Diabetes
Which of the following doesn't index to Diabetes with Hyperglycemia?
A. Uncontrolled Diabetes
B. Poorly Controlled Diabetes
C. Out of Control Diabetes
A - Uncontrolled Diabetes
What are the correct codes for this encounter?
Assessment and Plan
AFIB/Aflutter
- Continue apixaban
I4891, I4892
Both documented and supported.
No "Excludes 1"
Both can be captured.
Can these be coded together?
R56.9 Seizure(s) (convulsive) NOS
G40.909 - Epilepsy, unspecified, not intractable, without status epilepticus
No. You would use the most specific code that fully describes the medical condition. If the patient has been diagnosed with epilepsy, the G40.909 code (or another more specific G40 code, depending on the type of epilepsy) would likely be more appropriate.
Scenario 11: "Witch's Brew Renal Ruin"
Story: A sorceress comes into the clinic after a potion went horribly wrong, affecting her kidneys. She's now in stage 5 chronic renal disease and just started dialysis.
Question: What is the HCC code for chronic renal disease stage 5 with dialysis?
N18.6, Z99.2
Question: How many conditions can you find in this PE that have a causal relationship with DM?
Patient Physical Examination
General Appearance: Patient is well-nourished and in no acute distress.
Skin: Multiple dry, scaly patches present on both arms, consistent with eczema. No open sores or ulcers.
Eyes: Bilateral cataracts. No redness or discharge.
Ears, Nose, Throat:
Neurological: loss of protective sensation noted in the soles of both feet .
3 -
E11.40 - Diabetes with LOPS
E11.36 - Diabetes with Cataract
E11.630 Type 2 diabetes mellitus with periodontal disease
"Consistent with" is unconfirmed verbiage. Would not code E11.620 Type 2 diabetes mellitus with diabetic dermatitis (eczema)
What are the correct codes for this encounter? For the sake of the game, let's assume all conditions are supported.
A/P
CKD Stage 3 ?HTN related
HTN
N18.30, I10
The question mark indicates a questionable relationship between CKD and HTN. Unconfirmed link.
Can these codes be coded together?
J44.0 - Chronic obstructive pulmonary disease with (acute) lower respiratory infection
J44.1 - Chronic obstructive pulmonary disease with (acute) exacerbation
Yes, both codes are needed to fully identify the patient condition.
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2017 Issue 4; Ask the Editor
Scenario 9: "Alien Abduction Anxiety"
Story: A patient comes in anxious and paranoid, convinced that he was recently abducted by aliens. He is afraid to leave the house. He's diagnosed with panic disorder and agoraphobia.
Question: What is the correct code(s) for this encounter?
F40.01 Agoraphobia with panic disorder
What are the correct codes for this encounter? For the sake of this question, assume all conditions are supported.
A/P
1. Type 2 diabetes with diabetic nephropathy
2. Stage 3 CKD
3. Hypertension
E1122, I10, N1830
"When the patient has diabetes, hypertension and chronic kidney disease (CKD) and the provider documents CKD due to diabetes or diabetic CKD, diabetic nephropathy or other similar terminology a causal relationship is indicated, and denotes the CKD is not related to the hypertension. In this case, assign a code for diabetic chronic kidney disease. Do not assign a code for hypertensive CKD, as the hypertension would be coded separately. "
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2019 Issue 3; Ask the Editor
Which of the following heart diseases cannot be coded with HTN as I11.9?
A. Cardiomegaly
B. CAD
C. Diastolic Dynsfunction
B. CAD
I11
Includes:any condition in I50.- or I51.4-I51.7, I51.89, I51.9 due to hypertension
Can these codes be coded together?
F29 Psychosis
F25.9 - Schizoaffective Disorder
No.
"Use a more definitive diagnosis if one is available (e.g., schizoaffective disorder)." - Common Language Description FAC
Scenario 21: "The Cursed Cranium"
Story: A fortune teller has been having terrible headaches and vision problems ever since she read the future in a cursed crystal ball. She is diagnosed with chronic migraines.
Question: What is the HCC code for chronic migraines?
G43.809 Other migraine, not intractable, without status migrainosus
What is the correct code for this encounter?
Assessment/Plan (A/P):
Past Medical History (PMH):
Type 2 Diabetes E11.9
ICD-10 GL "When the type of diabetes mellitus is not documented in the medical record, the default is type 2, which classifies to category E11. " If the type is conflicting, you would also default to type 2.
How is "Diabetes complicated by HTN" coded?
E11.9, I10
Complicated by" is not the same as “with," “in,” "due to” or "associated with.” If the documen?tation states diabetes “complicated by” hypertension, the DM and HTN would be coded as
E11.9 and I10. Code E11.9 and I10 are comorbidities, two conditions that are affecting each
other but not caused by the other (no relationship).
Ciox Newsletter 2023 Issue 2: September 12, 2023
Can these codes be coded together?
I50.812 Chronic right heart failure
I50.32 - Chronic diastolic (congestive) heart failure
Yes, these codes can be coded together.
AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2023 Issue 3; Ask the Editor
Right-sided heart failure and chronic diastolic heart failure can be coded together because they refer to different aspects of heart failure. Right-sided heart failure specifies which side of the heart is affected, whereas chronic diastolic heart failure (or HFpEF) refers to the functional nature of the failure (impaired filling of the heart).
Scenario 22: "Vampire's Vein"
Story: A young vampire complains about continuous joint pain that limits his flying abilities. He is diagnosed with rheumatoid arthritis of the lumbar vertebrae.
Question: What is the HCC code for rheumatoid arthritis of lumbar vertebrae?
M45.6 - Ankylosing spondylitis lumbar region
Is Diabetes supported in the below example?
PMH: Diabetes
Med List:
Yes,
What is the correct code(s) for Coronary atherosclerosis due to calcified coronary lesion?
I25.10, I25.84
I25.84 has a "code first" note instructing to code coronary atherosclerosis I25.10
Can these codes be coded together?
M06.4 - Inflammatory Polyarthropathy
M06.9 - RA
No, Per FAC
Common Language Description
Inflammatory polyarthropathy refers to a condition in which inflammation of the joints (eg., rheumatoid, psoriasis, ankylosing spondylitis) affect the joints of the body. This code would be rerported when an inflammatory polyarthropathy exists, but the specific type has yet to be identified.
Scenario 28: "Spectral Sclerosis"
Story: A spirit complains about feeling "tight" and "stiff" even in her ethereal form. Findings are consistent with scleroderma..
Question: What is the correct code??
No code! "Consistent with" is unconfirmed verbiage.