March 2020

Ask the Experts
For The Record
Vol. 32 No. 2 P. 5

Question:
Any advice on how to best capture the codes for the novel coronavirus?

Anonymous

Response:
The new, scary variety is deemed “Novel 1 coronavirus.” There is more than one coronavirus; the regular kind is one of the viruses that cause the common cold. This new critter doesn’t yet have its own specific code.

It’s hard to find the coronavirus codes from the index alone; you have to know exactly what the virus causes. 3M software is more user friendly.

B34.2, Coronavirus infection, unspecified

Pneumonia due to coronavirus influenza takes two codes; if the patient has “pneumonia due to coronavirus” but without related influenza, you only need the second code.

J10.08, Influenza due to other identified influenza virus with other specified pneumonia

J12.81, Pneumonia due to SARS-associated coronavirus

B97.21, SARS-associated coronavirus as the cause of diseases classified elsewhere

B97.29, Other coronavirus as the cause of diseases classified elsewhere

This new superbug is “2019-nCoV” per the Centers for Disease Control and Prevention (www.cdc.gov/coronavirus/2019-ncov/summary.html). (The World Health Organization recently announced an official name for the disease caused by the novel coronavirus: COVID-19.)

Judy Sturgeon, CCS, CCDS, CICA
Clinical coding/reimbursement compliance manager at Harris County Hospital District in Houston and a contributing editor at For The Record

 

Question:
I work for a state-run behavioral health inpatient hospital. The attending physician documented on the discharge summary (and elsewhere) the diagnoses of “Schizophrenia (F20.9)” and “Rule out Schizoaffective disorder, bipolar type (F25.0).” The official guidelines state that for a diagnosis stated as “still to be ruled out” at the time of discharge, you should “code it as if it existed or was established.” These diagnoses have mutual Excludes 1 notes. Should both diagnoses be coded despite the Excludes 1 note?

Linda Parks, CCS
Southwestern Virginia Mental Health Institute

Response:
If the documentation and any queries support that the physician cannot determine the type of schizophrenia and cannot rule out bipolar type, then you should report both. This rationale is supported by the ICD-10-CM Official Guidelines for Coding and Reporting, specifically Section II, Selection of a Principal Diagnosis.

Kathryn Williamson
Education specialist at AAPC

 

Question:
When documentation of a fall is stated as “Patient slipped and fell hitting left hip and left side of head,” should I code W18.30XA - Fall on same level, unspecified, or W01.198A - Fall on same level from slipping, tripping, and stumbling with subsequent striking against other object? Is the floor considered an “other object”?

Anonymous

Response:
The correct code assignment would be W01.198A - Fall on same level from slipping, tripping, and stumbling with subsequent striking against other object. The other object refers to objects other than those listed within the code set.

Nichole Hunt, RHIT, CPC
CEO of Coding Concepts, LLC

Follow-Up Question:
Are you saying that all falls should be coded as “… with subsequent striking against … object” because something must stop the fall? If not something on the list, then it must be the floor they are striking against to stop the fall; otherwise, you would just keep falling into infinity? If this is what you intended, then when would you use the code for “Fall … without subsequent striking against object,” W01.0XXA/D/S?

Anonymous

Response:
The fall and striking against object provides support for further evaluation of the head and hip possible injuries.

Nichole Hunt, RHIT, CPC