Updating Facility-Specific Coding Guidelines

Updating Facility-Specific Coding Guidelines

The next big thing in the coding world is the release of the ICD-10-CM and ICD-10-PCS codes for the 2024 fiscal year (FY). These codes should be released soon so that facilities and vendors can prepare for Oct. 1, 2023.

In the meantime, review your facility-specific coding guidelines. If you don’t have them, then develop them. These guidelines address your specific data needs. The benefit of having facility-specific coding guidelines is consistency among the coders and collected data. Also, you will no longer have to answer questions about what items are coded.

Let’s walk through the update process. First, identify the documentation utilized during the coding process (for example, all documentation that is signed or co-signed by a physician). There may be some exceptions, such as the documentation for Social Determinants of Health (SDoH), or the documentation utilized to assign body mass index (BMI) codes.

Another focus is the inpatient procedures. Here are some procedure topics that your coders or contract coders may wonder if they should be coding:

  • Electroencephalogram (EEG)
  • Computerized Tomograms (CT)/Computerized Tomography Angiograms (CTA)
  • Magnetic Resonance Imaging (MRI)
  • Echocardiograms
  • Transfusions
  • Peripherally Inserted Central Catheters (PICC)
  • Midline Catheters
  • Total Parenteral Nutrition
  • Dialysis

When coding procedures, there should always be a good explanation. Remember, for every procedure that is coded, a date and performing physician are also assigned.

A related topic is New Technology Add-On Payment (NTAP) items. It is important to identify these items, as the NTAP is usually triggered by the ICD-10-PCS code. You don’t want to leave money on the table. There is a list of NTAP items for FY 2023 in the FY 2024 Inpatient Prospective Payment System (IPPS) Proposed Rule.

For diagnosis coding, there are many topics to be considered. If you don’t have facility-specific coding guidelines, your coders may wonder if they should code:

  • Family History
  • Personal History
  • Smoking Status
  • Allergies
  • Long-term Drug Use
  • External Cause Codes
  • Status Post-Procedures (e.g., history of Total Hip Arthroplasty)

If you have a cancer registry, you may want to code family and personal history of cancer. The coders are also coding for Hierarchical Condition Categories (HCCs), so coding long-term drug use may be important. External cause code requirements vary across states, so it is imperative that external cause codes be assigned. For example, Pennsylvania has a data commission that requires an external cause code to be assigned for every trauma code assigned. If the external cause code is not assigned, then the case will fail the data commission processing and must be corrected.

Your facility guidelines should also address physician queries, the official documentation for discharge disposition, escalation when a conflict between coding and quality occurs, SDoH, and abstracting. You will find that the most difficult task is to write the first version of these guidelines, but the benefits will far outweigh the effort.

Programming note: Listen to Laurie Johnson’s live coding report today on Talk Ten Tuesdays, 10 Eastern, with Chuck Buck and Dr. Erica Remer. 

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