HIMagine That: In control with ICD-10

July 6, 2016 / By Donna Smith, RHIA, Sue Belley, RHIA

Donna:  Hi, Sue – how was your 4^th of July holiday weekend?

Sue:  Full of fireworks and time with my family. Hope yours was good as well!

Donna:  I had a great time too, but now it’s back to business. Have you had a chance to review the new FY 2017 ICD-10-PCS Official Guidelines for Coding and Reporting that were recently released?

Sue:  Yes, I have started reviewing them.  Why do you ask?

Donna:   Did you notice there is a slight change to guideline B3.7? That’s the guideline for control vs. more definitive root operations?

Sue:  I didn’t get that far in my review, but what’s the change?

Donna:  It appears that the definition of Control has been expanded. Control is now defined as, “Stopping, or attempting to stop, postprocedural or other acute bleeding.”

Sue:  Oh, you’re right! That’s very subtle – other acute bleeding, not just postprocedural bleeding – great pick up on your part!

Donna:  Thanks! What do you think of this new definition?

Sue:  I think it’s a good change. I have seen instances of the attempt to stop bleeding that are not postprocedural and required different root operations. It will allow coding professionals to better classify similar procedures which in turn provide more meaningful data.  What do you think?  

Donna:  I agree with your thoughts. I also think that some of the Coding Clinic advice regarding control of bleeding will need to be updated to reflect the updated definition of Control.

Sue:  You’re probably right about that. Even with this change in definition, I think Control is one of the more difficult root operations for coding professionals to recognize.

Donna:  What do you mean by “difficult to recognize?”

Sue:  Well, while doing ICD-10 coding validations, I have identified cases where attempts were made to code postprocedural bleeding where coders did not select Control as the root operation for the procedure. When I point these instances out, coders usually say something like, “I didn’t even think of using Control.”

Donna:  Do you have a specific example?

Sue:  I recently reviewed a case of a patient who experienced rectal bleeding as a result of a transrectal ultrasound guided biopsy of the prostate done as an outpatient several days prior to admission. The patient underwent a colonoscopy and received an injection of epinephrine and application of clips to control the bleed.

Donna:  Interesting. . . the definition of Control would apply to this scenario. . . what do you think coding professionals should do to improve their ability to identify situations in which Control might be the root operation of choice?

Sue:  Well, anytime bleeding has occurred and treatment is required, the coder needs to zone in on the specifics  then determine if the procedure meets the definition of Control. Per the definition, if controlling the bleeding requires a more definitive root operation, such as Bypass, Detachment, Excision, Extraction, Reposition, Replacement or Resection, then that should be coded.

Donna:  What you’re saying is they need to have a heightened awareness of bleeding and treatment situations.

Sue:  Yes, that’s right. Stay tuned for updates related to the definition expansion which become effective October 1, 2017.

Sue Belley, RHIA, Donna Smith, RHIA, are with the consulting services business of 3M Health Information Systems.