Coding Clinic

Coding Clinic for ICD-10-CM and ICD-10-PCS is the quarterly newsletter published by the American Hospital Association's Central Office on ICD-10-CM and ICD-10-PCS. The advice provided in Coding Clinic is the result of a formal cooperative effort between the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS). In addition to these organizations, the Editorial Advisory Board consists of an expert panel of physicians representing the American Medical Association, the American College of Surgeons, the American Academy of Pediatrics and the American College of Physicians, as well as coding professionals representing healthcare facilities.

AHA Coding Clinic for ICD is the official source for ICD (ICD-10-CM/PCS) coding advice to supplement and clarify the Official Guidelines for Coding and Reporting.

Coding Clinic is published quarterly by the American Hospital Association (AHA) Central Office.

 Uses of AHA Coding Clinic:

 

            Official coding advice and official coding guidelines. 

            Correct code assignments for new technologies and newly identified  diseases.

             Articles and topics which will offer practical information and improve data     quality. 

             Provides information about coding changes and/or corrections to hospitals   and other parties.

 

                      Get it clarified………..

Query Process

 A query is a communication between the provider (Physician) and Medical Coder to clarify documentation in the health record for documentation integrity and accurate code assignment for an individual encounter in any healthcare setting. 

 A query will include information like; Patient name, Admission date and/or date of service, Medical record number, Date query initiated, Date query answered, Name and contact information of the individual initiating the query

 A query should have statement of the issue in the form of a question along with clinical indicators specified from the patient’s record.

Types of Query:

POA query, Ruled in /ruled out query, Clinical significance query, Cause and effect query, Conflicting documentation query, CHF acuity and specificity query, Debridement type and depth query.

Starting career as Medical Coder

 

Medical coding is the process of converting medical diagnosis, symptoms, procedures, and/or drugs into codes. Medical coders ensure that medical information is transmitted accurately and efficiently between healthcare providers and insurance payers. Physicians and hospitals depend on accurate coding to receive proper reimbursement, making the role of the coder a valued one. 

Medical coders work in all types of healthcare facilities, including doctor’s offices, clinics, hospitals and health care systems.

Thus Medical Coders play pivotal role in the financial success of Healthcare Centers. The greater the expertise of the Medical Coder in identifying relevant diagnoses for patient encounters, the greater the insurance reimbursement to the physician.

There is massive demand for medical coders throughout the World. The number of people covered under medical insurance is growing rapidly, so there is growing demand from hospitals for coders who can electronically maintain patients’ records and liaise with medical insurance companies for claims processing.

Eligibility: Graduates from sectors like science, B.Pharmacy, M.Pharmacy, nursing, biotechnology, microbiology or physiotherapy are eligible to pursue diploma/certificate programmes in medical coding offered by institutions accredited by the US-based American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC). 

                                    Certified Medical Coders are in high currently.

Pay-scale: Fresh graduates from the above said streams can expect an average salary of INR 12,000 to INR 20,000 per month. After 5 to 6 years of experience, a medical coder can expect a salary of INR 35,000 to 50,000 and growth in position to a Lead and then Manager, Sr.Manager followed by GM etcetera.

What Is the Future Outlook for the Medical Coding Industry?

Medical coding and billing careers offer health information technicians favorable job prospects, to say the least. The demand is so high that the U.S. Bureau of Labor Statistics lists medical coding among the 20 fastest growing occupations.

The Affordable Care Act has played a role in the demand for medical coders by ensuring that more people are eligible for medical care. In 2018, according to the most recent stats from the Centers for Disease Control and Prevention (CDC), “more” is defined as upwards of  1.4 billion patient visits in that year. Considering every patient encounter by every healthcare provider requires coded documentation and records, it’s not surprising that medical coding is among the most sought-after healthcare careers.

Job security factors into quality of life, which is one reason why medical coding is a good career choice. Despite economic fluctuations impacting employment opportunities for most professions, the need for healthcare professionals, including health information technicians, is at a historic high—and will remain so.

(Source: https://www.aapc.com/resources/research/medical-coding-salary-survey/)

COVID-19 Coding

COVID-19 Infections (Infections due to SARS-CoV-2)

Code only a confirmed diagnosis of COVID-19 as documented by the provider, documentation of a positive COVID-19 test result.

A presumptive positive COVID-19 test result should be coded as confirmed COVID-19 infection.

   For a confirmed diagnosis, assign code U07.1, COVID-19

 Confirmation does not require documentation of the type of test performed; the provider’s documentation that the individual has COVID-19 is sufficient.

Sequencing of codes:

 When COVID-19 meets the definition of principal diagnosis, code U07.1, COVID-19, should be sequenced first, followed by the appropriate codes for associated manifestations, except in the case of obstetrics patients as indicated in Section . I.C.15.s. for COVID-19 in pregnancy, childbirth, and the puerperium.


Acute respiratory illness due to COVID-19 :

(i) Pneumonia:

For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign codes U07.1, COVID-19, and J12.89, Other viral pneumonia.

(ii) Acute bronchitis:

 For a patient with acute bronchitis confirmed as due to COVID-19, assign codes U07.1, and J20.8, Acute bronchitis due to other specified organisms. Bronchitis not otherwise specified (NOS) due to COVID-19 should be coded using code U07.1 and J40, Bronchitis, not specified as acute or chronic.

(iii) Lower respiratory infection:

If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, codes U07.1 and J22, Unspecified acute lower respiratory infection, should be assigned.

If the COVID-19 is documented as being associated with a respiratory infection, NOS, codes U07.1 and J98.8, Other specified respiratory disorders, should be assigned.

(iv) Acute respiratory distress syndrome:

For acute respiratory distress syndrome (ARDS) due to COVID-19, assign codes U07.1, and J80, Acute respiratory distress syndrome.


Exposure to COVID-19:
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.

For cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

Screening for COVID-19:
For asymptomatic individuals who are being screened for COVID-19 and have no known exposure to the virus, and the test results are either unknown or negative, assign code Z11.59, Encounter for screening for other viral diseases. For individuals who are being screened due to a possible or actual exposure to COVID-19.

Asymptomatic individuals tested positive for COVID-19:
For asymptomatic individuals who test positive for COVID-19, assign code U07.1, COVID-19.


Pregnancy, Childbirth, and the Puerperium:
COVID-19 infection in pregnancy, childbirth, and the puerperium During pregnancy, childbirth or the puerperium, a patient admitted because of COVID-19 should receive a principal diagnosis code of O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, followed by code U07.1, COVID-19, and the appropriate codes for associated manifestation(s).
                     

                                                                    HAPPY CODING.......................,,,

CHF (Congestive Heart Failure)

Heart failure, sometimes known as congestive heart failure (CHF) is a chronic complex clinical condition, which prevents filling or emptying of blood from the heart.

CHF is caused by either a structural anomaly (valvular or congenital) and/or certain conditions, such as narrowed arteries in the heart (coronary artery disease) or high blood pressure, gradually leaves the heart too weak or stiff to fill and pump efficiently.

CHF Symptoms: CHF Symptoms may include;

Shortness of breath (dyspnea) on exertion or at rest

Fatigue/weakness

Edema of legs (ankles and feet)

Rapid or irregular heartbeat

Exercise intolerance

Increased urination at night

Abdominal swelling (ascites)

Very rapid weight gain from fluid retention

Lack of appetite and nausea

Sudden, severe shortness of breath

Chest pain.

CHF Clinical Indicators:

Echo:  Ejection fraction (EF) of <40% = Systolic heart failure

 Ejection fraction (EF) of >50%= Diastolic heart failure.

Elevated BNP (B-type natriuretic peptide)

+Ve Chest X-ray for Pulmonary Vascular Congestion/Pulmonary Edema.

Medications:

IV or PO diuretics (Lasix, Bumex, Zaroxylin)

ACE Inhibitor/ARB

Betablockers, Coumadin, ASA (Aspirin), IV Dobutamine

Types of CHF:

Systolic heart failure: The left ventricle can't contract adequately, indicating a    pumping problem. HFrEF (Heart failure with reduced ejection fraction).

Diastolic heart failure: Also called HFpEF (Heart failure with preserved ejection fraction). The left ventricle will not relax or fill fully, indicating a filling problem.