Sharpening Coding Skills and Documentation Tips

AGENDA FOR ICD-10 CODING SEMINAR

SHARPENING CODING SKILLS AND DOCUMENTATION TIPS

Presenter: Lois Kastner, M.A. CPC-H, Inpatient coder Department Veteran Affairs

Member of ICD-10 coding committee Department Veteran Affairs.

AHIMA Approved ICD-10 C/PCS Trainer

Coding Exercises (see ATTACHMENT A)

Coding exercises were sent via email to chapter membership prior to the date of the seminar

Logic:

1.  to give people time to work on exercises at home (total 20—10 will be discussed with PowerPoint, remaining for people to work on and bring questions to seminar).

2.  to be able to start seminar and move on with coding discussion and rationale for assigned

codes and not to take up valuable time in seminar waiting for people to complete coding.

Coding Answers (see ATTACHMENT B)

Answer sheets will be given to chapter membership in the seminar

It is anticipated that this part of presentation will take maximum three hours—possibly a bit less for each section (respiratory,circulatory, endocrine). Presenter will keep an eye on the time element.

Majority of my chapter are outpatient coders. I tried to choose senarios that people would come across

In their day to day job situation. For the brave souls in the group, there is one ICD-10 procedure code scenario (Needle biopsy of liver).

Last hour will be discussing what coder needs to look for in provider documentation in order to better assign proper code in ICD-10. Example: laterality documentation, etiology, types, stages, association words such as “due to”, “complication of—key words that will assist in finding proper I-10 code (see page 4 of this Agenda). Plan also to have question and answer period for the additional coding exercises and questions that are not addressed in the PowerPoint.

Agenda for presentation:

RESPIRATORY CODING

·  Coding exercises in this area chosen to illustrate different types of respiratory situations

1.  Exercises on 1st screen

2.  Answer for 1st exercise next screen, definition of code

·  Info on disease—two forms of COPD (chronic bronchitis & emphysema)

·  Causes of COPD (smoking and exacerbation of)

·  Rationale for codes used

1. Additional codes needed and rationale.

3.  ICD-10 guidelines for COPD, exacerbation and infection

·  definitions

·  reference to instructional notes

exclude notes with regard to COPD/bronchitis area in Tabular

reinforcement of meaning of Excludes 1 & 2 notes

4.  Respiratory #2 exercise

·  Answer on next screen

Agenda, p2 ICD-10 Seminar, Lois Kastner, M.A., CPC-H, presenter

·  Exercise was chosen to show contrast to #1 exercise by only having one code

·  Rationale for one code, acute bronchitis info

How classified

Attention to combo codes

Only one code needed

Signs/symptoms not reported if part of disease

Reminder to read all Exclusion notes

5.  Respiratory exercise #3 with code options

Answer on next screen

·  Exercise was chosen to illustrate need to understand status of persistency

New concept to coders for I-10 versus what was required in I-9

·  Rationale, with I-10 coding references guideline from I-10 manual

·  Explanation of what to look for in I-10

·  Emphasis on provider documentation requirements

·  Emphasis on coder requirement to understand classification of type of episode

6.  What coder needs to know for asthma conditions:

·  Status of persistency –mild, moderate, mod persistent or severe persistent

·  Characteristics of disease associated with type of persistency

·  Coder reminded to read notes thoroughly

·  Query if needed

7.  Respiratory I-10 Clinical documentation tips

·  Info on where to look for code based on documentation

·  Tips regarding COPD, emphysema, bronchitis

·  I-10 requires smoking code (active or history) in addition to respiratory code

·  Separate codes for respiratory failure with hypercapnea or with hypoxia

New requirement for coding, didn’t have in I-9

·  Adult respiratory distress syndrome: “adult” deleted, “acute” added instead

I-10 feels that adult or pediatric patient can have this condition

New concept for I-10, didn’t have this in I-9

Reference to P22.0 if infant respiratory distress syndrome

ENDOCRINE CODING

1.  Exercises chosen for diabetes coding with variable manifestation coding options

2.  Scenario # 1 and code options

·  Answer on next screen, with rationale for answer, ICD-10 guidelines reference

3.  Scenario #2 and code options

·  Answer on next screen with code rationale

·  I-10 requirements and ICD-10 coding guideline reference info

4.  Scenario #3 and code options

·  Answer on next screen

·  I-10 requirements and coding guideline reference

Agenda, p3 ICD-10 Seminar, Lois Kastner, M.A., CPC-H, Presenter

5.  Scenario #4 and code options

·  Answer on next screen

·  Rationale, coding guideline reference and explanations

CIRCULATORY, RENAL and ASSOCIATED STUFF

CIRCULATORY SCENARIO #1

·  Exercise chosen for illustration of atherosclerosis and ulcer

·  Answer on next screen

·  Reasons why certain codes used

=Explanation of atherosclerosis hierarchy of codes (just like I-9 with

code progression as severity progresses)

=Reminder that causal relationship is assumed when atherosclerosis and

chronic ulcer

RENAL-RELATED SCENARIO #2

·  Exercise chosen to illustrate adverse effect of drug

·  Answer on next screen

·  What the coder needs to know

·  Code sequence as used to do in I-9

·  Reminder that T codes in I-10, were E codes in I-9

·  Explanation how to determine Keflex code

=determine use of Keflex in scenario (antibiotic)

=determine type of antibiotic (sulfa etc)

=Keflex is cephalosporin—code s to T36.1-

CIRCULATORY SCENARIO #3

·  Exercise chosen to illustrate “problem” due to chemotherapy

·  Answer on next screen

·  Rationale for codes, I-10 coding guideline reference

·  Code sequencing explanation

=Reminder: works same way as it did in I-9

=code 1st the manifestation 2nd the neoplasm, 3rd T code

·  Reminder that sequencing depends on provider documentation

·  Reminder to query if uncertain

CIRCULATORY SCENARIO #4

·  Exercise chosen for “what to do when coder needs info” type of situation

·  Exercise chosen to see if coders would identify coding problem

·  Answer next screen

·  Rationale:

=Dr needs to be queried for additional info-not enough info to code

=Numerous dxs under tabular-need more info to code properly

=Coder needs to be aware of differences of thalassemia major and

minor—might assist with narrowing down code assignment

=Explanation of major and minor thalassemia

=Next screen: signs/symptoms/characteristics of thalassemia types

Agenda, p4, ICD-10 Seminar, Lois Kastner, M.A. CPC-H, Presenter

For last hour of seminar-

Quick overview of documentation importance (synopsis here):

·  No one is asking dr to do the coding

·  What the coder needs is the “tools”, the documentation that will assist us to do our jobs properly, and hopefully without having to query every last thing if we can do so.

·  ICD-10 is based on precision and detail. It is here to stay. We all have to get used to it and work with it—coders and providers alike.

Documention “clues” done by providers that coders can look for to assist them in assigning correct

ICD-10 code.

Includes some of these examples :

TIMING: “frequency”, “initial” “subsequent”, exact time of onset or occurrence

ACUITY: acute, acute on chronic, chronic, exacerbation, decompensation

SEVERITY does condition create problems for another part of body?

TYPES AND STAGES: Type I, Type II, cancer staging info, groups

LATERALITY/LOCATION: left, right, upper, lower, ascending, descending

ASSOCIATION WORDS: “caused by”, “due to”, “secondary to”, “causing”, “with…”

MANIFESTATIONS: Miscellaneous adjectives, intractable, displaced, non-displaced, congenital

ETIOLOGY: infection, traumatic, pathological fracture, induced by alcohol/drugs/lifestyle

ABBREVIATION USE: encourage correct abbreviations

Finishing up –question and answer session