ICD-10 QUICK TIPS: Reviewing 4th Quarter Coding Clinic Updates

ICD-10_1.pngAs the largest outsource coding provider in the country we have identified trends and gained unique insights from our coders throughout the transition to ICD-10.  We are sharing these insights with the broader HIM Community through our bi-weekly blog series "ICD-10 Quick Tips." 

The subject matter for this series is currated based on the trending topics in our online question and answer system which services over 1,200 of our HIM professionals.  Our Subject Matter Experts have an average of 20 years of experience and are considered leaders in their field. 

This week's post comes from National Compliance Manager, Melissa McLeod, CDIP, CCDS, CCS, CPC, CPC-1, and AHIMA Approved ICD-10 Trainer. 

Let me begin by wishing you a Happy New Year!  Those of us in HIM know that 2015 was a monumental year full of many accomplishments including the successful transition to ICD-10.  As we start 2016, let's begin on strong footing by first taking a look back the 4th quarter of 2015 for clarifications revealed in the latest Coding Clinic. 

The latest release of Coding Clinics was available 4th Quarter 2015 effective for discharges November 13 2015, and has some snippets in there that you may still be having animated discussions about with your fellow coders around the water cooler.  Let’s clear a couple of those up as we continue on our ICD journey in 2016.

When coding central venous catheter insertions, how many of you have fallen into the trap of coding the insertion site as opposed to the end placement of the catheter?  What about fluoroscopic guidance?  CC 4th Quarter pg. 28 addresses this for encounters discharged November 13, 2015.

When coding the placement of a central venous catheter, radiological guidance does not need to be reported in an inpatient setting. However, for facilities that wish to collect this information, in ICD-10-PCS fluoroscopic guidance is classified in table B51 with the qualifier value "Guidance."  For placement of a central venous catheter, assign the following ICD-10-PCS code:

02HV33Z – Insertion of infusion device into superior vena cava, percutaneous approach

As stated in Coding Clinic,Third Quarter 2013, page 18, "The correct coding of venous catheters depends on the end placement of the catheter, meaning the site where the device ended up."

Another clarification that came out was in relation to the catheter tip with an end placement in the cavoatrial junction and is a perfect example of our need for a strong understanding of anatomy:

“The cavoatrial junction is where the superior vena cava joins the wall of the right atrium; therefore, it would be appropriate to assign the body part value "V", Superior Vena Cava, for the cavoatrial junction." For placement of a dialysis catheter, assign the following ICD-10-PCS code:

02HV33Z - – Insertion of infusion device into superior vena cava, percutaneous approach

Coding Clinic, Fourth Quarter ICD-10 2015 Pages: 29-30 Effective with discharges: November 13, 2015

We also received some much needed clarification relating to the Excludes 1 note application.  Coding Clinic Fourth Quarter ICD-10 2015 Page: 40 Effective with discharges: November 13, 2015 provides this interim Coding advice for us:

There are circumstances that have been identified where some conditions included in Excludes1 notes should be allowed to both be coded, and thus might be more appropriate for an Excludes2 note.  However, due to the partial code freeze, no changes to Excludes notes or revisions to the official coding guidelines can be made until October 1, 2016.  The new guidance concerning Excludes1 notes is intended to allow conditions to be reported together when appropriate even though they may currently be subject to an Excludes1 note.”

These are just two of the Coding Clinic highlights from the latest updates posted in 4th Quarter which I strongly recommend you get very ‘up close and personal’ with.  We all have our hands full adjusting to the new coding system but we must remain in touch with our Coding Clinics and make sure that we are compliantly coding using the most recent coding. Let's look forward to a busy and productive 2016!


Topics: ICD-10, Coding