Coding Tip: Exagamglogene autotemcel
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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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:
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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.
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.
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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.
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.
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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.
New codes related to respiratory acidosis are now in place.
Acute respiratory acidosis is now indexed to J96.02 (Acute respiratory failure with hypercapnia).
Chronic respiratory acidosis is now indexed to J96.12 (Chronic respiratory failure with hypercapnia).
Respiratory acidosis unspecified remains indexed to E87.29 (Other acidosis).
Definitions
Acute respiratory acidosis occurs when carbon dioxide builds up very quickly before the kidneys can return the body to a state of balance.
Chronic respiratory acidosis occurs over a long time. This leads to a stable situation because the kidneys increase body chemicals, such as bicarbonate, that help restore the body’s acid-base balance.
Respiratory acidosis is a condition that occurs when your lungs can’t remove all of the carbon dioxide produced by your body. This causes the blood and other body fluids to become too acidic.
Code K76.82
We now have a code (K76.82) for Hepatic Encephalopathy for FY 2023. This includes documentation such as: “Hepatocerebral intoxication” and “Portal-systemic encephalopathy.”
It is important to note in the ICD-10-CM manual that we are to Code Also underlying liver diseases such as acute and subacute hepatic failure without coma (K72.00), alcoholic hepatic failure without coma (K70.40), chronic hepatic failure without coma (K72.10), hepatic failure with toxic liver disease without coma (K71.10), hepatic failure without coma (K72.90), icterus of newborn (P55-P59), postprocedural hepatic failure (K91.82), viral hepatitis without hepatic coma (B15.9, B16.1, B16.9, B17.10, B19.10, B19.20, B19.9).
Patients with hepatic encephalopathy can lose consciousness and go into a hepatic coma. Therefore, there is an Excludes1 Note that prohibits us from coding hepatic encephalopathy with codes that have ‘with coma’ in the description: acute and subacute hepatic failure with coma (K72.01), alcoholic hepatic failure with coma (K70.41), chronic hepatic failure with coma (K72.11), hepatic failure with coma (K72.91).
Significant E/M changes are coming in 2023! Jeanie Heck, our director of Education, will begin her E/M Hot Topic series this month with an overview of these changes. Subsequent monthly E/M Hot Topic presentations will provide a deeper dive into the individual categories affected by these new changes.
For additional information about E/M Guideline Updates education, contact us.
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Providers often use the terms hyperlipidemia and hypercholesterolemia interchangeably. Technically, hyperlipidemia is a high or elevated lipid/fat level in the blood. High blood cholesterol is a lipid disorder. As a result, when hyperlipidemia and hypercholesterolemia are both documented in the record, only assign code E78.00 (Pure hypercholesterolemia) per Coding Clinic, Second Quarter 2022. On the other hand, when ‘mixed hyperlipidemia’ and ‘hypercholesterolemia’ are both documented, assign code E78.2 (Mixed hyperlipidemia). In this example, hypercholesterolemia is included in the E78.2 code.
Meconium gives the amniotic fluid a greenish color. This is called meconium staining. Coding Clinic, Second Quarter 2022 clarifies ‘light meconium-stained fluid’ and how to code it. The presence of any meconium staining may indicate fetal distress, therefore code O77.0 (Labor and delivery affected by meconium in amniotic fluid) is appropriate to code if documented as such. There does not need to be documentation of fetal distress or maternal conditions to code.
2022 ICD-10-CM CODE O77.0
Eliquis can be used as an anticoagulant or an antithrombotic. When a patient is on Eliquis long-term, it can be a coding conundrum. As published in Coding Clinic, Second Quarter 2022, ICD-10-CM classifies Eliquis as an anticoagulant medication. Therefore, if long-term use of Eliquis is documented in the record, assign code Z79.01 (The long-term (current) use of anticoagulants).
This condition is commonly documented along with chronic kidney disease (CKD). MBD is a broad term used to describe a group of bone disorders of bone strength usually caused by mineral abnormalities such as calcium, phosphorus, vitamin D, or magnesium. As published in Coding Clinic, Second Quarter 2022, when MBD is a component of another disease process, only the underlying condition (e.g., secondary hyperparathyroidism or renal osteodystrophy) is coded. If no underlying condition is documented, code the appropriate code from subcategory M89.8X-.
When Lupus (unspecified) is documented in a record, there is no default code. Therefore, it is important to have providers document this condition as precisely as possible.
For instance, document SLE (systemic lupus erythematosus) instead and add any complications that accompany this diagnosis. It is often accompanied by Sjogren’s syndrome or Sicca syndrome, which have very specific codes. Another solution is to develop facility or provider-specific guidelines to report M32.9 (SLE, unspecified) as a default for Lupus, unspecified.