The Coding Tip Corner

The Risk adjustment team is happy to announce a new segment in the HTA newsletter. The Coding Tip Corner will allow your office to forward questions to our email address: RiskAdjustment@healthteamadvantage.com. Even though we cannot send you a specific diagnosis code, we can direct you to the appropriate path.  

Another goal is to keep you updated on changes as well as common coding errors. Two common coding errors are: 

Myocardial Infarctions (MI)  

Coding an MI: This can be coded as a recent MI up to four weeks from the incident. This calculates to 28 days including the day of the incident, not one month. If you do not have the exact date which falls within a 28-day period, it should not and cannot be coded as an active MI. This will be rejected by CMS! 

Cerebrovascular Accident (i.e., infarction, stroke, or hemorrhage) 
When coding for a new stroke, the diagnosis code is only accepted at the initial period of the stroke. While it potentially could occur in an outpatient setting during an office visit, it would be very rare and would need to be substantially documented by the provider as such. Otherwise, once the patient is discharged from the acute care hospital, the diagnosis code becomes either a “history of” or a late effect condition. “These ‘late effects’ include neurologic deficits that persist after initial onset of conditions classifiable to categories I60-I67” (CDC, 2021, p. 49). Coding for the “history of” or late effect after the onset of the stroke is applicable to not only the provider in an outpatient office setting, it also should be coded by facilities such as Skilled Nursing facility, Rehab Centers, Long Term Care facilities, or Home Health.  

ICD-10-CM coding changes occur annually: Every year on October 1, the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics release an updated ICD-10-CM Official Guidelines as well as changes to the code set. These changes are to be used from October 1 of each year through September 30 of the following year. While it does not happen often, from time to time a code is changed or added within that timeframe as well.