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Complex issues in coding

Complex issues in coding. Linda Best 11.45 - 12.30 Thursday, 8 th December 2011. Complex coding. Coding is not always simple Complexity due to Multiple different conditions Multiple components of the one condition Complex surgery

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Complex issues in coding

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  1. Complex issues in coding Linda Best 11.45 - 12.30 Thursday, 8th December 2011

  2. Complex coding Coding is not always simple Complexity due to Multiple different conditions Multiple components of the one condition Complex surgery Multiple codes to translate the medical or surgical statement

  3. Complex coding cont. Multiple coding Reflect the various components of a disease For example: Young’s syndrome N46 Male infertility J98.4 Other disorders of lung J47 Bronchiectasis

  4. Complex coding cont. Multiple coding (cont) Ensure the entire concept is captured For example: Laparoscopic hepatectomy 90346-00 [953] Total hepatectomy 30390-00 [984] Laparoscopy

  5. Complex coding cont. Multiple coding (cont) When directed by a coding note For example: "Use additional code to identify presence of hypertension".

  6. Complex coding cont. Complex coding Multiple conditions For example: Patient admitted with a stroke, hemiplegia and dysphagia, unstable hypertension, develops urinary retention, UTI, decubitus ulcer. Has longstanding emphysema and all these conditions are treated during the episode of care

  7. Codes I64 Stroke, not specified as haemorrhage or infarction G81.9Hemiplegia, unspecified R13 Dysphagia I10 Hypertension R33 Retention of urine N39.0Urinary tract infection, site not specified L89.9 Decubitus ulcer and pressure area, unspecified J43.9Emphysema, unspecified

  8. Complex coding cont. Complex coding (cont) Multiple codes for a condition For example: Type 2 Diabetic patient with microvascular complications of end-stage kidney disease and retinopathy.

  9. Codes E11.71 Type 2 diabetes mellitus with multiple microvascular and other specified nonvascular complications N18.5 Chronic kidney disease, stage 5 H35.0 Background retinopathy and retinal vascular changes

  10. Complex coding cont. Complex coding (cont) Multiple codes for a condition For example: A patient with AIDS is admitted with a principal diagnosis of Kaposi sarcoma of skin, and additional diagnoses of wasting syndrome and CMV retinitis.

  11. Codes C46.0 Kaposi sarcoma of skin B21 Human immunodeficiency virus [HIV] disease resulting in malignant neoplasms H30.9 Chorioretinal inflammation, unspecified B25.8 Other cytomegaloviral diseases R64 Cachexia

  12. Complex coding cont. Complex coding (cont) Multiple trauma Code for each injury Code for the external cause of the injury Code for the place of occurrence of the external cause Code for the patient’s activity at the time of the external cause

  13. Complex coding cont. Complex coding (cont) Obstetrics Codes for antepartum conditions Codes for conditions related to labour and delivery Codes for postpartum conditions

  14. Complex coding cont. Complex coding (cont) Obstetrics (cont) Additional codes for further specificity e.g. O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium Coding note “Use additional code to identify specific condition” Outcome of delivery

  15. Complex coding cont. Complex coding (cont) Medical and surgical complications Code for each complication (+/- site code) Code for the external cause of the complication Code for the place of occurrence of the external cause

  16. Complex coding cont. Complex coding (cont) Complex surgery ‘Code also notes’ For example: 40903-00[1] Neuroendoscopy Intraventricularneuroendoscopy Code also when performed: • insertion of shunt (40003-00, 40003-01, 40003-02, 40003-03 [5]) • third ventriculostomy (40012-00, 40012-01 [19])

  17. Complex coding cont. Complex coding (cont) Complex surgery (cont) Need to capture all components For example: CABG x3 using LIMA and saphenous vein x2 under GA, ASA 3 with CPB. Post-op required 30 hours of ventilation.

  18. Complex coding cont. Codes 38500-00 [674] Coronary artery bypass, using 1 LIMA graft 38497-01 [672] Coronary artery bypass, using 2 saphenous vein grafts 38600-00 [642] Cardiopulmonary bypass, central cannulation 92514-39 [1910] GA, ASA 3 13882-01 [569]Management of continuous ventilatorysupport, > 24 and < 96 hours

  19. Complex coding cont. Complex coding (cont) Specialty standards Viral Hepatitis Tobacco use Outcome of delivery Personal history

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