While the ICD-10-CM Official Guidelines and the Uniform Hospital Discharge Data Set (UHDDS) outline the definitions or qualifications for additional diagnoses for inpatient admissions, grey areas remain. And these shades of grey are potentially troublesome.
As a coder, for example, how do you handle documented perioperative conditions, such as acute respiratory failure after thoracic surgery, postoperative ileus after bowel surgery, or other conditions occurring during or after a procedure as to determine whether to assign these as additional diagnoses or complications?
Join James S. Kennedy, MD, CCS, CDIP, CCDS, a general internist since 1982 and a certified coder since 2001, in a review of the ICD-10-CM Official Guidelines, Coding Clinic advice, and other authoritative references referable to additional diagnoses as to develop an action plan so one's facility can begin implementing the following Monday.
Why This Matters:
ICD-10-CM code assignment is not easy and is subject to second guessing by Recovery Audit Contractors (RACs), sanctioned by the Centers for Medicare & Medicaid Services (CMS), and payers. For example, in a recent review of severe malnutrition by the Department of Health and Human Services, Office of the Inspector General (HHS OIG), several additional diagnoses were denied because the auditor held that they were integral to a treated condition or were not "treated enough." Coding Clinic also provides circumstances whereby a "chronic systemic condition" can be coded on inpatient admissions if listed in the history section; however, they did not stipulate exactly what a "chronic systemic condition" is. Given that RACs appear to deny many codes just because they can, providers and facilities must have compliant defenses, particularly if they plan to address these issues in court.
From this crucially important webcast you will…
- Grasp ICD-10-CM Official Guidelines, Coding Clinic advice, and supportive information regarding additional diagnoses
- Understand unintended consequences of assigning additional diagnoses simply because they were documented by the provider
- Develop strategies that promote defendable additional diagnosis assignment, particularly those involving complications of care
- Learn from case scenarios and sample queries that outline concepts and strategies
- Compliantly defend denials based on additional diagnoses