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Ask the Experts: Dec. 28, 2010

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Q: My question is regarding the appropriate ICD-9-CM diagnosis codes to assign for an acute care inpatient Medicare admit. A patient was transferred to our hospital from another hospital due to Sickle Cell pain crisis. Prior to transfer to our hospital it was discovered that the patient was 8-weeks pregnant. During the hospital stay at our facility, the patient had a miscarriage via spontaneous abortion. What diagnosis codes and fifth digits should be assigned?

A: Assign code 634.90 as the principal diagnosis and code 648.93 with the sickle cell pain crisis code as additional diagnoses. See the Official ICD-9-CM Coding Guidelines where it addresses abortions with pregnancy codes. You would sequence the abortion first followed by the pregnancy complication code using the fifth digit of 3. I hope this helps.

Mary Mills, RHIT, CCS

Q: How would you code CAD with post two vessel CABG? I know you would code 414.0 for CAD and I need a 5th digit. Would it be 414.04?

A: The fifth digit is dependent on whether the CAD is present in a native artery or a bypass artery. If the CAD is documented as CAD with status post CABG, 414.01 is assigned. Arteriosclerosis of an artery involved in a bypass graft is coded 414.02, Coronary atherosclerosis of autologous vein bypass graft or 414.03, Coronary atherosclerosis of nonautologous biological bypass graft. Code 414.04, Coronary atherosclerosis of artery bypass graft, is assigned for an artery with arteriosclerosis. If in doubt, then you must query the physician.

See Coding Clinic, First Quarter 2004 for further guidance if needed.

Arlene F. Baril, MS, RHIA

Q: How do you code a physician office visit when there is no diagnosis? Do you code the PMH and the symptoms or just the PMH?

A: If there is no definitive diagnosis then reverting back to signs or symptoms is certainly appropriate. In the absence of signs/symptoms then you may only have past medical history. Best case scenario: I would code based on the chief complaint -- what did the patient present with? Past medical history can be listed as a secondary diagnosis.

Kim Heibel, CPC

Q: How should I code a COPD exacerbation if the physician also noted status asthmaticus?

A: Status asthmaticus refers to an acute exacerbation of asthma that does not respond to standard treatment. ICD-9-CM coding guidelines state "if status asthmaticus is documented by the provider with any type of COPD.. the status asthmaticus should be sequenced first." That code is 493.2x Chronic Obstructive Asthma (asthma with chronic obstructive pulmonary disease [COPD]). The 5th digit for status asthmaticus is 1. The only code to be used is 493.21.  The code for COPD is non-specific (496) and is superseded by the status asthmaticus code according to coding guidelines.

Jill M. Young, CPC, CEDC, CIMC

The consultants, their companies and ADVANCE do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information.

Coding Clinic is published quarterly by the American Hospital Association
CPT is a registered trademark of the American Medical Association.

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