Dr. Kennedy has generously allowed me to share his summary. He emphasizes that he is paraphrasing the recent advice in the spirit of “fair use” and we are responsible (and must) read the official advice directly from the Coding Clinic in light of previous Coding Clinic advice and in the context of the official ICD-10-CM conventions and guidelines.

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By James Kennedy, MD, CCS, CDIP, CCDS
President of CDIMD – ICD-10 Physician Champions

Coding Clinic, 2Q, 2023 came out and is effective 6/9/2023

Key points:

1. PSA elevations s/p total prostatectomy for prostate cancer (like me, though my PSA is OK), is coded as C79.9, Secondary malignant
   neoplasm of unspecified site (unless the metastatic site is known), R97.21, Rising PSA following treatment for malignant neoplasm of prostate plus other codes.
2. If a biopsy of a metastatic site (e.g., lymph node) reveals a newly diagnosed primary malignancy (e.g., small cell lung cancer), sequence the primary site first followed by the metastatic site. The metastatic site can be the primary ONLY when the Rx is directed ONLY to the metastatic site.
3. When a peripheral vascular graft thrombosis occurs (T82.868A), add I74.xx, Arterial embolism and thrombosis code (MS-DRG CC; APR-DRG SOI 3) as well since the graft functions as an artery.
4. For “Diabetic autonomic neuropathy type 2 with dysautonomia orthostatic hypotension syndrome”, add I95.1, Orthostatic hypotension, and G90.8, Other disorders of autonomic nervous system.
5. Chronic erosive duodenitis is coded as an duodenal ulcer, not duodenitis.
6. For patients presenting with gallstone pancreatitis and gallstones who undergo a cholecystectomy, sequenced EITHER of these first. Pancreatitis will be a MCC if gallstones are the PDx, which payers hate. When fighting your denials, explicitly quote CC as saying “The cholecystectomy (surgical removal of the gallbladder) is treatment for both cholelithiasis/ cholecystitis and the obstruction of the pancreas caused by the gallstones” as well as Section II. B. of the Official Guidelines for Coding and Reporting. This does NOT replace CC, 2Q, 1996, pp 13-15. Take the payers to the mat on this one.
7. Hypertension WITH hypothyroidism is NOT hypertension DUE TO hypothyroidism.
8. If the Index labels “with” or “in” as nonessential modifiers alongside “due to”, the “with” or “in” ICD-10-CM Guideline does not apply.
   • For example,
     Anemia
     due to (in) (with)
     antineoplastic chemotherapy D64.81
     To get D64.81, the doctor has to link the chemotherapy as the cause of the anemia
9. If a thymus is removed as part of a cardiac procedure only to enhance access the heart, do NOT code the thymectomy. This supersedes CC, 3Q, 2014, pp 16-17.
10. NSTEMI d/t “Myocardial infarction with non-obstructive coronary arteries (MINOCA)” is coded as I21.4, (Type 1) NSTEMI. A MD would have to say “Type 2” to get I21.A1, Type 2 MI, for MINOCA.
11. “When excisional and non-excisional debridements are both performed at the same site and the nonexcisional debridement is deeper, report only the code for excisional debridement since this is the definitive procedure. The fact that the non-excisional debridement was performed at a deeper layer does not affect code assignment.”

I encourage you to read the Coding Clinic yourself, to discuss this with your peers, and to engage your compliance departments to assure that this official advice is followed.