Author Archives: Kelly Vanek

Exagamglogene autotemcel (Exa-cel) (aka CTX001™) is a genetically modified cell therapy that is used to increase fetal hemoglobin (HbF) in patients with sickle-cell disease (SCD) and transfusion-dependent beta-thalassemia (TDT).  Exagamglogene autotemcel is an investigational therapy administered via a stem cell transplant procedure as a single dose through a central venous catheter. This is potentially a one-time functional cure for patients with transfusion-dependent beta-thalassemia or severe sickle cell disease!  WOW

First, the patient’s hematopoietic stem cells are harvested from the blood. Exa-cel is then used to edit the stem cells to produce high levels of HbF in the red blood cells. The edited cells are transfused back into the patient via an autologous stem cell transplant through a central venous catheter. Exa-cel reduces the β globin damage that occurs in TDT and SCD. The need for red blood cell transfusions may be reduced or eliminated in patients with a reduction in severe vasocclusive episodes due to the increase in total hemoglobin levels.

ICD-10-PCS Book snapshot:

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Intellis is dedicated to elevating the business of healthcare. We are committed to offering support and the most current information and updates to collaborate with coding and CDI professionals to realize their fullest potential. We enthusiastically seek opportunities to develop ourselves and each other. We understand that knowledge is the key to success for our clients navigating the ever-changing health information management landscape.

Our team offers quarterly coding clinic reviews, coding clinic reviews for CDI, and other valuable courses.

Looking for coding help?

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Intellis coding education

Need help to earn CEUs or educate your team? Visit the Intellis IQ Education Center and get your free account or contact us for more information. Our team offers quarterly coding clinic reviews, coding clinic reviews for CDI, and other valuable courses.

Intellis is dedicated to elevating the business of healthcare. We are committed to offering support and the most current information and updates to collaborate with coding and CDI professionals to realize their fullest potential. We enthusiastically seek opportunities to develop ourselves and each other. We understand that knowledge is the key to success for our clients navigating the ever-changing health information management landscape.

Coding or CDI careers

We’re always looking for qualified coders to join our industry-leading team. Check out our team and current openings if you’re interested in new opportunities.

In 2021, Social Determinants of Health (SDOH) were added as risk factors to the CPT table used to determine the level of medical decision-making for evaluation and management (E/M) services provided during visits in an office or other outpatient settings. As of Jan. 1, 2023, the same table was added for E/M services delivered in other settings, including inpatient, observation care, emergency departments, nursing facilities, and at a patient’s home or residence. Remember, not only the provider’s documentation is valid for the capture of SDOH codes. Often nurses, social workers, or case managers document this information on a patient’s record.

This link provides a great resource from CMS in regard to the use of SDOH codes: https://www.cms.gov/files/document/zcodes-infographic.pdf

What are SDOH?

According to Healthy People 2030, social determinants of health (SDOH) are the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

SDOH can be grouped into five domains:

• Economic Stability
• Education Access and Quality
• Health Care Access and Quality
• Neighborhood and Built Environment
• Social and Community Context

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Need help earning CEUs or educating your team? Visit the Intellis IQ Education Center and get your free account.

Intellis is dedicated to elevating the business of healthcare. We are committed to offering support and the most current information and updates to collaborate with coding and CDI professionals to realize their fullest potential. We enthusiastically seek opportunities to develop ourselves and each other. We understand that knowledge is the key to success for our clients navigating the ever-changing health information management landscape.

Our team offers quarterly coding clinic reviews, coding clinic reviews for CDI, and other valuable courses.

refers to the placement of a specialized hollow bore needle through the cortex of a bone into the medullary space for infusion of medical therapy. It is used when standard venous access would delay therapy or is not easily obtained. IO success rates are twice as high as intravenous line placement in critical trauma patients without a blood pressure and should have priority over IV placement and is a highly underutilized technique.  IO can be used to administer any substance that is infusible intravenously, but IO use should not be for longer than 24 hours due to an increased risk of complications. 

This codes to ‘Transfusion into Bone Marrow’ in ICD-10-PCS.  ICD-10-PCS Book snapshot:

Device Names to look for: First Access for Shock and Trauma (FAST1),  the EZ-IO, Bone Injection Gun (BIG), Jamshidi needle, Diekman modified needle

Common IO Access Sites include: Sternum, clavicle, humeral head, iliac crest, distal femur, proximal tibia, distal tibia, calcaneus

Looking for coding help?

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Need help to earn CEUs or educate your team? Visit the Intellis IQ Education Center and get your free account or contact us for more information.

Intellis is dedicated to elevating the business of healthcare. We are committed to offering support and the most current information and updates to collaborate with coding and CDI professionals to realize their fullest potential. We enthusiastically seek opportunities to develop ourselves and each other. We understand that knowledge is the key to success for our clients navigating the ever-changing health information management landscape.

Our team offers quarterly coding clinic reviews, coding clinic reviews for CDI, and other valuable courses.

  We’re pleased to congratulate Intellis’ Director of Education Kim Felix, RHIA, CCS, on being named the Pennsylvania Health Information Association (PHIMA) 2023 Distinguished Member. Kim was honored at the PHIMA Annual Conference. We’re amazed at her accomplishments and so proud to have her as a leader on our team. The PHIMA Distinguished Member Award honors an outstanding association member who is recognized for loyal services to the association and contributions to the profession. The award recognizes an individual for regional, state, and national service, including offices held, published articles, teaching, and other contributions. Kim’s contributions have been significant, and the PHIMA Board of Directors recognizes her long-standing commitment to the association and health information management profession.

Kim is the Director of Education for Intellis. She has over 25 years of HIM coding experience, including coding, auditing, and management at various University and Community Hospitals. She is the project manager for a large-scale HCC federal engagement.  She also was the project manager for an ICD-10 conversion for analytics software.  

Kim’s education experience includes adjunct faculty appointments at Gwynedd-Mercy College, Pierce College, and Thomas Jefferson University and acting as a study mentor at Western Governors University.

At Intellis, Kim was the visionary behind the Intellis IQ Center. The IQ Center is our online platform where individuals and facility personnel can earn AHIMA and AAPC continuing education units. She has presented over twenty courses on the platform addressing coding tips, coding updates, coding clinic reviews, and COVID-19 updates. Additionally, the platform provides insight into CDI education and documentation quality.

Congratulations, Kim, on receiving the PHIMA Distinguished Member Award. We appreciate all that you do for our team and the healthcare industry.

Laser interstitial thermal therapy was deleted from the Radiation Therapy Section (D) in ICD-10-PCS in FY 2023. It has been re-classified to the Medical/Surgical Section (0) since, technically, it is ‘thermal therapy,’ not ‘radiation therapy.’ These codes have been re-classified in the MS-DRG system according to their body system. LITT uses laser probe-generated heat to destroy soft tissue at targeted sites. Used to treat tumors in places that are hard to reach with conventional surgery.

What is LITT

Laser interstitial thermal therapy (LITT) is a minimally invasive surgical technique that uses a small laser to destroy unhealthy brain tissue. It can be an effective treatment option for recurrent brain tumors, radiation necrosis, and tumors that form deep within the brain. It is also used to treat certain types of epilepsy.

Looking for coding help?

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Intellis coding education

Need help earning CEUs or educating your team? Visit the Intellis IQ Education Center and get your free account.

Intellis is dedicated to elevating the business of healthcare. We are committed to offering support and the most current information and updates to collaborate with coding and CDI professionals to realize their fullest potential. We enthusiastically seek opportunities to develop ourselves and each other. We understand that knowledge is the key to success for our clients navigating the ever-changing health information management landscape.

Our team offers quarterly coding clinic reviews, coding clinic reviews for CDI, and other valuable courses.

A recent discussion regarding lactic acidosis in a patient with sepsis has prompted a review of some important points that need clarification.  

First and foremost, lactic acidosis is not considered inherent to Sepsis. Additionally, acidosis is not noted as an excludes 1 or excludes 2 note under code category “A41” – Other Sepsis. 

A query would certainly be appropriate if the patient has elevated lactate and has met the criteria of a secondary diagnosis. 

But don’t stop here; there is more to it! 

Under category E87, “Other disorders of fluid, electrolyte, and acid-base balance” in the 2023 ICD-10-CM manual, the codes are as follows:  

E87.2 Acidosis  

Excludes1: diabetic acidosis – see categories E08-E10, E11, E13 with ketoacidosis  

E87.20 Acidosis, unspecified  

Lactic acidosis NOS  Metabolic acidosis NOS  
Code also, if applicable, respiratory failure with hypercapnia (J96. with 5th character 2)  

E87.21 Acute metabolic acidosis  

Acute lactic acidosis  

E87.22 Chronic metabolic acidosis  

Chronic lactic acidosis  
Code first underlying etiology, if applicable  

E87.29 Other acidosis  

Respiratory acidosis NOS 
Excludes 2: acute respiratory acidosis (J96.02) chronic respiratory acidosis (J96.12) 

It is important to note the codes above are CCs and may change the SOI/ROM; however, in a septic patient, these diagnoses will most likely not affect the DRG itself. 

This is very valuable information with regard to quality initiatives that may be important to your organization.  This could indicate an increased severity of illness and support a longer length of stay.  Consequently, this is one of the main reasons why many healthcare facilities are querying for acidosis in the presence of sepsis.  

So, when do you query for lactic acidosis outside of the usual elevation of lactic acid in sepsis?  

According to the ACDIS document  (https://acdis.org/articles/qa-lactic-acidosis-and-sepsis) 

Q&A: Lactic acidosis and sepsis 

May 30, 2019 – CDI Strategies – Volume 13, Issue 24 

“From a clinical standpoint, any patient with severe sepsis would be expected to have elevated lactate levels; they would not, however, be expected to always have a large anion gap and persistent levels of lactate > 5mmol/l after hydration. In fact, such a patient would be considered by many definitions (Sepsis-3 included) to be in septic shock.”

The article goes on to clarify when it would be appropriate to query and address the important query questions to ask. 

To summarize: 

1. If the lactic acid levels are mild, they would be considered part of the sepsis diagnosis and not reportable under ICD-10 CM. 
2. If the lactic acid level is out of sync with the severity of the sepsis (a radically elevated lactic acid without severe sepsis or septic shock), a query to determine the underlying cause of the lactic acidosis would be appropriate.   If another underlying cause is found, the acidosis may be reportable as long as it is not expected in the other associated diagnosis. 
3. Septic shock, with severely elevated lactate levels and anion gap, would also be routinely associated with septic shock and not reportable using basic coding guidelines.   

In closing, let’s review some considerations for queries: 

• Before querying lactic acidosis in conditions such as sepsis and respiratory failure, consider if the elevated lactic acid would be routinely associated with the diagnosis. 
• Also, consider if there could be another underlying cause for the elevation and if it is considered to be routinely associated with those diagnoses.   
• Then use your best critical thinking skills and your organization’s guidelines to determine if a query for lactic acidosis is compliant in that situation. 

New codes were assigned for refractory angina pectoris in FY 2023. These codes will differentiate refractory angina pectoris from other angina types and help ensure precise data collection coding.

Chronic refractory angina pectoris is angina caused by irreversible ischemia, lasting more than three months, and not controlled by a combination of medication, PCI, or CABG. Caring for patients with refractory angina pectoris is challenging since treatment options are limited and further revascularization is contraindicated. These patients are unsuitable for or at higher risk for PCI and CABG surgery.

Learn more about Intellis IQ coding services. Our solutions are leading the way in the HIM industry.

Looking for coding help?

Learn more about Intellis IQ coding services. Our solutions are leading the way in the HIM industry.

Intellis coding education

Need help earning CEUs or educating your team? Visit the Intellis IQ Education Center and get your free account.

Intellis is dedicated to elevating the business of healthcare. We are committed to offering support and the most current information and updates to collaborate with coding and CDI professionals to realize their fullest potential. We enthusiastically seek opportunities to develop ourselves and each other. We understand that knowledge is the key to success for our clients navigating the ever-changing health information management landscape.

Our team offers quarterly coding clinic reviews, coding clinic reviews for CDI, and other valuable courses.

New code for Prostatic Artery Embolization under root operation (Occlusion)

For 2023, a new code was introduced for Prostatic Artery Embolization (PAE) under root operation (Occlusion). It is in the same body system, Lower Arteries, as Uterine Artery Embolization. PAE helps improve benign prostatic hyperplasia (BPH) symptoms by blocking blood flow to areas of the prostate most affected by BPH. This results in the necrosis of the isolated regions. These areas of necrosis cause the prostate to initially be softer, alleviating some of the pressure that is causing blockage of the urine. Over several months, the body’s immune system reabsorbs the dead tissue and replaces it with a scar. This scar tissue slowly contracts to result in shrinkage of the prostate. Over six months, the prostate will shrink by 20-40%, resulting in improved and less frequent urination. Amazing technology!

In a recent Health Data Management article, Keystone Health Chief Operating Officer David Grant addressed the importance of ensuring clinician satisfaction with data integrity during EHR conversion. Legacy data missing from a new EHR can result in data gaps causing physician frustration, redundant treatment, and disjointed care management. To help overcome the challenges caused by missing patient data, meet go-live deadlines, and ensure physician satisfaction, Keystone Health turned to Intellis.

Read the article here.

Find out more about Intellis HIT solutions.

FY 2023 includes new codes for Hemolytic uremic syndrome (HUS), category D59.3-. Hemolytic uremic syndrome (HUS) occurs when the small blood vessels in the kidneys become damaged and inflamed. This damage can cause clots to form in the vessels. The clots clog the filtering system in the kidneys and can lead to kidney failure, which could be life-threatening. HUS often occurs as a complication of a diarrheal infection (usually E. Coli). It is most commonly found in children who are less than five years old or people with weakened immune systems, such as those with cancer, HIV/AIDS, or a previous transplant.

Our coding clinic review education is offered each quarter on our education platform — Intellis IQ Center. The courses highlight information that may help coders and CDI specialists obtain the clarification needed for appropriate coding.

The World Health Organization (WHO) declared monkeypox a public health emergency of international concern on July 23rd, 2022. Following consultations with global experts, WHO began using a new preferred term, “mpox” as a synonym for monkeypox. Both names are used simultaneously for one year while “monkeypox” is phased out.

Most patients will not be admitted to the hospital with mpox, but some patients with weakened immune systems, children under age 8, and pregnant or breastfeeding women can experience serious illness.

When a pregnant patient with mpox is encountered and mpox is the only complication, assign O98.51 – Other viral disease complicating pregnancy. The trimester is required, plus a Z code for the completed weeks of pregnancy. Assign B04 for mpox as well.  

BUT

It is also important to look for other complications such as Bronchopneumonia resulting in respiratory complications, Sepsis with organ failure, and in severe cases, neurological manifestations such as encephalitis with seizures or Guillain-Barre.

A query may be required to link mpox to sepsis, pneumonia, and other complications. Watch for neurological signs and symptoms without a diagnosis and query to clarify.