ACDIS tip: Highlights from AHA Coding Clinic, second quarter 2023

by Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC

I enjoy reading the American Hospital Association’s (AHA) Coding Clinics, watching for consistency in direction, and testing myself to see if I would agree with the conclusions reached. The second quarter, AHA Coding Clinic release did not contain surprises, but it is a worthy review to assist our daily functions in CDI record review. I would like to highlight some features of the Coding Clinic and direction that may be impactful to your daily record reviews. That said, I always encourage you to review the entire publication, as well as the questions and answers in their entirety.

COVID-19

The instruction reminds us to continue assigning Z20.822, Contact with and (suspected) exposure to COVID-19 for a screening for COVID-19. This direction will change on October 1, 2023. Effective October 1, Z11.52, Encounter for screening for COVID-19, will be assigned.

Effective October 1, 2023, when COVID-19 screening is performed as part of pre-operative testing, assign code Z01.812, Encounter for preprocedural laboratory examination as the first listed diagnosis, followed by the Z11.52 code.

Biochemically recurrent prostate cancer

Biochemically recurrent prostate cancer describes rising prostate specific antigen levels in a patient who has received treatment with surgery or radiation. The National Cancer Institute states this could mean cancer is present, but this is not definitive.

If biochemically recurrent prostate cancer is documented in a patient status post prostatectomy and salvage radiation therapy, we are instructed to assign C79.9, Secondary malignant neoplasm of unspecified site. Additional codes to be assigned would be Z85.46, Personal history of malignant neoplasm of the prostate and Z90.79, Acquired absence of other genital organ(s).

Sequencing instruction for primary and secondary cancers

When both primary and secondary malignant neoplasms are diagnosed concurrently, we are to sequence the primary cancer as the principal diagnosis. The instruction also reminds us that the primary malignancy is sequenced as the principal diagnosis unless the focus of care was only directed to the secondary site.

Incidental findings

An incidental finding is an extra finding observed during a test or procedure that does not impact the patient’s plan of care. One question described the discovery of a clot found within a ventricular assist device as it was being removed in preparation for a heart transplantation. Because the clot did not impact the patient’s care, it would not be reported in this instance.

Autoimmune diabetes related to immunotherapy with hyperglycemia in a patient with DM type 2

This question describes contradicting documentation, in which two types of diabetes are indicated. The documentation described autoimmune diabetes mellitus (DM), with hyperglycemia in a patient with DM type 2. We are instructed to report, E11.65, Type 2 diabetes mellitus with hyperglycemia, and T45.1X5A, Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter. The explanation for this assignment is that the DM type 2 was exacerbated because of immunotherapy.

Two or more interrelated conditions, each potentially meeting the definition for principal diagnosis (Section II.B. The Official Guidelines for Coding and Reporting)

If both acute cholecystitis and biliary acute pancreatitis are present on admission, and both equally contribute to the circumstances of admission, either of these two interrelated conditions can be sequenced as the principal diagnosis.

Review of the “with” guideline (Section 1.A.15 The Official Guidelines for Coding and Reporting)

This guideline continues to confuse people. There were two questions related to this component. The guidance stated, “The use of the terms due to and associated with is intended to explain the inference of “with” in the classification. However, these terms are not interchangeable, and the connotation in the Alphabetic Index and Tabular List is different,” (17). In other words, only the words “with” and “in” as defined within the Guidelines support a presumed causal relationship. The word “with” is not interchangeable with “due to” within the indexing.

The guidance also reiterated that these presumed relationships do not apply to index entries that cover a broad category of conditions, such as “endocrine disorders.” In these instances, the provider must document a causal relationship.

Bone marrow used in spinal fusion procedures

Bone marrow aspirate or stem cells are used to assist in enhancing the growth of health bone tissue and should not be classified as a bone graft within ICD-10-PCS. This will not impact the assignment of the character representing the device used.

Myocardial Infarction with non-obstructive coronary arteries (MINOCA)

When MINOCA is documented, the code assignment will vary depending upon the type of myocardial infarction documented. For example, documentation of non-ST elevation and MINOCA would allow for the assignment of I24.4, non-ST elevation myocardial infarction.

Debridement procedure

When both an excisional and non-excisional debridement are performed at the same site, only the excisional debridement should be reported.

As I mentioned at the start, it is important that you review the entire Coding Clinic release, as I only spoke to a few of the questions. This is always good practice when reviewing summaries of Coding Clinic releases. I strongly encourage you to always review the questions and answer in their entirety to ensure that you are interpreting the direction consistently and correctly. Happy reading!

Editor’s note: Prescott is the interim director for ACDIS and director of CDI education for HCPro, based in Middleton, Massachusetts. Contact her at lprescott@acdis.org. To read highlights from the 2023 first quarter AHA Coding Clinic, click here.