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Leah Savage MSN, RN, CCDS Norton Children’s Hospital

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1 Leah Savage MSN, RN, CCDS Norton Children’s Hospital
2018 UPDATES Leah Savage MSN, RN, CCDS Norton Children’s Hospital

2 Objectives Verbalize three coding updates for ICD-CM 2018.
Acknowledge three query opportunities from ICD-10 CM 2018. Identify two changes to ICD-10 PCS that affect assigned DRG.

3 UPDATES There are new ICD-10-PCS codes effective October 1, 2017. There are revised and 646 codes deleted, mostly to simplify certain body part values or to correct clinical discrepancies. 3,562 1,821

4 Code updates

5 Clostridium difficile enterocolitis
Code A04.7, Enterocolitis due to Clostridium difficile recurrent (A04.71) not specified as recurrent (A04.72). ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Page: 4 Effective with discharges: October 1, 2017

6 Diabetic ketoacidosis
E11.10, Type 2 diabetes mellitus with ketoacidosis without coma E11.11, Type 2 diabetes mellitus with ketoacidosis with coma ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Page: 6 Effective with discharges: October 1, 2017

7 Substance related disorders, in remission
Alcohol (F10.11) Opioid (F11.11) Cannabis (F12.11) Sedative, hypnotic or anxiolytic (F13.11) Cocaine (F14.11) Other stimulant (F15.11) Hallucinogen (F16.11) Inhalant (F18.11) Other psychoactive substance (F19.11) ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Page: 8 Effective with discharges: October 1, 2017 Prior to this change, ICD-10-CM included codes for "in remission" for substance dependence, but not for substance abuse. The new codes for substance abuse in remission have inclusion terms for substance use disorder specified as "mild in early remission" and "mild, in sustained remission."

8 Types of acute myocardial infarction
I21 Acute myocardial infarction Addresses “Type” of MI I21.0-I21.4 designated as Type 1 I21.9 Acute myocardial infarction, unspecified I21.A1 Myocardial infarction Type 2 MI due to demand ischemia I21.A9 Other myocardial infarction type Types 3, 4a, 4b, 4c, 5 ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Pages: Effective with discharges: October 1, 2017

9 Types of acute myocardial infarction
Type 1: Spontaneous myocardial infarction due to a primary coronary event like plaque rupture. Type 2: Myocardial infarction secondary to an ischemic imbalance as in coronary vasospasm, anemia or hypotension. Type 3: Myocardial infarction resulting in death when biomarker values are unavailable Type 4a: Myocardial infarction related to percutaneous coronary intervention (PCI) Type 4b: Myocardial infarction related to stent thrombosis Type 4c: Myocardial infarction due to restenosis greater than or equal to;50% after an initially successful PCI Type 5: Myocardial infarction related to coronary artery bypass grafting (CABG) "Third Universal Definition of Myocardial Infarction“ (consensus clinical classification of myocardial infarctions) developed by A global task force, which included the European Society of Cardiology, the American College of Cardiology, the American Heart Association and the World Heart Federation (WHF)

10 Pulmonary hypertension
Expanded I27.2 Other secondary pulmonary hypertension I27.20 Pulm htn, unspecified I27.21 Secondary pulmonary arterial hypertension I27.22 Pulm htn d/t left heart disease I27.23 Pulm htn d/t lung disease and hypoxia I27.24 Chronic thromboembolitic pulm htn I27.29 Other secondary pulm htn ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Pages: Effective with discharges: October 1, 2017

11 Other heart failure Expanded I50.8
I Right heart failure, unspecified I Acute right heart failure I Chronic right heart failure I Acute on chronic right heart failure I Right heart failure due to left heart failure I Biventricular heart failure I High output heart failure I End stage heart failure ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Pages: Effective with discharges: October 1, 2017

12 COPD J44.0 COPD with acute lower respiratory infection
“use additional code” to identify infection mandated that J44.0 be sequenced first regardless of reason for admission October 1, 2017 changed to “code also” to identify infection Sequencing is no longer mandated COPD or respiratory infection can be sequences ad principle diagnosis ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Page: 96 Effective with discharges: October 1, 2017

13 ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 Page 49 of 117

14 ICD-10-CM Official Guidelines for Coding and Reporting FY 2018 Page 50 of 117

15 Spinal stenosis Expanded M48.06 spinal stenosis, lumbar region
M Spinal stenosis, lumbar region without neurogenic claudication M Spinal stenosis, lumbar region with neurogenic claudication ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Pages: Effective with discharges: October 1, 2017

16 Acute respiratory distress
R Finally has a code!!! Acute respiratory distress, was created to separate acute respiratory distress from the life-threatening condition, acute respiratory distress syndrome (ARDS) ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD Page: 23 Effective with discharges: October 1, 2017

17 Neonatal codes Several new codes added to allow for greater specificity when coding newborn diagnoses P29.30 Pulmonary hypertension of newborn P29.38 Other persistent fetal circulation P83.81 Umbilical granuloma P Neonatal encephalopathy in diseases classified elsewhere P Neonatal encephalopathy, unspecified P91.88 Other specified disturbances of cerebral status of newborn

18 Pediatric codes R40.22 Coma scale, best verbal response has new descriptions to more appropriately assess the patient based on their age

19 Pediatric codes R40.23 Coma scale, best motor response has new descriptions to more appropriately assess the patient based on their age

20 Non-pressure chronic ulcer
63 new codes have been created for category L97 to provide additional information regarding severity of the ulcer

21 Non-pressure chronic ulcer

22 DRG updates

23 DRG 23 Previously craniotomy with major device implant or acute complex central nervous system (CNS) principle diagnosis with MCC or chemotherapy implant Now includes or Epilepsy with neurostimulator

24 DRG 61/62/63 Previously for CVA’s with use of thrombolytic agent Now includes Precerebral occlusion or transient ischemia with thrombolytic agent

25 DRG 246 and 248 Title has changed- Previously used the term vessels, now states arteries Percutaneous cardiovascular procedures with non-drug eluting stent with MCC or 4+ Arteries

26 Mitral Valve Replacements
Previously grouped to Now group to 266 & 267, along with percutaneous aortic valve replacements

27 DRG 469 Previously stated Major hip and knee replacement or reattachment of lower extremity with MCC Now states or Total ankle replacement Total ankle replacement revisions are included in this DRG.

28 Complications of internal prosthetic devices, implants, and grafts
Previously in DRG 949 & 950 Now in DRG’s

29

30 Reserved for future guideline expansion
kind of scares me……

31 Just in case you need to know….
Swallowing eye drops now goes to poisoning DRG ( ) instead of eye DRG’s ( )

32 Questions

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