News: Catch up on Coding Clinic guidance

Highlights from Coding Clinic, Third and Fourth Quarters 2010, include:

• When a primary lung cancer metastasizes into another lobe of the lung, the second lesion should receive an additional code as a metastasis—not as a primary lesion. However, coders cannot assume that a second lesion is a metastasis or a primary cancer of both lungs. If two primary lesions occur in the same lobe, a coder may report only one code. (Third Quarter, p. 3)
• Count the period of ventilator weaning during the process of withdrawing the patient from ventilator support. The duration includes the time the patient is on the ventilator as well as the weaning period. It ends when the mechanical ventilation is turned off (after the weaning period). (Third Quarter, pp. 3-4)
• Report complication code 997.02 (iatrogenic cerebrovascular infarction or hemorrhage) as well as code E934.4 (drugs, medicinal and biological substances causing adverse effects in therapeutic use) in the instance of a patient whose hemorrhagic conversion was caused by tPA therapy. (Third Quarter, p. 5)
• Excisional debridement of the fascia to the bone should be reported with 83.39 (excision of lesion of other soft tissue) and not a code for excisional debridement of the bone. (Third Quarter, p. 11)
• When physicians document "hypertensive urgency," a query is necessary to determine the specific type of hypertension. (Fourth Quarter, p. 9)