Many HIM directors and coding managers say it takes all three to recruit high-quality, experienced medical record coders post-ICD-10. While coder shortages are nowhere near what they were in ICD-9, new challenges have emerged for HIM staffing.
The new ICD-10-CM codes for FY 2018, effective October 1, 2017, represent significant changes in some of our documentation and coding practices. Review the changes to the FY 2018 ICD-10-CM Official Guidelines for Coding and Reporting (the Guidelines), which must be embraced if our documentation, coding, and billing is to withstand compliance scrutiny from outside auditors and accountability agents.
Q: Our team had a recent case that involved a small midline episiotomy which extended to a second-degree laceration which was repaired with 3-0 vicryl rapide sutures. Would we code the episiotomy and repair or just the repair, and why? We are considering ICD-10-PCS code 0KQM0ZZ (Repair of the perineum muscle, open approach) and/or 0W8NXZZ (Division of the female perineum, external approach).