Section III Other Diagnoses
TLDRIn this informative session, Dr. Campbell discusses Section 3 of the ICD-10-CM guidelines, focusing on other diagnoses. He explains the concepts of complications and comorbidities, emphasizing their impact on patient care and hospital stay. He outlines five situations to consider when reporting additional diagnoses and highlights the importance of clinical evaluation, therapeutic treatment, and conditions extending the length of stay. Dr. Campbell also addresses the coding of previous conditions, abnormal findings, and uncertain diagnoses, providing valuable insights for medical coders in inpatient settings.
Takeaways
- 📚 The session focuses on Section 3 of ICD-10-CM guidelines, which pertain to other diagnoses.
- 🏥 Other diagnoses include conditions coexisting at admission, developing later, or affecting treatment and length of stay.
- 💡 A comorbidity is a pre-existing condition that can increase a patient's length of stay, while a complication arises during hospitalization and modifies the course of illness.
- 🤔 When reporting additional diagnoses, consider five situations: clinical evaluation, therapeutic treatment, diagnostic procedure, extended length of stay, and increased nursing care/monitoring.
- 🧪 Diagnostic procedures include tests like EKG, EEG, EGD, MRI, and CT scans, which determine the cause of a patient's signs, symptoms, or complaints.
- 🚫 Do not code for diagnoses unrelated to the current state or inpatient stay, unless they impact care or treatment.
- 📈 Abnormal findings should only be coded when clinically significant and not based solely on lab or test results outside the normal range.
- 🎓 Newer coders should learn by experience to discern which conditions have no bearing on the hospital stay.
- 📊 Abnormal findings codes (e.g., 70-97) are nonspecific and used when no related diagnosis is identified.
- 🛌 Inpatient uncertain diagnoses can be coded unless specified otherwise.
- 📝 It's important to query providers about adding diagnoses or listing abnormal findings in the diagnostic statement when they are clinically significant.
Q & A
What is the focus of Section 3 of the ICD-10-CM guidelines?
-Section 3 of the ICD-10-CM guidelines focuses on other diagnoses, which are conditions that coexist at the time of admission, develop subsequently, or impact the treatment received, the length of stay, or payment received, particularly by Medicare.
What is the difference between a complication and a comorbidity in the context of ICD-10-CM guidelines?
-A complication is an additional diagnosis that arises after the beginning of hospital observation and treatment, modifying the course of the patient's illness or the medical care required. A comorbidity, on the other hand, is a pre-existing condition that can increase the patient's length of stay or impact the treatment for a principal diagnosis.
How should coders determine if an additional diagnosis should be reported?
-Coders should consider five situations: whether the diagnosis requires clinical evaluation, therapeutic treatment, diagnostic procedures, extends the length of stay, or increases nursing care and monitoring. If the additional diagnosis falls into one of these categories, it should be considered for reporting.
What are some examples of therapeutic treatments mentioned in the transcript?
-Examples of therapeutic treatments include medications, physical therapy, and surgery.
How do coders handle historical diagnoses or status post procedures from previous admissions?
-Historical diagnoses or status post procedures from previous admissions should not be coded if they do not have any bearing or impact on the current state. However, if the historical condition or family history influences care or treatment, it may be used as a secondary diagnosis.
What should be considered when coding abnormal findings?
-Abnormal findings should only be coded when the provider indicates that the finding is clinically significant and cannot be related to a specific diagnosis. The coder should not assign abnormal findings based solely on the computer-generated results stating that a value is higher or lower than the normal range.
How are incidental findings on an x-ray, such as a hiatal hernia or diverticulum, handled in coding?
-Incidental findings on an x-ray should not be reported unless further evaluation or treatment is carried out. If the patient is not experiencing symptoms related to these findings, they are typically not coded.
What is the guideline for coding uncertain diagnoses in inpatient settings?
-In inpatient settings, uncertain diagnoses can be coded unless otherwise specified.
What is the significance of understanding the definitions related to inpatient settings in the ICD-10-CM guidelines?
-Understanding these definitions is crucial for accurate coding, as they impact the patient's length of stay, the medical care provided, and the payment received, especially in relation to Medicare and other payers.
What types of diagnostic procedures are mentioned in the transcript?
-The diagnostic procedures mentioned include EKG, EEG, EGD, MRIs, and CT scans.
How do coders approach a situation where a patient is ready to be discharged but develops a new condition?
-If a patient develops a new condition that requires additional investigation, monitoring, or waiting to ensure no further issues arise, the length of stay may be extended. This new condition should be considered in the coding process.
Outlines
📚 Introduction to ICD-10-CM Section 3: Other Diagnoses
This paragraph introduces the audience to Section 3 of the ICD-10-CM guidelines, focusing on other diagnoses. It explains that these are conditions that coexist at the time of admission, develop later, or impact the treatment or length of stay. The key terms introduced are 'complication' and 'comorbidity'. A complication is an additional diagnosis that affects the patient's course of illness or medical care, typically arising after hospital admission. A comorbidity is a pre-existing condition that can increase the patient's length of stay. The speaker advises on evaluating additional diagnoses based on five situations: clinical evaluation, therapeutic treatment, diagnostic procedures, extended length of stay, and increased nursing care. It emphasizes understanding the context of these diagnoses in relation to payment, particularly in Medicare.
📝 Coding Considerations for Previous Conditions and Abnormal Findings
This paragraph discusses the coding of previous conditions and abnormal findings. It clarifies that historical diagnoses or status post-procedures from previous admissions should only be coded if they impact the current state of care or treatment. The speaker then delves into the coding of abnormal findings, which are nonspecific and fall under a certain code range. These should only be coded when the provider has not reached a related diagnosis but deems the finding clinically significant. It also addresses the difference in coding abnormal findings for inpatients versus outpatients, emphasizing that coders should not assign abnormal findings based solely on computer-generated results. The speaker advises on querying the provider for uncertain diagnoses and mentions that incidental findings on imaging should not be reported unless they lead to further evaluation or treatment.
Mindmap
Keywords
💡ICD-10-CM
💡Other Diagnoses
💡Complication
💡Comorbidity
💡Clinical Evaluation
💡Therapeutic Treatment
💡Diagnostic Procedures
💡Length of Stay
💡Abnormal Findings
💡Incidental Findings
💡Uncertain Diagnosis
Highlights
Today's focus is on Section 3 of ICD-10-CM guidelines related to other diagnoses.
Other diagnoses include conditions coexisting at admission, developing subsequently, or impacting treatment or length of stay.
Complication and comorbidity are key terms in understanding other diagnoses.
A complication is an additional diagnosis that modifies the course of the patient's illness or medical care.
A comorbidity is a pre-existing condition that can increase the patient's length of stay.
When reporting additional diagnoses, consider five situations: clinical evaluation, therapeutic treatment, diagnostic procedure, extended length of stay, and increased nursing care.
Diagnostic tests like EKG, EEG, EGD, MRI, and CT scans are used to determine underlying causes.
Conditions from the patient's past medical history may not be coded unless currently being treated.
Abnormal findings should only be coded when clinically significant and not based solely on lab or test results.
Many factors influence lab values, including collection and transport methods, and the patient's overall condition.
Abnormal findings clearly outside normal range, with further evaluation or treatment, may warrant a query to the provider.
Incidental findings on x-rays, like a hiatal hernia or diverticulum, should not be reported unless further evaluation or treatment is carried out.
Uncertain inpatient diagnoses can be coded unless otherwise specified.
The guidelines discussed are specific to inpatient settings, including hospitals, long-term care, psych home health, rehab, nursing home, and alike.
Coding for previous conditions may involve using history of codes as secondary diagnoses if they impact care or influence treatment.
Outpatient coding differs from inpatient coding, especially when dealing with abnormal findings.
This review aims to enhance understanding of ICD-10-CM guidelines for other diagnoses, crucial for accurate coding practices.
Transcripts
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