This page addresses follow-up questions and additional information pertinent to our webinar
What’s New? Second Quarter 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:  Now that the Excludes1 note has been changed to an Excludes2 note, allowing a code from J43 to reported with a code from J44, when would a code from each category be assigned?
A:  Since emphysema is a type of COPD, if both conditions are documented, assign just a code from category J43 for emphysema since it is more specific. However, if the emphysema and COPD are both documented and the COPD is specified as an acute exacerbation, or a lower respiratory tract infection is present, assign codes from both categories. For example, a patient with emphysema and COPD with acute exacerbation should be reported with codes J44.1, Chronic obstructive pulmonary disease with (acute) exacerbation, and J43.9, Emphysema, unspecified.

Q:  Isn’t there an assumed link between conditions linked by the terms “with” or “in” in the alphabetic index and tabular list? Why isn’t there an assumed link between dementia and epilepsy since the index lists “Dementia; in; epilepsy?”
A:  Yes, there is. Guideline I.A.15., also known as the “with” convention states that if two conditions are documented using the terms with or in, there is an assumed relationship. However, in Second Quarter 2024 Coding Clinic they stated that the dementia can be due to the epilepsy or vice versa and documentation should clarify the underlying cause.

Q:  Why is code S43.43- used to report a Bankart lesion when the code indicates a superior tear and Bankart lesions are inferior tears?
A:  Per Coding Clinic, code S43.43- is correct for reporting a Bankart lesion because it is specific to a tear of the glenoid labrum. The other codes in subcategory S43.4 are specific to other parts of the shoulder joint, such as rotator cuff and coracoacromial ligament.

Q:  In Coding Clinic, 2nd Quarter 2024 page 18, they advised coding an ascending aorta and total aortic arch replacement using a frozen elephant trunk (FET) with placement of stent grafts into the left common carotid and left subclavian arteries. How is this procedure different than the codes for repair and replacement of the aortic arch using a branched synthetic substitute with intraluminal device as listed in tables X2R and X2V in the New Technology section?
A:  The Thoraflex hybrid device is a dual-purpose device that replaces the ascending aorta and arch while simultaneously repairing the descending aorta. In the case discussed in the Coding Clinic article, no repair of a descending aortic aneurysm was performed, and the device used GORE conformable thoracic stent graft. The Thoraflex device was not used. In the case presented in Coding Clinic, just the ascending aorta and aortic arch were replaced, but during the replacement, blood flow had to be restored to the left common carotid and left subclavian arteries, which supply blood to the left side of the brain and left arm. The placement of the stent grafts allows for this.

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