General Question for the Week of March 5, 2018

General Compliance Question of the Week

Question:

If a record only states “lupus” what would this condition map/code to? I am an auditor at work, and I am in a debate on how to code lupus not otherwise specified (NOS). I say this condition codes to L93.0 but a colleague suggests I am incorrect and that lupus should code/map to M32.9? Do you have any guidance on this particular condition?

Answer:

First, educate the providers that they must specify what type of lupus the patient has in the record.  There is no index entry for just Lupus or Lupus NOS. Code L93.0 is for lupus erythematosus NOS.  Code M32.9 is for SLE (systemic lupus erythematosus), unspecified. Neither code is the appropriate choice because you are making a choice of what type of lupus is being treated without supporting documentation.

That being said, Coding Clinic (4Q 2013 p. 125)  assumes that a history of lupus complicated by lupus nephritis to be SLE, as they advised that the coder assign M32.4 (glomerular disease in SLE) for the documentation of “history of lupus complicated by lupus nephritis.” Based on this Coding Clinic, it may be safe to assign M32.9 in the absence of any further documentation other than “lupus.”

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.