Question

A 79 year old nursing home patient, Mary Creed was admitted to Parkview hospital with severe cellulitis of the left lower leg. The cultures grew streptococcus B, and this was documented by the physician as the cause of the cellulitis. Patient was given IV antibiotics. She also has dominant right-sided hemiplegia from an old CVA and was found to have a stage 4 decubitus ulcer in the left buttock region.

Coder I assigned: L03.119, L89.324, I69.353 POA indicators; L03.119 – N, L89.324 – Y, I69.353 – N

As the coding supervisor, review the clinical documentation, the diagnosis codes & the POA indicators assigned by this coder.

Answer these 4 questions:

1) What coding quality issues do you find as you are auditing the coder’s work?

2) What would be your feedback to this coder?

3) Are any diagnosis code(s) missing? If so, what are the diagnoses that should be added to this case?

4) Are the POA indicators correct?

Answer 1

1. Coding quality issues in the coder’s work:

• A) Wrong codes assigned.

a) ICD-10-CM Code L03.119 - This code is wrong because this code is for cellulitis of unspecified part of the limb.

b) ICD-10-CM Code I69.353 - This code is wrong because this is the code for the diagnosis of hemiplegia and hemiparesis following cerebral infarction affecting the right non-dominant side.

• B) Wrong POA indicators assigned.

a) Wrong POA indicator, code L03.119 – N: This is the wrong code for cellulitis of the left lower leg with POA indicator N. Here POA indicator N is incorrect because N is given if the diagnosis was not present at the time of inpatient admission.

b) Wrong POA indicator, Code I69.353 – N: This is the wrong code for the diagnosis of dominant right-sided hemiplegia from an old CVA with POA indicator N. Here POA indicator N is incorrect because N is given if the diagnosis was not present at the time of inpatient admission.

• C) Missing diagnosis codes for culture with Streptococcus group B

ICD-10-CM Diagnosis Code B95.1 should be given for Streptococcus, group B, the cause of a disease with another code.

2. Feedback to the coder:

a) Error: Wrong code, ICD-10-CM Code L03.119 - This code is wrong because this is the code for the diagnosis of cellulitis of the unspecified part of the limb.

Correction: The correct code should be for cellulitis of the left lower leg, which is L03.116

b) Error: Wrong code, ICD-10-CM Code I69.353: This code is wrong because this is the code for the diagnosis of hemiplegia and hemiparesis following cerebral infarction affecting the right non-dominant side.

Correction: The correct code should be for dominant right-sided hemiplegia from an old CVA, which is I69.351.

c) Error: Wrong POA indicator, Code L03.119 – N: This is the wrong code for cellulitis of the left lower leg with POA indicator N. Here POA indicator N is incorrect because N is given if the diagnosis was not present at the time of inpatient admission.

Correction: The correct POA indicator should be Y, which is given if the diagnosis was present at the time of inpatient admission.

d) Error: Wrong POA indicator, Code I69.353 – N: This is the wrong code for the diagnosis of dominant right-sided hemiplegia from an old CVA with POA indicator N. Here POA indicator N is incorrect because N is given if the diagnosis was not present at the time of inpatient admission.

Correction: The correct POA indicator should be Y, which is given if the diagnosis was present at the time of inpatient admission.

e) Error: Missing diagnosis codes for culture with Streptococcus group B

Correction: ICD-10-CM Diagnosis Code B95.1 should be given for Streptococcus, group B, the cause of a disease with another code.

Feedback comments: Read everything carefully before assigning codes. List the diagnoses first and then code. Read POA indicators well to avoid errors.

3) Missing diagnosis/codes for culture with Streptococcus group B. ICD-10-CM Diagnosis Code B95.1 should be given for Streptococcus, group B, the cause of disease elsewhere with another code.

4) There is only one correct POA indicator, L89.324 – Y. This is the code for pressure ulcer of left buttock, stage 4, with POA indicator Y.  This is given if the diagnosis was present at the time of inpatient admission. The other two codes have POA indicator N, which is incorrect because N is given for conditions that are not present during inpatient admission.