Official Coding Guidelines Provide Direction for Other Care Settings

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Original story posted on: November 30, 2020

If a patient has COVID-19 and pneumonia, he or she should be admitted to a skilled nursing facility (SNF) at the hospital until the patient tests negative.

There are frequent coding questions for non-acute care facilities posted in coding listservs. One official resource that will assist in answering questions for other care facilities is the 2021 Official Coding and Reporting Guidelines for ICD-10-CM.  

When a patient is admitted to a rehabilitation unit, the reason for the rehabilitation should be the principal diagnosis. For example, say the patient is admitted for right-sided dominant hemiplegia following a stroke. The sequela code, I69.351 (hemiplegia and paresis following cerebral infarction affecting right dominant side) would be the principal diagnosis.

For rehabilitative services following an injury, utilize the seventh character for a subsequent encounter. In the case of a patient with severe degenerative osteoarthritis of the hip who undergoes a hip replacement, assign Z47.1 (aftercare following joint replacement surgery) as the principal diagnosis. If a patient with severe osteoarthritis of the hip falls and requires hip replacement surgery, then assign the injury code with the seventh character for the subsequent encounter. For example, S72.141D (subsequent encounter for closed fracture with routine healing) could be an appropriate code for the rehabilitative admission.

According to the Coding Clinic issued for the third quarter of 2020, pg. 11, if a patient has COVID-19 and pneumonia, he or she should be admitted to a skilled nursing facility (SNF) at the hospital until the patient tests negative. Say the patient’s pneumonia resolved at the hospital, and the treatment was completed in the hospital. It would be appropriate to assign U07.1 (COVID-19) for the SNF encounter in this situation.

The Coding Clinic edition issued for the fourth quarter of 2012, pgs. 90-98, offers review of long-term care coding issues for ICD-10-CM. The first listed diagnosis is the diagnosis chiefly responsible for the admission to, or continued residence in, the nursing facility.

Some examples in the guidance include the following:

  • The medical documentation does not have to state “old CVA” to assign the sequela codes. There are no time limits on the late effects of a stroke.
  • When a patient is admitted to a long-term care facility following a CVA and has made a complete recovery, the patient may still have long-term medical conditions that require continued residence. Examples of diagnoses may include progressive senile dementia, coronary artery disease, and congestive heart failure. In this case, any of the chronic conditions may be sequenced as the principal diagnosis.
  • If a patient develops an acute condition such as urinary tract infection during their long-term care stay, assign the code for the acute condition until the condition is resolved.

Remember that the Uniform Hospital Discharge Data Set (UHDDS) definitions apply to all non-outpatient settings (acute care, short-term, long-term, psychiatric hospitals, home health, rehabilitative facilities, nursing homes, etc.

The Official Coding and Reporting Guidelines do specify that these guidelines are applicable to those facilities.

Programming Note: Laurie Johnson is a permanent panelist on Talk Ten Tuesdays. Listen to her live reporting on ICD-10 codes every Tuesday at 10 a.m. EST.

Laurie M. Johnson, MS, RHIA, FAHIMA AHIMA Approved ICD-10-CM/PCS Trainer

Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an American Health Information Management Association (AHIMA) approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

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