2020 Challenges…and a Happy New Year!

As we welcome in 2021 and say goodbye to 2020, we are still dealing with many issues of 2020.

Covid-19 and is it active infection or just a positive test without infection U07.1 vs Z86.19?  We know that the test can remain positive for several weeks after the infection.  What about sequela of the infection and infection not active?  Code first the sequela manifestation and then B94.8 Sequelae of other specified infectious and parasitic diseases.

How do we code ARDS when a patient presents with acute respiratory failure and develops ARDS during the stay?  We code ARDS J80 as POA Y per CC Q4 2020

Remember when we thought vaping disorders U07.0 was going to be the US epidemic of 2020?

GCS scores: where did they go?  They should only be coded in association with head trauma but can be used in other circumstances such as SOFA scoring for Sepsis 3 criteria.

Atrial fibrillation: This has been a challenge since 2019 with persistent atrial fib requiring having been present for more than 7 days or repeat pharmacologic or electrical cardioversion.  Long standing persistent a fib is persistent and continuous for more than one year.  The difficulty in supporting this has been difficult and this will continue into 2021.

2021 brings forth a new challenge with E&M coding in the office having different rules than hospital and other ambulatory settings.  The coding in the office will be dependent upon time or medical decision making and no longer dependent upon elements in the history or physical.  The important thing to remember is that the old rules still apply to other settings.  To get a brief overview, listen to our breakroom series from September 11, 2020 here.