This page addresses follow-up questions and additional information pertinent to our webinar
CM Countdown to October 1.
** 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:  If a patient presents in sickle cell crisis with dactylitis, is a crisis code assigned in addition to the code for the dactylitis?
A:  No. The title of the subcategories that include the dactylitis codes include the terminology of “crisis,” so no additional code is necessary to show that the patient was in sickle cell crisis.

Q:  For new code E88.A, the word “syndrome” is in parentheses. Is this a nonessential modifier or does the provider have to document “wasting disease syndrome” in order to assign this code?
A:  In the code description for code E88.A, Wasting disease (syndrome) due to underlying condition, the term “syndrome” is a nonessential modifier. According to guideline I.A.7., parentheses are used in the Alphabetic Index to Diseases and Tabular List to enclose supplementary words that may be present or absent in the diagnostic statement. Assign code E88.A when wasting disease is documented with or without the term “syndrome.”

Q:  How do the new OB codes for intrahepatic cholestasis affect Coding Clinic advice from first quarter 2023?
A:  In first quarter 2023, Coding Clinic advised to assign several codes to report intrahepatic cholestasis of pregnancy: O26.62 for liver and biliary tract disorders in childbirth; E78.79 for other disorders of bile acid and cholesterol metabolism, and K76.89, Other specified diseases of the liver. It’s important to note that with the addition of the new codes for intrahepatic cholestasis of pregnancy, a single code from subcategory O26.64 is assigned to capture the condition, rendering the Coding Clinic article obsolete.

Q:  According to Coding Clinic, 4Q 2018, page 87, only the code referenced in the Excludes1 note is assigned. For the new migraine codes, there are Excludes1 notes for subcategories G43.1 and G43.E that exclude each other. Which code should be assigned?
A:  Assign a code from category G43.E when migraine with aura is specified as chronic. Code G43.1 is used when chronicity is not documented.

Looking for additional information on this topic?

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Kristi Pollard, RHIT, CCS, CPC, CIRCC, AHIMA-Approved ICD-10-CM/PCS Trainer

Director of Coding Quality & Education

Kristi is the Director of Coding Quality & Education with more than 25 years of industry experience; she is responsible for the development of web-based, instructor-led, and webinar training materials; conducting training in ICD-10-CM/PCS and CPT; and performing DRG and APC audits. Kristi has an extensive background in coding education and consulting and is a national speaker and published writer on topics related to ICD-10 and CPT coding and code-based reimbursement. She has designed and developed training programs for inpatient and outpatient hospital-based coding, with a focus on vascular interventional radiology, interventional cardiology, orthopedics, and obstetrics.


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