Coding Counts

Diabetes Statin Intolerance

August 28, 2018

Star Ratings

Star Ratings is a quality measurement tool the Centers for Medicare & Medicaid Services (CMS) uses to rate the quality of medical care and services provided by Medicare Advantage health plans. In the 2018 Star Ratings, Health Alliance and Health Alliance Northwest earned 4 out of 5 stars for our Illinois and Washington HMO and POS plans. We have a goal of 5 stars, and we need your help to make this a reality!

Here is one area of focus for 2018–2019:

Diabetes Care

There are four measures related to people with diabetes:

  1. Yearly eye exam
  2. Yearly kidney function test
  3. Yearly A1C lab test showing average blood sugar is controlled
  4. One statin fill per year

Documentation in the patient’s electronic medical record and accurate coding are key to ensuring all patients receive the diabetes care they need.

Statin Intolerance

If a patient is not able to take a statin, this must be documented and coded annually to exclude them from the diabetes measures listed above.

Exclusions include:

  • Pregnancy
  • Having in vitro fertilization procedure
  • Current prescription for clomiphene
  • End-stage renal disease
  • Cirrhosis
  • Myalgia
  • Myositis
  • Myopathy
  • Rhabdomyolysis

Below is a list of suggested codes for these excluded conditions. This is for your reference but is not an all-inclusive list.

Code Definition
G72.0 Drug-induced myopathy
G72.2 Myopathy due to other toxic agent
G72.9 Myopathy, unspecified
K74.60 Cirrhosis of the liver, unspecified
M60.9 Myositis, unspecified
M62.82 Rhabdomyolysis (Idiopathic)
M79.1 Myalgia
N18.6 End-Stage Renal Disease
T46.6X5A Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter
T46.6X5D Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, subsequent encounter
T46.6X5S Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, sequela
Z31.83 Encounter for Assisted Reproductive Fertility Procedure Cycle

Disclaimer: Every year, Medicare evaluates plans based on a 5-star rating system.

HCC 107 and HCC 108 – Aneurysm

May 25, 2018

This month, we are focusing on aortic aneurysms.

Patients diagnosed with an aneurysm may not need surgical intervention right away but could be defined clinically as “under surveillance” for an active aneurysm. The diagnosis code should reflect the active condition code from series I71.1–I71.9.

Types of aortic aneurysms specified in ICD-10-CM include:

  • Thoracic aortic aneurysm
  • Abdominal aortic aneurysm
  • Thoracoabdominal aneurysm

Below is the listing of ICD-10 codes for reporting aortic aneurysms (notice location and rupture vs. without rupture are defined by the code):

ICD-10 Code Description
I71.1 Thoracic aortic aneurysm, ruptured
I71.2 Thoracic aortic aneurysm, without rupture
I71.3 Abdominal aortic aneurysm, ruptured
I71.4 Abdominal aortic aneurysm, without rupture
I71.5 Thoracoabdominal aortic aneurysm, ruptured
I71.6 Thoracoabdominal aortic aneurysm, without rupture
I71.8 Aortic aneurysm of unspecified site, ruptured
I71.9 Aortic aneurysm of unspecified site, without rupture

ICD-10 code Z86.79: Report personal history of other diseases of the circulatory system if an aneurysm has been surgically repaired.

If you have questions or would like to talk more about coding for this or any other chronic conditions, contact us at CodingCounts@healthalliance.org.

 

Resources: ICD-10-CM Official Guidelines for Coding and Reporting FY 2018

HCC 79 – Seizures

April 20, 2018

This month we are focusing on ICD-10 Category G40 – Seizures.

The codes in this category are:

ICD-10 Description
G40.0 Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset
G40.1 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures
G40.2 Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures
G40.3 Generalized idiopathic epilepsy and epileptic syndromes
G40.4 Other generalized epilepsy and epileptic syndromes
G40.5 Epileptic seizures related to external causes
G40.8 Other epilepsy and recurrent seizures
G40.9 Epilepsy, unspecified

When selecting a code from Category G40, it’s important to assign the appropriate 5th and 6th characters to identify if the seizure is intractable versus not intractable and with or without status epilepticus.

In order to select the code with the highest level of specificity, the documentation must indicate if the seizure is:

  • Focal or generalized
  • Idiopathic or symptomatic
  • With or without status epilepticus
  • Intractable or not intractable

According to the instructional notes, these terms are to be considered equivalent to intractable:

  • Pharmacoresistant (pharmacologically-resistant)
  • Treatment-resistant
  • Refractory (medically)
  • Poorly controlled

If you have any questions or would like to talk more about coding for this or any other chronic conditions, contact us at CodingCounts@healthalliance.org.

 

AAPC ICD-10 CM Expert for Physicians and Hospitals
Mayo Clinic

Autoimmune Diseases and ICD-10

March 16, 2018

Autoimmune diseases cause the body to produce antibodies that attack its own tissues, leading to deterioration, and in some cases destruction, of tissue.

Many autoimmune diseases that carry a higher risk to the patient’s health are defined in ICD-10 nomenclature, but codes are not narrowed down to one particular section.

 

Type 1 Diabetes

Age can be misleading with Type 1 diabetes. Don’t let a patient’s age determine your code selection since either type of diabetes can occur at almost any age. You should also remember that diabetes can come with multiple complications, and ICD-10 guidelines let you use as many codes within a particular category as you need to accurately indicate an individual’s health status.

When coding diabetes with manifestations, make sure you assign the appropriate additional digits needed to identify the type of complication.

ICD-10 Code Description
E10.1 – E10.11 Type 1 diabetes mellitus with ketoacidosis with or without coma
E10.2 – E10.29 Type 1 diabetes mellitus with kidney complications
E10.3 – E10.37 Type 1 diabetes mellitus with ophthalmic complications
E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complication
E10.5 – E10.59 Type 1 diabetes mellitus with circulatory complications
E10.6 – E10.69 Type 1 diabetes mellitus with other specified complication
E85.0 – E85.9 Amyloidosis

 

Heart Conditions

If there is a causal relationship between hypertension and a heart condition, a code from I50.- or I51.4-I51.9 must be assigned to a code from category I11 (Hypertensive heart disease). If there is no causal relationship between hypertension and the heart condition, they must be coded separately. Sequence the codes according to the circumstances of the encounter.

ICD-10 Code Description
I24.1 Dressler’s syndrome
I51.4 Autoimmune myocarditis

 

Other Risk-Adjusted Autoimmune Conditions

ICD-10 Code Description Coding Guidelines
D59.0*, D59.1, D68.61 Severe Hematological Disorders *Use additional code for adverse effect, if applicable identify drug (T36-T50 with fifth or sixth character 5)
D89.82, D89.89* Disorders of Immunity *Excludes human immunodeficiency virus disease (B20)
G35, G36.0 Multiple Sclerosis
G37.3, G90.1 Spinal Cord Disorders & Injuries
G61.0, G61.81, G70.00, G70.01, G70.80, G70.81, G73.1*, G72.41 Myasthenia Gravis, Myoneural Disorders, and Guillain-Barre Syndrome, Inflammatory and Toxic Neuropathy *Code first underlying neoplasm (C00-D49)
K50.00 – K50.919, K51.80 – K51.919 Inflammatory Bowel Disease Use additional code to identify manifestations, such as pyoderma gangrenosum (L88)
K74.3 Cirrhosis of Liver Code also, if applicable, viral hepatitis (acute)(chronic)(B15-B19)
K75.4 Chronic Hepatitis
K86.1 Chronic Pancreatitis

 

ICD-10-CM Official Guidelines for Coding and Reporting
MedlinePlus Autoimmune Diseases

HCC 40 – Rheumatoid Arthritis

February 21, 2018

This month, we’re focusing on Rheumatoid Arthritis.

Rheumatoid Arthritis (RA) is a chronic autoimmune disease that progresses over time. It’s characterized by pain, swelling, and inflammation in the joints and surrounding tissues. It can also affect other organs in the body.

Things to remember when documenting and coding RA:

  • Laterality
  • Site
  • Joint vs. organ
  • With Rheumatoid factor (Seropositive) vs. without Rheumatoid factor (Seronegative)

ICD 10 Categories for RA

Rheumatoid Arthritis with Rheumatoid Factor

ICD 10 Category Category Description
M05.0** Felty’s Syndrome
M05.1** Rheumatoid lung disease with rheumatoid arthritis
M05.2** Rheumatoid vasculitis with rheumatoid arthritis
M05.3** Rheumatoid heart disease with rheumatoid arthritis
M05.4** Rheumatoid myopathy with rheumatoid arthritis
M05.5** Rheumatoid polyneuropathy with rheumatoid arthritis
M05.6** Rheumatoid arthritis with involvement of other organs and systems
M05.7** Rheumatoid arthritis with rheumatoid factor without organ or systems involvement
M05.8** Other rheumatoid arthritis with rheumatoid factor
M05.9** Rheumatoid arthritis with rheumatoid factor, unspecified

Rheumatoid Arthritis without Rheumatoid Factor

ICD 10 Category Category Description
M06.0** Rheumatoid arthritis without rheumatoid factor

Other Rheumatoid Arthritis

ICD 10 Category Category Description
M06.1 Adult-onset Still’s disease
M06.2** Rheumatoid bursitis
M06.3** Rheumatoid nodule
M06.4 Inflammatory polyarthropathy
M06.8** Other specified rheumatoid arthritis
M06.9 Rheumatoid arthritis, unspecified

**Add fifth character to designate site:

  • 0 – unspecified site
  • 1 – shoulder
  • 2 – elbow
  • 3 – wrist
  • 4 – hand
  • 5 – hip
  • 6 – knee
  • 7 – ankle and foot
  • 9 – multiple sites

Add sixth character to designate laterality:

  • 1 – right
  • 2 – left
  • 9 – unspecified side

Examples:

Patient 1: 89-year-old female referred to Rheumatology for shoulder pain and stiffness. Patient has pain and stiffness in multiple joints and complains of swelling in both wrists and hand. This has been going on for many months.

Patient is diagnosed with seronegative rheumatoid arthritis affecting multiple joints.

The correct code for this scenario is:
M06.09 – Rheumatoid arthritis without rheumatoid factor, multiple sites

Patient 2: 51-year-old female returns to rheumatology clinic for follow up on seropositive RA of right wrist.

The correct code for this scenario is:
M05.731 – Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement

Notice that in both examples the laterality and site were documented with ease.

For more coding tips, check out the rest of Coding Counts, or if you have any questions, email us directly at CodingCounts@healthalliance.org.

 

AAPC ICD-10 CM Expert for Physicians and Hospitals