Coding Roundtable/ICD-10

August 2016 Codewrite by AHIMA

AHIMA Certified ICD Trainers

CMS ICD-10 Regional Office Toolkit
Resources for CMS Regional Offices Conducting ICD-10 Outreach and Education

Ruth Gappa was able to attend the Clinical Coding Meeting in New Orleans and wanted to share these notes with you.  If you woudl like copies of handouts for these 2 presentations, contact Ruth at

Coder Confidence with ICD-10 notes (presenter: Laura Legg):

There is a need for confident coders, to code right the first time, in light of how many audits there are of coded data.

1) Important not to have “analysis paralysis”. The key to avoiding this paralysis is to know the coding guidelines backwards and forwards and how to look up codes in the book, as the encoder is only a tool, it doesn’t have critical thinking.
   • Self confidence is your reputation with yourself
   • Confidence counteracts feelings of anxiety

2) Ability to defend your codes

3) Ability to research

4) Embrace auditing and feedback, learn from your mistakes.

5) Tackle area you are afraid of – research and know rationale, educate, and code those cases

6) Be resilient in the midst of the auditing and pressure. Resiliency is the ability to cope well with high levels of ongoing disruptive change. It is something you do, not something you have. Sustain good health and energy under constant pressure. Manage time and stress.
          Learning to be Resilient
          • Remain calm under pressure
          • Improve your problem solving skills
          • Keep a sense of humor
          • Break free from inner barriers
          • Stay detached from the reactions of others
          • Value your complex qualities

7) Network

Grow your knowledge:
1) Actively code every work day
2) Peer communication and sharing
3) Coding Clinic
4) Official Coding Guidelines
5) Enhance chart review skills – know clinical indicators to support diagnosis code assignment
6) Coding roundtables weekly with co-workers – talk through problem areas and learn from each other

Barriers to confidence:
1) Putting too much weight on failure – learn from your mistakes, pick up and move on. You do work hard to find the right code.
2) Take criticism too hard
3) Refuse to leave our comfort zone
4) Refuse to speak up

Managers – coders need help and support, keeping sense of humor. Build relationships with coders. Talk to them on a regular basis and give them positive experiences. “Whatever happens we are going to stay positive.”

Define the “gray” areas of ICD-10 for your staff. Train Coding and CDI staff together, utilize CDI to help improve coders’ chart review skills. Provide coding roundtables and query training.

Auditors – find the rationale the coder is using to choose codes, there may be a misunderstanding of a guideline.

ICD-10 Update notes  (presenters Sue Bowman and Nelly Leon-Chisen):

Follow the CMS Q&A document – CMS/AMA joint announcement and subsequent clarification.

Only applies to part B phsician only fee schedule. Does not apply to pre-payment, pre-authorization procedures.

Public request to create new section in ICD-10-PCS for new technologies
• General goal of section X is two-fold:
– Create codes uniquely identifying procedures requested via the New Technology Application Process or that capture services not routinely captured in ICD-10-PCS that have been presented for public comment at a C&M meeting

How Are Past Issues Of AHA Coding Clinic For ICD-9-CMTo Be Used In The ICD-10 Environment?

1) Clinical information, in general not unique to ICD-9-CM, can be used in ICD-10-CM with some caveats
– Clinical clues: Not coding separately signs and symptoms integral to a condition
• NOT clinical criteria
– Must be reviewed carefully for similarities and differences on a case by case basis—whether dealing with past Coding Clinic for ICD-9-CMadvice and applying it towards current ICD-9-CM coding, or trying to apply it to ICD-10-CM or even applying ICD-10-CM advice to a similar ICD-10-CM case.

2) Documentation Issues
– Generally not unique to ICD-9-CM, and so long as there is nothing new published in Coding Clinic for ICD-10-CM and ICD-10-PCSto replace it, the advice would stand.

3) Guidelines
– Every attempt was made to remain as consistent with the ICD-9-CM guidelines as possible, unless there was a change inherent to the ICD-10-CM classification.
– If a particular guideline has remained exactly the same in both coding systems, and Coding Clinic for ICD-9-CMhas published an example of the application of that guideline, it’s more than likely that the interpretation would be similar.

Groin: Inguinal Region Versus Femoral Region
• ‘Groin’ can refer to either the inguinal region or the femoral region.
– The inguinal region is above the inguinal ligament.
– The femoral region is below the inguinal ligament.
• When the documentation does not specify, the default
ICD-10-PCS body part value for groin is the inguinal region.

CVA with Unilateral Weakness
What is code for residual right/left-sided weakness from acute or old CVA without mention of hemiplegia/hemiparesis?
– No index entry for left or right sided weakness following cerebral infarction
– Can coder make leap and code hemiplegia when weakness documented as “with” or “following” CVA?

Case #1:
– Patient admitted because of GI bleed
– Has history of cerebral infarction with residual right-sided weakness (dominant side)
– Evaluated by physical and occupational therapy

Case #2:
– Patient admitted secondary to cerebral infarction
– Provider documented, “acute cerebral infarction involving the right hemisphere with left-sided (nondominant) weakness.”

Case #1:
– Assign code I69.351, Hemiplegia and hemiparesis following cerebral infarction, affecting right side

Case #2:
–Assign codes:
• I63.9, Cerebral infarction, unspecified
• G81.94, Hemiplegia, unspecified affecting left nondominant side
Coding Clinic, First Quarter 2015, pages 25-26

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