The first quarter of the American Hospital Association (AHA) Coding Clinic for 2021 has been released and contains the updated AHIMA/AHA FAQ on COVID-19 coding, as well as the January 1, 2021 update to the Official Guidelines for Coding and Reporting.  In addition, this edition contains several ICD-10-CM coding questions and answers, and ICD-10-PCS scenarios to help with inpatient surgical coding. The “new” codes discussed in this issue were effective January 1, 2021, however, the specific coding advice is effective on March 10, 2021.

The AHA Central Office is the publisher of the AHA Coding Clinic for ICD-10-CM and ICD-10-PCS and the AHA Coding Clinic for HCPCS.  There is an Editorial Advisory Board (EAB) for Coding Clinic for ICD-10-CM and ICD-10-PCS which was developed to ensure that the needs of users of the ICD-10-CM and ICD-10-PCS classification system are addressed. EAB members represent important stakeholders in the health care community. Along with the AHA, AHIMA, CMS and NCHS, the EAB includes the following representatives:

  • American Academy of Pediatrics
  • American Medical Association
  • American College of Physicians
  • American College of Surgeons
  • Other physician specialties on ad hoc basis
  • Coding Professionals

There are over twenty ICD-10-CM topics discussed in this Q1 2021 issue. To hi-light a few of the topics or areas that are covered, here is a short list (does not contain all coding topics/areas):

  • CPR that Results in Rib Fractures
  • Pseudoseizure, without conversion disorder; non-epileptic Pseudoseizure
  • Depression and Anxiety
  • Peripheral Neuropathy and Multiple Sclerosis                    
  • Hepatic Encephalopathy and Toxic Metabolic Encephalopathy
  • Contractions at 37 Week Pregnancy
  • Carotid Artery Disease Not Specified as Occlusion/Stenosis           

For guidance on the ICD-10-PCS coding area, the Q1 2021 issues includes information on:

  • Reconstruction of Maxilla (Maxillectomy)
  • Placement of Spacer for Decompression
  • Placement of “Sentinel” Embolic Protection Device
  • Total Proctocolectomy with J-Pouch Creation
  • Rectal Suction Biopsy
  • Arthroplasty Revision of the Ankle with Insert

In this particular issue there were three corrections made to prior fourth quarter 2020 AHA Coding Clinic advice. The three coding subjects with corrections were:

  • HIV Disease (B20 code) and the excludes I note under the D84.81
  • Interbody Fusion and PCS Guideline B3. 10c (with strike-through)
  • Removal Ectopic Pregnancy via Laparotomy and “Approach” digit to use

Some important steps to take now that this coding guidance has been released includes first obtaining the AHA Coding Clinic, this requires a subscription, so you will need to go to the AHA Coding Clinic website and sign up (there is a fee). Go to the following link at AHA: Subscriptions | AHA Coding Clinic (codingclinicadvisor.com)

If you already have or receive the quarterly subscription then read through it. Now do not just skim it but read it over and have your coding staff and even CDI staff also read it over. Next thing to do is to schedule a meeting to discuss with both groups of professionals, a virtual meeting will work.  Allow enough time for a discussion of the guidance contained in this issue. Ask during your discussion if there are any documentation concerns or issues to consider; or documentation issues that could arise in the future in relation to the coding advice. Consider preparing and offering some education to physicians; hospitalists, intensivists, and ED physicians are a good place to start.

If there are questions that your own staff (including CDI) have that you believe needs further clarification, be sure to submit a question to AHA Coding Clinic through their online portal, there is no fee for this which is a great benefit, go to: AHA Coding Clinic (codingclinicadvisor.com).

As always, follow up within 45-60 days with a coding audit to validate some of the specific coding areas from this issue. You may want to even consider the services and assistance that an external coding consulting vendor can offer.

Written by Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer

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