1 chapter 5 unit 4 presentation icd-9-cm hospital inpatient, outpatient, and physician office coding...
TRANSCRIPT
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Chapter 5
Unit 4 Presentation
ICD-9-CM Hospital Inpatient, Outpatient, and Physician Office Coding
Shatondra Surulere, MBA, RHIA, CCS
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Inpatient Coding
Settings Reimbursement systems Indexes and data entry Coding guidelines and rules of
coding
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Sequencing of Diagnoses
Uniform Hospital Discharge Data Set (UHDDS) Principal diagnosis Additional diagnoses Principal procedure Other significant procedures
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Inpatient Health Care Settings
Acute care facilities (hospitals) Behavioral health care facilities Hospice inpatient care Long-term care
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Acute Care Facility (ACF)
Range of services Ancillary services Single hospital versus multi-hospital
system Bed size (bed count) Short term versus long term
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Hospital Categories
Critical access General Long-term acute care (LTAC) Specialty Behavioral health care
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Patient Coding Guidelines
Sequencing Principal diagnosis Other (additional) diagnoses
Complications Comorbidities
Principal procedure Significant other procedures
(secondary)
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Codes for Symptoms, Signs and Ill-defined Conditions
Codes from Chapter 16 are not reported as the principal diagnosis when a related definitive diagnosis has been established
Chest Pain vs. Myocardial Infarction Short of Breath vs. Emphysema
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Two or More interrelated Conditions that meet Definition of Principal Diagnosis
When two or more interrelated conditions potentially meet the definition of principal diagnosis, either condition can be sequenced first (unless the ICD-9 book indicates otherwise).
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Two or More Diagnoses that equally Meet Definition of Principal Diagnosis
Circumstances of admission Diagnostic work up and/or therapy
provided Alphabetic index tabular list or
coding guidelines
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Two or More Comparative or Contrasting Conditions
When you have two or more comparative or contrasting diagnoses they are coded as confirmed diagnoses.
Sequence them according to coding rules. Either can be first.
Patient has chest pain, shortness or breath and doctor documents “acute asthma or acute pneumonia” you code both .
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Symptoms Followed by Contrasting/Comparative Diagnosis
When a symptom is followed by contrasting/comparative diagnosis, the symptom code is sequenced first. Contrasting and comparative diagnoses are coded as secondary codes.
Overflow incontinence (symptom), Rule Out neurogenic bladder, rule out urinary stones
Code 788.38 incontinence and all rule out diagnoses.
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Original Treatment Plan not Carried Out
Patient was supposed to have surgery for salpingo-oophorectomy for cystic ovaries and after anesthesia the patient’s blood pressure drops and surgery is cancelled. Still code the cystic ovaries as principal.
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Complications of Surgery and Other Medical Care
When patients is admitted for complications of previous surgery or other medical care the complication is sequenced first.
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Uncertain Diagnosis
Probable Suspected Likely Questionably Possible Still to be ruled outCode the condition as if it
existed!!!!!
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Other Key Terms
Optimizing reimbursement Permitted
Maximizing reimbursement Not permitted
Consolidated bill
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Principal Diagnosis for Admission Following Observation Care
Admission following observation, principal diagnosis is medical condition that led to hospital admission
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Principal Diagnosis for Admission Following Observation Care
Admission following post-operative observation, principal diagnosis is: Complication of outpatient surgery If no complication, then reason for
outpatient surgery If another condition unrelated to
surgery, assign unrelated condition
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Hospital Outpatient Services
Ambulatory patients (outpatients)
Ambulatory surgery patients
Emergency care patients
Observation patients
Freestanding Ambulatory Care Facilities
Ambulatory surgical center
Cardiovascular center
Clinical laboratory Imaging center Industrial health
clinic Infusion center Neighborhood health
center
Pain management center
Physician office Primary care center Public health
department Radiology center Rehabilitation
facility
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Other Ambulatory Care Facilities
Staff model health maintenance organization
Student health center
Urgent care center
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Hospital-Based Departments
Ambulatory surgery Outpatient department Emergency department Partial hospitalization program
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Outpatient Coding and Reporting Guidelines
Diagnostic Coding and Reporting Guidelines for Outpatient Services (Hospital-Based and Physician Office) Selection of first-listed diagnosis ICD-9-CM Tabular List of Diseases
(001.0 through V89) Accurate reporting of ICD-9-CM codes Always code to greatest degree of
accuracy and completeness
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Outpatient Coding Guidelines
Reason for encounter (001.0–999.9) Reporting signs and symptoms Factors Influencing Health Status
and Contact with Health Services (V codes)
Level of detail in coding Sequencing diagnoses
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Outpatient Coding Guidelines
Reporting qualified diagnoses (e.g., suspected pneumonia; questionable)
Reporting chronic diseases Reporting coexisting conditions Encounter for diagnostic services
(continued)
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Outpatient Coding Guidelines
Encounter for therapeutic services Encounter for preoperative
evaluations Ambulatory surgery Routine outpatient prenatal visits
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Outpatient Diagnostic Tests
Determining first-listed diagnosis (e.g., due to signs and/or symptoms)
Instruction to determine reason for test Information unavailable from physician Incidental findings Always code to greatest degree of
accuracy and completeness
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Outpatient Diagnostic Tests
Unrelated/Coexisting conditions Tests ordered in absence of signs
and/or symptoms If order communicated via
telephone, both treating provider and testing facility must document the call
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Routine Laboratory and Radiology Encounters
In the absence of any signs, symptoms, or associated diagnosis, assign: V72.5 for radiology exam V72.6 for laboratory exam
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Outpatient Surgery
Code reason for surgery as first-listed diagnosis Even if surgery is cancelled due to
contraindication
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Observation Stay
When admitted for observation of a medical condition, code as first-listed diagnosis
When admitted after outpatient surgery, code for reason for surgery as first-listed diagnosis and complication as secondary