[Music] ch [Music] [Music] [Music] ch [Music] [Music] oh [Music] [Music] in the chat and we're going to move on I'm going to ask Miss Stephanie to come to the four please and thank you thank you a 0241 one3 02 4.41 Z3 a.40 024 410 024 913 c 02493 d 024 410 and Z 38.4 a pregnant woman in her 40th week has gestational diabetes which is controlled by her diet what icd1 CM codes are reported it time begins now two and a half minutes e e e e okay I think you are outstanding outstanding all right right let's go ahead and highlight our keywords all right so we have 40 weeks pregnant patient gestational diabetes and it is controlled her gestational diabetes is controlled by her diet and I'm writing it 40 weeks pregnant gestational diabetes controlled by diet now is there a guideline that's going to help me eliminate some things on site can anybody eliminate some on site go ahead type in the chat if you were able to eliminate anything on site outstanding outstanding somebody is doing it outstanding yes this is gestational diabetes it could be one or the other did the gestation cause the diabetes or did the diabetes preexist was the diabetes there first okay all right yes so when you have gestational diabetes it tells you sequence first from 02 4.4 subcategory yeah we can eliminate A and C A is coding for pre-existing diabetes first and C well that nine is telling me that it wasn't specified if it was pre-existing or gestational just saying and don't forget when it is for the gation caused the pregnancy maybe that resonates for some people and maybe it doesn't but let's go ahead and do our due diligence and let's look up these codes so 02 4.1 as I've said before is pre-existing type 2 diabetes there is no mention that this was pre-existing right it's gational so O2 4.1 gotta go next 02 4.9 this is unspecified diabetes metis and pregnancy they didn't specify that's what this means this means that the doctor didn't specify if it was just gational or pre-existing so the doctor did say hey this is gational so 024 excuse me 0249 is incorrect are you all with me when somebody also points out that that a is coding for both pre-existing and gestational diabetes that is not clinically correct and you're probably never going to see that I'm not g maybe I shouldn't say never because they're you know everyone's different right yeah but you typically should not code for both so that leaves us with b and d b and d both have 0244 one0 so we know that's correct on site we know this is the code for gestational diabetes oh my goodness but B is incorrect also because it's coding for just stational diabetes and unspecified diabetes and just like a having both you can't have unspecified and specified in the same encounter so B is incorrect and the answer is D 02410 gestational diabetes in um gestational diabetes metis in pregnancy diet controlled that is how specific this code is and our second code is our week's gestation code Za Z3 a.4 weeks gestation of pregnancy 40 weeks or greater yeah so this patient is 40 weeks and that is our code Z3 a.40 and if you said outstanding but if you learned something I hope you did that's priceless and I see people self-correcting that is phenomenal definitely self-correct if you see that you you made a mistake go ahead and S correct and if you want to let us know that's awesome I love when I see that all right we got another scenario yeah these are flip exercises so these are probably in an old or current MCG manual okay Miss Stephanie please and thank you a z34.01 b 9511 Z3 a13 c o z 9521 Z3 a13 D 9511 z34 01 Z3 a13 a 36 year old woman presents to the obstetrician with her first pregnancy she is 13 weeks along in her pregnancy called her two and a 2.5 minutes thank you you I'm not going to give you 2.5 minutes for this one you all we just reviewed this one so I want to see what you can do with this somebody is just answering in record time I just want to let you know I see you outstanding and you know your guidelines I do I see you outstanding e e e okay I did give you more time and I just wanted to for those of you that are answering rapidly um definitely share why and how you're able to answer rapidly for your peers and um if you get an opportunity to put it in the chat I will definitely share with um your peers I'm guessing I know but let me know all right so the key words we have a 36 year old woman right she's high risk first pregnancy she is 13 weeks along in her pregnancy okay so all right so here is the inventory here is the guideline we just reviewed this guideline C15 V2 and it says you got to sequence your supervision of high-risk pregnancy first and that is what we're going to do so we are also going to eliminate a because that is not a high-risk pregnancy code so that's what we're going to do next let's go look up our codes all right 9.5 category this is supervision of elderly primigravid and multigravid we already established that this patient was prei gravida because this is her first pregnancy so her codes are going to likely come from 9.51 supervision of elderly primi gravida and we're not going to code from 9.52 supervision of elderly multigravida because she's the is her first pregnancy so we're going to eliminate 9.52 category specifically C 9.52 and that leaves us with b and d and 09 9511 is correct this is elderly supervision of elderly primig gravita first triester we know that's correct and we know the trimester is Z3 a13 but the difference between B and D are D is coding for this z431 and this is the code for encounter for supervision of of normal pregnancy right yeah so normal pregnancy is never a high-risk pregnancy so they're never coded together you can't have a normal pregnancy and a high-risk pregnancy in the same encounter so z34.01 is incorrect and even in the excludes one notes it says hey you cannot use this code for encounter for supervision of high-risk pregnancies so z34.01 encounter for supervision of normal first pregnancy is incorrect so D is coding for it and it's got to go and your answer is B how many of you feel comfortable right now with identifying Z3 a13 as weeks gestation 13 weeks gestation good some people say yeah okay so no one really said how they're answering the questions really rapidly they didn't just answer this one rapidly but a few of them and I'm guessing they have a command of the guidelines yeah do you have your MCG manuals all right so this is your week's gestation we're doing our due diligence Z3 a13 this is the code for 13 weeks gestation of pregnancy all right so that one of the person said yeah they are looking at their guidelines and they do have their MCG manual I'm just letting you know they are answering in Rapid Fire time outstanding and this is the first time they're in this class so I just want to share that with your peers all right we got another scenario exercise five okay Miss Stephanie please and thank you a b370 z21 Z3 a13 B 098 711 B20 B 37.0 z3a 13 C 98. 711 z21 B 37.0 Z3 a13 D b370 B20 Z3 a13 Megan who is 13 weeks pregnant with asymptomatic HIV presents to the Ed with elevated temperature stomach pains and unusual spots on her tongue after examination the Ed physician diagnoses Megan with world thres go time begins now e e okay coders I'm going to stop right here I think the class let's see all right [Music] um outstanding job everyone all right so here are the key words we have 13 weeks pregnant asymptomatic HIV and she's here in the Ed with elevated temperature she's got some stomach pains unusual spots on her tongue and after examination she's been determined to have oral thres so I'm documented documenting everything and it says she has HIV asymptomatic HIV but I'm questioning that because HIV asym tomatic HIV means without symptoms so coders do you think this patient is showing some HIV related symptoms yeah yeah she is and we're going to show you how we know she's got some stomach pains and some temperature and she's been diagnosed with oral thres oh let's I'm going to go to the HIV and pregnancy and it says that this patient if they have have symptoms in pregnancy then they are no longer asymptomatic now in chapter one we listed in the pregnancy HIV not pregnancy but the HIV um complications we listed the complications and if you can recall oral thrush was a listed complication so if you go back to chapter one you'll see that oral thrush is an HIV complication so this patient is no longer asymptomatic without symptoms so we are definitely going to sequence B20 instead of z21 so a is sequencing for z21 oh wait D is wrong it's wrong because it's not sequencing your chapter 15 code first so I kind of got ahead of a little ahead of myself it's telling you to sequence first your o code 0987 guidelines say whenever you have a chapter 15 um diagnosis they will not they must go first nine times out of 10 chapter 15 codes will be sequenced first so if you look at a and C A and D excuse me they're sequencing this B3 7.0 this infectious diseases the thrush code first so that's going to be wrong also anything sequencing z21 those symptoms that's going to be wrong too and you know what you can deduce just based on these guidelines and the sequence order that b is our answer and there here are your HIV related conditions from chapter one if you go right here where it says common HIV related conditions you'll see your kosi saroma lymphoma Etc thrush is the last one so we're going to get rid of z21 look at this we have uh we have a sequencing Guru in this class he said M B20 is out of sequence it is it is yep at D it's out of sequence all right so this oral thrust is an HIV related condition z21 is incorrect because it's coding for symptoms and B is your answer let's do our diligence 0 98.7 is HIV disease complicating pregnancy and underneath it tells you how to sequence it yeah I'm loving these instructional notes so 09871 you're going to sequence first and this is for the first trimester and then these instructional notes say use an additional code for your HIV related your HIV and B20 is next there you go and then if you go to B20 it's going to tell you what to do after that it's going to say hey code first you know your pregnancy comp application then use additional codes to identify all manifestations or your HIV related condition so if you go to B20 it says sequence your o code first then it tells you to sequence additionally or after any and all manifestations of HIV or HIV related conditions and that's your thrush B3 7.0 and then we're going to sequence last our week's gestation we know that 13 weeks gestation is Z3 a13 and if you said B outstanding now I want to kind of speed things up just a bit and I want to take you to a quick discussion on coding for deliveries just icd1 CM coding for deliveries all right thanks for tuning in and until next time happy [Music] coding