This page addresses follow-up questions and additional information pertinent to our webinar
Spring is in the Air: April 2024 ICD-10-CM Updates and Quarterly Coding Update.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q: In Coding Clinic, First Quarter 2024, a scenario advised assigning code I46.2, Cardiac arrest due to underlying condition since the patient was diagnosed with complete heart block. The scenario doesn’t specify that the complete heart block caused the cardiac arrest. Is this something that can be assumed?
A: There is no assumed link between complete heart block and cardiac arrest based on indexing. Remember that Coding Clinic reviews documentation when formulating their answers and they don’t always include all the details in the publication. We do recommend making sure the link is documented before assigning the code for cardiac arrest due to an underlying cause.

Q: If a patient presents with a ureteral stone and has hydronephrosis and infection, are all conditions reported with a single code?
A: Yes. Assign code N13.6, Pyonephrosis, per the ICD-10-CM index. Whether you look under hydronephrosis, urinary calculi, or infection as your main term, because of the subterm “with,” there is an assumed link between these three conditions, which are reported with the single combination code N13.6, Pyonephrosis. Another way to look at this is that urinary calculi lead to obstruction, which leads to a hydronephrosis, which can infect the kidneys and cause pus formation (pyonephrosis).

Q: Can you address the addition of the words “clinically significant” to guideline section III. for reporting additional diagnoses? How does the inclusion of this term change the intent of the guideline?
A: This changed guideline has been reviewed by our entire staff of coding auditors and educators. We do not believe the addition of the words “clinically significant” changes the intent of the coding guideline, as outlined in our Best Practice document, which is part of our compliance plan (accessible at: https://www.thehaugengroup.com/haugen-best-practice-clinically-significant-secondary-diagnoses/). In that document, we point out that this guideline was changed to match the corresponding newborn guideline, which already included the “clinically significant” terminology. We also point out that the guideline defines “clinically significant” as conditions that impact patient care in terms of requiring clinical evaluation, therapeutic treatment, diagnostic procedures, extended length of stay, or increased nursing care and/or monitoring. We interpret the guidelines to say that by virtue of meeting one of those criteria, a condition is clinically significant.

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