Transcript for:
ICD-10 CM Chapters 10-14

good morning everyone and welcome you all to the week 6 of part two classes by AMCI and yes it's week six and we are going to cover the chapters from 10 to 14 from ICD-10 CM today it includes the copds the fractures and the skin so how are you all doing in the Saturday morning how are you all and what's the weather over there so you know we have changed the format a little bit we will start up with the pre-class videos where we will be giving some uh warm scenarios for you so that you get prepared and ready to roll in the class the meat of the class which we which will be followed so are you guys ready for the pre-class so let's start team let's start code is yeah that's a spirit so as I said we will be doing some warm-up scenarios with the homework you will be familiar with this so let's do it foreign yes and this is your first warm-up homework scenario for this week what icd-10-cm codes is or are reported your options are option a j45.901 r06.2 option bj45.901 option cj45.909 r06.2 and option D r06.2 a nine year old with a history of reactive fa disease was admitted into overnight observation with the complaints of today's history of increased reason the parents stated that the nebulizer treatment were not helping after monitoring and additional treatments given while in observation breathing was stabilized documented diagnosis is rad accessibility and CM cores are reported for this case and I will give you two and a half minutes quarters you know the drill so let's meet after 250 minutes and your time starts right away that's two and a half minutes quarters and let me have a look into the chat yes from what I see in the chat I can show you that you all have picked up from where you left last week you guys were awesome last week with all the scenarios you're doing an amazing job this week as well so the correct answer is going to be option b j 45901 and these are your keywords and I have highlighted them about a nine year old with a history of reactive every disease r80 is what the full form of rad is reactive every disease the patient was having increased wheezing and the fine diagnosis is rad excess impiration so you can see there was increased wheezing for this patient in the scenario and r06.2 is the ICD code for freezing the patient is already diagnosed with rad reactive evidence is excess separation so do you think we need to code for r06.2 which is wheezing I think that's an integral to reactive every this is right yes it's a symptom it's a symptom we're using is a symptom of reactive airway disease and once we have a conformed diagnosis are we going to quote for the symptoms no yes we are not going to code the symptoms along with the confirmed diagnosis so r06.2 is not needed and if I look I have three options which is having r06.2 so anyway r06.2 is not going to be in our code selection so I can eliminate option a option C option D right away I can delete them spot on and the correct answer is going to be J 45.901 which is coding for unspecified asthma with acute excess separation so if you go into the alphabetic index and lead a DC's under the disease reactive airway disease you will find it will take us to asthma and you have seen the patient is having rad excess separation so go and select asthma with access separation that will give you the code say 45.901 so good work orders great great job done so I have another scenario for you all and I will read the answers first what icd-10cm course CM codes reported the options are option A d63.1 and 18.30 option b and 18.30 d63.1 option C d63.8 and 18.9 and option D and 18.9 d63.8 efficiency is a nephrologist for the B12 injection to treat arthropoietin resistant anemia due to stage 3 chronic kidney disease what ICD-10 CM codes are reported so again your time Remains the Same you have got two and a half minutes to solve the scenario and put your answers in the chat so your time begins now code is that's time and I can see mixed response here I can see a mixed response between option A and option b uh well once I complete the explanation I think you all know where you made the mistake and that will be a teachable moment so the correct answer for this scenario is option b and 18.30 d 63.1 and these are your keywords vitamin Mutual injection is reporting resistant anemia due to stage 3 CKD so the very important word is anemia due to ch3 chronic kidney disease because that's going to drive our answer so let's have a look into the two codes of D6 3.1 and D6 3.8 so if you have a closer look d63.1 is coding for anemia in chronic kidney disease well uh if you look in the D6 3.8 it is coding for anemia in other chronic disease classified elsewhere so what do you think of this which is the correct answer it must be D6 3.1 right because it's specified we're having anemia which is due to chronic kidney disease and if you have a look into here look over here it's also saying ultravoiding resistant anemia EPO resisting anemia as well which is exactly the same which we have in our scenario so D6 3.1 is going to be the correct one and d63.8 is wrong so option C and option D is having d63.8 right so we get eliminate option C and D onside and the remaining two options yes these were uh the one which I think most of you were going option A and option b yes the both the option A and B have having the same ICD code but the only different thing only uh difference between option A and option b is the sequencing order so in such scenario it's very important for us to go and look if there is any sequencing guideline uh that will drive us to the correct answer well if you have a close look into uh D6 3.1 under which the instruction guideline is asking us to code first and first the underlying chronic kidney disease that is an 18 Series right so it is asking us to code first the ckddcs and the stages of the CKD so of course the first code must be n 18.30 which must be followed by D6 3.1 so given that I think option A is wrong so we are going to select n18.30 which is chronic kidney disease stage three unspecified followed by d60p g63.1 which is anemia in chronic kidney disease so how are you feeling for this how are you feeling was that a teachable moment yes now you have got that where we went wrong [Music] thank you [Music] each other [Music] [Music] foreign [Music] foreign [Music] foreign [Music] [Music] [Music] all right [Music] all right [Music] now [Music] foreign coders I think everybody's ready okay we've heard our theme music we've heard it twice over and we already we are ready okay so again this is week six we're going over chapters 10 through 14 COPD fractures and skin and I can't wait to dive into this content and before we do we got to do a little housekeeping and give the copyright copyright CPT 2023 American Medical Association All Rights Reserved CPC is a registered trademark of the aapc aapc content found within this presentation is copyright of aapc keyword concept FTR Chun AMC ifap 7 AMCI ICD-10 flip tap or trademarks of a m c i all right we've got some things on tap you know we have just really really uh put together something that we think will be very beneficial to you all and we've got some some new things rolled into there of course it's all new to you all but Mr Sandeep when I have taken the time to freshen up some things that are already there and to add a few things that are new so for our last class we went over specific coding guidelines for chapter nine diseases of the circulatory system as well as practice coding scenarios to strengthen your guideline knowledge goes for today's class we are going to first review chapters 10 through 14 diseases of the respiratory skin and musculoskeletal system we're also going to practice coding scenarios to strengthen guideline knowledge and bring you one step closer to ICD-10 coding proficiency and those are our goals we've got three of them so let's get to it coming up is Mr Sandeep thank you Mr Migos you all are red he I believe you all are ready and you had your warm-up scenarios as well and you warmed up for this one so we are going to have a quick review the pop-up cues yes the pop-up cube is back at let's start so again this is a true for the scenario your question is chronic obstructive pulmonary disease is driven by complication so is a code is ICD code for the chronic obstructive pulmonary uh DC is driven by complication with answers in the chat it's a true or false I'll give you around maybe 10 to 15 6 seconds is more than enough it's a true or false foreign yes and answer is going to be true yes it's true that chronic obstructive pulmonary disease is driven by complications always watch out for uncomplicated or complicated now let's look into the next one ventilator assisted pneumonia is assumed and coded as uh assumed encoded as long as pneumonia is indicated so is it true or false awesome awesome to see those answers and I'm happy to see that you again have reviewed all the guidelines the answer is going to be false the guideline is the 10. D1 and it says that only assigned j95.81 wind liters is in pneumonia when it is documented by the doctor to be ventilated Associated pneumonia so now assume or this follow the documentation here we go for the next scenario next true and for true or false scenario unstageable also is when the base of ulcer is covered by iska and is indicated in the documentation that CH is not determined is a true or false Horus and yes the answer is going to be true you all said it correctly unsaverable also is when the base of the ulcer is covered by S car and indicated in the documentation at the stage is not determined that's when we go for unsage also and the guidelines which we refer is c12.82 next true or false scenario the patient admitted with ulcer documented as healed is not coded is this statement true or false exactly there was no confusion on this one right there was no confusion on this one this was pretty straightforward the answer is going to be true the guideline which we follow here is C12 a or so when the patient is admitted with an ulcer documentation and ulcer is healed we are not going to quote them next one unspecified ulcers are coded to l89 slash o is this true or false this looks little bit wide maybe you all are checking the book so answer is false unspecified ulcers are equal to L90 l89 slash nine good job goddess I saw that you took some time and I believe that's for referring the book so the next one when coding evolving ulcers V code we only call the highest stage during the admission is this treatment true or false yes I was waiting for your answers and the answer is going to be is this true or false god is and there's a note that please correct your MCG manual and I saw someone also place it in the chart that on the MCG it's different so when coding the evolving answer you are not only coding the highest stage so this statement is false there are two codes that are required while coding the ulcer which is evolved into a higher stage so the code first one is going to be the stage on admission which is POA that is present on the admission and we are going to code the second uh code as well that is a higher stage which is the stage during the admission so one it's a stage on the admission second first one is going to be the stage uh the ulcer stage on which is present on the admission second is the stage which is during the admission so if it is evolved from stage 1 to stage two you have to code the ch1 first followed by the stage two so and it is also important note to make these changes in your MCG manual yes probably yes it is an inpatient only so if the patient either is also saying the patient is on admission right so admission cases are impatient so don't forget to highlight or change this in your MCG so let's move to the next one okay I've seen someone asking I don't understand that very well okay I've replayed again so if the patient is admitted one for example it's a stage one ulcer that is present on the admission when the patient has come to the hospital during the admission and later on after the admission the stage is evolving the siege of the ulcer is evolving to a stage two and then in such scenarios we will be coding two codes the first code will be the stage that was present on admission that is stage one and the second code which you have to assign is a highest stage during the admission so it have it evolved from stage one to stage two right so the second code will be the stage two also as well is that clear okay we are good to go great so once again I have to emphasize on the fact that please correct this in your NCG manual because it's different so the next true or false scenario a fracture that results after the acute phase of an illness is called pathological fracture oh my god I've started receiving the answers before completing the question so you are guys are so good on this anyhow I will wait for remaining of the code just to put the answers yes and the answer is going to be true exactly so the guideline which we follow is c 13. c and these are coded to chapter 13s so a fracture that results after an acute phase of illness is called as pathological fracture so coming to the next one the pathologic fractures and acute fractures can be coded in the same setting for the same side is this treatment true or false quarters and this statement is calls and the guidelines is I'm I don't know yes I don't have the guidelines over here so it's the false the statement is false so the pathological fractures and acute fractures are never coded together in the same setting for the same site so let's move on to the next one next row of all scenario when coding for the chronic kidney disease if the both stages of the CKD and as Rd are documented we are only going to assign the code for ESRD is a statement true or false goddess and this statement is true so by encoding for chronic kidneys if the both CKD and ESRD are documented we are only going to code for ESRD so ESRD is is full form is nch3 analysis right so this is uh end stage is a more final like it's more the severe state so if you're having a CKD and ESRD we are only going to code for ESRD and the guideline is c14.a1 so I think it's it's Mr Mika coming up isn't it you Mr Mika yes it is Mr Sandeep thank you so much and I tell you I I do believe that they're ready and I don't want you guys to to have any concerns about that uh evolving ulcer because we've got you covered okay and so that is on me that particular slide um I saw some people were like so is it false what is it it is false okay that particular one is false and so let me uh share with you all because I again that was that one was on me okay so um that should have been much clearer for you guys and I'm gonna move back on that one and this one um it should it is correct in the 2023 manual like I said we're doing some housekeeping and updating some things and so this one is on me this one here um just as Mr Sandy read it um this is this is this is false and the reason it is false because we don't only code the highest stage during the admission you're gonna need two codes that are required so you're you're gonna code the stage that is present on admission and then the highest stage during the admission will go second so if a patient comes in and they have an ulcer and it is a stage three and the highest hit mission was a five you would not only code the five you have to code what the state what the stage was on admission so you would capture the three the stage three first followed by the stage five which was the highest stage and you have to always remember as well when you are dealing with that missions you are coding for what bought them there so that particular stage that they were at that's what bottom there they had that on admission the other reason think about it like this that you would not only code the highest stage is because the ulcer is evolving so you need to capture both in order to see what that ulcer has done does that does that uh help them to to make sense and again that is on me okay so uh we do have uh some scenarios so no no worries I've got a scenario for you Mr Sandeep and I both have a lot of yumminess in store for you so don't don't don't worry I don't I don't think you guys are worried you know we've got you Mr Sandeep he was serving up some some breakfast and stuff and I'm I'm gonna continue on with the breakfast too Mr Sandy so thank you for that beautiful presentation and for getting them ready and and we're going to continue on with diseases of the respiratory system we're going to go over COPD and acute respiratory failure and you know just kind of brush up on a few things you all know you get the meat of the lecture with your homework and you come here and we kind of fine tune some things so I want you to keep in mind these particular key terms and definitions acute exacerbation this is a worsening or decompensation of a chronic condition so keep that in mind if you see the word that the patient you know they they have decompensated COPD that means it's getting worse or it's an exacerbation so these are things that need to become a part of your working knowledge if it's not make no of it in your manual so when you see these things it it clicks if you see asthmaticus this is a severe intractable episode of asthma it's not it's not being responsive to normal therapeutic measures and I can tell you that it is a scary thing to see a patient have asthma asthmaticus okay because they're not responding and they're not moving air uh very efficiently and everything you're doing and throwing at it it's not moving the needle so just know that this is serious business okay all right so what about respiratory failure you want to pay attention to these uh three things and I always tell you get over there in that chapter see where these codes live so pay attention to acute that will be when you're coding J 96 point something if it's chronic it's going to be J 96.1 followed by something if it's acute and chronic it's going to be J 96.2 followed by something now I know some of you might be like I got the cute I got The Chronic but that acute and chronic I don't know about that okay so are some of you wondering about that like are they sure is that a misprint right it's not okay so let me put this in perspective for you if a person has chronic COPD and they come in to the ER they're having an acute episode of an attack say they have asthma along with it they're having an acute asthmatic attack then you can see how they can have a chronic disease that's with them but they're having an acute episode of something that's bought them in that's tied to it okay all right so let's go ahead and keep on moving so let's let's move through some flip exercises I know you've got your manuals ready okay and and let's let's do this all right so we have for our answers hey J 96.02 B J 96.01 cj96.12 and D J 96.22 a patient is seen for acute respiratory failure she's found to have elevated carbon dioxide in the blood and low oxygen levels she is diagnosed with hypercapnia all right coders you have two and a half minutes and your time it begins now all right colors I see a lot of good things in that chat you guys are working and and the answer is hey and many of you got there some of you needed a little nudge and you figured it out and you were like never mind it's hey what we love to see so we're going to use this this guideline here you're going to make sure you are really referencing your guidelines and your sequencing so acute respiratory failure as the principal diagnosis okay so they have acute respiratory failure and they've been diagnosed with hypercapnia so we can take a look here acute respiratory failure and we can look here with our tap we know that it's going to be 96.0 something all right so knowing that what could you immediately eliminate you've got this tapped and you and you see acute respiratory feeling let me go and reference my sequencing let me go and reference my guideline so that means that J 96.1 that's referring to Chronic okay because this is just giving you the you know really just giving you the framework you're gonna have to go over and see where it lives in order to complete the code but this is getting you into the coding category you know Jade 96.1 that's going to be chronic if it's j 96.2 that's acute and chronic think two I need two a QA chronic I need one that is chronic and then acute it's zero all right so we're going to take a look knowing what our guidelines are we're going to go ahead like I said in eliminate C J 96.12 we can eliminate D because it indeed is acute and chronic we don't even have to see the specifics of it because we know based on those first four characters that that coding category is not where we need to be therefore we're going to move to a and b this is where we need to look a little closer because here based on what we know J 96.0 that is acute so let's take a closer look well J 96.01 that is acute respiratory failure in D but it is with hypoxia that's not what this patient has this patient has hypercapnia and therefore J 96.02 acute respiratory failure with hypercapnia that is your code and you guys were on it and now you know that if you just missed it okay I had a few sprinkles of other answers in there get over there with those guidelines and let them push you towards that answer even quicker all right so let's move along to our next one we have Jay AJ 45.20 f 1 7.200 b j 45.31 f 17.210 cj45.30 f 17.210 and finally D J 45.30 followed by Z 72.0 and asthmatic patient presents for a checkup she has mild persistent asthma that is currently well controlled she does however continue to smoke cigarettes she states that she's tried to quit but just can't she's dependent having smoked for 25 years all right coders you've got two and a half minutes again and then we are going to talk about this one all right coders we're gonna talk about it I see some good work in that chat yes the answer is C yeah it is C okay so let's go ahead and take a a quick peek at it so for your keywords you have mild persistent asthma well-controlled smokes cigarettes and dependent okay they're dependent on these cigarettes so let's start taking a look at what we have we start with j 45.20 and this is incorrect because it's mild intermittent asthma this patient has mild persistent asthma and remember when you're coding that's what it means to be forensic because one word can change your code selection it sure can so make sure you're looking closely if you need readers or glasses I know I have my readers and you know don't judge y'all cause I'll go in there and get a 2.5 and a three a 2.75 you know I never know what size the words are going to be I need you know I have to have options so we're going to continue on and we see J 45.30 that is mild persistent asthma uncomplicated I like that and look up under there it's giving you also other ways you would see it mild persistent asthma not otherwise specified so uh we know that that's where we need to be so let's take a look what is j45.31 that what is that telling us it is mild persistent asthma but it is with an exacerbation there's no mention of an exacerbation this patient's mild person sister asthma is well controlled so we're going to eliminate that okay remember exacerbation that means it's getting worse that is definitely the opposite of well-controlled so we would eliminate B and they are a smoker now oftentimes when you have things that are related to the respiratory system you always anyway regardless you need to see if the boss is giving you some information and indeed it is telling us to use an additional code to identify various things that could be related to Tobacco well tobacco use 272.0 this patient is a bit more uh involved with the cigarettes it's a bit more extreme okay it's it's a bit more going on it's a a bit more serious I would say okay they're not only using they are dependent on these cigarettes so we're going to code for that f17.210 nicotine dependent on cigarettes that is a more uh concise a more uh specific code because they are dependent on the cigarettes not only using so we would eliminate D and we're going to choose C all right okay yeah you gotta be forensic I'm telling y'all if it means getting you know different pairs of glasses or magnifying glass or using the tip of your pen or your pencil to help guide your eye do that all right so we have the next one what are the correct icd-10-cm codes for this encounter we have a j10.08 j14 j 96.01 b j 96.00 and j13 cj96.02 j13 finally D J 96.01 and j14 a 65 year old male with a history of chronic obstructive pulmonary disease or COPD is admitted to the hospital in acute respiratory failure with hypoxia on the third day of hospitalization the patient was diagnosed with pneumonia and his sputum grew hemophilus influenza again what are the correct ICD-10 codes for this encounter all right coders you know the drill you've got two and a half minutes to solve and your time it begins next all right coders I'm seeing some good things you guys are thinking it through some people are like hey wait a minute I checked again I didn't need that particular code I'm on it I'm on it so so we had a little a little bit of uh a little bit of a mix uh between A and D in fact and so we're gonna we're gonna get down here and and take a look we're gonna take a look at this one all right so the answer is D it sure is it's D so you guys were getting there I like that I like that so we have for our keywords COPD they've been admitted in acute respiratory failure with hypoxia they've been diagnosed with pneumonia okay and in fact the the sputum culture grew homophilus influenza so that is the causative organism that's what's causing the pneumonia so we're gonna pull out acute respiratory failure with hypoxia as well as pneumonia uh with homophilus influenza so we're gonna go back to our uh acute uh respiratory failure and you know what my other my other uh code that I had over there you don't need it all right so uh I I took it out and didn't trans transpose that to this one all right so this one we're going to take a look here we have uh J 96.0.1.2 and just as before that's going to help us narrow it down which coding category we should be in we're going to eliminate the j14 just simply based on sequencing because the acute respiratory failure can be sequenced first as long as there are no chapter specific guidelines that would provide any type of sequencing that would take precedence so when we take the look here at J 96.00 that is acute respiratory failure unspecified whether or not it is hypoxic or uh with hypercapnia we know that's not the case and so we're going to eliminate that and then j13 that's pneumonia due to streptococcus pneumonia this pneumonia was caused by homophilus influenza so we're going to eliminate B and we take a look at J 96.02 acute respiratory failure with hypercapnia that's when a patient has excessive carbon dioxide so we're going to eliminate that one as well and really once we grab the j13 we could eliminate it because the pneumonia is not due to streptococcus pneumonia so there are various ways that you could take a look at it okay so you can immediately uh eliminate B and C right so that leaves you with the A and D so now it's a matter of sequencing okay so you take a look here J 96.01 that's acute respiratory failure with hypoxia which means that the patient has an oxygen deficiency and then the causative agent is pneumonia due to hemophilus influenza j14 and so we're going to default to this guideline here that the acute respiratory failure is indeed the principal diagnosis you might be saying well how do I know that they were admitted with it that's what drove them there and on the third day they were diagnosed with the pneumonia so we're going to follow up with j14 as well these particular um the particular instructional notes Here none of these uh coding categories apply here any Associated influ influenza or an Associated abscess so we're going to use this guideline here to drive us to D all right so yeah I took it off on this one but it does not change the code selection okay all right so we're going to keep moving along and take a look you know I've got some more you know I'm a southern cook I just keep you know company comes over we just just I just keep cooking so we're gonna move to chapter 12 skin and subcutaneous tissues and there are various things that can go you know arrive with the skin so I always tell you take a look at what is in each of these chapters so we have diseases of the skin and subcutaneous tissue which takes us through l00 through L99 and you have various things in their infections of the skin bolus disorders dermatitis and eczema we're gonna also uh uh be taking a look today though specifically other disorders of the skin and subcutaneous tissue l80 through L99 pressure ulcers and non-pressure ulcers this category also includes impetigo verticals carbuncles and abscesses cellulitis and lymphangitis why are they there because these are diseases or conditions that affect the skin all right so all right so we're going to keep rolling and so I'm glad I see some people saying I understand it now or yes that is beautiful so let's keep going here's some things to keep in mind so you guys know I am very much a visual learner and so I teach the way I learn these pressure ulcers you have to have a visual of what these stages mean they're also referred to as bed sores or decubitus ulcers also grab the terminology common terminology that you will see so when you are looking at scenarios then you will you will be able to you know really solve a bit better and really come to the right uh conclusion quicker and more efficient more efficiently so a pressure ulcer it could be a bed sore or referred to as a decubitus ulcer be aware of the stages what does that mean stage one it's a persist it's a focal erathema just you know red knee of the skin stage two there's partial thickness loss involving the epidermis the dermis or both remember your terms remember the epidermis that's on top all right so and the I'm sorry the dermis is on top the epidermis above that's on top and then the dermis is underneath so you want to to be aware of that this epidermis you've got some loss of skin but now you you're getting down just a little bit to the dermis okay both of those can be involved all right so just a little bit more a little bit more than focal erythema now we've got some some skin loss just a little we move on to stage three that's full thickness because now it is going from the epidermis the dermis and now we're touching on the subcutaneous tissue or the fat you see how now that would be more severe because now you're getting into deeper layers of the skin when you get to stage four this is not only persistent focal erythema but now we have necrosis of the soft tissue so we have gone from the from the epidermis down through the dermis we are now moving down past that fat layer or the subcutaneous tissue now we're getting down to muscle and bone this is muscle and bone you see like these little lines of striations and stuff okay that's the muscle and then the bone that's getting real serious and you can see why oftentimes these need to be controlled and while you often deal with infections as well because you think of your skin as Nature's coat okay and you think of the skin as as that that is your coat and also someone was asking about ashar that's like Nature's Band-Aid okay all right so we're gonna keep on going with the key terms so now if a patient has an unstageable ulcer and it's l 89 points dash dash zero so what you want to pay attention to is the l89 and it ends in zero this stage is undetermined that means that based on the clinical documentation that the provider can't determine the stage because you're looking at skin you're looking at a body like I saw someone in the chat they had typed you know like how would you know I thought that the stage would stay the same you're talking about now when you're coding that's what makes it so Dynamic you're talking about a human body in a human condition so we can't tell that body you stay stage two because that's what I'm coding you as you use stage two you stay there don't you evolve past stage three maybe because that's what I got my book all right so what about if it is an unspecified ulcer well that just simply means that the stage is not specified okay so so if you see unspecified ulcer or if or if you're not given any information on it then it's going to be l89 dot dot and then it's going to end in nine so that's the thing the takeaway unstageable l89 it ends in zero l89 and it ends in nine that's unspecified so those are two different things again green that is condition that occurs when the body tissue dies right so you'll see uh like a person will have say like frostbite and they're losing uh fingers or toes and it becomes black think about it there's no longer no longer any circulation getting there okay you need the circulation in the blood for for that tissue to stay warm for getting for it to get nutrients and take uh uh various trash and and and and different things away waste away when it's no longer doing that the tissue is dying because it's not getting oxygen that it needs in order to live so let's take a look at some exercises okay so we have a straightforward one all right we're gonna start you off slow and we're gonna build on it you know how we like to we're building a sandwich this is a sub sandwich I guess yeah yeah okay so we're gonna select some diagnosis code or codes and we have a l 97.409 b l 89.619 c l 89.610 l 89.620 and finally D L 89.619 and L 89.629 A patient is diagnosed with pressure ulcers on each heel select the diagnosis code or codes all right you've got two and a half minutes in your time it starts now you all are doing phenomenal I can I I know you guys have been spending time with this material and you definitely uh understood the takeaway about how to quickly uh determine if something is unstageable or if it is unspecified so let's take a look yeah the answer is D okay so I had I had a few few takers with the sea and that's okay we can get that little that little nudge so let's look at these codes pressure ulcer on each heel all right so if it is unspecified because it is we don't know what stage it is we are so we're gonna hone in on l89 and it ends in nine as soon as we do that we could just about uh we could we could eliminate at least one on site and that would be C it sure would it would be C all right so yeah and with this one we wouldn't know we could take it away until we get over there because we don't know if there is a buy you know a bilateral code so we wouldn't know yet okay but we already know okay we're gonna be looking at B and D based on l89 and it ends in nine okay because this is L 97 it's ending in nine but that's 97. all right and this one right here l89 but it's not ending as as you shoot okay so we get over here in l97.4 that is a non-pressure ulcer and we are dealing with a pressure ulcer on each of this patient's heels so L 97.409 that is eliminated we continue on and we take a look at L 89.61 this is a pressure ulcer of the right heel but it is unstageable there's no uh reference to it being unstageable uh it's simply not given to us the information is not given to us as far as the specifics of this ulcer so it is not unstageable it's unspecified so we are looking for L 89.619 for pressure also of the right heel unspecified well this tells me hey if we need laterality and there is not a combination code to record both what do we have to do we have to use each code all right in order to capture uh what's going on here so each heel so we're going to also follow that up with L 89.629 pressure ulcer of left heel unspecified stage so that eliminates uh B we're on the right track we we've got to re record or document rather for both heels so that pushes us to D yeah yeah I know it is easy to get unspecified and unstageable uh get it across so definitely jot down those definitions like at the beginning of these chapter specific guidelines to keep you straight you could even put it up at the top uh when you are in the in the code specific areas to just kind of keep you on track and give you a nudge I know I do that for various things and my manual as well to keep me keep me straight all right so boy I told you I'm still cooking I'm still cooking y'all still cooking we're gonna be so full so here we go with our next example all right so I want you guys to let me see how I have this situated here uh all right okay all right I restructured this I was like I made that bigger okay so we're gonna start out with this and I'm gonna give you two minutes to solve this one and I want you guys to give me the code for pressure ulcer ankle stage one all right your time it begins now all right coders let's do the reveal yeah it is L eight nine point five zero one ulcer pressure ankle yeah it sure is so let's go ahead and take a look all right so we have our order of doing things how do we get there we're gonna go to the alphabetic index and we're going to look up ulcer and we're going to scroll down to pressure specifically we are looking for uh stage one okay so it's telling you what type of ulcer it is it is a stage one whenever we start talking about specificity because I'm glad someone asked that in the chat like hey it it the right and left that is a laterality but as far as the specificity of the ulcer that is referring to the stage is that given to you is it stage one two or what not and this is given to us okay so we start with ulcer pressure stage one specifically we're looking for the angle and so that's going to bring us to L 89.5 we've got the check mark we know we've got a bit more work to do and we're going to complete this code over in the tabular index so we're going to go over to the Tabler and verify and read all of our notes we know we're at l89 specifically l 89.5 pressure ankle of the ankle and we have L 89.501 because now we're capturing pressure ulcer of unspecified ankle we don't know if it's the right or left ankle but we do know Edie's stage one okay all right so there we go l 89.501 okay all right okay so we're gonna keep on moving and we're going to tow code for pressure ulcer unstageable face so you've got two minutes again and your time it starts now all right I'm loving it I'm loving it you guys are doing some amazing work in the chat and I tell you team thank you for taking care of them they are in there engaging with you guys and y'all are on fire it's hard to hear y'all it's hot in here so we have L 89.810 ulcer pressure face all right so let's take a look we're going to look up ulcer in the index as before we are specifically looking under pressure and unstageable this time we're going to go down to the face and that is giving us our code l89.81 followed by a dash and a check so that's telling us hey we better get over to that tablet index so that we can complete this code and verify some things we are in l89 we continue on L 89.8 and then L 89.81 pressure ulcer of the head pressure ulcer of face all right so what do we need now we've got to do what we've got to move on down because it's telling us we need six so we gotta what keep going so we have L 89.810 pressure ulcer of head unstageable and you guys were on it y'all were on it l89.810 holder I look here I'm celebrating I'm doing the happy dance I'm gonna Y'all Gonna Make Me raise my Vera Dash Okay I need to be standard I need to be standing here we go guys we've got pressure ulcer stage four left heel you've got two minutes to solve this one as well coders and your time it begins now all right y'all are doing it y'all are doing it I tell you y'all are keeping the team busy in the chat and you all are really really digging in today so uh let's take a look y'all were there y'all are spot on it is l 89.6244 l 89.624 let's do that again ulcer pressure heal so you all know the drill we're gonna look up ulcer in the index scroll down to pressure and specifically we are looking for stage four of the heel and that leads us to l89.6 we've got our check mark that's telling us hey head on over to that tabular list so we can verify some things so indeed we do that and we get over here to the l89 category for pressure ulcer we move down to l89.6 pressure ulcer of heal and specifically we need an additional some additional digits we have L 89.60 pressure ulcer of unspecified heal and we move here to L 89.61 pressure also of right heel and then we continue on l89.62 pressure ulcer of left heel and it tells us hey keep moving we need six digits now we have not only the specific stage okay we also have the laterality of the left heel so again coding two providers certainty and specificity so that leads us to L 89.624 pressure ulcer of left heel stage four and y'all were on it y'all are on it all right coders let's continue on with our discussion concerning pressure ulcers so let's move along and talk about now evolving ulcers and again reminding you to um pay attention to this particular guideline I'm going to give it to you after we talk about this statement again I want to be sure you're clear on this true or false when coding evolving an evolving ulcer we only code the highest stage during the admission so I want to hear from you guys in the chat and tell me do we only code the highest stage during the admission all right so I'm going to give you guys a few a few moments to to pop your answers in the chat this is simply true or false and then we're gonna we're gonna chit chat about it just a little bit more all right so I think I think many of you are getting there okay so yeah when we are coding and evolving ulcer all right and this is coming from our guideline c12.8.6 that is false we do not only code the highest stage during the admission remember how many stage how many cones do we need to to code for we have to have two codes two codes are required with the following sequencing order in fact the first code has to be the stage that is present on admission or the POA followed by the highest stage during the admission right so I want to be sure you guys are clear on this if it's not sequence this way in your MCG manual please make this uh correction as well as when you tap in your manual you're jotting this down be sure that you sequence first the ulcer stage on admission followed by the highest stage during the admission so let's go ahead and take a look at two scenarios and then uh and then we'll we'll further explore this and and be sure that you're clear on this particular concept so let's let's take a look now what stages because we know what's going to be a stage I have savior stages but you know because it's evolving that you're gonna need two that's that's the primary thing that is rule number one right so let's talk about this scenario Anna is admitted with a stage two pressure ulcer and the next day it evolves into a stage four pressure ulcer and upon discharge it's a stage one so what stages would we code I'm going to give you one and a half minutes to solve and your time it begins now coders all right so let's take a look now we have stage two and stage four that will be our sequencing order now we take a look at our keywords admitted stage two pressure ulcer the next day it evolves into stage four and upon discharge it's a stage one and we simply follow our sequencing order first is the stage POA or present on admission it was indeed a stage four when she was admitted it evolved into a stage it would let me correct myself when she was admitted it was indeed a stage two and that would be first followed by what it evolved to into which was a stage four that is the highest stage so we're gonna sequence it accordingly stage two that was present on admission followed by stage four which was the highest stage that the pressure also evolved to during the admission so let's take a look at another now with this one again what stages would we code we know that there's two we're going to go ahead and just let the cat out of the bag I want to be sure you've got this so we're gonna take a look at this one and indeed this patient was admitted with a stage three pressure ulcer and over the next four days it evolved into a stage five pressure ulcer upon discharge it's a stage two again what stages would we code all right so I'm going to give you one and a half minutes to solve I don't think you'll need it I'm sure yeah some of you are already popping answers in the chat but I'm gonna give you one and a half minutes uh to to do this one anyway so your time it begins now foreign beautiful job beautiful job I'm loving what I'm seeing and it's very apparent that you guys have a very firm grasp of how to code evolving ulcers so yeah just like before we're gonna follow those sequencing guidelines that we have so we have that the patient was admitted have a stage three uh pressure also it evolved into a stage five and on discharge it was a stage two so yes just like our guidelines we're going to capture the ulcer that was present on admission which was stage three she was admitted it evolved into a stage five we're gonna sequence that second that's our highest stage during the patient's admission and so there's our order stage three followed by stage five you guys are doing fabulous and I can tell you have a firm grasp of coding evolving ulcers so we're going to continue on with our next scenario now we have Henry coming into the ER and we're going to code for Henry so we have uh a l 23.89 b l 23.9 CL 25.9 and DL 25.3 Henry visited the ER with complaints of excessive itching and swelling in the trunk area the review of systems uncovered that Henry has been experiencing these symptoms ever since changing his laundry detergent the Ed physician diagnosed Henry with allergic contact dermatitis due to detergents all right so I want you guys to take a go at this you've got two and a half minutes to solve and your time it begins now all right coders so I'm seeing some good things in here this is this one is rather straightforward so uh your answer is hey yeah it is a so I had a few outliers there so some of you were grabbing B and and d and and and and just a little bit of a sprinkling so so we're gonna go ahead and talk about this one and get everybody on the same page so for our keywords we have itching and swelling and they have been diagnosed with allergic contact dermatitis due to detergents so we've got to keep in mind uh specificity so we already know we're gonna take a look here at this coding category l23 this is allergic contact dermatitis and then l25 is coding for unspecified contact dermatitis okay we have a specific dermatitis it is allergic contact dermatitis due to detergents all right so we're going to eliminate C and D right so so we already know it's allergic contact dermatitis so so if you chose C or D remember you've got to be forensic you have when you look at these coding categories l23 versus l25 allergic contact dermatitis start matching up oftentimes it is a matter of matching up these keywords that's spot on unspecified no not in this case we know it's allergic all right so we're going to eliminate those and continue on all right and and it's telling you right here even when you if you chose this you've got to look at everything that's related to that boss it's telling you excludes allergic contact dermatitis l23 what does the excludes one tell you don't code that here okay don't code that there all right so we're going to keep on l23 l23.8 allergic contact dermatitis due to other agents l23.89 allergic contact dermatitis due to other agents allergic contact eczema all right and then L 23.9 allergic contact dermatitis unspecified cause so we know what the cause is it is due to the detergent so we are going to eliminate L 23.9 and that pushes us here to L 23.89 allergic contact dermatitis due to other agents and that is your code you are going to code and choose the best answer and that is the best answer because we do know the cause the Ed physician has determined that it is allergic contact dermatitis and it is due to a detergent so we know the cause okay all right all right so we are going to keep on going opinion to talk about our next one all right so muscles pathological fractures all right so uh if any of you still have questions about certain things that we're talking about please email Mr Sandeep or myself and we'll be glad to help okay we want you focused on what's right here so so just hope put a pin in it and we'll be glad to help you send us an email okay all right so we're gonna keep on rolling key terms and definitions pathological fractures that's a broken bone it's a broken bone that occurs in the area of a weakened bone all right osteoporosis that's a bone disease that decreases bone density so be sure you you grab that okay pathological fracture a broken bone it's occurring in an area of a weakened bone often because of some type of pathological process that is going on that is causing the bone to weaken osteoporosis the density of the bone is is decreasing hence osteoporosis you think of of holes in the bone okay all right so osteoporosis with versus without a current pathological fracture now what is the difference with a current pathological fracture if the patient has a current pathological fracture at the time of the encounter you're going to identify the side of the fracture and this code M80 Point whatever will follow should be used even if the patient had a minor fall or trauma if that fall or trauma would not usually break a normal healthy bone than you would use M80 okay so it's a matter of is it a current pathological fracture the site and you have to determine if the follower trauma would usually not break a normal bone because the bone is is very fragile now if it's without a current pathological fracture this is for patients with osteoporosis who do not currently have a pathological fracture any fracture in the past is not accounted for that makes sense because we are capturing things after the diagnosis so you would use m81 followed by whatever is is is specific for that code all right so uh just giving you a look when you go into your your alphabetic index a way to keep yourself organized to be sure you're where you should be because you could pick up the right body location and all of that good stuff but you could be under the Inc incorrect heading so what you might want to do is go over there you'll see osteoporosis male or female m81 if you go down with current pathological fracture I chose red because I'm thinking that that that could be serious so red to help distinguish and guide my eye if it is age related you're back to the 81.0 if it's with a current pathological fracture back to M 80.00 and then follow it with your check you continue to move along you have disuse this pushes you back to the m81 category again with pathological fracture back to M80 postmenopausal that's going to push you into the m81 category with pathological fracture back to M80 specific type not elsewhere classified m81 if there is a pathological fracture m80.0 so this is just to show you how if it's a pathological fracture where you're going to be and if not where you're going to be so you want to definitely distinguish where you are in your manual and you can do that for various categories when you have multiple types of categories and sub categories and little sub categories up under there you want some type of way to distinguish it so that you're clear that you're picking up the code from the proper from the proper Source okay all right and so your provider is going to be the provider will provide all of that we are coders we don't have to worry about how they come up with it you are going to code what you see you cannot document what is there so we capture what we see if it's not there as you move along and if you need certain information then that is when you would query a provider but you code what you see all right so for our extender boxes seventh character pathological fractures if there is a non-union that means that it didn't heal okay it didn't it it didn't Unite if there is a bad heel meaning that the bones were trying to heal but it's a male Union meaning that it's off it's healing but it's not a very good a very good heel that it's a male Union so you think about none didn't heal Mal it's bad okay it's not it's not a very good uh Union of the bones all right so coming up is Mr Sandeep he's got the mic he's got the floor okay the man with the plan come on Mr Sandy thank you Miss Tamika for all those beautiful scenarios and create great instructions so meanwhile I will just take the screen and here we go quarters now next we are going to do some ICD-10 walkthrough exercise so let's get started so the exercise Let's uh together let's look up the code for idiopathic out of the left elbow so you can try you can try and we will walk along we'll go along in this so what's the main term going to be for this code lookup um yes come on chorus let's make this one interactive I want everyone participate here yes the main term is going to be gout so what's a sub tool yes you all are correct the sub term for this one is going to be idiopathic and where is the site excellent excellent see you guys all are proficient I see someone went ahead and put the ICD code as well in the chat wow you guys are amazing really yes site is elbow and the laterality is this all right is this left or exactly it is unspecified it is not mentioned that means it is unspecified so we have a main term gout we have an idiopathic as subterm and the site is elbow and the laterality is unspecified and the code is going to be yes you all have already placed it in the chat the code is going to be M 10.029 that is a code uh the code for idiopathic gout of the elbow unspecified elbow right so next one next one is an example post menopausal osteoporosis without current pathological fracture so what is the main term here code is without current pathology fracture yes I also think the main term is going to be osteoporosis next question what is sub tone phenomena said it you said it it is going to be post menopausal and asmus Tamika said it is going to start with m81.0 now next we are going to verify m81.0 in the tablet list so what do you think of this what is going to be the answer exactly the final answer is m81.0 and the guideline which we refer here is C13 Point d one so great great great great work the next one we are having post menopausal osteoporosis without current pathologic fracture she has she also had her hip uh sorry she also fractured her hip 10 years ago and it is fully healed now so what will be the main term for this scenario okay yes again this is going to be osteoporosis and how about the subterm yes once again it is going to be post menopausal and it's going to start with m81.0 and so is another statement which which says that she also fractured her hip 10 years ago and it is healed now so are we going to do something extra for here extra for this what will be the code mm-hmm I'm seeing some wonderful answers in the chat exactly you said is correct so there is a guyline C13 Point D1 which asks us to code the history of personal history of osteoporosis fracture if any right so we are also going to assign that code we are also going to assign that history code along with m81.0 so the final answer is going to be m 81.0 z 87.310 which is the code for the fracture history so how are you all feeling gorgeous are you feeling good the code lookup good way to here wait here so next we are having some ICD-10 flip exercises and you've got two and a half minutes to solve this one so your quest to your options are option am 81.0 m 80.851 a m 18.051 a m84.551a how would you code a new pathologic fracture of right fever due to postman personal osteoporosis so you got two and a half minutes to put your answers in the chat and let's do this one chorus so that is time and let me have a look into the chat so I think we are having a mixed answer here just mix up between B and C okay I will I okay I will help you I will help you to eliminate wrong and so here so the correct answer for this scenario is going to be option C and these are our keywords as a new pathological fracture of the right femur and it is you to post menopausal osteoporosis so we are having our guidelines listed over here in the bottom so you can see M80 is the first code which we are going to code if the osteoporosis is with current pathological fracture and m81 is the code series which we are going to assign it osteoporosis is without current pathological fracture and if you have a look into the question we are having a pathological fracture right there's a new pathological fracture so it's a current pathological fracture so m81 is wrong and we can eliminate option A and as well as option D because yeah already decided we already seen that M80 is the first code which we will assign when there is an osteoporosis with current pathological fracture so option D is also wrong now the question is between option b and option C let's have a look into those two questions those two codes and here there is a seventh character which is to be assigned depending upon whether it's an initial encounter for the fracture or a subsequent encounter well in our scenario we saw that the patient is having a new pathologic fracture so this is going to be an initial encounter so we are going to assign a as the seventh character and let us have a look into the next the code a and code B option uh I'm sorry option b and option C and option I think option C is coding for age related osteoporosis with current pathological fracture of right femur and we are having M 80.851 which is coding for other osteoporosis with current pathological fracture of the right fever so right FEMA so well option b is wrong it is coding for other osteoporosis and if you look if you have a look into the or into the terms which they have mentioned under m80.0 it is saying it is coding for m80.0 it includes the post menopausal osteoporosis with current pathologic fracture right so this is exactly what our scenario is coding for so you have to pick the correct answer and that will be m 80.051 a how are you all doing on this one goddess so is does the explanation help great great job quarters so I think it was aha moment first few few well most of you have done great jobs so let's move on let's move on to the next one we are having a okay I've read all the answers First Option AE scoring for m80.059 t m 84.68 XD option b m 80.059 a option C M 80.059 D and we are having option dm80.059 am 84.68 XD a 90 year old male returns to the physician's office for the treatment of a pathological fracture of thigh bone he has no history of riotoma to the area or previous false so you got two and a half minutes quarters and your time begins now and that is again two and a half minutes let me have a look into the chat thank you okay so I think you all have done a good job here for this scenario yes that's good for this so let's solve this one together the correct answer is going to be option C and this is how we solve it the keywords a 90 year old male returns to the office for uh the treatment of pathological fracture of the thigh bone so keyword is patient is returning to the physician's office so we have a guideline which states osteoporosis with pathological fracture we are going to code M80 point zero series first and these are our code Series so as I said the since the patient is returning to the precision's office it is going to be a subsequent encounter right we are going to give the seventh seventh character as d since the patient is returning yes that's a keyword here to look into so any answer with the seventh character a is wrong so we can eliminate option b here so remaining options are option a c and d and if you look into option D as well there is two sets of codes one is coding with the seven character a and another one is coding with a seventh character D so as we already decided seventh character a is wrong for this encounter so option D and option D is wrong so remaining two options are C and A now we have to decide between C and A and these are the codes so we are having M 18.059 which is calling for age related osteoporosis with current pathological fracture and specified female and we are having M 84.68 which is coding for a pathologic fracture in other this is other side so if you are having already age related F code with an age-related osteoporosis with current pathologic effect it's is that necessary to give another code another additional code that again indicates a pathological fracture that is in orthodesis in other side what do you think what is is that is that required foreign yes it is not required because one code is is it is every it is explaining everything to us right m80.059d is explaining everything yes so we don't need two sets of codes here so option A is wrong and the correct one is going to be option C m80.059 t okay code is how are you feeling on this one do you need any more clarifications are you feeling good are you feeling okay please let me know in the chat good to know good to know yeah everyone is feeling good okay feeling great so I think it's time to move on to the next scenario again you got 25 minutes to solve this one this one has no options with you so you have to pick up the correct answer and you go two and a half minutes for this one so I will read out the scenario for you what is the icd-10-cm codes used for the above scenario a 65 year old with a history of COPD presence to the emergency department with SOB fever and cough his ex he has been experiencing these symptoms for past three days the physical examination patient's temperature is around 102 degree Fahrenheit his heart rate is one one zero beats per minute and his respiratory rate is 24 reads per minute he has a decreased breath sounds bilaterally and crackles in the right lower lobe Laboratory test the patient's wvc is elevated at 15 000 cells per mm3 and his JS x-rays shows right pneumonia diagnosis patient is diagnosed with COPD with pneumonia and the treatment patient is admitted to the hospital and started on IV antibiotics he is also given oxygen therapy and bronchitiator so what is icd-10-cm coach used for the above scenario so I have already highlighted the diagnosis of the patient it is going to be COPD with pneumonia so you are two and a half minutes shots what is eight times up quarters let me have a quick look into the chat hmm this is going to be a good one I can see some create answers out there okay goddess so let's let's do this together so the correct answer for this one is going to be J 44.0 and J 18.9 I can see a lot of correct answers here so the keywords so the keywords is going to be a 65 year old COPD and starting patient came with the shortness breath fever cough and the X-ray shows pneumonia and finally doctor has diagnosed a patient or COPD with pneumonia so how are we going to look up for the code we will be going to the TCS and then we will be going to the lungs over here then we will go to the obstructive chronic because the patient is having COPD right it's a chronic obstructive pulmonary disease so we will go to the obstructive chronic J 44.9 and then if we look further it is going on like obstructive width we are having a pneumonia over here and pneumonia is a lower respiratory tract infection so we are not going to code for j44.9 we have to go further below and we have to select a COPD with lower respiratory infection that will lead us to j44.0 and well are we going to stop over here no right because it is not the edge you have a guideline which is saying asking us to code also the identify the infection code so we have to go and code for the infection as well so here it's a pneumonia and we're having unspecified organisms so we will be coding J 18.9 so the code for this one is going to be J 44.0 and J 18.9 that's fine that's understandable you have to look up for the code so it's okay that you understood and you also selected the code that's that's that's a great thing so how are you code how are you all feeling coders was this a good one okay if you have if you need any clarifications please please in the chat we'll be replying to them and I have see yes I've got one more scenario for you and the question is I'll read out the options for this one J 95.851 option BG 18.9 option C is going to be j95.851 j44.0 J 18.9 option D and of the none of the above patient 75 year old male with a history of chronic obstructive pulmonary disease is admitted to the hospital with pneumonia he has been on ventilator for past three days and given antibiotics so what is the answer what is ICD code for this scenario and I think I don't you don't need to end up minutes this is pretty straightforward let's see let me see how fast you all are going to solve this one anchors that's two and a half minutes and I I think from the chat which I'm seeing this this was an interesting interesting scenario and I can see a lot of mixed answers in the chat and let's highlight the keywords here patiently is a 75 year old male with a history of COPD and pneumonia and the correct answer is going to be option D it's out of all the four options the correct one is going to be option D none of the above because this is a guideline related scenario if you remember we went through this in the beginning I'm sure Mr Meeka went through this in the beginning on the ventilator assisted pneumonia if you can read from the MCG guidelines we can see our MCG manual you can see the guidelines for the documentation of ventilator Associated pneumonia as with all the procedure or procedure related complication code assignment is based on the provider's documentation of the relationship between the condition and the procedure the code J 95.851 ventilator Associated pneumonia should be assigned only when the provider has documented ventilator Associated pneumonia and it goes and says the code J 95.851 should not be assigned for the cases where the patient has pneumonia and is on mechanical ventilator and the provider has not specifically stated that the pneumonia is ventilator Associated pneumonia if the documentation is unclear as to better the patient has pneumonia that is a complication attributable to the mechanical ventilator always query the provider so that's what they say assign only when the doctor document and tonight occurred additional codes from the category J12 to j18 to identify the type of the pneumonia between 95.851 so what we have to do here is to query The Physician right because there is pneumonia and the patient was on a ventilator so the doctor hasn't specified whether this is a ventilator Associated pneumonia as well so since the guideline States us to carry the physician to get a clarification on that we will be doing what yes we will requiring the provider whether it is a ventilator Associated pneumonia or not and for the code accordingly so that was a good one I think so isn't it that was a guideline related exactly so I hope that was a teachable one and I believe you won't forget this guideline you are not going to forget this guideline for the exam as well so that's all from me and I'll be heading over to Mr Mika again Mr Mika it's all yours thank you Mr Sandeep I tell you you've got everybody on their toes so hey those are always those are the ones that make you think because you know if the coders are like me I'm like wait a minute is it one of these has got to be the answer it can't be none of the above it can't be so definitely uh phenomenal uh scenario and giving everybody an opportunity to really trust the guidelines because that is what's key is really being able to put your hand and your your eyes on the guidelines so we have just a little bit more and we're gonna we're gonna start wrapping it up here so we're moving along to diseases of the genital urinary system and that is going to be between n000 through in 99. so for some key terms and definitions and and we've been visiting chronic kidney disease because oftentimes it's integral to other disease processes which really uh reminds you that your body is is made up of various systems and if something goes wrong with what oftentimes times it can have an effect on the other systems around it and so with chronic kidney disease it's a condition characterized by a gradual loss of kidney function over time and as you see with the stages with stage one you've got 90 percent to give or take some a little over you've got some kidney damage but the kidney is functioning normally with stage two you're at 89 to 60 percent you have some kidney damage but there's mild loss of function and then with stage three you're at 59 to 30 percent moderate to severe loss of function once a patient starts getting into stage four 29 15 of ability to filtrate and function normally they have a severe loss of function at that point and with stage five or below 15 percent like you are nothing's going on kidney failure need treatment to live because the kidneys are no longer filtering not actively uh doing what they need to do so remember if both stage of the if both the stage of chronic kidney disease and in stage disease is documented then you're simply going to document the end-stage renal disease only the n18.6 so if you have both chronic state if you have both the stage of chronic kidney disease and in stage then the in stage is going to take precedence so let's move along with a few exercises so uh select the diagnosis coder codes for the following we have a in 40.0 r39.15 B in 40.1 or 35.0 C in 40.1 r39.15 and finally D in 40.1 a patient diagnosed with BPH presents with urinary urgency select the diagnosis codes all right coders you've got two and a half minutes and your time it begins now all right coders you guys are on it so we're gonna we're gonna walk this one through and the answer is indeed uh C so I see a lot of uh a lot of a lot of things in the chat all right so I'm I'm I'm I'm liking it I'm liking it okay I see a lot of good answers okay so just a few uh folks that are that are answering otherwise but I'm pretty sure it won't take long to nudge it in the right direction this patient has BPH along with urinary urgency all right so NP BPH is benign prosthetic hyperplasia okay so that makes sense if if uh the the prostate is giving uh this particular gentleman and you know fits and it's enlarging it makes sense that they could uh experience urgency so BPH Falls up under this and so we know that we are looking for something in the in 40 category and we take a look at in 40.0 that is BPH without lower urinary tract symptoms and this patient indeed has uh lowered urinary tract symptoms so we are going to eliminate a this pushes us to these last three now we know that D would not be an answer because they don't just have BPH but they with symptoms we've got to say what those symptoms are we've got a code for the additional symptoms and it's telling us hey if they have urinary urgency you're going to use r39.15 along with the n40.1 and so therefore we would eliminate d we take a look at R 35.0 that's frequency of of micturition and we know that that's not it okay and then we have a look here urgency of urination and it's already given us that code there okay so we need urgency again you know it's close but not exactly what we need so there we have it uh right there and so we're going to code first the BPH followed by the urinary urgency so first and then second this leads us to C all right okay so we're gonna keep on moving with it what is are the correct diagnosis codes and we have a q62.0 and 13.30 b in 13.30 q 62.0 c in 13.30 and finally d q 62.0 a 55 year old female with right hydronephrosis presents for a cystorethroscopy with a retrograde pyelogram what is the correct diagnosis all right coders you've got two and a half minutes and your time it begins now all right yes you guys could solve this one somebody somebody found the secret sauce okay so what is the correct diagnosis well we are simply coding for right hydronephrosis so what do the Q codes tell you okay what does that tell you we're talking about A congenital diagnostic uh code so it would be something that has been present from birth and we don't have any documentation saying that this is congenital hydronephrosis so we could eliminate everything but see okay and I know somebody's saying hey I'm trying to figure out the laterality if it's right and if it's right hydronephrosis I don't see anything addressing that we have to code and select the best answer that we have in front of us okay so so we're teaching you coding we're also teaching you when you're on the exam you've got to code what is best all right based on what you have in front of you and indeed it is C and so for our keywords we have 55 year old they have right hydronephrosis and so we're simply going to take a look at the Q codes uh anyway Q 62.0 congenital hydronephrosis boom we're eliminating it that's that's in each one of them all right so boom they're gone now we take a look at the n13.30 unspecified hydronephrosis Okay so if we don't know what other type of hydronephrosis is it is it uh you know Crossing like they're they're specifying Crossing vessel hydronephrosis and that type of thing we don't have any other specifics of the type of hydronephrosis so it is unspecified okay all right so there we have it so in 13.30 all right so it's going to be other or unspecified so I think many of you many of you got there so don't get hung up I know you're like hey what about the right you will have some questions on your exam and you're like wait a minute you got to choose what's best and look at what's in front of you it cannot be any of the other coats okay it could only be that one because the others are referring to a congenital abnormality all right okay so we are going to continue on yeah don't let it trip you up it is not uncommon on an exam you'll see certain things you'll see just a few of them don't get caught up choose the best thing in front of you okay all right so I'm proud of you okay I really am all of us we see the work you guys are doing keep going keep doing what you're doing it's good it's a good thing coders you guys are amazing thank you so much team I appreciate you Mr Sandeep always a joy to join you and I appreciate this phenomenal intern team encoders we so appreciate you all coming prepared and ready to dig in with your questions and everything and you continue to challenge us and we appreciate that 4 000 exam passers and free classes at AMCI learn to go straight from home or on the road at a m c i we're on the East Coast the West Coast we're all around the world [Music] a m c i