T82868a i120 n186 d631 e109 optum 2016 12 references

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T82.868A I12.0 N18.6 D63.1 E10.9 (Optum 2016, 12) References Centers for Medicare and Medicaid Services. 2016. Local Coverage Determinations by State Index. . aspx?bc=AgAAAAAAAAAA Optum360°. 2016. ICD-10-CM Expert for Hospitals . Official Coding Guidelines. Salt Lake City: Optum.
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Copyright ©2017 by the American Health Information Management Association. All rights reserved. 233 5.7 Coding and UHDDS Subdomain V.B.1 Analyze current regulations and established guidelines in clinical classification systems You have agreed to accept an HIM student for their professional practice experience at your facility. Today you are working on coding. You are giving feedback on the codes that the student assigned for the following scenario. Explain in detail, by tying your feedback to the Uniform Hospital Discharge Data Set and reimbursement, justify what the correct coding should be. Patient: John Smith MR#121212 Acct. # 000633553 Patient came to ER complaining of chest pain. EKG and labs, including troponin levels, were performed. Nitroglycerin was administered and oxygen therapy initiated. Results of the tests indicated the patient was having an anterior wall myocardial infarction. Patient was taken to the cath lab for immediate single vessel angioplasty. Following the percutaneous coronary intervention, the patient was admitted to the floor. He was monitored continuously. Beta blockers and Coumadin therapy were begun. The patient’s hypertension was addressed and he received medication for low potassium levels as well. His diabetes was managed by medication and diet with no significant issues during the admission. After four days the patient was discharged home to continue his medication regime and begin cardiac rehab. Codes assigned by student: Px Dx: R07.9 I10 E87.6 I21.09 E11.9 PX Px 02703ZZ Answer Correct coding and sequencing: Px Dx: I21.09 I10 E87.6 E11.9 PX Px 02703ZZ Principal diagnosis is the condition after study that occasioned the admission. In this case, the chest pain was a symptom of the underlying myocardial infarction and should not be coded. Therefore, the MI should be the principal diagnosis and sequenced first. This will also impact reimbursement. The MS-DRG for the student’s codes would be 250, with the chest pain as principal and the MI creating an MCC for the MS-DRG. The correct MS-DRG should be 251, with the MI as principal diagnosis and no MCC. This will result in a reduced reimbursement, but it is the correct coding and sequencing for the account. (Optum 2016, 27–28; Brinda 2016, 142–146)
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234 Compliance Copyright ©2017 by the American Health Information Management Association. All rights reserved. References Optum 360°. 2016. ICD-10-CM Expert for Hospitals. Official Coding Guidelines: Section II Selection of Principal Diagnosis. Salt Lake City: Optum.
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