Wiki 2021 ICD-10 Coding for COVID-19

[WEBBE324]

The CDC has VERY recently released additions to ICD-10 for COVID-19, eff 01/01/2021. (So recently that they are not in my 2021 ICD-10 book.) Most of them are straight-forward, ie, screening for (Z11.52), pers hx of (Z86.16); however, there are two complication codes added, M35.81- Multisystem Inflammatory Syndrome (MIS), and M35.89- Other specified systemic involvement of connective tissue. One of my physicians is asking about guidelines for what would classify an adult as having MIS, as it has primarily involved children, and when would it be appropriate to use M35.89? Any clarification or guidance would be greatly appreciated.

 

[SharonCollachi]

I would think the American Medical Association, the CDC, or other authority would have the definition of those diseases/conditions, not coders and billers.

 

[WEBBE324]

I would think the American Medical Association, the CDC, or other authority would have the definition of those diseases/conditions, not coders and billers.

Yes, I was wondering if anyone had come across the definitions from one of those organizations mentioned, as a cursory search did not provide me with an answer.

 

[thomas7331]

Yes, I was wondering if anyone had come across the definitions from one of those organizations mentioned, as a cursory search did not provide me with an answer.

This type of guidance, especially if you need the most recent and current information, usually requires a paid subscription (e.g. uptodate.com). Your provider or the organization you work for may offer access to this, and if so I'd recommend starting there. But as mentioned in Sharon's post above, clinical guidance on diagnosing a patient is really outside the scope of coding.

 

[WEBBE324]

This type of guidance, especially if you need the most recent and current information, usually requires a paid subscription (e.g. uptodate.com). Your provider or the organization you work for may offer access to this, and if so I'd recommend starting there. But as mentioned in Sharon's post above, clinical guidance on diagnosing a patient is really outside the scope of coding.

Thank you for your perspective. I initially thought the same thing, actually, and told the provider that those diagnoses should be coded according to physician discretion. But the physician that asked me can be rather...bristly, so I was just trying to see if anyone had official literature on hand. Thanks again!

 

[thomas7331]

Thank you for your perspective. I initially thought the same thing, actually, and told the provider that those diagnoses should be coded according to physician discretion. But the physician that asked me can be rather...bristly, so I was just trying to see if anyone had official literature on hand. Thanks again!

That's normal physician behavior, don't take it personally. However, I'd suggest avoiding telling physicians that a diagnosis should be coded according to their discretion - most physicians aren't coders and don't understand how codes are assigned and using their discretion will often result in incorrect codes. Rather, I'd tell them that they should they should describe the patient's diagnosis in the own words, and that a diagnosis code should be assigned based on those words according to guidelines.

If in your practice physicians are required to choose their own codes, a coder can help guide them in the code choice based on their wording, but coders cannot help them decide how to word their diagnosis. A common example of this that I see is when a provider diagnosis a patient with GERD. They don't see a code for GERD, only one for 'GERD with esophagitis' and one for 'GERD without esophagitis' and they'll say that they don't know whether the patient has esophagitis or not. In a situation like this, it's not our role to help the provider make the decision as to whether or not the patient has esophagitis - they need to document just that the patient has GERD. But we can explain to them that the diagnosis of GERD that is not further specified is correctly classified in ICD-10 under the header of 'GERD without esophagitis', and that the wording in that code does not imply that the patient does not have esophagitis, but only that there is no documentation of esophagitis in the record.