7th Annual Association for Clinical Documentation Improvement ... · Natalie Sartori, MEd, RHIA, AHIMA-Approved ICD-10-CM/PCS Trainer Senior Consultant United Audit Systems, Inc

7th AnnualAssociation for Clinical Documentation

Improvement SpecialistsConference

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ICD-10-CM/PCS Documentation Requirements for Children's Hospitals

Rebecca A. “Ali” Williams, RN, MSN, CCDS

Manager Clinical Documentation Improvement Consulting

United Audit Systems, Inc.

Cincinnati, Ohio

Natalie Sartori, MEd, RHIA, AHIMA-Approved ICD-10-CM/PCS Trainer

Senior Consultant

United Audit Systems, Inc.

Cincinnati, Ohio

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Learning Objectives

• At the completion of this educational activity, the learner will be able to:– Explain the difference in terminology & specificity

between ICD-9 and ICD-10-CM/PCS codes for common conditions/procedures in children’s hospitals

– Recognize clinical documentation required to fully leverage the specificity available in ICD-10-CM/PCS codes in children’s hospitals

– Determine how to modify current documentation improvement efforts to begin to incorporate the additional specificity that will be needed to ensure appropriate reflection of severity of illness and risk of mortality using ICD-10-CM/PCS codes

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Outline

• Brief review of ICD-10 compared to ICD-9

• Conditions/procedure & relative information – Asthma

– Respiratory failure

– Cerebral palsy

– Traumatic fracture repair

• Summary for documentation for ICD-10 in children’s hospitals

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Brief Review of ICD-10 Compared to ICD-9

Difference in terminology and specificity

Key impacts in children’s hospitals

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Diagnosis Code Structure

ICD-9-CM

• 3–5 characters

• First is numeric or alpha (E, V)

• 2–5 are numeric

• Always at least 3 characters

• Use of decimal after first 3 characters

ICD-10-CM

• 3–7 characters

• First is always alpha

• 2–7 are alpha or numeric

• Always at least 3 characters

• Use of decimal after first 3 characters

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More New Features

• Inclusion of trimester in obstetrics codes (and elimination of 5th digits for episode of care)

• Updated clinical terminology (e.g., diabetes mellitus, malignant/benign hypertension)

• Changes in time frames specified in certain codes

• Added standard definitions for two types of excludes notes

• More combination codes

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Some Common Pediatric Diagnoses Impacted

• Acute otitis media• Asthma• Cerebral palsy• Chromosomal abnormalities• Coma• Epilepsy• Injuries (fractures, brain, internal)• Respiratory failure• Diabetes mellitus

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Documentation Requirements: Asthma

Specificity available in ICD-9 codes


Documentation required for ICD-10 codes

Relevant clinical indicators (if applicable)

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Asthma

ICD-9-CM classification (493)

• Classified as either intrinsic, extrinsic, other, or unspecified asthma

• Finally asthma is classified as uncomplicated, with acute exacerbation or with status asthmaticus

ICD-10-CM classification (J45)

• Both intrinsic and extrinsic asthma included in this category

• Asthma classified as mild, moderate, severe, or unspecified

• Mild asthma is further classified as intermittent or persistent

• Finally asthma is classified as uncomplicated, with acute exacerbation or with status asthmaticus

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Asthma

ICD-9-CM asthma codes

Total of 10 valid codesThe following fifth-digit subclassification is for use with category 493.0–493.2, 493.9:

0 unspecified1 with status asthmaticus2 with (acute) exacerbation

493.0 Extrinsic asthma493.1 Intrinsic asthma493.2 Chronic obstructive asthma 493.9 Asthma, unspecified


Total of 18 valid codesThe following subcategories (J45.2–J45.5 & J45.90) are further specified with the following fourth or fifth digits:

0 unspecified 1 acute exacerbation2 status asthmaticus

J45.2 Mild intermittent asthmaJ45.3 Mild persistent asthmaJ45.4 Moderate persistent asthmaJ45.5 Severe persistent asthma

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Asthma


493.8 Other forms of asthma493.81 Exercise induced

bronchospasm493.82 Cough variant asthma


J45.90 Unspecified asthmaJ45.901 Unspecified asthma w/ (acute) exacerbationJ45.902 Unspecified asthma w/ status asthmaticus**J45.909 Unspecified asthma, uncomplicatedJ45.99 Other asthma

J45.990 Exercise induced bronchospasm

J45.991 Cough variant asthmaJ45.998 Other asthma

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Asthma ICD-10-CM CC Codes

J45.21 Mild intermittent asthma with acute exacerbationJ45.22 Mild intermittent asthma with status asthmaticusJ45.31 Mild persistent asthma with (acute) exacerbationJ45.32 Mild persistent asthma with status asthmaticusJ45.41 Moderate persistent asthma with (acute) exacerbation

J45.42 Moderate persistent asthma with status asthmaticusJ45.51 Severe persistent asthma with (acute) exacerbationJ45.52 Severe persistent asthma with status asthmaticusJ45.901 Unspecified asthma with (acute) exacerbationJ45.902 Unspecified asthma with status asthmaticus

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Other ICD-10-CM documentation considerationsNew instructional notes to use additional codes to identify (if specified; it is NOT mandatory):

• Exposure to environmental tobacco smoke (Z77.22)• Exposure to tobacco smoke in the perinatal period (P96.81)• History of tobacco use (Z87.891)• Occupational exposure to environmental tobacco smoke

(Z57.31)• Tobacco dependence (F17.-)• Tobacco use (Z72.0)

Asthma

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Other ICD-10-CM documentation considerations• ICD-10-CM Excludes2 notes – ICD-10-CM does not

provide a code for asthma with COPD (493.2x) but rather instructs the coder to assign an additional code if COPD is present

Excludes2 (i.e., not included, may need to code also):• Asthma with chronic obstructive pulmonary disease

(J44.9)• Chronic asthmatic (obstructive) bronchitis (J44.9)• Chronic obstructive asthma (J44.9)

Asthma

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• No longer relevant:– Intrinsic vs. extrinsic

• Specify for ICD-10-CM code assignment:– Mild, moderate, or severe– Intermittent or persistent– With exacerbation (acute) or with status

asthmaticus– Type: exercise induced, cough variant, other

Asthma: Documentation Requirements

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Intermittent Asthma

• Symptoms:– ≤ 2 days/week

• Nighttime awakenings:– Ages 0–4: none– Ages 5 and older: ≤ 2x/month

• Interference with normal activity:– None

• SABA use for symptom control:– ≤ 2 days/week

• Lung function:– Ages 5 and younger: normal FEV1 between exacerbations; > 80%– Ages 5–11: > 85% FEV1/FVC– Ages 12 and older: normal FEV1/FVC

Reference: UMHS Asthma Quality Improvement Steering Committee http://www.med.umich.edu/i/oca/practiceguides

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Mild Persistent Asthma

• Symptoms:– > 2 days/week but not daily

• Nighttime awakenings:– Ages 0–4: 1x–2x/month– Ages 5 and older: 3x–4x/month

• Interference with normal activity:– Minor limitation

• SABA use for symptom control:– > 2 days/week but not daily

• Lung function:– Ages 5 and younger: > 80% FEV1– Ages 5–11: > 80% FEV1/FVC– Ages 12 and older: normal FEV1/FVC


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Moderate Persistent Asthma

• Symptoms:– Daily

• Nighttime awakenings:– Ages 0–4: 3x–4x/month– Ages 5 and older: > 1x/week but not nightly

• Interference with normal activity:– Some limitation

• SABA use for symptom control:– Daily

• Lung function:– Ages 5 and younger: 60%–80% FEV1– Ages 5–11: 75%–80% FEV1/FVC– Ages 12 and older: reduced 5% FEV1/FVC


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Severe Persistent Asthma

• Symptoms:– Throughout the day

• Nighttime awakenings:– Ages 0–4: > 1x/week– Ages 5 and older: often 7x/week

• Interference with normal activity:– Extremely limited

• SABA use for symptom control:– Several times daily

• Lung function:– Ages 5 and younger: < 60% FEV1– Ages 5–11: < 60% FEV1/FVC– Ages 12 and older: reduced > 5% FEV1/FVC


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Acute Exacerbation vs. Status Asthmaticus

• Asthma exacerbation– Also referred to as an asthma attack; airways become

swollen and inflamed causing bronchial tubes to narrow. As asthma exacerbation may be minor, with symptoms getting better with prompt home treatment, or more serious requiring medical emergency. (Mayo Clinic)

• Status asthmaticus– Life-threatening form of asthma in which progressively

worsening reactive airways are unresponsive to usual appropriate therapy that can lead to deteriorating clinical conditions. (S. Agarwal, MD; S. Kache, MD Stanford)

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Types of Asthma

• Exercise-induced asthma: asthma symptoms triggered by exercise or physical exertion. Difficulty in breathing usually subsides within 30 minutes after stopping exercise.

• Cough-variant asthma: main symptom is a dry, non-productive cough. Often there are no other “classic” asthma symptoms such as wheezing or shortness of breath.

• Allergic asthma: asthma symptoms induced by allergens.

• Other types: occupational asthma, nocturnal asthma, etc.

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• Look for other possible acute events such as:– Otitis media– Acute respiratory failure– Acidosis and alkalosis (respiratory and/or metabolic)– Dehydration– Underlying heart or pulmonary disease– Apnea– Pneumonia – Immune disorders (compromised) – Other: exposure to tobacco smoke

Asthma CDI Opportunities

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Documentation Requirements: Respiratory Failure





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Respiratory Failure

ICD-9-CM (518.8x)

• Classified as acute, chronic, or acute on chronic

ICD-10-CM (J96.xx)

• Classified as acute, chronic, acute on chronic, or unspecified

• Further classified as with hypoxia, hypercapnia, or unspecified

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Respiratory Failure

• ICD-9-CM codes

Total of 3 valid codes518.81 Acute (unspecified) respiratory failure (MCC)

518.83 Chronic respiratory failure (CC)

518.84 Acute on chronic respiratory failure (MCC)

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Respiratory Failure

• ICD-10-CM codes Total of 12 valid codesJ96.00 Acute respiratory failure, unspecified whether with hypoxia or hypercapniaJ96.01 Acute respiratory failure with hypoxiaJ96.02 Acute respiratory failure with hypercapniaJ96.10 Chronic respiratory failure, unspecified whether with hypoxia or hypercapniaJ96.11 Chronic respiratory failure with hypoxiaJ96.12 Chronic respiratory failure with hypercapniaJ96.20 Acute and chronic respiratory failure, unspecified whether with hypoxia or

hypercapniaJ96.21 Acute and chronic respiratory failure with hypoxiaJ96.22 Acute and chronic respiratory failure with hypercapniaJ96.90 Respiratory failure, unspecified, unspecified whether with hypoxia or

hypercapniaJ96.91 Respiratory failure, unspecified with hypoxiaJ96.92 Respiratory failure, unspecified with hypercapnia

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Respiratory Failure

Respiratory failure ICD-9-CM CC codes

518.83 Chronic respiratory failure

Respiratory failure ICD-10-CM CC codes

J96.10 Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia

J96.11 Chronic respiratory failure with hypoxia

J96.12 Chronic respiratory failure with hypercapnia

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Respiratory Failure

• Respiratory failure ICD-10-CM MCC codesJ96.00 Acute respiratory failure, unspecified whether with

hypoxia or hypercapniaJ96.01 Acute respiratory failure with hypoxiaJ96.02 Acute respiratory failure with hypercapniaJ96.20 Acute and chronic respiratory failure, unspecified

whether with hypoxia or hypercapniaJ96.21 Acute and chronic respiratory failure with hypoxiaJ96.22 Acute and chronic respiratory failure with hypercapniaJ96.90 Respiratory failure, unspecified, unspecified whether

with hypoxia or hypercapniaJ96.91 Respiratory failure, unspecified with hypoxiaJ96.92 Respiratory failure, unspecified with hypercapnia

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No longer relevant:

• Respiratory failure that was not specified as acute or chronic defaulted to acute respiratory failure

Specify for ICD-10-CM code assignment:

• Specify acute or chronic

• Type: hypoxic or hypercapniac

Respiratory Failure: Documentation Requirements

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Acute vs. Chronic Respiratory Failure

Acute

• Acute respiratory failure develops over minutes to hours

Chronic

• Chronic respiratory failure develops over several days or longer

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Hypoxemic Respiratory Failure

• Hypoxemic respiratory failure– Also called Type I – Most common form of respiratory failure– Characterized by an arterial oxygenation tension (PaO2)

lower than 60 mm Hg with a normal or low PaCO2

– Can be associated with virtually all acute diseases of the lung, which generally involve fluid filling or collapse of alveolar units

– Some examples of hypoxemic respiratory failure:• Cardiogenic or noncardiogenic pulmonary edema• Pneumonia• Pulmonary hemorrhage

www.chest.mohealth.gov.eg/mawared/respiratory_failure.doc

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Common Causes of Hypoxemic Respiratory Failure

– Bronchitis – Pneumonia – Reactive airway

disease– Pulmonary edema – Pulmonary fibrosis – Asthma – Pneumothorax – Pulmonary embolism – Pulmonary arterial

hypertension

– Cyanotic congenital heart disease

– Bronchiectasis – Fat embolism

syndrome – Kyphoscoliosis – Obesity


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Hypercapnic Respiratory Failure

• Hypercapnic respiratory failure – Also called Type II.

– Characterized by a PaCO2 of more than 50 mm Hg.

– Hypoxemia is common in patients with hypercapnicrespiratory failure who are breathing room air. The pH depends on the level of bicarbonate, which, in turn, is dependent on the duration of hypercapnia.

– Common etiologies include: drug overdose, neuromuscular disease, chest wall abnormalities, and severe airway disorders (e.g., asthma, COPD).


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Common Causes of Hypercapnic Respiratory Failure

– Bronchitis

– Reactive airway disease

– Severe asthma

– Cystic fibrosis

– Drug overdose

– Poisonings

– Polyneuropathy

– Poliomyelitis

– Primary muscle disorders

– Porphyria

– Head and cervical cord injury

– Primary alveolar hypoventilation

– Pediatric obesity hypoventilation syndrome

– Pulmonary edema

– Myxedema

– Tetanus


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Documentation Requirements: Cerebral Palsy





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Cerebral Palsy

Infantile cerebral palsy ICD-9-CM (343.x)

Categorized by the level of palsy or paralysis

Cerebral palsy ICD-10-CM (G80.x)

Categorized by the level of palsy or paralysis

Paralysis is further specified as spastic or unspecified

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Cerebral Palsy

ICD-9-CM cerebral palsy codes

343.0 Diplegia

343.1 Hemiplegic

343.2 Quadriplegic

343.3 Monoplegic

343.4 Infantile hemiplegia343.8 Other specified infantile

cerebral palsy343.9 Infantile cerebral palsy,

unspecified

ICD-10-CM cerebral palsy codes

G80.0 Spastic quadriplegic cerebral palsy

G80.1 Spastic diplegiccerebral palsy

G80.2 Spastic hemiplegic cerebral palsy

G80.3 Athetoid cerebral palsy G80.4 Ataxic cerebral palsyG80.8 Other cerebral palsyG80.9 Cerebral palsy,

unspecified

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Cerebral Palsy

ICD-9-CM cerebral palsy CC codes

343.0 Diplegic

343.1 Hemiplegic

343.4 Infantile hemiplegia

ICD-10-CM cerebral palsy CC codes

G80.1 Spastic diplegiccerebral palsy

G80.2 Spastic hemiplegic cerebral palsy

G80.3 Athetoid cerebral palsy

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Cerebral Palsy

ICD-9-CM cerebral palsy MCC codes

343.2 Quadriplegic G80.0 Spastic quadriplegic cerebral palsy

ICD-10-CM cerebral palsy MCC codes

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• ICD-10-CM documentation considerations:– Paralysis associated with cerebral palsy must be

specified in the documentation as “spastic” in order to fall into the more specific codes and qualify as CC or MCC diagnosis codes

Cerebral Palsy

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Cerebral Palsy: Documentation Requirements

• Diplegic, hemiplegic, monoplegic, paraplegic, quadriplegic, and tetraplegic cerebral palsy not specified as spastic all coded to G80.8, Other cerebral palsy

• Spastic quadriplegic or tetraplegic CP code to G80.0 (MCC)

• Spastic diplegic, monoplegic, or paraplegic CP code to G80.1

• Spastic hemiplegic CP codes to G80.2

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Cerebral Palsy: Clinical Indicators/Types

• Athetoid– Represents approximately 10% of the cases of

cerebral palsy currently (used to be higher)

– Two of the risk factors for this form of CP: • Hyperbilirubinemia (jaundice)

• RH incompatibility with the mother

http://www.originsofcerebralpalsy.com/

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• Ataxia– Lack of balance or impairment in the ability to

perform smoothly coordinated voluntary movements

– Very rare in children with CP though frequently seen as a contributing difficulty in one of the other forms of the condition


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• Mixed– Term used to describe form of CP that does not fit

neatly into one of the other classifications

– Different types of movement disorders may exist at the same time

– Healthcare professionals usually classify CP according to the predominant form of involvement


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• Spastic– Characterized by abnormal control of voluntary

limb muscles and by exaggerated reflexes, sometimes in association with a reduction in muscle tone in the trunk of the body

– Muscles are stiffly and permanently contracted



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• Diplegia– Form of CP primarily affecting the legs– Arms are less involved & less severe (most children

with CP have some problem with their arms)– Spasticity; difficulty with balance and coordination– Leg muscles tend to be short resulting in a decrease

in range of motion as the child grows and joints become stiff

– Feet and ankles can present problems due to short tight Achilles tendon, which can lead to toe walking

– Hips are at risk for dislocation in this type of CP


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• Hemiplegia– Form of CP affecting one arm and leg on the

same side

– Hemiplegia in the arm is more involved than the leg usually; end of limbs have more problems• Wrist and hand have more problems than the

shoulder with the elbow in the middle

• Similarly, the ankle and foot will exhibit more problems than the knee


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• Monoplegia– Involvement of only one limb

– Rare form of the condition and commonly thought of as hemiplegia with mild involvement of the other limb on the affected side of the body


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• Quadriplegia/tetraplegia– Form of CP affecting all four limbs

– Usually accompanied by more severe motor dysfunction than the other forms

– If head and neck are involved, terms “pentaplegia” or “full body involvement” are used

• Full body involvement: often additional complications with eating and breathing due to lack of muscle control or inability of muscles to work together in normal patterns


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• Triplegia– Form of CP affecting three limbs; most common

pattern is for both legs and one arm to be affected

– Often thought of as hemiplegia overlapping with diplegia due to the primary motor dysfunction being that of the legs

– This form of CP is thought of as quadriplegia with less severe involvement of one of the arms

• Physician may need to be queried for a more specific term as this term is not able to be coded in ICD-10


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Documentation Requirements: Traumatic Fracture Repair

Overview of ICD-10-PCS charactersSpecificity available in ICD-9 codesSpecificity available in ICD-10 codesDocumentation required for ICD-10-PCS codesRelevant clinical indicators (if applicable)

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Fracture Reduction & Stabilization

ICD-9-CM

• Codes located under main term reduction

• Location specified by bone only with some specificity for location: proximal, distal, or shaft

ICD-10-CM

• Codes located under the main term reposition

• Increased specificity for bone location (body part), laterality, and fixation devices

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ORIF right tibial fracture ICD-9-CM

Reduction

fracture

tibia (closed) 79.06

with internal fixation 79.16

open 79.26

with internal fixation 79.36

ORIF right tibial fracture ICD-10-CM

Reposition

Tibia

Left 0QSH

Right 0QSG

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Section 0 Medical and Surgical

Body system Q Lower Bones

Operation S Reposition: Moving to its normal location, or other

suitable location, all or a portion of a body part


Body part Approach Device Qualifier

6 Upper Femur, R 7 Upper Femur, L 8 Femoral Shaft, R 9 Femoral Shaft, LB Lower Femur, R C Lower Femur, L G Tibia, RH Tibia, LJ Fibula, RK Fibula, L

0 Open 3 Percutaneous 4 Percutaneous

Endoscopic

4 Internal Fixation Device5 External Fixation Device 6 Internal Fixation Device,

Intramedullary B External Fixation Device,

Monoplanar C External Fixation Device, RingD External Fixation Device, Hybrid Z No Device

Z No Qualifier

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• Specify for ICD-10-CM:

• Identify the bone, including laterality, specific site on the bone

• Approach: open, external (closed), percutaneous or percutaneous endoscopic

• Device: specify the device used, if any, to stabilize the fracture

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Fracture Reduction & StabilizationCDI Opportunity

• In children, look for any underlying chronic conditions that could impact SOI/ROM and/or MS-DRG. Generally, children with fractures are healthy; however, there will be some with conditions that need to be documented.

• If trauma, look for other areas of trauma that may move to a multiple site trauma & any acute processes such as acute respiratory failure, acute renal failure, spleen injury, rib fractures, etc.

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• Secondary diagnoses that may exist or appear during the stay or after surgery:– Hypovolemic– Electrolyte disturbances– Acute blood loss anemia– Metabolic/resp acidosis or alkalosis– Acute respiratory failure– Acute renal failure (with or without acute tubular

necrosis)– Disseminated intravascular coagulation (DIC)

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• In adults, osteoporosis is often a query opportunity for distinguishing a traumatic vs. pathological fracture linkage; however, in the pediatric clientele:– CDI should look for comorbid conditions that weaken the bones

and query when a pathological fracture can not be ruled out

• Pathological fractures in children can be due to conditions such as: – Metabolic bone disease (i.e., vitamin D deficiency, rickets)– Benign tumors (i.e., non-ossifying fibroma; osteochondroma)– Malignant tumors (i.e., osteosarcoma, Ewing’s sarcoma)– Connective tissue bone disease (i.e., osteogenesis imperfecta,

aka “brittle bone disease”)– Other etiology (i.e., drug induced)

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• In traumas, look for opportunities to query, such as rhabdomyolysis and acute renal failure (with or without ATN)*– Rhabdomyolysis is a condition where muscle fiber

breakdown & muscle necrosis releases CPK, potassium, & myoglobin. Often seen in traumatic falls, prolonged immobilization, trauma, crush or electrical injury.

• Clinical: CPK increased to > 10,000–100,000 U/L• CPK accounts for 8%–15% incidence of acute kidney failure

due to acute tubular necrosis as large molecules are filtered through and damage the nephrons

– Increased serum creatinine as renal failure progresses– Hypocalcemia– Hypophosphatemia (from renal failure and release from cells)– Positive urine hemoglobin in approx. 50% of patients

*possible but not common

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• Secondary diagnoses associated with rhabdomyolysis:– Hypovolemia

– Hyperkalemia

– Metabolic acidosis

– Acute renal failure (with or without acute tubular necrosis)

– Disseminated intravascular coagulation (DIC)

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Documentation for ICD-10 in Children’s Hospitals

Summary of documentation requirements reviewed

Tips for identifying additional clinical documentation needs

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Asthma:Documentation Requirements

• No longer relevant:– Intrinsic vs. extrinsic

• Specify for ICD-10-CM code assignment:– Mild, moderate, or severe– Intermittent or persistent– With exacerbation (acute) or with status

asthmaticus– Type: exercise induced, cough variant, other

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Respiratory Failure: Documentation Requirements

• No longer relevant:– Respiratory failure that was not specified as

acute or chronic defaulted to acute respiratory failure

• Specify for ICD-10-CM code assignment:– Specify acute or chronic

– Type: hypoxic or hypercapniac

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• ICD-10-CM documentation considerations:– Paralysis associated with cerebral palsy must be

specified in the documentation as “spastic” in order to fall into the more specific codes and qualify as CC or MCC diagnosis codes

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• Diplegic, hemiplegic, monoplegic, paraplegic, quadriplegic, and tetraplegic cerebral palsy not specified as spastic all coded to G80.8, Other cerebral palsy

• Spastic quadriplegic or tetraplegic CP code to G80.0 (MCC)

• Spastic diplegic, monoplegic, or paraplegic CP code to G80.1

• Spastic hemiplegic CP codes to G80.2

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Fracture Reduction & Stabilization:Documentation Requirements

• Specificity for ICD-10-CM:– Identify the bone, including laterality, specific site

on the bone

– Approach: open, external (closed), percutaneous, or percutaneous endoscopic

– Device: specify the device used, if any, to stabilize the fracture

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Identifying Additional Clinical Documentation Needs for ICD-10

• Tips for your facility:– Conduct your own mini documentation assessment

• Identify your top 10 pediatric diagnoses and procedures– Code 10 charts each and recode in ICD-10 – Where are your gaps in specificity? Go from there!

– Educate• Share the knowledge

– Incorporate templates into your EHR system for the needed specificity

– Report findings from documentation assessment to your physician champion

– Email blasts, mini-education sessions at dept. head meetings, flyers, etc.

– Update queries to promote ICD-10 documentation specificity

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Identifying Additional Clinical Documentation Needs for ICD-10

• More tips for your facility:– Use available resources

• CMS website http://www.cms.gov/icd10manual/version31-fullcode-cms/P0001.html

– Appendix G Diagnoses Defined as Complication or Comorbidities

– Appendix H Diagnoses Defined as MajorComplication or Comorbidities

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Thank you. Questions?

[email protected]@uasisolutions.com

In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the workbook.

Documents

7th Annual Association for Clinical Documentation Improvement ... · Natalie Sartori, MEd, RHIA, AHIMA-Approved ICD-10-CM/PCS Trainer Senior Consultant United Audit Systems, Inc