icd-9-cm to icd-10-cm prep presented by: khaleelah wagner, rhia staci lepage, rhit

ICD-9-CM to ICD-10-CM Prep

PRESENTED BY: Khaleelah Wagner, RHIA Staci LePage, RHIT

ICD-9 TO ICD-10 PREP 01-13-15

Objectives

Participants will: ● Correctly assign diagnoses to ICD-9-CM codes● Correctly identify primary/secondary diagnoses ● Identify correct sequence of diagnoses for coding assignment ● Identify documentation needed for ICD-10-CM coding

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ICD-9 and ICD-10 History

The 9th revision was published in 1977. The U.S. National Center for Health Statistics (NCHS) and CMS are responsible for maintaining ICD-9-CM.

The World Health Organization (WHO) adopted ICD-10 (International Classification of Diseases, Tenth Revision) in 1990 and it came into use in 1994 by other countries.

The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) was developed under the oversight of National Center for Health Statistics in 1997 and has undergone several modifications since then.

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ICD-9 TO ICD-10 PREP 01-13-15 4

2014 ICD-9-CM and ICD-10-CM Availability

http://www.cdc.gov/nchs/icd/icd9cm.htm

http://www.cdc.gov/nchs/icd/icd10cm.htm or http://www.cms.hhs.gov/ICD10● 2014 ICD-10-CM Index to Diseases and Injuries● 2014 ICD-10-CM Tabular List of Diseases and Injuries

o Instructional Notations

● 2014 Official Guidelines for Coding and Reporting ● 2014 Table of Drugs and Chemicals● 2014 Neoplasm Table ● 2014 Mapping ICD-9-CM to ICD-10-CM and

ICD-10-CM to ICD-9-CM”



http://www.cms.hhs.gov/ICD10

ICD-9 TO ICD-10 PREP 01-13-15 5

ICD-9-CM and ICD-10-CM Coding Guidelines

The guidelines are approved by four organizations:● American Hospital Association (AHA)● American Health Information Management Association

(AHIMA)● Centers for Medicare and Medicaid Services (CMS), and● National Center for Health Statistics (NCHS)

ICD-9 TO ICD-10 PREP 01-13-15 6

Coding to Support Need for Medicare

The principal diagnosis and top 8 secondary diagnoses are entered onto the UB-04.

Accurate reporting of ICD-9 CM codes effect:● Medicare billing● Quality measures● Data collected● Overall accuracy of MDS/RUG categories

The main benefit of correct coding is validation of service delivered and reduced compliance risk.

The industry is using more checks and balances to reject claims and review for fraud and abuse.

Inaccurate codes will lead to rejection of claims and services.


Coding Conventionsand Guidelines

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Coding from ICD-9-CM to ICD-10-CMICD-9-CM ICD-10-CM

Three to five characters Three to seven characters

First digit is numeric but can be alpha (E or V)

First character always alpha

2–5 are numeric All letters used except U

Always at least three digits Character 2 always numeric: 3–7 can be alpha or numeric

Decimal placed after the first three characters (or with E codes, placed after the first four characters)

Always at least three digits

Alpha characters are not case-sensitive Decimal placed after the first three characters

Alpha characters are not case-sensitive

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Alphabetic Index -2

Main terms in boldface font are listed in alphabetic order. Then, indented beneath the main term, any applicable subterm or essential modifier will be shown in alphabetical order. The indented subterm is always read in combination with the main term.

Pneumonia 486 [J18.9]

aspiration 507.0 [J69.0]

due to food

507.0 [J69.0]

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Alphabetic Index -3

Nonessential modifiers appear in parentheses ( ) and do not affect the code number assigned.

The “-” at end of an index entry indicates that additional characters are required (ICD-10)

Amblyopia (congenital) (ex anopsia) (partial) (suppression) 368.00 [H53.00-]

deprivation 368.02 [H53.01-]

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Alphabetic Index -4

Manifestation codes are included in the alphabetic index by including a second code, shown in brackets [ ] directly after the underlying or etiology code which should always be reported first.

Chorioretinitis – see also inflammation chorioretinal

Tuberculosis 017.3 [363.13]

[A18.53]

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ICD-9 TO ICD-10 PREP 01-13-15 12

Tabular List

Most but not all categories are subdivided into four or five character subcategories, e.g. (496 [J44.9] COPD or 401.9 [I10] – Hypertension)

The fourth character when placed after the decimal point of:● 8 - (.8) is used to indicate “other specified”, and● 9 - (.9) is usually reserved for “unspecified”

365.89 Other specified glaucoma 365.9 Unspecified glaucomaK52.89 Other specified noninfective gastroenteritis and colitisK52.9 Noninfective gastroenteritis and colitis, unspecified


Tabular List -4

(NEC) – “not elsewhere classified”

(NOS) – “not otherwise specified”

Both NEC and NOS have their own codes

Five and six character codes provider greater specificity or more information about the condition

Codes must be assigned to the highest number of characters available or to the highest level of specificity, or bills will be rejected

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Coding Convention Abbreviations

Not Elsewhere Classified “NEC” – A residual category, subdivision, or subclassification that provides a location for “other” types of specified conditions that have not been classified anywhere else in the code set. These residual codes may also contain the term “NEC” as part of their descriptor.

276.9 Electrolyte and fluid disorders, not elsewhere classified

E87.8 Other Disorder of electrolyte and fluid balance, not elsewhere classified

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Tabular List Notes

Pertinent coding information is located at the beginning of chapters or any subdivisions that follow and apply to all the categories within it.

Beginning of the chapter – 780-799 or R00-R99 Beginning of a subchapter – 235-238 or D37-D48

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Coding Convention Abbreviations -2

Not Otherwise Specified “NOS” - for use when the documentation of the condition identified by the provider is insufficient to assign a more specific code.

294.20 Unspecified dementia without behavioral disturbance or Dementia, NOS

F03.90 Unspecified dementia without behavioral disturbance – Dementia, NOS

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Coding Conventions Punctuation

( ) Parentheses – supplemental words that may or may not be present.

[ ] - Brackets – synonyms, alternative wordings or explanatory phrases.

401.9 Hypertension (essential) (primary)I10 – Essential (primary) hypertension

814.02 Fracture of lunate [semilunar]S62.12 Fracture of lunate [semilunar]

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Coding Conventions Punctuation -2

Colon ( : ) – used after an incomplete term which needs one or more of the modifiers following the colon. Used in both “includes” and “excludes” notes in which the words that precede the colon are not considered complete terms and therefore must be appended by one of the modifiers indented under the statement.

359.6 Symptomatic inflammatory myopathy in diseases classified elsewhereCode first underlying disease, as:

malignant neoplasm (140.0-208.9)rheumatoid arthritis (714.0)

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Coding Conventions Punctuation -3

Dashes ( - ) in the Alphabetic Index, dashes at the end of a code indicates an incomplete code *ICD-10 only

In the Tabular List, a dash preceded by a decimal point (.-) indicates an incomplete code *ICD-10 only

J43 EmphysemaExcludes 1: emphysematous (obstructive) bronchitis (J44.-)

Fracture, pathological ankle M84.47- carpus M84.44-

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Coding Convention Instructional Notes

Includes notes – used to clarify the condition included within a particular chapter, section, category, subcategory or code. They are not exhaustive and may include diagnoses not listed in the inclusion note. The word “includes” is not preceded by the list of terms at the code level.

531 Gastric ulcer Includes: ulcer, stomach

K25 Gastric ulcerIncludes: stomach ulcer (peptic)

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Coding Convention Instructional Notes -2

Excludes – terms excluded from the code are to be coded elsewhere *ICD-9

Excludes 1 – not coded here. Used when two codes cannot occur together *ICD-10

355.9 Mononeuritis of unspecified siteExcludes:

Causalgia, upper/lower limb (355.71/354.4)G59 Mononeuropathy in disease classified elsewhere Excludes 1:

Diabetic mononeuropathy (E09 – E14 with .41)

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Excludes 2 – not included here. Used when the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time *ICD-10 only

J01 Acute SinusitisExcludes 1 – Sinusitis NOS (J32.9)Excludes 2 – Chronic Sinusitis (J32.0 – J32.8)

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ICD-9 TO ICD-10 PREP 01-13-15 23

Coding ConventionsCode First & Use Additional Code

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. The underlying condition is sequenced first followed by the manifestation. The “use additional code” note appears at the etiology and a “code first” note at the manifestation code.



331.0 Alzheimer’s diseaseUse additional code to identify…

294 Persistent mental disorders due to conditions classified elsewhere

Code first underlying condition

G30 Alzheimer’s disease Use additional code to identify:

dementia with behavioral disturbance (F02.81) dementia without behavioral disturbance (F02.80)F02 Dementia in other diseases classified elsewhere Code first the underlying physiological condition, such as: Alzheimer’s (G30.-)

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Coding ConventionsCross Reference Notes

Cross reference notes are used in the Alphabetic Index to advise the coding professional to look elsewhere before assigning a code. There are three terms used: see, see also, see condition

Hemorrhage, cranial – see Hemorrhage, intracranialLabyrinthitis (circumscribed) (destructive) (diffuse) (inner ear) (latent) (purulent) (suppurative)– see also subcategory H83.0 Hematoma (traumatic) (skin surface intact) (see also Contusion)

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Coding ConventionsRelational Terms

And – should be interpreted to mean “and/or” when it appears in the code title within the Tabular List.

451 Phlebitis and thrombophlebitisI80 Phlebitis and thrombophlebitis

453 Other venous embolism and thrombosisI82 Other venous embolism and thrombosis

ICD-9 TO ICD-10 PREP 01-13-15 27

Coding ConventionsRelational Terms -2

With – should be interpreted to mean “associated with” or “due to” when it appears in the code title, the Alphabetical Index, or an instructional note in the Tabular List. The term “with” in the Alphabetical Index is sequenced immediately following the main term, not in alphabetical order.

Asthma, asthmatic with chronic obstructive pulmonary disease 493.2/J44.9493.2 Chronic obstructive asthmaJ44 Other chronic obstructive pulmonary disease Includes asthma with COPD

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General Coding GuidelinesSigns and Symptoms

Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider

Chapter 16 of ICD-9-CM contains many, but not all codes for symptoms

Chapter R00 – R99, for ICD-10-CM, Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified contains many, but not all codes for symptoms

ICD-9 TO ICD-10 PREP 01-13-15 29

General Coding GuidelinesIntegral Part of a Disease

Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

Examples:Altered Mental Status due to UTI -599.0/N39.0COPD with Shortness of Breath -496/J44.9

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General Coding GuidelinesNot an Integral Part of Disease -2

Signs and symptoms that may not be associated routinely with a disease process should be coded when present.

Resident has a culture that returned difficile. The resident has diarrhea with additional symptoms of malaise, low-grade fever and frequent diarrhea. The resident was started on Flagyl. The resident is weak, dehydrated, and needs IV fluids.

Infection, Clostridium, difficile, food borne (disease) 008.45/A04.7 Dehydration 276.51/E86.0


General Coding GuidelinesMultiple Coding

In addition to the etiology/manifestation convention that requires two codes, there are other single conditions that also require more than one code. See “Use additional code” notes in the Tabular List at the code level. These are sequenced secondary to the condition code.

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General Coding GuidelinesMultiple Coding -2

“Code first” notes are under certain codes that are not specifically manifestation codes but may be due to an underlying cause. When there is a “code first” note and an underlying condition is present, the underlying condition is sequenced first.

“Code if applicable, any causal condition” notes indicate that this code may be assigned as a principal diagnosis when the causal condition is unknown or not applicable.

If the causal condition is known, then the code for that condition should be sequenced as the principal diagnosis or first-listed diagnosis.

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General Coding GuidelinesMultiple Coding Example

Multiple codes may be needed for sequela conditions. See Guideline #10.

E. coli urinary tract infection

Infection, Urinary (tract) 599.0/N39.0 Use additional code to identify infectious organism/agentInfection, bacterial, Escherichia coli [E. coli] (see also Escherichia coli) 041.04/B96.20

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ICD-9 TO ICD-10 PREP 01-13-15 34

General Coding GuidelinesAcute and Chronic Conditions

If the same condition is described as both acute (subacute) and chronic and separate subentries exist in the Alphabetic Index at the same indention level, code both and sequence the acute (subacute) code first

Acute and chronic bronchitisBronchitis, acute or subacute (with bronchospasm or obstruction) 466.0/J20.9Bronchitis, chronic 491.9/J42

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General Coding GuidelinesCombination Code

A combination code is a single code used to classify:● Two diagnoses, or● A diagnosis with an associated secondary manifestation Type 2 diabetes with other specified complication 250.80/E11.69o Use additional code to identify complication

A diagnosis with an associated complication o Acute Bronchitis with COPD 491.22/J44.0


General Coding Guidelines Combination Code -2

Assign only the combination code that fully identifies the diagnostic conditions involved or when directed by the Alphabetical Index

Multiple coding should not be used when the classification provides a combination code that clearly identifies all the elements documented in the diagnosis

When a combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code

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General Coding GuidelinesLate Effects/Sequela

“A residual effect (condition produced) after the acute phase of an illness or injury has terminated.”

There is no time limit for the late effect or sequela code

The residual may be apparent early or years later

Generally requires two codes:● The condition or nature of the late effect/sequela – first

o 438.5/I69.16 Other paralytic syndrome following intracerebral hemorrhage

● The late effect/sequela code – secondo 344.00/G82.5- Quadriplegia

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General Coding GuidelinesSequela

Exceptions to above guideline.● In instances where the code for the late effect/sequela is

followed by a manifestation code identified in the Tabular List and title, or the late effect/sequela code has been to include the manifestation.

Example: 438/I69 Late Effects/Sequela of Cerebrovascular Disease

● The code for the acute phase of an illness or injury that led to the late effect/sequela is never used with a code for the late effect.

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General Coding GuidelinesReporting Same Dx More than Once

Each unique code may be reported only once for an encounter

This applies to bilateral conditions when there are no distinct codes for laterality or two different conditions classified to the same ICD-9-CM or ICD-10-CM diagnosis code

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General Coding GuidelinesLaterality *ICD-10 only

Laterality Guidelines● For bilateral sites, the final character of the codes indicates

laterality.● An unspecified site code is also provided should the side not be

identified in the medical record.● If no bilateral code is provided and the condition is bilateral,

assign separate codes for both the left and right side

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General Coding GuidelinesDocumentation of BMI and Pressure Ulcer Stages

Body Mass Index (BMI) and pressure ulcer stage codes may be based on the medical record documentation from clinicians who are not the patient’s provider, such as a dietician for BMI or licensed nurse for pressure ulcer staging.

Associated conditions (overweight, obesity, or pressure ulcer) must be documented by the patient’s provider. If there is conflicting medical record documentation, either from the same clinician or different clinicians, the patient’s attending provider should be queried for clarification.

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General Coding GuidelinesSyndromes

Follow the Alphabetical Index for guidance when coding syndromes

If there is no guidance in the Alphabetical Index assign codes for the documented manifestations of the syndrome

Look for the syndrome by its name in the alphabetical index first and then if not there, under syndrome

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Coding GuidelinesComplications

“Code assignment is based on the provider's documentation of the relationship between the condition and the care or procedure.”

The guideline extends to any complications of care, regardless of the chapter the code is located in.

Note: not all conditions that occur during or following medical care or surgery are classified as complications.

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Coding GuidelinesComplications -2

There must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a complication. If the complication is not clearly documented, query the provider for clarification.

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Principal Diagnosis

Uniform Hospital Discharge Data Set/UHDDS Definition:

“The condition established after study to be chiefly responsible for occasioning the admission of the resident to the facility”

Two or more diagnoses equally meet the definition for principal diagnosis

Uncertain diagnoses – probable, suspected, possible…are NOT coded

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Other Additional or Secondary Diagnoses

UHDDS defines other diagnoses as “all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or the length of stay. Diagnoses that relate to an earlier episode which have no bearing on the current stay are to be excluded”

For purposes of the UB04, secondary diagnoses include the 2nd listed code thru the 9th listed code

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INFECTIOUS AND PARASITIC DISEASES

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HIV Infections Code Only Confirmed Cases

Code only confirmed cases of HIV

“Confirmation” does not require documentation of positive serology, the provider’s diagnostic statement that the patient is HIV positive is sufficient

Asymptomatic HIV is to be applied when the patient without documentation of symptoms is listed as being “HIV Positive”. Do not use this code if the terms AIDS is used or if the patient is treated for any HIV-related illness.

If resident is admitted for an HIV-related condition, principal diagnosis should be 042 followed by add’l codes for all reported HIV-related conditions *higher Medicare payment

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Infectious Agents

Certain infections are classified in chapters other than Chapter 1 and no organism is identified as part of the infection code

An additional code from Chapter 1 should be used to identify the organism:● 041/B95 Streptococcus, Staphylococcus, and Enterococcus● 041.8/B96, Other bacterial agents● 079/B97 Viral agents

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Infectious Agents -2

An instructional note will be found at the infection code advising that an additional organism code is required

Use an additional code to identify infectious agent

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Examples

UTI with hematuria due to E.coli● 599.0, 599.70 UTI,

hematuria, orN30.91, Cystitis unspecified with hematuria

● 041.4 Escherichia coli, orB96.2, Escherichia coli [E. coli] as the cause of diseases classified elsewhere

Pneumonia due to streptococcus group B with sepsis● 482.32, or

J15.3, Pneumonia due to streptococcus, group B

● 995.91, orA41.9 Sepsis, unspecified organism Septicemia NOS

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Infections Resistant to Antibiotics

Infections Resistant to Antibiotics● Identify all infections documented as antibiotic resistant

Assign code V09.9-/Z16● Infection with drug-resistant microorganisms following the

infection code

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Septicemia, SIRS, Sepsis, Severe Sepsis, and Septic Shock

Septicemia and sepsis are often used interchangeably, but they are NOT considered synonymous terms.● Septicemia refers to a systemic disease associated with the

presence of toxins in the blood● Systemic inflammatory response syndrome/SIRS refers to

the systemic response to infection with symptoms of fever, tachycardia, tachypnea and leukocytosis

● Sepsis refers to SIRS d/t infection● Severe sepsis refers to sepsis with associated acute organ

dysfunction● Septic shock refers to circulatory failure associated w/severe

sepsis

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Coding of SIRS, Sepsis and Severe Sepsis for ICD-9-CM

Requires a minimum of 2 codes:● A code for the underlying cause (such as infection; if

unspecified septicemia, code 038.9) *sequence first● And a code from subcategory 995.9- *sequence second

Severe sepsis requires an additional code for the associated acute organ dysfunction

Either the term sepsis or SIRS must be documented to assign a code from subcategory 995.9-

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Urosepsis Guidelines

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Sepsis documentation to look for…Or query MD for…

Streptococcal sepsis 995.91, 041.00 [A40.9]

Sepsis d/t Staphylococcus aureus 995.91, 041.11 [A41.01]

Sepsis d/t other Gram-negative organisms 995.91, 041.85 [A41.5]

Severe sepsis 995.92 [R65.20]

Sepsis d/t MRSA 995.91, 041.12 [A41.02]

Sepsis d/t MSSA 995.91, 041.11 [A41.01]

d/t joint prosthesis (complication) 996.66, V43.6- [T84.5-]

d/t indwelling catheter (complication) 996.64 [T83.51]

Other organism??

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Severe Sepsis Coding Example

ICD-9-CM

• Severe sepsis due to hemophilus influenza with septic shock and acute renal failure

• 038.41 (Hemophilus influenza septicemia)

• 995.92 (Severe sepsis)• 785.52 (Septic shock)• 584.9 (Acute renal failure)

ICD-10-CM

• Severe sepsis due to hemophilus influenza with septic shock and acute renal failure

• A41.3 (Hemophilus influenza sepsis)

• R65.21 (Severe sepsis with septic shock)

• N17.9 (Acute renal failure)

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Coding Note: In ICD-9-CM, when coding an infection due

to an indwelling urinary catheter, the coding

professional is instructed to use an additional code to

identify the infection (besides coding the complication

996.31). Additionally, if the infectious agent is also known, this should be

assigned as an additional diagnosis.

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Methicillin Resistant Staphylococcus Aureus (MRSA) Conditions

Selection and sequencing of MRSA codes● (a) Combination codes for MRSA infection – when an infection

due to MRSA has a combination code that includes the causal organism (e.g. sepsis, pneumonia) assign the appropriate combination code for the condition o Do not code 041.12/B95.62 MRSA infection as the cause of diseases

elsewhere or V09.0/Z16.11 Resistance to penicillin as additional codes

● (b) Other codes for MRSA infection – when there is a current infection and that infection does not have a combination code that includes the causal organism, assign the appropriate code to identify the condition along with code 041.12/B95.62o Do not use V09.0/Z16.11 Resistance to penicillin

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Methicillin Resistant Staphylococcus Aureus (MRSA) Conditions -2

Other codes for MRSA infection● c) Methicillin susceptible Staphylococcus aureus (MSSA) and

MRSA colonization- means that MSSA or MSRA is present on or in the body without necessarily causing illnesso Assign code V02.54/Z22.322 Carrier or suspected carrier of MRSA, or

V02.53/Z22.321 Carrier or suspected carrier of MSSA

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Neoplasms

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General Neoplasm Guidelines

The Neoplasm Table in the Alphabetic Index should be referenced first. However, if the histological term is documented, that term should be referenced first, rather than going immediately to the Neoplasm Table, in order to determine which column in the Neoplasm Table is appropriate.

Example: Epidermoid, in situ, Bowen’s type

see Neoplasm, skin, in situ

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Neoplasm Table

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Neoplasm Table -2

Malignant – Primary● Original site of cancer● 2 primary sites may be coded, if indicated● Alphabetic Instructions will indicate if malignant● Primary site unknown or unspecified

o Use 199.1/C80.1, Malignant (primary) neoplasm, unspecified

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Neoplasm Table -3

Malignant – Secondary● The site where the cancer spreads to (metastasizes)● Primary cancer that spreads to a secondary site may be stated

as:o Primary site with metastasis to secondary siteo Secondary site with metastasis from primary siteo Secondary site due to metastatic primary site

● If secondary site unknown - use 199.1/C79.9, secondary malignant neoplasm of unspecified site

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Neoplasm Table -4

Ca in situ● Atypical malignancy; encapsulated – has not spread● Physician must indicate “in situ” or index will instruct you to

code this type

Benign● Not malignant● Does not metastasize

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Neoplasm Table -5

Uncertain ● Alphabetic index will instruct to use this type if appropriate –

See neoplasm, by site, uncertain behavior● Not used if it is the coder that is uncertain of the behavior

Unspecified Behavior● Not specified as malignant or benign● Index instructions will direct here as appropriate – See

neoplasm, by site, unspecified behavior

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Current vs. History of

Neoplasm is coded as a current condition if

being actively treated

• Diagnosed but no treatment administered

• Has been removed surgically but treatment is still being administered

(for example, chemotherapy/radiation)

Neoplasm is coded as a “history of” if

• Site has ben surgically removed and/or treatment has been completed AND

• There is no mention of recurrence

• Use V10/Z85 category to indicate a personal history of neoplasm

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Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism

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Anemia Defined

A condition in which your blood has a reduced number of circulating red blood cells usually defined as an abnormally low hemoglobin or hematocrit level.

Caused by:● Disease (malignancy, kidney failure, immunity)● Blood loss● Decreased blood formation or destruction of cells● Nutritional Deficiency● Drug induced

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Anemia -2

Specified type● General = unspecified● Acquired hemolytic *caused by high rates of red blood cell

destruction● Chronic blood loss *such as chronic posthemorrhagic anemia● Iron *fewer red blood cells made or red blood cells that are too

small ● Nutritional *such as simple chronic anemia● In chronic diseases *such as neoplastic disease, CKD,

hypothyroidism

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Anemia, Due to

280.0/D50.0 – Iron deficiency secondary to blood loss (chronic blood loss)

280.9/D50.9 – Iron deficiency Anemia

281.1/D51.0 – Vitamin B12 deficiency anemia

281.4/D53.0 – Protein deficiency anemia

285.1/D62 – Acute blood loss

285.21/D63.1 – Anemia in chronic kidney disease

285.22/D63.8 – Anemia in neoplastic disease

285.3/D64.81 – Anemia due to antineoplastic chemotherapy

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ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES


Diabetes Combination Codes

Documentation needs to include type of diabetes● Type I● Type II● Secondary● Other specified

Is there a body system affected:● Kidney ● Ophthalmic● Neurological● Circulatory● Other specified (diabetic ulcer, etc.)

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Diabetes Combination Codes -2

What is the specific complication affecting the system(s)?

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DIABETES

TYPE I

DIABETES

TYPE II

What’s the difference?

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Diabetes TypesAge Not Sole Factor Determining Type

Diabetes, Type I

•Cause: Absent or insufficient insulin production•10% of diabetics•Usually juvenile onset•Does not respond to oral anti-glycemic agents•Always requires insulin

Diabetes, Type II

•Cause: Improper utilization of insulin•90% adult onset (age 40>, but being seen more in younger population)•Responds to oral anti-glycemic agents•May require insulin

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Secondary Diabetes – ICD-9 Code 249.-

Due to another underlying condition● Cystic Fibrosis● Malignant Neoplasm of Pancreas● Pancreatectomy

Drug or chemical induced● Adverse effect of drug● Poisoning*Follow coding directions at the beginning of each category!

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Diabetes Type Not Documented?

Default = Type II DiabetesDEFAULT

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Q: Do I always use an additional code for

long term use of insulin when ordered?

A: No

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Diabetes and Long Term Use of Insulin – V58.67/Z79.4

Type I: Do NOT code long term use of insulin

Type II: Code long term use of insulin

Secondary to underlying condition: Code use of insulin

Drug/Chemical induced: Code use of insulin

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Obesity

Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person's weight is greater than what's considered healthy for his or her height.

Type of obesity● Morbid/severe 278.01/E66.01● Due to excess calories E66.09● Drug-induced obesity E66.1

Vs. Overweight (code for this too) 278.02/E66.3

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Gout

Gout is a kind of arthritis. It can cause an attack of sudden burning pain, stiffness, and swelling in a joint, usually a big toe.

Types: acute, chronic or secondary *ICD-10 only● Idiopathic M1A.0-● Lead-induced gout 984.-/M10.1-● Drug-induced gout M10.2-● Due to renal impairment 274.1-/M10.3-● Other secondary gout M10.4-

Specify joint site/laterality *ICD-10 only

(shoulder, elbow, wrist, hand, hip, knee, ankle/ft)

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Dehydration

The excessive loss of body water with an accompanying disruption of metabolic processes

Note: make sure this is a current condition that is being actively treated upon admission to your facility, otherwise do NOT code

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Hypothyroidism

Often called underactive thyroid, it is a common endocrine disorder in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as tiredness, poor ability to tolerate cold, and weight gain

Acquired 244/E03.9 or congenital 243/E03.1?

Due to:● Iodine deficiency 244.2/E01.8● Post-irradiation therapy 244.1/E89.0● Post-surgery 244.0/E89.0● Other specified 244.8/E03.8

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Hypercholesterolemia

Hypercholesterolemia is the presence of high levels of cholesterol in the blood. It is a form of “hyperlipidemia" (elevated levels of lipids in the blood) and "hyperlipoproteinemia" (elevated levels of lipoproteins in the blood) 272.0/E78.0

Does documentation show:● With hyperglyceridemia 272.1/E78.2 (an elevated

concentration of glycerides in the blood), or● With dietary counseling (use additional code) Z71.3

*ICD-10 only

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Hyperlipidemia

Abnormally elevated levels of any or all lipids and/or lipoproteins in the blood. It is the most common form of dyslipidemia (which includes any abnormal lipid levels).

Specified type:● Combined (also known as "Multiple-type

hyperlipoproteinemia” ) 272.2/E78.2o Familial combined hyperlipidemia 272.0/E78.4

● Group o A (272.0/E78.0), B (272.1/E78.1), C (272.2/E78.2) or D (272.3/E78.3)

● Mixed 272.2/E78.2● Other specified type 272.4/E78.5● Lipoprotein deficiency 272.5/E78.0

87


Mental and Behavioral Disorders

88


Dementia

Specific type● Vascular/multi-infarct *a result of infarction of the brain due to

vascular disease, including hypertensive cerebrovascular disease. Code 1st underlying condition (CVD, etc.) 290.40/F01.5-

● In diseases classified elsewhere code 1st underlying condition (Alzheimer’s, Parkinson’s, etc.) 294.1-/F02.8-

● Senile *separate code in ICD-9, but dementia unspecified in ICD-10 290.0/F03.9-

● Delirium superimposed on dementia/Sundowning 293.-/F05.● Unspecified 294.2-/F03.9-

89


Dementia -2

With or without behavioral disturbance● Aggressive, combative, violent behavior

Old code 294.8 *should NOT be using anymore, invalid for coding dementia, NOS

Additional code for wandering Z91.83 *ICD-10 only

If psychotherapeutic drugs given, check guidelines

90


Episodic Mood Disorders/Bipolar Disorder*also known as Manic-depressive Illness

ICD-10-CM changes:

Bipolar, F31, and Major depression, F32-33, have separate categories

Bipolar disorder, severe *with or without psychotic features

Major depression, severe *with or without psychotic features

91


Episodic Mood Disorders/Bipolar Disorder*also known as Manic-Depressive Illness -2

Specify type/subcategory


ICD-9 Single or Recurrent (296) •Manic •Depressed•Mixed •Other

ICD-10 (F31)•Hypomanic•Manic•Depressed•Mixed•In remission•Other

92


Major Depression

Has its own category in ICD-10 – F32-33

In ICD-10, Depression, NEC (coded as 311 in ICD-9) is coded to Major depressive disorder, single episode, unspecified F32.9

Specify type:● Major depressive disorder, single episode 296.2-/F32.-● Major depressive disorder, recurrent 296.3-/F33.-● Major depressive disorder, recurrent, in remission 296.3-/F33.4-

Specify intensity: mild, moderate or severe (5th digit)

If severe: with or without psychotic features


93


Schizophrenia

Specify type● Paranoid 295.3-/F20.0● Disorganized 295.1-/F20.1● Catatonic 295.2-/F20.2● Undifferentiated *atypical 295.9-/F20.3● Residual 295.6-/F20.5● Schizophreniform disorder 295.4-/F20.81● Schizotypal disorder *types like borderline, latent, etc. 295.5-/F21.● Schizoaffective disorder *types include bipolar or depressive

295.7-/F25.-● Other 295.8-/F20.89

In ICD-10, 5th digit of chronic, in remission, etc. is gone


94


Psychosis

If d/t a known mental disorder, code to that condition● Delusional disorder *includes paranoia, paranoid state

297.1/F22● Mood disorder w/psychotic symptoms 296.-/F39● Brief psychotic disorder *includes paranoid reaction 298.8/F23● Shared psychotic disorder *includes induced paranoid disorder

297.3/F24● Unspecified mental disorder d/t known physiological condition

*includes OBS, NOS; mental disorder NOS , *code 1st underlying physiological condition 306.-/F06.-

● Unspecified psychosis NOT d/t known physiological condition *includes Psychosis, NOS 298.9/F29

95


Psychosis -2

If d/t a known mental disorder, code to that condition (cont.)● Other psychotic disorder NOT d/t known physiological

condition *includes chronic hallucinatory psychosis F28● Mental disorder, NOS *includes mental illness, NOS 300.9/F99


96


Anxiety

Specify type● Panic disorder *includes panic attack, panic state 300.01/F41.0● Generalized anxiety disorder *includes anxiety reaction,

anxiety state 300.02/F41.1● Other mixed anxiety disorders *suffer from both anxiety and

depressive symptoms F41.3● Other specified anxiety disorders *includes anxiety depression

300.09/F41.8


97


Diseases of the Nervous System

98


Hemiplegia 342.-/G81.-

These codes are only to be used when the paralytic syndrome is specified w/o further specification, or is stated to be old but unspecified cause

This category is also for use in multiple coding to identify the specific type of hemiplegia resulting from any cause *flaccid, spastic or other

99


Hemiplegia -2

Should the affected side be documented, but not specified as dominant or non-dominant, and the classification system does not indicate a default, code selection is as follows: ● For ambidextrous (using both sides equally) patient, the default

should be dominant ● If the left side is affected, the default is non dominant● If the right side is affected, the default is dominant

*5th digit

100


Dementia with Parkinson’s Disease vs. Parkinsonism

Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells *code 332.0/G20, with dementia add 294.1-/F02.-

Parkinsonism shares symptoms found in Parkinson’s disease, from which it is named; but Parkinsonism is a symptom complex, and differs from Parkinson’s disease which is a progressive neurodegenerative illness*code 331.82/G31.83 *same as Lewy body dementia

101


Alzheimer’s Disease 331.0/G30.-*the most common form of dementia

Identify type *ICD-10 only● Alzheimer’s disease with early onset G30.0● Alzheimer’s disease with late onset G30.1● Other Alzheimer’s disease G30.8● Alzheimer’s disease, unspecified G30.9

Use additional code to identify:● Dementia w/behavioral disturbance 294.11/F02.81● Dementia w/o behavioral disturbance 294.10/F02.80● Delirium , if applicable 293.0/F05

*ICD-10 requires the use of both the Alzheimer and dementia codes

102


Seizure Disorder vs. Convulsions

Epilepsy/seizure disorder is a spectrum of brain disorders ranging from severe, life-threatening and disabling, to ones that are much more benign

Convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body

If seizures repeatedly continue after the underlying problem is treated, the condition is called epilepsy (resident is usually on a routine med for seizures)

103


Epilepsy, Recurrent Seizures and Migraines

The following terms are equivalent to

intractable: pharmacoresistent (pharmacologically resistant), treatment resistant, refractory

(medically), and poorly controlled.

104


Coding of Epilepsy

Identify if epilepsy, seizure disorder, or convulsion, NOS

345.- vs. 780.39 (G40.909 vs. R56.9)

Specify type● Intractable (poorly controlled)● Not intractable● With status epilepticus (a life-threatening condition in which

the brain is in a state of persistent seizure) *ICD-10 expanded category

● Without status epilepticus *ICD-10 expanded category

105


Neuropathy 355.9/G62.9 vs. Peripheral Neuropathy 356.9/G62.9

Specify type● Polyneuropathy in diseases classified elsewhere 357.-/G63

ICD-9

• In diabetes 250.6- + 357.2

• In malignant disease CA code + 357.3

ICD-10

• In diabetes, type 2 E11.42

• With neoplasmcode CA + G63

106


Diseases of the Eye and adnexa

107


Combination Codes & Laterality

ICD-9-CM

• Diabetic Retinopathy with Macular Degeneration needs three codes: 250.50, 362.01, 362.50

• Cystic Macular Degeneration 362.54

ICD-10-CM (combination codes)

• Diabetic Retinopathy with Macular Degeneration uses a combination code: E08.351

• Laterality:• Macular cyst, hole,

right eye H35.341

108


ICD-10 Glaucoma Coding Changes

Identify the type of glaucoma, the affected eye, and the glaucoma stage.

A 7th character is to be assigned to designate the stage of glaucoma: mild, moderate, severe, indeterminate, or unspecified

109


Coding Note for Glaucoma Use additional external cause code, if applicable, to identify the cause of the eye

condition

Glaucoma types:● Borderline glaucoma 365.0-/H40.0-● Open-angle glaucoma 365.1-/H40.1-● Primary angle-closure glaucoma 365.2-/H40.2● Corticosteroid-induced glaucoma 365.3-● Glaucoma asso w/congenital anomalies, dystrophies, and systemic syndromes

365.4-/H42*includes glaucoma d/t diabetes 250.50, 365.44

● Glaucoma associated with disorders of the lens 365.5-● Glaucoma associated with other ocular disorders 365.6-/H40.5-● Other specified forms of glaucoma 365.8-/H40.8-*ICD-10 – new categories: H40.3- Glaucoma secondary to eye trauma

H40.4- Glaucoma secondary to eye inflammationH40.6- Glaucoma secondary to drugs

*Where do you get this information from?

110


Cataract Terms 366.-/H25-26

ICD-10 CM uses the terms “age-related” cataract and “senile cataract” interchangeably.

There are also terms for “age-related”, “infantile & juvenile cataract”, “traumatic cataract”, “complicated cataract”, “drug-induced cataract”, and “secondary cataract”.

Within the age-related/senile category there are cortical, subcapsular, incipient, nuclear, and morgagnian cataracts.*Similar terminology to ICD-9

111


Blindness and Low Vision Coding Notes

Visual impairment refers to a functional limitation of the eye.

Visual disability indicates a limitation of the abilities of the individual.

For international reporting, WHO, defines blindness as profound impairment. This definition can apply to blindness of one eye or both eyes.

For determination of benefits in the USA, the definition of legal blindness as severe impairment is often used. This definition applies to blindness of the individual only.

369.-/H54.-

112


ICD-10 Terms for Blindness

In the case of blindness, the code H54 has a note: Code first any associated underlying cause of blindness.

Blindness codes include laterality.

Example: ● H54.52, which is low vision left eye, normal vision right eye.

113


Diseases of the Circulatory System

114

http://www.bartleby.com/107/illus490.html


Cardiac dysrhythmias

427.0/I47.1 Paroxysmal supraventricular tachycardia427.1/I47.2 Paroxysmal ventricular tachycardia427.2/I47.9 Paroxysmal tachycardia, unspecified427.3-/I48.- Atrial fibrillation and flutter

*ICD-10 Includes a code for chronic a-fib

427.4-/I49.0- Ventricular fibrillation and flutter427.5/I46.9 Cardiac arrest427.6-/I49.- Premature beats427.8-/I49.- Other specified cardiac dysrhythmias

● Sick sinus syndrome

115


Heart Failure

428.0/I50.9 Congestive heart failure, unspecified

428.1/I50.1 Left heart failure

428.2-/I50.2- Systolic heart failure **

428.3-/I50.3- Diastolic heart failure **

428.4-/I50.4- Combined systolic and diastolic heart failure **

Code, if applicable, heart failure d/t HTN 1st *if supporting MD documentation

**also need to know if acute, chronic or acute on chronic

116


Acute Myocardial Infarction (AMI)

Myocardial infarction or acute myocardial infarction (AMI) is the medical term for an event commonly known as a heart attack. It happens when blood stops flowing properly to part of the heart and the heart muscles are injured due to not receiving enough oxygen.

117


Acute Myocardial Infarction (AMI) -2

Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to a buildup of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden and serious

118


Acute MI – 410.-/I21.-

ICD-9 Coding: ST elevation (STEMI) or non-ST elevation

(NSTEMI)?

Occurred 8 weeks or less for acute MI/410.-

5th digit needed for acute MI/410.--● 2 = Subsequent episode of care *appropriate code

for SNF, if treated 1st at hospital

If MI > 8 wks old, code 412.

ICD-10 Coding:

I21 – Initial AMIs

I22 – Subsequent AMIs

Occurred 4 weeks/28 days or less for acute MI

119


Atherosclerotic Coronary Artery Disease and Angina

Atherosclerosis (hardening of the arteries) ● can slowly narrow and harden the arteries throughout the body● when atherosclerosis affects the arteries of the heart, it’s

referred to as coronary artery disease

Coronary artery disease is the No. 1 killer of Americans. Most of these deaths are from heart attacks, caused by sudden blood clots in the heart’s arteries.

120


Atherosclerotic Coronary Artery Disease and Angina

Atherosclerosis is a blood clot causing an acute coronary syndrome.

Two things can happen:● Unstable angina - the clot doesn't totally

block the blood vessel and then dissolves without causing a heart attack

● Myocardial infarction (heart attack) - the coronary artery is blocked by the cloto the heart muscle, starved for nutrients and

oxygen, dies

121


Coding Coronary Artery Disease/CAD

Should be coding to 414.00/I25.10, unless MD specifies otherwise

Differentiate between coding of coronary arteries 414/I25.- or of the extremities 440/I70.--

122


ICD-10 Coding of Arteriosclerosis of the Heart I25

4th digit ● Vessel: Native, bypass graft, autologous vein bypass graft, non-

autologous biological bypass graft, non-biological bypass graft

5th digit● Symptom: claudication, rest pain, ulcer and with gangrene.

6th digit● Extremities: right, left, bilateral, other, unspecified ● Site of leg: thigh, calf, ankle, heel, mid-foot, foot, other.

*ICD-10 will also have a combination code for CAD with angina I25.11

123


Cerebrovascular System

124


CVA Versus TIA

125

CVA

• Brain infarction or hemorrhage usually associated with permanent or temporary neurologic deficits; includes transient focal neurological deficits lasting longer than 24 hours

• Persistent neurological deficit >24 hours

• Positive image study (MRI/CT)

TIA

• A brief period of focal neurologic deficit lasting less than 24 hours (usually less than one hour) due to temporarily blocked blood flow to a specific area of the brain

• Symptoms resolve in 24 hours (usually < 1 hour)

• No infarction or hemorrhage• Negative MRI/CT


Coding Late Effects of Cerebrovascular Disease 438.-/I69.-

Once cerebrovascular disease/CVD has been treated at the hospital, just the late effects/sequelae are being treated, if any.

Category 438/I69.- is used to indicate conditions/residuals that have occurred any time after the onset of CVD.

Use a separate code for each residual effect.

Should NOT be using codes from 430-437/I60-I67 if the late effects are being treated.

If no residual/late effects should code V12.54/Z86.73

126


Hypertension

Hypertension, also referred to as high blood pressure, it is a condition in which the arteries have persistently elevated blood pressure. Every time the human heart beats, it pumps blood to the whole body through the arteries.

127


ICD-10 Hypertension Coding Changes

Type of hypertension (benign, malignant, unspecified) is not used as an axis for the ICD-10-CM hypertension codes, there is only one code for essential hypertension (I10)

128


Types of Hypertension

401/I10 Essential hypertension

402/I11 Hypertensive heart disease*MD must document causal relationship

403/I12 Hypertensive chronic kidney disease*implied relationship if both diagnoses documented, also need to code

CKD to indicate the stage 585.-

404/I13 Hypertensive heart and chronic kidney disease*if resident has all three diagnoses/AKA cardiorenal – MD must still

indicate heart dx and hypertension have causal relationship

405/I15 Secondary hypertension*is high blood pressure that's caused by another medical condition

129


Peripheral Vascular Disease

443.81/I73.9 Peripheral angiopathy in diseases classified elsewhere *code 1st underlying disease

443.9/I73.9 Peripheral/arterial/vascular disease

*ICD-10 will have a combo code for DM w/PVD

*Excludes atherosclerosis of the extremities

130


Venous Embolism and Thrombosis

453.40/I82.40- DVT, NOS coded to acute venous embolism and thrombosis of deep vessels of the lower extremity

453.41/I82.4Y- (acute), I82.5Y- (chronic) DVT of proximal lower extremity

453.42/I82.4Z- (acute), I82.5Z- (chronic) DVT of distal lower extremity

453.5-/I82.50- Chronic DVT *also code V58.61/Z70.01 for long term use of anticoagulants

*if vein specified, make sure you have the correct code

*make sure treatment is currently being given and is NOT for prophylactic measures (Coumadin tx)

*if no current treatment given, code V12.51/Z86.718 for hx of DVT

131


Diseases of the Respiratory System

National Cancer Institute

132


Asthma Terminology for ICD-10

Terminology used to describe asthma has been updated to reflect the current clinical classification of asthma

The following terms have been added to describe asthma:● Mild intermittent, and● Three degrees of persistent

o mild, moderate, severe

133


Asthma Symptoms – Coding for ICD-10 Stage 1: mild / J45.2- thru J45.3-

● Possible chronic cough and sputum production

Stage 2: moderate / J45.4-● Shortness of breath on exertion● Possible chronic cough and sputum production

Stage 3: Severe / J45.5-● Shortness of breath● Fatigue● Multiple exacerbations● Reduced exercise tolerance

Stage IV: Very severe / J45.5-● Respiratory failure ● Elevation of jugular venous pressure● Pitting ankle edema. 134


Current ICD-9 Coding for Asthma

493.0- Extrinsic asthma *or allergic asthma, is characterized by symptoms that are triggered by an allergic reaction

493.1- Intrinsic asthma *a nonseasonal, nonallergic form of asthma, which usually first occurs later in life than allergic asthma and tends to be chronic and persistent rather than episodic

493.2- Chronic obstructive asthma

*includes asthma w/COPD and chronic asthmatic bronchitis

5th digit for:● Status asthmaticus, and● Acute exacerbation

135


Pneumonia

Remember, if you know the organism code it!

Default code = 486/J18.9 Pneumonia, unspecified organism

480-/J12.9 Viral pneumonia

481/J13 Pneumococcal pneumonia (includes lobar)

482-/J15.9 Other bacterial pneumonia

483-/J15.8 Pneumonia d/t other specified organism

484-/* Pneumonia in infectious disease classified elsewhere

485/J18.0 Bronchopneumonia, organism unspecified

507.0/J69.0 Aspiration pneumonia d/t inhalation food/vomitus

*in ICD-10 no general code for “PNA in dx classified elsewhere” code to specific dx w/PNA

136


COPD – 496/J44.9

This code is not to be used with any code from categories 491.- 493. (bronchitis, emphysema, asthma) *ICD-9 only

COPD w/emphysema 492.8/J44.9

COPD w/bronchitis:● Acute 491.22/J44.0 ● Chronic 491.20/J42

COPD w/acute exacerbation 491.21/J44.1

137


Other Diseases of the Lung – 518.8-/J98.4 Acute respiratory failure 518.81/J96.0- -can develop quickly and may require emergency treatment and is usually treated in an intensive care unit Acute respiratory insufficiency 518.82/R06.89 -condition in which the lungs cannot take in sufficient oxygen or expel sufficient carbon dioxide to meet the needs of the cells of the body Chronic respiratory failure 518.83/J96.1 -develops more slowly and lasts longer. Chronic respiratory failure can be treated at home or at a long-term care center Acute and chronic respiratory failure 518.84/J96.2 -pt exhibits severe pulmonary impairment as a baseline characteristic which may require hospitalization and mechanical ventilation

138


Diseases of the Digestive System


139


Esophageal Reflux Disease

530.81/K21.9 Esophageal reflux/GERD● Includes acid reflux● Excludes reflux esophagitis 530.11/K21.0● Excludes hemorrhage d/t esophageal varices 456/I85.01

Reflux esophagitis 530.11/K21.0

140


Constipation

564.0-/K59.00 Constipation● Slow transit 564.01/K59.01 -there is a prolonged delay in the transit of stool through the colon● Outlet dysfunction 564.02/K59.02 -difficulty or inability to expel the stool● Other 564.09/K59.09 -atonic, neurogenic, spastic

Irritable bowel syndrome 564.1/K58.--sometimes alternating bouts of constipation and diarrhea*ICD-10 includes 5th digit with or without diarrhea

141


Gastrointestinal Hemorrhage

Hematemesis 578.0/K92.0

-vomiting of blood

*ICD-10 with ulcer, code by site under ulcer w/hemorrhage,

K27.4

Blood in stool 578.1/K92.1

-melena

Hemorrhage of GI tract, unspecified 578.9/K92.2

Excludes: that with mention of:● diverticulitis of lg and sm intestine 562.13/K57.9-,● diverticulosis of lg and sm intestine 562.12/K57.9-,● Gastritis 535.--/K29.71 and duodenitis 535.--/K29.81, and ● stomach ulcers 531.4/K25.4

142


Diseases of the Skin and SubcutaneousTissue


143


Cellulitis and Abscess

Face 682.0/L03.211

Neck 682.1/L03.221

Trunk 682.2/L03.319

Upper arm/forearm 682.3/L03.11- *code laterality

Hand, except fingers and thumb 682.4/L03.11-

Buttock 682.5/L03.317

Leg, except foot 682.6/L03.11- *code laterality

Foot, except toes 682.7/L03.11- *code laterality

Other specified sites 682.8/L03.818

Unspecified site 682.9/L03.90

Use additional code to identify organism

144


Chronic Ulcer of Skin

Pressure ulcer 707.0-/L89.---

(elbow, upper back, lower back, hip, buttock, ankle, heel, other)

*ICD-10 5th digit = site w/laterality, 6th digit = stage

Ulcer of lower limb, except pressure ulcer 707.1-/L98.4--

(lower limb, thigh, calf, ankle, heel and midfoot, other part of ft)

*code any causal condition first

Pressure ulcer stages (I-IV, unstageable) 707.2-/L89.---*must use this code after coding 707.0- in ICD-9

should NOT be using an “unspecified site” code 707.9

145

ICD-9 TO ICD-10 PREP 01-13-15 146

VISUAL GUIDE TO SOME FREQUENTLY SEEN SKIN PROBLEMS


Pressure Ulcer Stage I

147


Pressure Ulcer Stage II

148


Pressure Ulcer Stage III

149


Pressure Ulcer Stage IV

150


Suspected Deep Tissue Injury

151


Unstageable Pressure Ulcer

152


Diabetic Ulcer

153


Vascular Ulcers

154


Cellulitis

155


Diseases of the Musculoskeletal System and Connective Tissue

156


Arthropathy vs. Arthritis vs. Osteoarthritis

Arthropathy = disease of the joints

Arthritis = inflammation of the joints

Osteoarthritis = degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth

Arthritis is a form of Arthropathy

In ICD-9, Arthritis is coded 716.- and Osteoarthritis is coded 715.-

In ICD-10, Arthritis and Osteoarthritis will have the same unspecified code M19.90

157


Osteoarthritis/OA/DJD

Osteoarthritis, generalized 715.0-/M15.9

Osteoarthritis, localized, primary 715.1-/M19.91

Osteoarthritis, localized, secondary 715.2-/M19.93

Osteoarthritis, localized, not specified whether primary or secondary 715.3-/M19.90

Osteoarthritis involving, or with mention of more than one site/polyosteoarthritis 715.8-/M15.-

Osteoarthritis, unspecified whether generalized or localized 715.9-/M19.90

158


5th digits for Osteoarthritis

0 – site unspecified

1 – shoulder region

2 – upper arm *use for elbow

3 – forearm *use for wrist

4 – hand

5 – pelvic region and thigh *use for hip

6 – lower leg *use for knee

7 – ankle and foot

8 – other specified sites

9 – multiple sites

*ICD-10 will only list joint sites and will also need laterality

159


Other Derangement of Joint Loose body in joint 718.1-/M24.0--

*Loose bodies are fragments of bone and/or cartilage

that freely float in the joint space

Recurrent dislocation of joint 718.3-/injury code depends on site for ICD-10

Contracture of joint 718.4-/M24.5--

*a permanent shortening of a joint

Ankylosis of joint 718.5-/M24.6--

*stiffness of a joint due to abnormal adhesion and rigidity of the

bones of the joint, which may be the result of injury or disease

Other joint derangement, NEC 718.8-/M24.8--

*instability of joint

160


Osteoporosis

Osteoporosis, unspecified 733.00/M81.0

Senile osteoporosis 733.01/M81.0

*a geriatric syndrome with a particular pathophysiology

Disuse osteoporosis 733.03/M81.8

*bone loss that results from not enough stress or pressure

on the bones. Bones become brittle and weak, causing

them to fracture easily.

In ICD-10, will code osteoporosis with or without current pathologic fracture

Use additional code to identify personal hx of pathologic fracture V13.51/Z87.311

161


Pathologic Fracture Terms

Spontaneous fracture● Occurs in seemingly normal bones with no apparent blunt-force

trauma

Fragility fracture● Sustained with trauma no more than a fall from a standing

height or less occurring under circumstances that would not cause a fracture in a normal healthy bone

162


Pathologic Fracture Sites

Pathologic fracture of humerus V54.21/M84.42-

Pathologic fracture of distal radius/ulna V54.22/M84.43-

Pathologic fracture of vertebrae V54.27/M84.48

Pathologic fracture of neck of femur V54.23/M84.45-

Includes aftercare for healing pathologic fracture

Includes chronic fracture, spontaneous fracture

Excludes aftercare following joint replacement V54.81

Excludes stress fracture, traumatic fracture

*ICD-10 6th digit = laterality

163


Other and Unspecified Disorders of Joint/Gait disorders

Difficulty in walking 719.7/R26.2

-in ICD-10, Excludes falling R29.6

Unsteadiness on feet R26.81

Abnormality of gait/ataxic/gait disturbance/paralytic/spastic/staggering gait 781.2/R26.9

-in ICD-10, separate code for ataxic gait R26.0,

paralytic gait R26.1

164


Other Disorders of the Back/Dorsalgia

Pain in thoracic spine 724.1/M54.6

Lumbago/low back pain 724.2/M54.5

Sciatica 724.3/M54.4-

*neuralgia or neuritis of sciatic nerve

Backache/back pain 724.5/M54.9

165


Disorder of Muscle, Ligament, and Fascia/Other Disorders of Muscle

Muscle weakness (generalized) 728.87/M62.81

*different than generalized weakness/malaise and fatigue 780.79/R53.1

Muscular wasting and disuse atrophy 728.2/M62.5-

*in ICD-10, extra digits for site and laterality

Other specific muscle disorders 728.3/M62.89

In ICD-10, category for disorders of muscle in diseases classified elsewhere M63

*includes dx such as: neoplasm

166


Diseases of the Genitourinary System National Cancer Institute Alan Hoofring

167


Acute and Chronic Kidney Failure

Acute kidney failure 584/N17 - develops rapidly over a few hours or a few days, can be fatal and requires intensive treatment. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care.

Chronic kidney disease/CKD 585/N18● 4th digit for stage ● ESRD is 585.6/N18.6

*code first any associated condition: diabetic chronic kidney disease 250.4-/E08-E13 hypertensive chronic kidney disease 403-404/I12-I13

Renal failure, unspecified 586/N19

168


Stages of Chronic Kidney Disease/CKD

585.1/N18.1 • CKD, Stage 1

585.2/N18.2 • CKD, Stage 2 (mild)

585.3/N18.3 • CKD, Stage 3 (moderate)

585.4/N18.4 • CKD, Stage 4 (severe)

585.5/N18.5 • CKD, Stage 5

585.6/N18.6 • End Stage Renal Disease (CKD requiring chronic dialysis)

169


Urinary Tract Infection

599.0/N39.0 is the code for site not specified, if site is known this would be an incorrect code:

-bladder – see cystitis 595.-/N30.-

-kidney – see infection, kidney 590.-/N15.9

-urethra – see urethritis 597.-/N34.-

• Use additional code to identify organism, if known

170


Hyperplasia/Enlarged Prostate

Benign prostatic hyperplasia/BPH is the same as enlarged prostate 600.0-/N40.0-N40.1

Subcategories for enlarged and nodular:● Enlarged prostate without lower urinary tract symptoms/LUTS 600.00/N40.0 -incomplete bladder emptying, nocturia, straining on urination, urinary freq, urinary hesitancy, urinary incont, urinary obstruction, urinary retention, urinary urgency weak urinary stream● Enlarged prostate with LUTS 600.01/N40.1● Nodular prostate without LUTS 600.10/N40.2 -nodular = a "bump" that can be felt in the prostate● Nodular prostate with LUTS 600.11/N40.3 171


Symptoms, Signs and Abnormal Clinical and Laboratory Findings

172


Codes Used For

a •No more specific diagnosis can be made even after all facts have been investigated

b •Signs or symptoms existing at time of initial encounter - transient and causes not determined

c •Provisional diagnosis in patient failing to return

d •Referred elsewhere before diagnosis made

e •More precise diagnosis not available

f •Certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right

173


Signs and symptoms associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the code book.● Examples:

o SOB in COPDo Edema in CHFo Fever in strep throato Urinary urgency in UTI

In LTC, often symptoms are used as therapy treatment diagnoses. Code as long as therapy is treating.

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Superficial injuries, such as abrasions or contusions are not coded when associated with more severe injuries of the same site.

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Coding from Lab/X-Ray Reports

Attending physician must document the significance of any abnormal finding

Can use lab/x-ray reports to further define documented diagnoses, but not to code a new diagnosis when the provider has not documented

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Common Signs and Symptoms

Syncope and collapse/fainting 780.2/R55

Other malaise and fatigue/gen. weakness 780.79/R53.1

Debility 799.3/R53.81 *weak and feeble

Generalized pain, pain NOS 780.96/R52 *site?

Altered mental status 780.97/R41.82 *on ER report

Other general symptoms 780.99/R68.89 *??

Adult failure to thrive 783.7/R62.7 *a descriptive, non-specific term that encompasses "not doing well"

Edema, unspecified 782.3/R60.9

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Common Signs and Symptoms -2

Shortness of breath 786.05/R06.02

Cough 786.2/R05

Nausea with vomiting 787.01/R11.2

*different code for nausea w/o vomiting 787.02/R11.0

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Insomnia/Sleep Disorders

Sleep disturbance, unspecified 780.50/G47.9

Insomnia with sleep apnea, unspecified 780.51/G47.3-

*ICD-10 only code the sleep apnea

Insomnia, unspecified 780.52/G47.00

Unspecified sleep apnea 780.57/G47.30

Insomnia d/t medical condition classified elsewhere 327.01/G47.01

*code first underlying condition

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Common Therapy Treatment Diagnoses Abnormality of gait 781.2/R26.9 *excludes ataxic gait, difficulty walking

Lack of coordination/muscular incoordination 781.3/R27.-

Abnormal posture 781.92/R29.3

Aphasia 784.3/R47.01 *if following CVA, code 438.11/I69.-

Symbolic dysfunction 784.60/R48.-

*may experience a lack of ability to initiate and/or terminate a

conversation, as well as difficulty with other forms of communication

Dysphagia 787.2-/R13.1- *identify phase of dysphagia after eval

*if d/t CVA, code first 438.82/I69.-

Cognitive communication deficit 799.52/*no like code in ICD-10

*a characteristic that acts as a barrier to the cognition process

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Factors Influencing Health Status & Contact with Health Services

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V Codes/Z Codes

There are numerous categories for V Codes (Z codes in ICD-10)

We will define the categories most frequently seen in post-acute care

We will explore examples of the common codes from frequently used categories in LTC.

We will practice coding conditions found in this chapter.

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V Codes

Represent reasons for encounters:

When person who may or may not be sick encounters health services for some specific purpose, i.e. to receive limited care or service for current condition, donate an organ or tissue, receive prophylactic vaccination, discuss problem

When some circumstance or problem is present which influences person’s health status but is not a current illness or injury

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V Codes Represent Reasons for Encounters

Identify significant past health histories

Identify services provided following an acute care episode

Identify services related to the provision of aftercare

Identify delivery of specific healthcare services: screening, tests & vaccinations

Identify presence of problem influencing health status but which is not a current illness (history of)

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Use of V Codes in any Healthcare Setting

V codes are for use in any healthcare setting

V codes may be used as either first-listed or secondary diagnosis, depending on the circumstances of the encounter

Certain V codes may only be used as first-listed or principal diagnosis ● *See the Official Coding Guidelines for a list of these codes

I.C.21.c.16. (ICD-10)

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V01/Z20 Contact / Exposure

These codes are for patients who do not show any signs or symptoms of a disease but are suspected to have been exposed to it by close personal contact or are in an area where a disease is epidemic.

This category also indicates contact with and suspected exposures hazardous to health

*may be used as a first-listed or secondary code

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V03 – V06/Z23 Inoculations and Vaccinations

Codes are for encounters for inoculations and vaccinations

It indicates that a patient is being seen to receive a prophylactic inoculation against a disease

There is only one code for inoculations, and if coded, need an additional procedure code to identify the vaccine

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Status Codes

Status codes indicate that a patient is either a carrier of a disease or has the residual of a past disease or condition

Includes presence of prosthetic or mechanical devices resulting from past treatment

A status code is informative, because the status may affect the course of treatment or its outcome

A status code is distinct from a history code (history code indicates that patient no longer has the condition)

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Resistance to Antimicrobial Drugs V09/Z16

NOTE: The codes in this category are provided for use as additional codes to identify the resistance and non responsiveness of a condition to antimicrobial

drugs.

Exclude 1:Code first the infection:

MRSA infection (038.12/A49.02)MSSA infection (038.11/A49.01)MRSA pneumonia (482.42/J15.212)

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Carrier of Infectious Disease

V02/Z22 Carrier of Infectious Disease

Colonization status

Suspected carrier

Example: V02.54/Z22.322

Carrier or (suspected) carrier of Methicillin resistant Staphylococcus aureus MRSA colonization

*Carrier = person that harbors the specific organisms of a disease without manifest symptoms and is capable of transmitting the infection

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Long Term (current) Drug Therapy V58.6-/Z79

Codes from this category indicate a patient’s continued use of a prescribed drug for the long term treatment of a condition or for prophylactic use.

Not used for patients with addictions to drugs

Used for patients receiving a medication for an extended period of time

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Long Term (current) Drug Therapy

Includes: Long term (current) drug use for prophylactic purposes

Exclude 1: Code also any therapeutic drug level monitoring (V58.83/Z51.81)

V58.61/Z79.01 Long term (current) use of anticoagulants

V58.66/Z79.82 Long term (current) use of aspirin

V58.62/Z79.2 Long term (current) use of antibiotics

V58.67/Z79.4 Long term (current) use of insulin

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Amputations

Determine cause of amputation, traumatic vs acquired

Traumatic = due to an incident

An amputation not identified as partial or complete should be coded to complete for traumatic amputations

Use the appropriate 7th character in ICD-10:

“D” subsequent encounter

“S” sequela/late effect

If acquired amputation, go to Absence, by site, acquired --V49.6-V49.7/Z89

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Acquired Absence of LimbAcquired Absence of Organ

Examples:

V49.75/Z89.5- Amputation status below knee

V49.76/Z89.6- Amputation status above knee

V45.71/Z90.1- Acquired absence breast and nipple

V45.73/Z90.5 Acquired absence of kidney

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Artificial Opening StatusTransplanted Organ Status

Examples:

V44.1/Z93.1Gastrostomy status

V44.3/Z93.3Colostomy status

V44.0/Z93.0Tracheostomy status

V42.0/Z94.0Kidney transplant status

V42.5/Z94.7Corneal transplant status

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Organ Or Tissue Replaced By Other Means

Examples:

V43.1/Z96.1 Presence of intraocular lens

(s/p cataract removal surgery)

V43.64/Z96.64 Presence of artificial hip joint

(s/p joint replacement)

V43.21/Z95.811 Presence of heart assist device

(cardiac shunt, etc.)

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Other Postprocedural Status

Examples:

V45.61/Z98.4- Cataract extraction status

V45.87/Z98.85 Transplant organ removal status

V45.11/Z99.2 Dependence on renal dialysis

V45.12/Z91.15 Noncompliance with renal dialysis

V45.01/Z95.0 Cardiac pacemaker status

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History (of)

Two types, family and personal

A history codes indicate that a patient no longer has the condition, and is no longer receiving any treatment, but has the potential for recurrence, and therefore may require continued monitoring

History codes are acceptable on any medical record, as the history of an illness is important information that may alter the type of treatment ordered

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History (of), Personal

V10.3/Z85.3 Personal history breast cancer

V12.04/Z86.14 Personal history MRSA infection

V12.51/Z86.718 Personal hx of venous thrombosis or embolism

V13.51/Z87.311 Personal hx pathological fx

V15.51/Z87.81 Personal hx traumatic fracture (healed)

V15.88/Z91.81 Personal history of falling

*at risk for falling

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Personal History of Medical Treatment

V87.41/Z92.21 Personal history of antineoplastic chemotherapy

V87.43/Z92.23 Personal history of estrogen therapy

V87.44/Z92.240 Personal history of inhaled steroid therapy

V87.45/Z92.241 Personal history of systemic steroid therapy

V15.3/Z92.3 Personal history of irradiation

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Aftercare

Aftercare visit codes cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease.

The aftercare V code should not be used if treatment is directed at a current, acute disease or injury.

Aftercare codes are generally first listed to explain the specific reason for the encounter.

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Aftercare + Status Codes

Status V codes may be used with aftercare V codes to indicate the nature of the aftercare or to indicate the surgery for which the aftercare is being performed

Example:● V58.73/Z48.812 Encounter for surgical aftercare following

surgery on the circulatory system ● V45.81/Z95.1 Aortocoronary bypass status – “CABG” status

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Aftercare Categories

V55/Z43 Attention to artificial openings

V54 Orthopedic aftercare *code to condition in ICD-10

V57 Care involving the use of rehabilitation procedures

*code that may only be principal/first-listed dx

*only use one code in this category (if > one therapy, code multiple therapy V57.89)

*not coded in ICD-10

V58/Z48 Aftercare following surgery

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Attention to Artificial OpeningsEncounter for Other Aftercare

V55.0/Z43.0 Attention to tracheostomy

V55.3/Z43.3 Attention to colostomy*includes toileting/cleansing of sites

V58.31/Z48.01 Attention to surgical dressings

V58.32/Z48.02 Attention to sutures

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Orthopedic Aftercare

V54.13 Aftercare for healing traumatic fracture of hip

V54.81 Aftercare following joint replacement*Use additional code to identify the joint (V43.-)

V54.82 Aftercare following explanation of joint prosthesis

V54.09 Other aftercare involving internal fixationdevice

V54.89 Other orthopedic aftercare

*code to condition in ICD-10

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Acute Fractures vs. Aftercare – ICD-9 Coding

Traumatic fractures are coded using the acute fracture codes (800-829) while the patient is receiving active treatment for the fracture.

Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.

Fractures are coded using the aftercare codes (V54) for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase.

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Fracture Coding for ICD-10

Code fracture (no aftercare codes)

Obtain documentation indicating specific fracture type and site

Use 7th character:● D = subsequent encounter for fracture with routine healing● G = subsequent encounter for fracture with delayed healing● K = subsequent encounter for fracture with nonunion● P = subsequent encounter for fracture with malunion● S = sequel/late effect*do not use “A” unless fracture was NOT treated elsewhere, this is for the initial encounter

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Aftercare Following Surgery for Neoplasm

V58.42/Z48.3 Aftercare following surgery for Neoplasm

*Use additional code to identify the neoplasm

If an organ was removed, in total or partial, use a code for acquired absence of the organ V42/Z90

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Aftercare following Surgery on Specified Body Systems V58.7-/Z48.81-

NOTE: These codes identify the body system requiring aftercare. They are for use

in conjunction with other aftercare codes to fully explain the aftercare encounter. The condition treated should also be coded if still present.

Excludes Aftercare following organ transplant V58.44/Z48.2-

Excludes Aftercare following surgery for neoplasm V58.42/Z48.3

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Aftercare Following Surgery to Specified Body Systems

V58.71/Z48.810 Sense organs

*conditions classifiable to 360-379, 380-389

V58.73/Z48.812 Circulatory system

*conditions classifiable to 390-459

V58.75/Z48.81- Teeth, oral cavity and digestive system


V58.78 Musculoskeletal system


*code to condition in ICD-10

*Should not need to use V58.49 Other specified aftercare following surgery **get those operative reports!

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Encounter for Miscellaneous Care

V66.7/Z51.5 Encounter for palliative care

V66.2/Z51.89 Convalescence following chemotherapy

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Procedure for Updating Codes

At Quarterly Care Conference, look at facesheet and physician orders

Resolve any diagnoses that are NOT current

Make sure that you have MD documentation to support ALL current diagnoses in the record.

Start querying MD’s for any additional documentation needed for ICD-10 (laterality, etc.)

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Tips for Correct Coding

Use code book!

Always count the number of digits and compare with the number of digits required

*use tabular listing in code book

Avoid unspecified codes

*Remember: payers may reject payment based on missing digits

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Any questions??

THANKS FOR COMING!

icd-9-cm to icd-10-cm prep presented by: khaleelah wagner, rhia staci lepage, rhit

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