[Music] ch [Music] [Music] [Music] ch [Music] [Music] oh [Music] [Music] all right a patient was admitted with an acute myocardial infraction 10 days later he is admitted for an acute anterior lateral infraction CER your time begins now and good luck e e e e okay yeah this was a little tough one right yeah but I think it's just um breaking them down and really understanding what you're coding for right what is this how do we have on okay there we go so we have an acute my cardial infarction so the patient was admitted 10 days ago for an acute myocardial infection then 10 days later right they're admitted again for an acute anterolateral infarction so it turns out we need to code for the current one right so let's assume we already build and code for that previous one but we need to code for the reason for the encounter the reason for the encounter is the recurring one right so let's look at our chart so if they were if they had a previous infarction and that infarction was 28 days or less then we're going to sequence it like this i22 for this one the recurring one and then i21 this is what we're going going to do are you with me so let's go ahead and document patient had a Ami 10 days ago and the patient's having an acute anterolateral infarction today now let's go ahead and look up this acute anal lateral in far ction today because this will be the reason for the encounter right and we're going to sequence it first so let's look up infarction subsequent right it's subsequent it's an acute one but it's subsequent recurring infarction and then let's go down and look underneath that right anterior anteroapical anol vatal andal I 22.0 this is the first one so let's go to i22 subsequent St and and semi and let's go down this is the right category I2 2.0 subsequent St elevation of an an terior wall and underneath subsequent anterolateral transmural Q wave inunction acute this is first I 22.0 are you with me yes somebody saying yeah you should be happy you knocked it out the park yes you did okay so this is the first one we're coding for the recurring one first next we got a code for for that previous inunction right and that previous infrction is still it's still um acute because it is less it's 28 days or less so it's still acute and we still use these acute codes so we're going to go to infarction what was this infarction it just says an acute mardial infarction so infarction my cardium if it was four weeks or less I to 1.9 I like that because there's no mention of the sight of the infarction or the type right yeah so I like it I2 2.0 is first I2 1.9 is second and look down here acute my cardial infarction not otherwise specified acute my cardial infarction we don't know what type or anything about that previous infraction and remember it's I 21.9 when the type in the coronary vessel is unknown so we don't know the location of the infraction on the heart and we don't know the type now if the type is known and not the vessel I to 1.3 all right are you all with me did that make sense all right yeah when you just break it down in those digestible nuggets it is perfect it's easier when you do that outstanding job out I see some I see all kinds of lights going off I do aha aha aha all right Miss Stephanie please and thank you coders A 122.8 and 12.09 B 12111 and 122.0 c 122.0 and d 122.0 0 And1 21.11 two days after being admitted for a right quinary acute myocardial infraction a patient suffers a new anti antio Excuse Me Pickle myocardial infraction of the right coronary vessel the patient is being seen for a new infraction your time begins now and I know you got this e aha all right I love it I love it I love it yes I see all kinds of you know comments in here that just say hey I got it I got it and I love it all right so let's go ahead and let's code this out but first my what am I doing here I got I'm eliminating stuff without um come on let's do this there we go all right there we go there's our inventory this patient was admitted two days ago well I guess this charged two days ago right and they had a right coronary myocardial infarction and today they have a new Andro appical myocardial infarction so this is a subsequent infarction right and the way you are going to code this subsequent infarction we're going to use the same guideline they had a previous Ami and it's not older than four weeks so we're going to sequence i22 first Follow by i21 and D is the answer somebody said and D is the answer it is it is because it's sequenced appropriately now let's go ahead and do our due diligence we're going to look these up right and we're not going to look it up from the index because we're given we're given the answers so if you look at I 22.0 this is the code for subsequent anro appical transmural qwave infarction this is correct right so I2 2.0 is correct and let's look at I2 2 1.11 this is the code for St this is for the first infarction the acute right right coronary infarction two days ago and it's still current it's still new so we still use these acute codes I 21.11 st stemi involving the right coronary artery and that that is correct as opposed to I2 1.01 because this is coding for an other coronary artery vessel we already know it's the right coronary vessel here not other so we're going to get rid of a and the answer is D all right how are you feeling you are doing this you're doing it you should really really feel good someone said which one is the reason for the encounter the first or the second the reason for the encounter will be what is happening now right now that documentation for that other infarction the previous one is already going to be coded so we're only dealing in the current right so whatever is happening now that is going to be the reason for the encounter great question absolutely someone said are we allowed to write more notes in the MCG manual yes [Music] absolutely there are limits for certain um there are limits to what you write not how much you write okay great questions everyone okay we got one more Miss Stephanie please and thank you yes coders A 15022 and 15032 B I'm sorry i50.23 and i50.33 c i50.42 d i50 43 Melanie returns to her cardio her cardiologist office for treatment of her chronic combined heart failure your time begins now cers e e okay I apologize for that I'm sorry if you saw the answer please try not to see it all right so this patient went to the cardiologist office and this patient has chronic combined heart failure so that's pretty much the code the diagnosis that we're going to code for chronic combined heart failure and the answer is C here is why anytime you have a combination code you use it right so when you have chronic combined heart failure that means you have both systolic and diastolic and you do not code them separate all right so systolic is coded from from the i50 .2 category and diastolic is coded from i50.30 point4 category all right so we can get rid of any that's coded separately so specifically if we go to i50.42 this is the code for chronic combin find systolic and diastolic congestive heart failure that's our combo code and anything from the point 2 3 category and 43 is incorrect because this is acute on chronic combined so there's no mention of any acute so that is incorrect and your answer is c and a lot of you got that correct outstanding 100% all right so we just have one more topic and then we're ready to go one more topic one more scenario and we are ready thank you to my readers I appreciate you and now I'll take it from here this segment of our discussion disc is cerebral infarction or strokes and there are a few type of Strokes you have esic strokes often caused by clotting hemic Strokes those are often caused by bleeding like aneurysms all right so those are some of the most common cerebral infarctions now when we code we have to know the guidelines guidelin c91 sea of cerebral vascular disease well let me tell you when a patient has a stroke sometimes they can have a residual effect they can have a sequa shortly after so if they have a stroke they could have some dfia they could have some hem Hemes they could pareses they could have any other type of neurological disorder caused by the stroke right and if that happens you're going to have to sequence first and the treatment is rendered at the um late effect of the stroke you're going to sequence I69 then you're going to sequence en code for that acute stroke if it's documented sometimes it's not sometimes they get that stroke that acute stroke they get it in um you know they kind of um treat it and the stroke is no longer and it's the residual effects that they're just um treating and therefore you don't cat it you only code it if they're both documented here's another guideline important guideline guideline C9 D1 sequa codes that specify hemiplegia hemiparesis and monoplegia identifies the affected site so you're going to have to understand what dominant and non-dominant are now dominant means that hey this is the patient's dominant side this is the patient or the side that the person writes with non-dominant is the non-dominant side this is the side of the body that they don't write with okay but when it's not documented as dominant or non-dominant if a patient is ambidextrous right the default is the side that is affected so if a patient's ambidextrous and they have left-sided um Hemi PR pris if it happens on the left side of their body then that's the dominant side if it happens on the right side of the body that will be the dominant side so if they are ambidextrous and it's on any side of the body they're dominant on both sides so the default will be the side affected now if the left side is affected remember the doc the default is non-dominant and the right side affected is dominant okay let me let me rephrase that if a patient is um we'll just leave it like this we'll leave it like this all right so let's test our knowledge of the guidelines I think this is I just want to reiterate that when a patient is ambidextrous the default is the side of the body and that other information that I had documented on the screen I think it was just left over you know from a subject a previous subject so this is the only thing that we want to discuss and then we're going to look at the guidelines now let's test our guideline knowledge and we have a scenario all right a a i69.351 i63.9 b I6 9.35 3 c i63.9 i69.351 d I6 9.34 one after suffering a cerebral infarction the ambidextrous patient continues to have right sided h [Music] pgia that is diagnosed as a late effect okay coders your time begins now e e e e okay let's go ahead and let's highlight our key terms a patient had cerebral infarction they are ambidextrous they have right sided hemiplegia that is a late effect all right so let's to the diag the guidelines the guidelines say this if a patient has squa of a cerebrovascular disease C9 D1 you're going to sequence first that late effect followed by that infarction if it's documented and it turns out our infarction is documented right but we're going to sequence i6 9 first so we can eliminate C it's sequencing i63.9 now and also just want you to know i63.9 is the code for the acute infarction that's unspecified now we have another guideline that's applicable right and I'll show you that in a moment but if you look at I6 9.34 this is the code for a monoplegia of lower limb we have right-sided hemiplegia so this is not applicable there's no monoplegia so if we're looking at D it's coding for i6 9.34 monop have lower limb following cerebral infarction following right dominant side uhuh this patient is ambidextrous you got to go so D has to go and I6 9.35 this is hemia I like this subcategory right so let's get rid of D because that's monoplegia and that leaves us with A and B we know that a is the correct answer because the guideline told us that we have to sequence um the the late effect first followed by the acute cerebral infarction however if you look at the guidelines it says when dominancy is not indicated if that patient is ambidextrous then the default is the side that's affected also these two guidelines here that I kind of just skimmed over because I thought it was written in the wrong place these are applicable too when not to this scenario but they're important so when dominancy is not indicated if the left side is affected the default is non-dominant if the right side is affected the default is dominant so whenever they don't say the patient's dominancy when they don't indicate the the hand that the patient writes with if the if the infrction occurred in the effect is on the left side we'll consider that non-dominant if it's on the right side it's dominant that's if it's not documented I guess because most people are right-handed so they just assume that all right so the answer is a and let's go ahead and look at 96351 hemiplegia and hemiparesis following cerebral infarction affecting right dominant side we select the right dominant side as opposed to the right non-dominant side because of the patient's ambidextrous the default is the side that's affected so if it's the right side that will be the dominant side for the ambidextrous person if it was on the left side that would be the dominant side okay so it's always going to be dominant if it's not documented okay so answer is a and if you got that correct outstanding good job 100% said a all right so we're down to the wire I want to know how you did how did you do how' you do today with cardiovascular as far as I'm concerned I knew you would be fantastic I just did somebody said they did awesome I love it somebody said good good pretty good if you miss something remember but you learned something that's better than good great or fantastic that's priceless all right somebody said they start at Rocky but I saw you end I saw your ending and you nailed it yeah I see my students I love it I love it thanks for tuning in and until next time happy [Music] coding