Prostatic Artery Embolization

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!

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.

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). 

Dementia: Will we need more queries?

The short answer is yes! We need documentation of none, other, or a specified type of mood disorder. 

But here is the long answer:

“Dementia The ICD-10-CM classifies dementia (categories F01, F02, and F03) on the basis of the etiology and severity (unspecified, mild, moderate, or severe). Selection of the appropriate severity level requires the provider’s clinical judgment, and codes should be assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting) unless otherwise instructed by the classification. If the documentation does not provide information about the severity of dementia, assign the appropriate code for unspecified severity. If a patient is admitted to an inpatient acute care hospital or other inpatient facility setting with dementia at one severity level and it progresses to a higher severity level, assign one code for the highest severity level reported during the stay.” (2023 ICD-10-CM official guidelines, page 43.)

To accurately assign dementia, it is necessary for the provider to document the severity of dementia as mild, moderate, or severe.

• Mild is coded with the fourth character A
• Moderate is coded with the fourth character B
• Severe is coded with the fourth character C

For example, Vascular dementia, Moderate is coded to F01.B-. There is a code for unspecified severity F03.9, but as CDI specialists, if we are going to query for the type of behavioral disturbance, we could ask for severity as well. Unspecified severity can be coded if the provider really does not know. The severity of dementia does not determine if the code is a CC.

However, there is no code for unspecified mood disturbance, only for other and without. The dementia code without behavioral disturbance is not a CC. Specified disturbances such as psychotic disturbance, agitation, mood disturbance, or anxiety are CCs. The tabular section of the ICD-10-CM code book found at www.CMS.gov/Medicare/coding/ICD10 gives examples of what is included in these different behavioral disturbances.

Where do you find clinical indicators to support documentation of behavioral disturbances?

• Previous encounters: Has the patient been seen previously with documentation of behavioral disturbances related to dementia? How were they described? Be sure to include the date and location of the information in your query!
• Nursing documentation: Does nursing describe behaviors that could be included in your query to support the query regarding the specificity of behavioral disturbances?
• Social services documentation: Is there documentation that indicates behavior has been a problem at home? Have family members indicated there are behavioral issues at home?
• Consult notes: Has the patient been evaluated by psychiatry, neurology, or gerontology related to dementia?
• Medications: Is the patient on medications that indicate there is a behavioral component of their dementia that is being treated?
• Provider documentation: Does the doctor mention any signs and symptoms such as hallucinations, or “the patient is anxious”? Look for statements that could support a query for a specific behavioral disturbance.

Remember that complete and accurate documentation improves patient care across the continuum of care, and the clinical documentation specialist plays a key role in making this happen.

The newly released and much anticipated 2022 UPDATE of the AHIMA/ACDIS Guidelines for Achieving a Compliant Query Practice is here! We’re offering two live webinar opportunities for you to be informed, stay up-to-date, and earn 1.5 AHIMA-approved CEUs. Choose your date and register: Friday, November 11th, 10 AM EST  or Thursday,  November 17th, 2 PM EST.

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.

Follow us on LinkedIn to keep up-to-date.

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-.

Cachexia (R64) is also known as ‘wasting’ or ‘wasting syndrome’. It is a general state of weakness involving marked weight and muscle loss. Emaciated is another term that may be found in the documentation that also maps to code R64.

These diagnoses are often missed since they are commonly only seen in the Physical Exam or Review of Systems portion of a record. There are often ‘knee-jerk’ reactions that can lead a coder to investigate further if a patient may have these diagnoses. 

What to look for

Cachexia is commonly seen in patients who have AIDS, cancer, or other advanced heart or lung disease. You will often see a lack of appetite, fatigue, low BMI, and malnutrition. Look for nutritional consults and a PEG tube in the documentation to trigger the search for cachexia in the documentation. 

Why is this so important? 

Cachexia is a diagnosis that can affect reimbursement for both Inpatient and Risk Adjustment. Don’t miss it!