HCC Blog by Caridad

The scenario is that both of these codes were documented in the past on a patient. 438.9 Unspecified late effects of CVA   AND   342.11 Spastic hemiplegia affecting dominant side The physician was queried on which code was appropriate. The documentation returned listing both codes.  If we look in the ICD-9 book, we will see the following, please notice the NOTE and EXCLUDES boxes: The ICD-9 guidelines state the 342.11 excludes 438.20 - 438.22 (they can't be used together). On a future appointment, query the physician for clarification on the patient's paralysis. This is regarding hierarchical condition categories or HCC codes.

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  In the ICD- 9 and ICD-10 books we have guidelines to support our coding choices. If there is ever a time to be sure the guideline is followed, this would be it. If a patient has a late effect from a previous CVA, it must be coded as such. A good example is 438.21 Hemiplegia affecting dominant side versus 342.11 Spastic hemiplegia affecting dominant side . Code 438.21 is a direct coordination with the patient's previous CVA. Choosing 342.11 would be appropriate in a patient who has this condition related to an acute or chronic illness. We thank physicians for choosing codes that are most descriptive of the diagnosis and its relationship to comorbidities  

New ICD-10 Compliance Date: October 1, 2015  About ICD-10 The transition to ICD-10 is required for everyone covered by the  Health Insurance Portability Accountability Act (HIPAA) . Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services. Road to 10: CMS Online Tool for Small Practices Road to 10 , an online resource built with the help of providers in small practices, is now available. This tool is designed to help small medical practices jumpstart their ICD-10 transition. “Road to 10” includes specialty references and helps providers build ICD-10 action plans tailored for their practice needs. CMS Resources Access three new Medscape Education resources that provide guidance around the transition to ICD-10. Continuing medical education (CME) and nursing continuing education (CE) credits are available to health care professionals who complete the learning modules, but anyone can take them and earn a certificate of