MCCG212-PortfolioProjectFinalSubmission-ShannonHutson

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Bryant and Stratton College, Buffalo *

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Mechanical Engineering

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Feb 20, 2024

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Portfolio Project [Blank line] Shannon Hutson Bryant & Stratton College MCCG 212: Advanced ICD Diagnostic Coding Dr. Meyer 12/19/2023

Training Plan for Advanced ICD Diagnostic Coding Skills Educational Program The primary goal of the ICD Diagnostic coding skills training program is to introduce complex coding scenarios that will challenge the learner to deeply examine coding guidelines and how they apply. Each scenario is tailored to acquaint the learner with specific coding examples that require an in- depth review of individual coding guidelines. The learner will be able to abstract and apply advanced coding classification requirements that fulfill official coding guidelines. The training program will be administered through three separate courses that will build upon each other while integrating new concepts each time. The first two courses will involve coding scenarios and the application of coding guidelines, and the final course will analyze guidelines that are often confused. The following coding scenarios will be presented in the first two courses and will be used to guide a larger conversation on coding guidelines and how to best apply them. Coding Scenarios for Week One and Two Outpatient Scenario 1: The ICD-10-CM code for Mary’s visit would be G56.03- Carpal tunnel syndrome, bilateral upper limbs. To find this code, first look up Syndrome, Carpal Tunnel G56.0- in the Alphabetic Index of your manual. The instructional notation of – indicates that additional characters are needed to complete the code. The next step is to find G56.0 in the Tabular List. The diagnosis states that Mary has bilateral carpal tunnel syndrome, which should que you into the code G56.03 being the highest degree of specificity. Outpatient Scenario 2: The ICD-10-CM codes for Tina’s visit would be sequenced as T65.891A- Toxic effect of other specified substances, accidental (unintentional), initial encounter and J69.1- Pneumonitis due to

inhalation of oils and essences. To find these codes, first look up Pneumonitis, oils, essences J69.1 in the Alphabetic index of your manual. Next find J69.1 in the Tabular list to find the instructional notation Code first (T51-T65) to identify substance. This notation should que you into the need for an additional code to describe the type of substance causing pneumonitis. The code T65.891 best describes the substance and that it was unintentionally inhaled. This code has an instructional notation that requires a seventh character to be added. The appropriate seventh character for this encounter would be A- initial encounter. It is important to remember to sequence the code for the substance first as directed by the instructional notation for J69.1. Inpatient Scenario 1: The ICD-10-CM coding for this scenario would be sequenced as I20.0 - Angina pectoris and I47.1- Paroxysmal ventricular tachycardia, unspecified. The admitting diagnosis for this scenario would be I20.0 because it best describes the unstable angina as the condition that required admission. The principal diagnosis for this scenario would be I47.9 based on Section II. Selection of the Principal Diagnosis of the coding guidelines. It states that the principal diagnosis is defined as “that condition established after study to be chiefly responsible for occasion the admission of the patient to the hospital for care.” In this case, the patient was found to have paroxysmal tachycardia after having an EKG. This is the reason I47.9 would be the principal diagnosis. According to the Present on Admission Reporting Guidelines, the POA indicator for I20.0 would be assigned as a Y for conditions diagnosed during admission but clearly present before admission. Inpatient Scenario 2: The ICD-10-CM coding for this scenario would be sequenced as Z51.11- Encounter for antineoplastic chemotherapy, C91.00- Acute lymphoblastic leukemia NOS, and R11.2- Nausea with vomiting, unspecified. The patient was admitted for her third round of chemotherapy for acute

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lymphoblastic leukemia and developed nausea and vomiting. When looking up the code Z51.11, the instructional notations que you into the need to code also the condition requiring care and to review coding guidelines C.2.a, C.2.e.2, C.2.e.3, and C.21.c.7. These guidelines direct the ordering of the coding as chemotherapy, condition, and then symptoms. This would make Z51.11 the principal diagnosis, C91.00 to describe the condition, and then R11.2 to describe the severe nausea and vomiting. Outpatient Scenario 1: The correct codes for Joseph’s case would be G30.9 - Alzheimer’s disease, unspecified and F02.80 - Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. To find these codes first look up Disease, Alzheimer’s disease in the index and then find G30.9 in the tabular list. It is important to follow the instructional codes to use additional codes to identify dementia, F02.80. There is also an instructional notation for code F02.80 that guides you to code first the underlying physiological condition, which would be G30.9 in this scenario. When coding this scenario, be careful not to choose a code based on the wording of onset. There is no specification for what type of onset Alzheimer’s noted in the record. Alzheimer’s symptoms can vary depending on the patient; it is vital to choose the code that best describes the symptoms supported by the documentation. It would be appropriate to Query the provider for more information to give greater specificity to the coding. To find out what type of onset of Alzheimer’s they are referring to and the severity of Dementia. Outpatient Scenario 2 : The correct codes for Jackie’s case would be S83.232A - Complex tear of medial meniscus, current injury, left knee, Y93.66 - Activity, soccer, and Y92.322 - Soccer field as the place of occurrence of the external cause. To find these codes first look up Tear, torn, meniscus, medial, complex, and then find S83.23- in the tabular list. Again, it is important to follow the instructional notations and coding guidelines

regarding S codes to ensure correct coding. This will direct you to add the 7 th character of A for initial encounter, even though the documentation mentions that the injury is acute on chronic. The guidelines note that the assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time. Make sure to include the external causes of morbidity. While it is not required in most cases, it provides valuable data for research and prevention strategies. When coding external cause codes use the chapter specific guidelines to ensure that the codes are listed in proper order that identify the sequence in which the injury occurred. In this case the code Y93.66 would come before the code Y92.322 based on the guidelines that when applicable, place of occurrence is sequenced after the main external cause code. Inpatient Scenario 1: The correct codes for Adam’s case would be L03.113 - Cellulitis of right upper limb, W55.01A - Bitten by cat, initial encounter, T82.7XXA - Infection and inflammatory reaction due to other cardiac and vascular devices, implants, and grafts, A41.59 - Other Gram-negative sepsis. To find these codes, code for the patient’s original reason for being admitted to the hospital which would be L03.113 for the cellulitis on his hand, be sure to note that the index instructs you to use upper limb in the place of hand. While the coding guidelines indicate that there is no national requirement for mandatory external cause reporting, it is beneficial to add the cause of the patient’s injury which would be W55.01A. This gives a clear picture of the patient’s encounter and remember to add the seventh character of A to indicate that this was the initial encounter. Next code for the nosocomial infection due to the midline catheter, T82.7XXA best describes the bloodstream infection due to the midline catheter, but a further code for the specific infection is needed. The code A41.59 is then used to describe the Gram-negative sepsis acquired. The order of the coding is important here to paint the entire picture of the patient’s encounter. Always

follow the instructional notations to point out how the codes should be listed, and which codes are to the highest degree of specificity. Inpatient Scenario 2 : The correct codes for Mr. Shultz’s case would be C7A.029 - Malignant carcinoid tumor of the large intestine, unspecified portion, and C7B.02 - Secondary carcinoid tumors of liver. To find these codes, refer to the coding guideline C.2.a that notes if the malignancy is chiefly responsible for occasioning the patient admission/encounter and treatment is directed at the primary site, designate the primary malignancy as the principal/first-listed diagnosis. In most cases the primary site would be defined by the Table of Neoplasms, but the morphology of neuroencorine tumors is included in the category and codes. This is why the code C7A.029 best describes the primary site as a malignant carcinoma of the large intestine. The secondary site is coded as C7B.02 to represent the metastatic disease of the liver. Diagnostic Coding Guidelines that are Often Misunderstood General Coding Guidelines - Signs, and symptoms, and conditions that are an integral part of a disease process. Signs and symptoms should only be coded when there is no definitive diagnosis in the medical record. Once the provider has established a definitive diagnosis, the signs and symptoms are considered associated with the condition and should not be coded. The Use of Aftercare Z Codes - An aftercare code following surgery to a body system are appropriate to use a primary diagnosis code. However, when the aftercare relates to an injury, the coder may not use the Z code for aftercare. The aftercare following injuries should be represented by the acute injury code with a subsequent encounter 7 th character.

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Exclusion Notes: The exclusion notes are found in the tabular list to indicate codes excluded from or independent of each other. If the coder does not use the tabular list, these instructions may be missed, and the specificity or accuracy of the coding could be affected. Team Expectations Rubric Scenarios: 45-50pts - All codes are accurately identified. 0-44pts - Most codes identified. Guidelines: 30-40pts - Indepth understanding presented. 0-29pts - Adequate or missed elements. Mechanics: 9-10pts- Zero errors in punctuation, spelling. 0-8pts - Minimal errors in mechanics. Continued Education To reinforce the skills learned through the course, monthly coding scenarios will be sent via email to students. These emails will present coding scenarios that challenge the learner to research and apply coding guidelines that are commonly misunderstood. Students will then meet monthly to discuss the scenarios and the reasoning behind their answers. The monthly meetings will have food and drinks served as part of a reward system to encourage attendance and create a comfortable atmosphere for conversation.

References Last Name, A. B. (Year). Article Title. Journal Title , Pages #-#. URL . Last Name, C. D. (Year). Book Title (Edition). Publisher Name. URL . Last Name, D. E., Last Name, F. G., Last Name, H. I. (Year). Report Title (report number). Publisher. URL . Last Name, J. K. (Year, Month Day). Article Title/Headline . Periodical. URL . Organization Name. (Year, Month Day). Webpage Title . URL . For additional information on APA Style formatting, please consult the APA Style Manual, 7th Edition .