Coding for Diabetes with Complications

Question:

If a patient has multiple diabetic complications, will coding all of them have an impact on the risk score?

Answer:

• Credit is given once for each HCC category captured within the calendar year (after hierarchies are implied).

• Depending on the specific complication, additional credit may be given for the HCC of the complication.

• See the chart below for specific examples.

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Coding for Morbid Obesity

Question:

When the BMI is below 40, but morbid obesity is documented by the anesthesiologist (no other documentation regarding the patient’s obesity is recorded in the health record), is it appropriate to code morbid obesity or is a query recommended?

Answer:

Codes for overweight, obesity or morbid obesity are assigned based on the provider’s documentation of these conditions.

Therefore, if morbid obesity is documented, assign code E66.01, morbid (severe) obesity due to excess calories.

While the BMI is used as a screening tool for patients who are overweight or obese, there is no coding rule that defines what BMI values correspond to obesity or morbid obesity since the conditions are coded only when diagnosed and documented by the provider or another physician involved in the patient’s care.


AHA Coding Clinic, Fourth Quarter 2018, pp. 79 – 80


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Coding for Prescription Pain Medication

Question:

Medical record documentation indicates the patient is taking opioids prescribed by their physician for treatment of chronic pain. Does Guideline I.C.5.b.3. mean that codes cannot be assigned for the opioid use unless there is documentation of an associated physical, mental or behavioral disorder?

Answer:

A code for the use of prescription opiates would not be reported because there is no associated physical, mental or behavioral disorder.


 – AHA Coding Clinic 2018 2nd Quarter, pages 11 and 12


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Coding for Recreational Marijuana Use

Question:

Should recreational marijuana use be coded when documented by the patient’s provider?

Answer:

No, a code for the marijuana use is not assigned unless the provider documents an associated physical, mental, or behavioral disorder in accordance with ICD-10 Guideline I.C.5.b.3.

This guideline states “As with all other diagnoses, the codes for psychoactive substance use (F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-) should only be assigned based on provider documentation and when they meet the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses). The codes are to be used only when the psychoactive substance use is associated with a physical, mental or behavioral disorder, and such a relationship is documented by the provider.”


– AHA Coding Clinic 2018, Second Quarter, page 11


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Data Submission Deadlines for Medicare Advantage

Question: 

When does CMS run the risk score model to calculate risk scores for Medicare Advantage? What is the deadline for submitting claims data? 

Answer: 

The chart above highlights when CMS will the risk model to calculate risk scores for the PY 2021 Initial Run. Dates of service included and data submission deadlines are also highlighted above.


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Coding for Hyperaldosteronism

QUESTION: 

How is hyperaldosteronism coded in ICD-10? Does the etiology impact code choice?

ANSWER: 

Hyperaldosteronism occurs due to the excess production of aldosterone from the adrenal gland.

Hyperaldosteronism can initially present as essential and refractory hypertension and can often go undiagnosed. This disorder can be of primary or secondary origin, both presenting similarly but differentiated by a set of lab values and diagnostic studies. Treatment is specific to the individual causes of hyperaldosteronism.

Etiology
Its primary or secondary origin can differentiate hyperaldosteronism.

Primary hyperaldosteronism is due to the excess production of the adrenal gland, more specifically the zona glomerulosa. This can present more commonly as a primary tumor in the gland known as Conn syndrome or bilateral hyperplasia. Rarer forms are unilateral adrenal hyperplasia, ectopic aldosterone-secreting tumors, aldosterone-producing adrenocortical carcinomas, and familial hyperaldosteronism type 1.

Secondary hyperaldosteronism occurs due to excess activation of the renin-angiotensin-aldosterone system (RAAS). This activation can take the form of a renin-producing tumor, renal artery stenosis, or edematous disorders like left ventricular heart failure, pregnancy, cor pulmonale, or cirrhosis with ascites.


ICD-10 Codes

▪ Primary hyperaldosteronism – E26.0 (HCC 23)
▪ Secondary hyperaldosteronism – E26.1 (HCC 23)



Documentation Tips

• Document the clinical findings which lead to the diagnosis of the primary condition responsible for the aldosteronism and the status, the diagnosis of secondary aldosteronism, and a plan of care.

• As with most secondary diagnoses due to an underlying primary condition, the causal condition should be identified and documented, if known.

For Example:

▪ Secondary aldosteronism (E26.1) due to heart failure (I50.9)

▪ Alcoholic cirrhosis of liver with ascites (K70.31) and secondary hyperaldosteronism (E26.1)

▪ Aldosteronism, secondary (E26.1) due to severe renal artery stenosis (I70.1)



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Coding for Chronic Orthostatic Hypotension

Question:

How is orthostatic hypotension coded in ICD-10? Does the pathophysiology or severity of OH impact the code choice?

Answer:

Orthostatic hypotension (OH) can be divided into 2 pathophysiological subtypes: neurogenic and non-neurogenic.

In ICD-10, chronic neurogenic orthostatic hypotension is coded to G90.3 (HCC 78) and chronic non-neurogenic orthostatic hypotension is coded to I95.1 or I95.2, if OH is due to drugs. See ICD-10 Index below. 

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Coding for AAA s/p Repair

Question:

How would an AAA be coded s/p EVAR? Is the coding the same with an open abdominal repair?

Answer:

Coding for an AAA s/p repair, will depend on the type of surgical procedure:

For patients with EVAR, assign codes:

 – I71.4, AAA, without rupture

 – Z95.828, presence of other vascular implants and grafts

In EVAR, the graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm. Over time, the aneurysm will shrink because of the lack of pressure on it. Patients who have an endovascular stent-graft must have the position of the stent-graft regularly monitored by a CT scan.

For patients who had an AAA open abdominal surgery repair, assign code:

 – Z95.828, presence of other vascular implants and grafts

In an open abdominal surgery, the damaged section of the aorta is removed and replaced with a synthetic tube (graft). In this case, the aneurysm no longer exists and would not be coded per ICD-10 guidelines.

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