Question

PLEASE ANSWER ALL THE QUESTIONS:

1) In textbook“Conquer Medical Coding - A Critical Thinking Approach with Coding Simulations”   2017, Chapter 7, page 231 there are specific directives regarding "Pressure Ulcers." Specifically, there is a yellow dot box, which means that the coder should "proceed with caution." That the notes explain how to move ahead carefully in the particular coding situation. In this case, when coding "Pressure Ulcers." According to the Inpatient Prospective Payment System (IPPS), Stage III and Stage IV pressure ulcers are major complications and comorbidities. The Centers for Medicare and Medicaid Services (CMS), does not provide additional payment for inpatient services for hospital-acquired (not present on admission) stage III or stage IV pressure ulcers. Why do you think the CMS will not provide additional payment in this situation?

2) Documentation of the presence of a pressure ulcer is noted in the medical record by the skin care team, which is made up of a nurses who specialize in wound care. Though the stage of the pressure ulcer is documented by the skin care team, the physician must also document the presence of the pressure ulcer, specifically site, size, and location, in order for the coder to assign the code. If the physician does not include this information regarding the pressure ulcer in his documentation, what can the coder do?

3) According to the Official Coding Guidelines Signs and Symptoms that are integral to the underlying disease process should not be reported as additional diagnoses. The example the text gives you is that shortness of breath due to pneumonia, the shortness of breath is not coded because the definitive diagnosis has been established and the symptom of shortness of breath is integral to the pneumonia. In your discussion please explain what this means. What should a coder do if they are unsure whether or not a sign or symptom is routinely associated with a disease process?

Answer 1

1) If the pressure ulcer is reported after the admission in the hospital: the centres for medicare and medicaid services value based purchasing initiative considers pressure ulcers to be reasonably preventable and has included them on its list of so called no pay conditions. 2) Physician documentation of the specfific cause of a skin ulcerr is important to acurate coding because coders may not assume cause and effect realtionship between disease process and a skin ulceration, so if the physiican does not document about pressure ulcer, then the code L89-9) it is used in assigning when there is no documentation indicating the stage of the pressure ulcer. 3) According to the official coding guidelines signs and symptoms that are integral to the underlying disease proces should not be reported as additional diagnosis becaause they are included in the disease process, if the coder is unsure whether or not a sign or symptoms is youtinely associated with a disease process, then the coder should research the disease process in order to make the determination , here given example the patient with pneumonia usually have shortness of breath then the symptoms of shortness of breath is i ntegral to the pneumonia and is not reported separately.