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October 2017

Editor's Note: Code Changes Complicate Coder Lives
By Lee DeOrio
For The Record
Vol. 29 No. 10 P. 3

Keep it simple? When it comes to coding rules, it's more like keep it complicated. As discussed in this month's cover story, coders are seemingly under more pressure than ever. Various factors are contributing to the stress, including keeping up with myriad regulatory changes coming down the pike at a dizzying pace.

By now, every coding department is aware of the recently released Coding Clinic. You know, the one with 114 pages of updates, new codes, explanation of procedures, and a ton of deletions (most of which were warmly received).

Several coders I spoke with shared their highlights with me. Among the most welcomed changes was the new ruling that "diabetes with cellulitis" does not automatically move to "diabetes with skin complication NEC (not elsewhere classified)," making it an exception to the "diabetes with …" rule. Coders are advised to seek documentation with a specific "due to" link or query the provider.

Heart failure has new detailed codes for "other heart failure" in I50.8 that can identify right heart, acute right heart, chronic right heart, acute on chronic right heart, right due to left, biventricular, high output, and even end-stage heart failure.

Other highlights include the following:

• codes for several types of substance abuse in remission, not just for substance dependence in remission;

• expanded pulmonary hypertension codes;

• new codes for severity of lower limb nondecubitus ulcers;

• additional detail on the Pediatric Glasgow Coma Scale;

• clarified excludes notes for "Observation of newborn for suspected condition ruled out";

• a new Z code for "Exercise Counseling"; and

• external cause codes to differentiate between types of ATV accidents instead of lumping them all together.

To take advantage of and not trip over the changes, savvy coding leaders are arranging special education sessions to ensure staff are up to speed. At the same time, clinical documentation specialists are receiving the same courtesy, a wise move considering how often the paths of these two professions collide. The goal is to bill correctly and document accurately while keeping queries to a minimum until the changes become second nature.

It definitely complicates things, but if the long-term goal is quality at a lower cost, then this fine-tuning will be well worth any short-term inconvenience.