On July 27, CMS and the National Center for Health Statistics released the FY2019 CD-10-CM Official Guidelines for Coding and Reporting. Take note of these key changes so you’re ready to code accurately come Oct. 1.
Takotsubo syndrome and hypertension. Effective Oct. 1, coding guidelines will no longer allow you to assume a connection between Takotsubo syndrome (I51.81) and hypertension. The new guidelines specifically exclude I51.81 from the list of codes that you can assume are connected to hypertension even in the absence of physician documentation.
Current guidelines assume any condition coded between I51.4 (Myocarditis, unspecified) and I51.9 (Heart disease, unspecified) is connected to hypertension even without physician documentation. [I.C.9.a.1]
The FY2019 guidelines align with Q2 2018 Coding Clinic guidance, which states that you should code for a patient with Takotsubo syndrome and hypertension using I51.81 and I10 (Essential (primary) hypertension).
Potential hazards related to socioeconomic and psychosocial circumstances. Look for new guidance in section I.B.14, including a new title: “Documentation by Clinicians Other than the Patient’s Provider.” Updates to this section allow you to assign codes between Z55 and Z65 (Persons with potential hazards related to socioeconomic and psychosocial circumstances) based on clinician documentation rather than requiring physician documentation.
The FY2019 coding guidelines align with Q1 2018 Coding Clinic guidance in stating that codes between Z55 and Z65 capture social information and not medical diagnoses. As a result, you can assign these codes based on information documented by other clinicians. [CPH, 4/18]
Neoplasms. Assign a code from Z85.- (Personal history of malignant neoplasm) when a patient’s primary malignancy has been previously excised or eradicated, no treatment is directed at that site and there’s no evidence of a primary malignancy at that site.
Only codes in the Z85.8- subcategory (Personal history of malignant neoplasms of other organs and systems) may be used to report either primary or secondary malignancies, according to the FY2019 coding guidelines.
“With” and “in.” The FY2019 guidelines specify that the "with" and "in" concetions apply whether the word appears under a subterm or under a main term in the alphabetic index. For example, "with" appears under the main term "Diabetes" but it appears under the subterm "leg" in the alphabetic index listing for “arteriosclerosis, extremities, leg.”
The updated guidelines specify that the word operates the same way in both instances. Previously, the guidelines only mentioned how the words should be interpreted when they appear in the alphabetic index but didn’t specify where or in what capacity.
Read the FY2019 guidelines and see all of the updates here.