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ICD10 Coding of Osteoarthritis ICD10 Coding Guidelines
Chandra: A: For the ICD10 for osteoarthritis,the guidelines actually state that you should use the multiple osteoarthritis code unlessthe specific codes are more appropriate for the circumstantial coding, and basically itcomes down to the payer rules. If you're seeing a patient simply to manage their osteoarthritisand they've got osteoarthritis in multiple joints, maybe they got in their left shoulder,their right shoulder, their left elbow and their left hip. Most providers are going toreport that with a multiple osteoarthritis code. The times that you would break into the specificjoint and laterality would be when you're
trying to prove or substantiate medical necessityfor certain things, like if you were evaluating a patient or planning to do a hip replacementon that same patient, they may have osteoarthritis and all these different joints but you'refocused on the hip joint, specifically the left hip joint. So, your claim should havethe specific code to say, â€œSpecifically we're dealing with osteoarthritis of theleft hip,â€� then you could add additional codes, say â€œthey also have it here, here,and here,â€� but for our purposes we want that specificity. That's really the onlytime that she usually going to come into play, it all comes down to payment, unfortunately.
Laureen: Is this the guidelineé Alicia: M15 â€“ M19 are the codes that we'relooking at, that's it. Chandra: Yeah. Usually there's a multiplesites option, for categories where there's no multiple site, code should be used to indicatethe different sites involved. Alicia: M15.3 secondary multiple arthritisé Chandra: That's secondary. When you'retalking M15, remember secondary is the result of something else. These are more than likely,I think they're M19s if I remember correctly. Alicia: Yeah, I was thereâ€¦
Laureen: I just wanted to share this is howyou can be your own consultant and basically answer your own questions. Not that we don'tlove doing it, but this is what I typed in as they were talking â€œICD10 guidelinessite and lateralityâ€� boom! It brought me right here, I opened it up. I typed in â€œsiteand lateralityâ€� and it brought me right to it. Google is your friend, double checkit, but when you have questions like that, that's how we startall of these questions and then we try double check each other. Chandra: Especially when you have ICD10 questions.My colleagues and myâ€¦
ICD 9 Coding Tutorial Late Effect Guidelines
late effect guidelines. How does a coder determineand sequence late effect and principal diagnosis in ICD9é This is probably a very basic questionbut as a rookie coding student, itÃs confusing to me right now. Well, itÃs confusing toeverybody so donÃt feel bad. This is probably one of the first guidelines that you get taughtin most coding courses and it just baffles everybody. So letÃs look at the little answersheet we created for you. Here we go. Go ahead and slide down a littlebit to that answer part. As a general rule, donÃt forget that when you do ICD coding,you code the main reason why they walked in the door. And then here are some examples.This person has aÃ– how do you say thaté
Laureen: Kyphosis. Alicia: Kyphosis, okay. I was going to saythat but I didnÃt want to screw it up, you knowé Kyphosis due to polio. Now, 138 is yourpolio code but 737.41 is the late effect code. And I donÃt even have to look at my codebook to know that. I just know that polio is an early number code, late effect codesare higher numbers. So they came in with the kyphosis that comes first and the reason ourcause goes as a supporting code. But to get to it, we have to use the main term late inthe index. So when you see something that says late effect or due to, go to your firstword. ItÃs late that you look up in your
index. Otherwise, weÃll be coding an acuteor current condition. The dysphagia just means theyÃre having problemsswallowing due to CVA which is a cerebrovascular accident. And thatÃs pretty common with peoplewho had a stroke. So 438.82, I know thatÃs the dyphagia code and 787.20 is the late effect.438 is due to the CVA. So 438.82, late effect to the cerebrovascular disease, dysphagiausedÃ– and it says in the guidelines. Use additional code to identify the type of dysphasia.If none, thereÃs a range to look at. So all your ICD9 official guidelines for the codingsection areÃ– theyÃre actually listed in there.
Laureen: But on that one, if you donÃt mindme jumping in, this is whatÃs known as a combo code. Sometimes with late effect codes,you can tell the story with one code. Other times, you need two. But this was a greatexample because the 438.2 actualy tells the whole story. It tells that itÃs a late effectof a CVA and that their problem today is dysphagia. But we are told in the ICD tabular to alsocode an additional code that just qualifies the type of dysphagia. Because youÃre like,Ã¬Why do I need this other codeé ItÃs already saying dysphagia.Ã® Well, thereÃs differenttypes and thatÃs what this is. YouÃll see that a lot with diabetes too like diabeticretinopathy. ItÃll tell you, Ã¬Okay, but
what type of diabetesé Is it insulindependentor whateveréÃ® So they want you to do that second code. So this is an example of wherethe one code really told the late effect story but per ICD guidelines, weÃre being toldto code an additional one to round the story out. Alicia: Yeah, I would like to tell the viewers,if youÃre painting a picture, thatÃs the highlight. YouÃre painting in the highlights.So more example of late effects coding. You got aphasia due to previous CVA. Now dysphagiais difficulty in swallowing. Aphasia is inability or you know, the absence of swallowing. Soyou got 438.11, one code only is needed here
because the description, like the other one,it tells you the whole story and thereÃs no guideline telling you that you need touse additional codes. You got late effect, this CVA disease or cerebrovascular diseaseand itÃs aphasia. Traumatic athritis due to old fracture ofleft ankle. Now hereÃs whare youÃre going to use more than one code. YouÃve got arthritisand itÃs traumatic arthritis, 716.17. What caused the traumatic arthritisé 905.4 is thecause of the arthritis. Ataxia due to CVA, 438.84. It says it all. You donÃt need anymore coding to go with that. Now, mental retardation due to a viral encephalitis, 319 is mentalretardation and 1'.0 is the encephalitis,