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Focus the New Year on ICD-10 Coding Compliance

Posted on Tuesday, January 3, 2017 3:21 PM

Make your New Year’s resolution ICD-10 coding compliance. Many home health agencies are still having trouble understanding the new coding guidance that came out October 1, 2016, which concerns conditions that can be assumed related without requiring physician documentation of the relationship. These assumed relationships are allowed per ICD-10 Coding Guidelines due to the presence of the coding convention “with” when located as a subterm in the main index or in the code title.

Diabetes ranks number #1 as having the most assumed related conditions, but remember you can only assume when no other cause is stated. Some of the most common assumed relationships with diabetes (when both are documented) include:
• Polyneuropathy/Neuropathy
• Osteomyelitis
• Chronic kidney disease
• Lower extremity ulcers (with no known cause)

Hypertension was always assumed as related to chronic kidney disease (even if another cause was stated). As of October 1, 2016, ICD-10 Coding Guidelines state if the chronic kidney disease is documented as caused by another condition, then we should not code it as related to hypertension. Hypertension is assumed related to heart diseases found from I51.4 – I51.9 when both are present as well as heart failure. When coding hypertensive heart disease, no additional code from I51.4- I51.9 is needed, but do add an additional code to show heart failure when it is present.

These assumption rules are difficult for everyone. For years we were told not to assume, but now we can within limits.

Corridor’s Coding Services offers ICD-10 coding, multi-level OASIS reviews, Clinician documentation review, as well as trends and reporting. Contact us to learn more.

Written by Mary Deakle, BCHH-C, COS-C, Corridor's Senior Manager of Compliance and Education.

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