Third Quarter Coding Clinic 2017
As you all know, I like to discuss controversial topics.
I am just going to place this right here....
•If the Physician documents
“Emaciation” assign the code R64: Cachexia
–Note: The ICD 10 Indexes Emaciation to
ICD 10 code E41-Nutritional Marasmus
–Coding Clinic instructs coders to ignore
the indexing and assign R64
–Rationale: “A basic rule of coding is
that further research is done if the title of the code suggested by the Index
does not identify the condition correctly”.
•CC 3rd
Q 2017 Pg. 25
So the conclusion the AHA seems to be making is the following: a coder is at fault if they strictly follow the index to a code which does not identify the patients medical condition correctly????
Comments
Precisely, Allan. I wrote a letter to AHA several years ago - can't remember precise date - pointing out this contradiction, and I was told the Indexing issues would be resolved. This structure is not logical to me; a coding professional must 'remember' this issue and proceed cautiously. I can tell you from my perspective that I read the RD notes very carefully in this situation, and I believe a clarification to the MD is in often order so that the proper nutritional status can be reported.
Paul
My concern Paul, is this is dangerous and wreckless. It opens up Pandora's box.
Were I looking to pick a fight, I could completely unload on coders, accusing them of wrongly assigning codes they indexed from "flash pulmonary edema" to assigning "Chronic blood loss anemia" on patients where it was clearly acute (because the Physician only documented "blood loss anemia" and the coder followed the index).
If this is really their intention, it is open season on coders who should not follow the index but should just "know better".
Yep: And that is what happens when folks not as seasoned as yourself peek at coding, failing to comprehend the nuances and complexities of the task. The seeming contradictions of Coding Clinic exacerbate this difficult task. Enjoy your views, Allan.
Paul
When I was a coder, I was forced to ignore this particular "basic rule of coding".
If I had followed it, my "coding accuracy rate" probably would have been marked down to 50%. One of us needs to get a job at the AHA and try and fix this stuff!! I nominate you.
Wow...that is a real tragedy that anyone would be forced to apply such a flawed rule...that would make me very upset!! I like my current profession (CDI), but thank you for the nomination.