symptoms reported as existing at the time of the initial encounter prove to be transient or cause cannot be determined.

A patient fails to return, or is referred elsewhere, and all the coder has is a provisional diagnosis.

A more precise diagnosis is not available for any other reason.

Certain symptoms that represent important problems in medical care exist, and it might be desirable to classify them in addition to the known cause.

Injury, Poisoning, and Certain Other Consequences of External Causes, Chapter 19

S00-T88

Many codes have 7th characters

A initial encounter

Receiving active treatment for the injury

D subsequent encounter

Completed active treatment and is receiving routine care during healing

S sequela

Direct result of injury, add S to injury code, not to sequela code

Slide ‹#›

Would usually report a secondary code from Chapter 20, External Causes of Morbidity, to indicate injury.

There are T codes that include the external cause as part of the code description.

Traumatic Fractures (1 of 2)

Fractures not indicated as

Open or closed, report as closed

Displaced or not displaced, report as displaced

Assign 7th character

A initial encounter for closed fracture

B initial encounter for open fracture

D subsequent encounter for fracture with routine healing

G subsequent encounter for fracture with delayed healing

K subsequent encounter for fracture with nonunion

S sequela

(Cont’d…)

Slide ‹#›

Traumatic Fractures (2 of 2)

Multiple fractures, sequence according to severity

If dislocation and fracture of same bone, report only fracture

Category M80 reports nontraumatic fracture for patients with osteoporosis

Even if injury by trauma

Pathological fracture occurs due to disease or weakness

Slide ‹#›

Burns and Corrosions (1 of 2)

Thermal burns from heat source

Except sunburn

Corrosion burns due to chemicals

Guidelines same for burns and corrosions

Burns classified by depth:

1st erythema

2nd blistering

3rd full-thickness

Slide ‹#›

Includes burn codes from radiation or electricity.

Current burns are classified by:

Depth

Extent

Agent (X code)

Burns and Corrosions (2 of 2)

Sequence first

Highest degree of burn

Multiple burns, same area

Report only the highest degree burn

Infected burns

Use additional code for infection

Late effects of burns

Report with burn or corrosion code + 7th character “S”

Slide ‹#›

Nonhealing burns are coded as acute burns.

If different degrees of burns are documented at the same site, assign a code to burns of highest degree only.

Second-degree burns may also be referred to as “partial-thickness burns.”

Adverse Effects, Poisoning, Underdosing, and Toxic Effects

T36-T65

Combination codes that include

Substance

External cause

Sequence these codes 1st

Follow with code(s) that specify nature

Slide ‹#›

Do not code directly from the Table of Drugs and Chemicals.

Assign a code for adverse effect when the drug was correctly prescribed or administered.

Poisoning

Assign code from categories T36-T50, poisoning codes

Report any associated intent

Such as accidental, intentional, etc.

Report all manifestations of poisoning

Such as vomiting

Slide ‹#›

Examples of poisoning include:

Error in drug prescription

Intentional overdose

Combination of drugs taken

Interaction of drugs and alcohol

Drug Adverse Effect or Poisoning

Adverse Effect: Occurs when drug is taken correctly but patient has negative response

Poisoning: Occurs when drug is incorrectly taken

Slide ‹#›

Abuse, Neglect, or Maltreatment

Sequence first (T74.- or T76.-)

Medical documentation states

Abuse or neglect, code as confirmed

Suspected, code as suspected

Confirmed cases of abuse or neglect

Report an assault code (X92-Y08) to indicate cause of physical injury

Report perpetrator code (Y07.-)

Slide ‹#›

When suspected abuse, neglect, or maltreatment is ruled out, report Z04.71 for an adult and Z04.72 for a child.

External Causes of Morbidity, Chapter 20, Factors Influencing Health Status and Contact with Health Services, Chapter 21, and Codes for Special Purposes, Chapter 22

I-10 Guideline information for Chapters 20-21 is located in Chapter 3 of the text

To review I-10 Chapter 20, refer to "External Cause Index" on page 55.

To review I-10 Chapter 21, refer to Z codes content on pages 49-65.

To review 1-10 Chapter 22, refer to "Coronavirus Infection" on page 100.

Slide ‹#›

Conclusion CHAPTER 7

CHAPTER-SPECIFIC GUIDELINES (ICD-10-CM CHAPTERS 15-22)

Slide ‹#›

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Explain combination coding and multiple coding. Give an example of each in your response.Use your own words when writing your post. The reference

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