Have Comprehensive Knowledge of CPT, HCPCS, and ICD-9-CM

The interest in ICD-10-CM training is at a high level with most coders, which is not going to stop till October 1, 2013, implementation date. We are constantly seeing the drive for education careening to ICD-10-CM; however, but ICD-9-CM isn't supposed to be left behind.

Coders should be well-versed with their coding manuals. Remember, outpatient coding is not simply about CPT coding, but it is relatively about conceptualizing the whole picture in conjunction with CPT and ICD-9-CM codes. ICD-9-CM has a comprehensive listing of guidelines similar to the CPT manual. Interpreting ICD-9-CM knowledge prevents coders from fully understanding why diagnosis codes are used or sequenced in a specific way to produce complete claims. A coder must have a well-rounded knowledge of CPT, HCPCS, and ICD-9-CM. This will lead to fewer denials owing to ICD-9-CM mismatches with the CPT codes chosen.

The basics of ICD-9-CM should be well known; though, let's evaluate the important steps coders are required to take in order to correctly report the diagnosis for the following example.

A patient was admitted after developing severe diarrhea on day 50 following a living donor kidney transplant. A stool sample revealed a significant number of donor lymphocytes due to acute graft-vs.-host (GVH) disease. The physician diagnosed the patient with acute GVH disease.

First, find the main entry term; in this scenario, let's look at GVH disease. Keep in mind, conditions are expressed in the documentation as well as the index as nouns, adjectives, and eponyms. Numerous synonyms are also used for some circumstances, letting a coder to find the precise code through numerous lookup methods.

The next step is to look at the code found in the tabular section of the index to confirm correct code selection.

Here, you will find the code 279.50. If you look under this code, it explains that in case this is a complication because of organ transplant not somewhere else classified, see Complications, transplant, organ. Although this is a complication arising from a kidney transplant, you will still necessitate reporting the GVH disease, so look at the tabular section for code 279.50, where you will get 279.51, which precisely reports the disease documented at the maximum specificity.

Prior to applying 279.51 to the claim, you need to carry out one additional step. Most coders overlook to look around the code to see in case there is any parenthetical information that may affect the coding. Possibly an added code is needed to report a manifestation or if the code comprises or not comprises a condition or disease. It may also have the instruction to code the underlying disease first.

This example requires the use of an ICD-9 code such as 996.81, Complication of transplanted organ, kidney. An additional code also is required to specify any associated manifestations. The documentation states that the patient suffers from diarrhea because of the disease and transplantation, so the coder would report 787.91, Diarrhea.

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