I work for a Hospitalist group. I'm finding that it's hard to have more specificity with some codes. For instance, anemia, unspecified D64.9. Insurance companies are denying these claims even if it's the 5th dx on the claim. I'm curious to know how others are handling this. It also happens with COPD patients. They may not be COPD with acute exacerbation, but we can't use J44.9.
Thanks
One thing to remember is that the guidelines for "with" "in" "due to" changed on 10/1/16:
"The word “with” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the alphabetic index, or an instructional note in the tabular list.
The classification presumes a causal relationship between the two conditions linked by these terms in the alphabetic index or tabular list. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states that the conditions are unrelated. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related."
For anemia, there are ton of terms under it. For Anemia>due to (in) (with) and Anemia>with (due to) (in), there are tons of terms there as well. If there is any condition listed under Anemia, the guidelines allow for the causal relationship.
COPD is basically a blanket term for any number of progressive lung diseases. The main types being emphysema and chronic bronchitis. Certain types of asthma would also be included. You would use the unspecified
J44.9 if the provider doesn't diagnose a more specific classifiable condition.
It's also worth noting that words in parentheses are nonessential modifiers; they are "supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned."
For example, the code descriptor for J44.1 is "Chronic obstructive pulmonary disease with (acute) exacerbation". Because the word "acute" is a nonessential modifier, J44.1 can also mean "Chronic obstructive pulmonary disease with exacerbation." J44.1 also includes Decompensated COPD.