Major Diagnosis Coding ICD-9-CM And ICD-10-CM
Major Diagnosis CodingICD-9-CM and ICD-10-CMJeanne Yoder, RHIA, CCS-P,CPC, CPC-IFebruary 2009AAPC All Rights Reserved1Overview ICD-9-CM and ICD-10-CMHeart DiseasesNeoplasmsCerebrovascular DiseasesChronic Respiratory DiseasesInjuries, UnintentionalDiabetesAAPC All Rights Reserved21
Goals After listening to this briefing,– Be able to correctly select the answer from amultiple guess format 80% of the time– Be able to list at least five the majordifferences in ICD-9-CM and ICD-10-CM forcommon causes of mortality– Be able to list produce a list of web sites withuseful information on ICD-10-CMAAPC All Rights Reserved3Intent of Both Systems ICD-9-CM – used in USA to collectmorbidity data, reason for the encounter ICD-10-CM – used in USA to collectmortality data, reason for deathAAPC All Rights Reserved42
http://www.cms.hhs.gov/ICD10/03 ICD 10 CM.asp#TopOfPageAAPC All Rights /AAPC All Rights Reserved63
http://www.who.int/classifications/icd/ICD-10 2nd ed volume2.pdfBe aware, this is notICD-10-CM, it is ICD10.AAPC All Rights d9/icd10cm.htmAAPC All Rights Reserved84
Heart Diseases Acute Myocardial Infarction (AMI)– ST elevation myocardial infarction (STEMI) Changes in EKG due to prolonged blockage Part of the heart muscle is damaged ICD-9-CM Code with 410.0-410.6, 410.8– Non ST elevation myocardial infarction (NSTEMI) No changes in the EKG Markers in the blood indicate damage occurred to heartmuscle Blockage may be partial or temporary so damage is minimal Site of blockage may or may not be documented ICD-9-CM Code with 410.7 Subendocardial InfarctionAAPC All Rights Reserved9Heart Diseases Acute Myocardial Infarction (AMI)– Nontransmural infarction ICD-9-CM Code with 410.7 SubendocardialInfarction– Unspecified, code with 410.9 If only “STEMI” or “transmural MI” but no location,ICD-9-CM code 410.9– If STEMI becomes a NSTEMI (due tothrombolytic therapy) still code as STEMI– If NSTEMI becomes STEMI, code as STEMIAAPC All Rights Reserved105
Heart Diseases Acute Myocardial Infarction (AMI) in ICD-9-CM– 5th digit 0 – Episode of care unspecified 1 – Initial episode (no matter number of times transferred) ofa newly diagnosed myocardial infarction 2 – Subsequent episode, admitted for further observation,evaluation or treatment within 8 weeks of the myocardialinfarction– Need to know location of the damage Anterolateral, inferolateral, posterior, atrium AAPC All Rights Reserved11Heart Diseases410411ICD-9-CMAcute Myocardial InfarctionOther Acute and SubacuteForms of Ischemic HeartDiseaseI21I24I22I23412413414Old Myocardial InfarctionAngina PectorisOther Forms of ChronicIschemic Heart DiseaseI25.2I20I25ICD-10-CMAcute Myocardial InfarctionOther Acute Ischemic HeartDiseasesSubsequent Acute MyocardialCurrent Complicationsfollowing Acute MyocardialOld Myocardial InfarctionAngina PectorisChronic Ischemic HeartDiseaseAAPC All Rights Reserved126
Heart Diseases ICD-9-CM 414 - Other Forms of Chronic Ischemic HeartDisease– Coronary Atherosclerosis Includes coronary atherosclerosis, coronaryarteriosclerosis,endarertis, atheroma, sclerosis, stricture Need type of vessel (e.g., native, autologous vein, artery bypassgraft) ICD-9-CM Code to 414.0x– Aneurysm ICD-9-CM Code to 414.1x– Chronic Total Occlusion of Coronary Artery ICD-9-CM Code to 414.2– Coronary Atherosclerosis Due to Lipid Rich Plaque Secondary to ICD-9-CM 414.0x Coronary Atherosclerosis ICD-9-CM Code to 414.3New code!AAPC All Rights Reserved13Heart Disease Valve Diseases– Right side (Tricuspid and Pulmonary) Code to 397– Left side (Mitral [bicuspid] and Aortic) Code to 394, 395, 396Plumbing394395396397ICD-9-CMDiseases of Mitral ValveDiseases of Aortic ValveDiseases of Mitral and AorticValveDiseases of EndocardialStructures (Tricuspid)ICD-10-CMI34 Nonrheumatic Mitral Valve DisordersI35 Nonrheumatic Aortic Valve DisordersI36 Nonrheumatic Tricuspid Valve DisordersI37 Nonrheumatic Pulmonary Valve DisordersAAPC All Rights Reserved147
Heart Diseases Hypertension– Code to 401– Only use 401.0 Malignant, or 401.1 Benign, if documentationsupports– In ICD-10-CM – only one Essential (primary) Hypertensioncode I10 – Essential Hypertension– Includes hypertension (arterial) (benign) (essential) (malignant)(primary) (systemic); high blood pressure Hypertension with Heart Disease– Use 402 when causal relationship is stated/implied Due to l HypertensionHypertensive Heart DiseaseSecondary HypertensionICD-10-CMI10 Essential HypertensionI11 Hypertensive Heart DiseaseI15 Secondary HypertensionAAPC All Rights Reserved15Heart Diseases Electrical Conduction426427428ICD-9-CMConduction DisordersCardiac Dysrhythmias427.5427.0-427.2427.3427.4, 427.6, 427.8Heart FailureICD-10-CMI44 Atrioventricular and LeftBundle-branch BlockI45 Other Conduction DisordersI46 Cardiac Arrest (code firstunderlying cardiac condition)I47 Paroxysmal TachycardiaI48 Atrial Fibrillation and FlutterI49 Other Cardiac ArrhythmiasI50 Heart FailureAAPC All Rights Reserved168
Review One BIG change – only one Hypertension(high blood pressure) code I10 Pretty much coding is the same– ST elevation myocardial infarction (STEMI)– Non-ST elevation myocardial infarction(NSTEMI) ICD-10-CM has more space for rheumaticheart conditionsAAPC All Rights Reserved17Neoplasms Benign – does not have any of the three malignant properties(unlimited growth, invasion, metastases)– Can still cause problems by growing too big, compressing nearbytissues, or by becoming “functional” as in producing hormones In-Situ – a neoplasm that does not invade surrounding tissues, butfollows the existing tissue Malignant – new, abnormal, uncontrolled growth with properties of:– Anaplasia – lack of differentiation, to become less defined– Invasion – develop in one tissue and move into surrounding tissue– Metastatic sites – spread from one organ to a non-adjacent organ Uncertain Histologic Behavior – after tissue exam, unable to beclassified as malignant or benign, cell type cannot be determined Unspecified – no documentationAAPC All Rights Reserved189
Neoplasms Mass – see “mass” in the alphabetic index,not assumed to be neoplasm Lump – see “mass” in the alphabeticindex, not assumed to be neoplasm Cyst – see “cyst” in alphabetic index, notassumed to be neoplasm Lesion – see “lesion” in alphabetic index,not assumed to be neoplasmAAPC All Rights Reserved19Neoplasms Don’t use a malignant neoplasm code untilthere is a pathology report confirming thehistologic type of the neoplasm– Unless it is a confirmed case, such asencounters for chemotherapy If you code before a pathology report,code based on the term used (e.g., mass)AAPC All Rights Reserved2010
Neoplasms Refer to the Neoplasm Table first UNLESShistological term is documented– If you have a histological term, look up theterm in the alphabetical to determine thecorrect column in the table Then check the tabular to verify the codeand that a more specific site codes doesnot existAAPC All Rights Reserved21Neoplasms Treatment directed at malignancy – code themalignancy as principal diagnosis– Unless encounter is only for chemotherapy,immunotherapy or radiation therapy – then V58.x isprincipal and diagnosis is secondary If undergoing treatment, code the primary sitefirst, metastatic sites as secondary codes If a primary and metastasis to secondary site,with only treatment of secondary site (primarymalignancy is still present) – code the secondaryneoplasm as principalAAPC All Rights Reserved2211
Neoplasms Primary malignancy previously excised/eradicated– Code V10 Personal history of malignantneoplasm Primary malignancy excised/eradicated,but there is a secondary– Secondary becomes principal with V10Personal history becomes secondary codeAAPC All Rights Reserved23Neoplasms Malignant neoplasm associated withtransplanted organ– Code as transplant complication 996.8 Complication of transplanted organ 199.2 Malignant neoplasm associated withtransplanted organ 3rd code is for the specific malignancyAAPC All Rights Reserved2412
Neoplasms If for treatment of a complication due to theneoplasm, and no treatment of the neoplasmoccurs (e.g., dehydration), code the complicationfirst, then the neoplasm as a secondary code– Except “anemia in neoplastic disease” which is amanifestation and is a secondary code For treatment of a pathological fracture due to amalignancy, code the pathological fracture asthe principal and the malignancy is secondary– If the focus of the treatment is the malignancy withassociated pathological fracture, then the malignancyis principalAAPC All Rights Reserved25Neoplasms For pregnancy, use the complication ofpregnancy, then the appropriate neoplasm code For functional neoplasms, use an additionalcode (e.g., endocrine) to identify the functionalactivity Primary malignant overlapping boundaries,which would code to different subcategories in a3 digit rubric and point of origin cannot bedetermined, use .8AAPC All Rights Reserved2613
Neoplasms For pain management encounter due tomalignancy, code the pain managementas principal Remember to use the “Geneticsusceptibility to cancer” V-codes ifapplicable to encounterAAPC All Rights Reserved27Neoplasms140-149150-159160-165170-176ICD -9-CMMalignant Neoplasm of Lip, Oral Cavity,and PharynxMalignant Neoplasm of DigestiveOrgans and PeritoneumMalignant Neoplasm of Respiratory andIntrathoracic OrgansMalignant Neoplasm of Bone,Connective Tissue, Skin, and 0C51-C58179-189Malignant Neoplasm of t Neoplasm of Lip, Oral Cavity, andPharynxMalignant Neoplasm of Digestive OrgansMalignant Neoplasm of Respiratory andIntrathoracic OrgansMalignant Neoplasms of Bone and ArticularCartilageMalignant Neoplasms of the SkinMalignant Neoplasms of Nesothelial andSoft TissueMalignant Neoplasms of the BreastMalignant Neoplasms of the Female GenitalOrgansMalignant Neoplasms of the Male GenitalOrgansMalignant Neoplasms of the Urinary TractAAPC All Rights Reserved2814
Neoplasms190-199Malignant Neoplasm of Other andUnspecified Sites190 Eye191 Brain192 Rest of the Nervous System193 Thyroid194 Other Endocrine Glands andRelated Structures195 Other and Ill-defined SitesC69-72C69C70C71C72C73C74C75C76196 Secondary and Unspecified, Lymph C77Nodes197 Secondary Respiratory andC78Digestive System198 Secondary Other SpecifiedC79199 Without Specification of Site(Disseminated)C80Malignant Neoplasms of the Eye, Brain andOther Parts of the CNSMalignant Neoplasm of Eye and AdnexaMalignant Neoplasm of MeningesMalignant Neoplasm of BrainMalignant Neoplasm of Spinal Cord, CranialNerves and Other Parts of the CNSMalignant Neoplasm of the ThyroidMalignant Neoplasm of the Adrenal GlandMalignant Neoplasm of Othe EndocrineGlands and Related StructuresMalignant Neoplasm of Other and Ill-DefinedSitesSecondary and Unspecified MalignantNeoplasm of Lymph NodesSecondary Malignant Neoplasm ofrsepiratory and Digestive OrgansSecondary Malignant Neoplasm of OtherSitesMalignant Neoplasm W ithout Specification ofSiteAAPC All Rights Malignant Neoplasm of Lymphaticand Hematopoietic TissueBenign NeoplasmCarcinoma In SituNeoplasms of Uncertain BehaviorNeoplasm of Unspecified NatureC81-C96Malignant Neoplasms of Lymphoid,Hematopoietic and Related TissueD00-D009 In Situ NeoplasmsD10-D36 Benign NeoplasmsD37-D48 Neoplasms of Uncertain BehaviorD49Neoplasms of Unspecified BehaviorAAPC All Rights Reserved3015
Review If treating primary malignancy, it isprincipal diagnosis If treating a complication of a neoplasm,the neoplasm is secondary ICD-10-CM will sometimes have right/left ICD-10-CM has more space, andinfrequently, more detail ICD-10-CM lists malignant, in-situ, benign Both have neoplasm tableAAPC All Rights Reserved31Review Benign - does not have any of the three malignant properties (unlimitedgrowth, invasion, metastases)– Can still cause problems by growing too big, compressing nearby tissues, or bybecoming “functional” as in producing hormones In-Situ – a neoplasm that does not invade surrounding tissues, but followsthe existing tissue Malignant – new, abnormal, uncontrolled growth with properties of:– Anaplasia – lack of differentiation, to become less defined– Invasion – develop in one tissue and move into surrounding tissue– Metastatic sites – spread from one organ to a non-adjacent organ Uncertain Histologic Behavior – after tissue exam, unable to be classifiedas malignant or benign, cell type cannot be determined Unspecified – no documentationAAPC All Rights Reserved3216
Cerebrovascular Diseases Stroke/Cerebral Infarction/ Cerebrovascular Accident(CVA)– ICD-9-CM Code to 434.x1 (cerebral infarction)– ICD-10-CM Code to I63.x (cerebral infarction) Late Effects – neurologic deficits– Code to 438– May be present from the onset or may arise at any time after theonset– Can be used with the 430-437 (acute) codes if there is a deficitfrom a prior CVA– If a history of cerebrovascular disease without presentneurologic deficits, then consider V12.54 Transient ischemicattack (TIA) and cerebral infarction without residual deficitsAAPC All Rights Reserved33Cerebrovascular Diseases Postoperative Cerebrovascular Accident– Occurs as a result of a medical intervention– Code to 997.02 Iatrogenic CerebrovascularInfarction or Hemorrhage– Documentation must clearly specify thecause-and-effect relationship– Secondary code from 430-432, or 433 and434 with 5th digit “1”– Do not use 436, Acute , but ill-definedAAPC All Rights Reserved3417
Cerebrovascular -CMCerebrovascular DiseaseSubarachnoid HemorrhageIntercerebral HemorrhageOther and Unspecified IntracranialHemorrhageOcclusion and Stenosis ofPrecerebral Arteries5th digit 0 w/o mention of cerebralinfarction5th digit 1 w/cerebral infarctionOcclusion of cerebral arteries5th digit 0 w/o mention of cerebralinfarction5th digit 1 w/cerebral infarctionTransient Cerebral IschemiaI63ICD-10-CMCerebrovascular DiseaseNontraumatic Subarachnoid HemorrhageNontraumatic Intracerebral HemorrhageOther and Unspecified NontraumaticIntracranial HemorrhageCerebral InfarctionI64StrokeI65Occlusion and Stenosis of PrecerebralArteries, Not Resulting in Cerebral InfarctionOcclusion and Stenosis of Cerebral Arteries,Not Resulting in Cerebral InfarctionOther Cerebrovascular DiseasesI60-I69I60I61I62Acute, But Ill-DefinedI66Cerebrovascular DiseaseOther and Ill-DefinedI67Cerebrovascular DiseaseLate Effects of CeberobascularI68Cerebrovascular Disorders in DiseasesDiseaseClassified ElsewhereOpenI69Sequelae of Cerebrovascular DiseaseAAPC All Rights Reserved35Cerebrovascular Diseases435Transient Cerebral Ischemia437.7Transient Global AmnesiaICD-9-CM has these in thecirculatory systemG - Diseases of the Nervous SystemTransient Cerebral Ischemic Attacksand Related SyndromesG45.4 Transient Global AmnesiaG45ICD-10-CM G45 is in theNervous System CodesAAPC All Rights Reserved3618
Cerebrovascular Diseases I69 Sequelae of Cerebrovascular Disease– More detailed, to the 6th character– I69.020 Aphasia following nontraumaticsubarachnoid hemorrhage– I69.120 Aphasia following nontraumaticintracerebral hemorrhage– 438.11 Aphasia, late effect ofcerebrovascular diseaseAAPC All Rights Reserved37Cerebrovascular Diseases I69.231 Monoplegia of upper limb following other nontraumaticintracranial hemorrhage affecting right dominant side I69.232 Monoplegia of upper limb affecting left dominant side I69.233 Monoplegia of upper limb affecting right non-dominantside I69.234 Monoplegia of upper limb affecting left non-dominantside 483.31 Monoplegia of upper limb affecting dominate side 483.32 Monoplegia of upper limb affecting nondominate sideAAPC All Rights Reserved3819
Review With ICD-10-CM we have the ability tocollect if a CVA impacts a dominate ornon-dominate side If documented, for Cerebral VascularInfarctions (stroke), we can collect theimpacted arteryAAPC All Rights Reserved39Chronic Respiratory Diseases Chronic Obstructive Pulmonary Disease (COPD)– Obstructive chronic bronchitis – 491.2/J42– Emphysema 492/J43 Asthma, 493/J45– Chronic airway obstruction, NEC, 496/J44 Use when documentation does not specify type of COPD Status asthmaticus – continuous, obstructiveasthmatic state which continues after initialtherapyAAPC All Rights Reserved4020
Chronic Respiratory Diseases490491.0491.1ICD-9-CMBronchitis, not specified as acute orchronicSimple chronic bronchitisMucopurulent chronic bronchitis491.20 Obstructive chronic bronchitiswithout exacerbation491.21 Obstructive chronic bronchitis with(aute) exacerbation491.22 Obstructive chronic bronchitis withacute bronchitis491.8 Other chronic bronchitis491.9 Unspecified chronic bronchitisICD-10-CMBronchitis, not specified as acute or chronicJ40J41.0J41.1J41.8Simple chronic bronchitisMucopurulent chronic bronchitisMixed simple and mucopurulent chronicbronchitisJ42Unspecified chronic bronchitisAAPC All Rights Reserved41Chronic Respiratory Diseases492.8ICD-9-CMOther emphysemaJ43.0492.8492.8492.8492.0496496496Other emphysemaOther emphysemaOther emphysemaEmphysematous blebChronic airway obstruction NESChronic airway obstruction NESChronic airway obstruction NESJ43.1J43.2J43.8J43.0J44.0J44.1J44.9 ICD-10-CMUnilateral pulmonary emphysema (MacLoed'ssyndrome)Panlobular emphysemaCentrilobular emphysemaOther emphysemaEmphysema, NOSCOPD with acute lower respiratory infectionCOPD with (acute) exacerbationCOPD, NOSJ43 - Emphysema is split out by typesJ44 - COPD is split out, it includes:–––––––––Asthma with COPDChronic asthmatic (obstructive) bronchitisChronic bronchitis with airway obstructionChronic bronchitis with emphysemaChronic emphysematous bronchitisChronic obstructive asthmaChronic obstructive bronchitisChronic obstructive tracheobronchitisCode also type of asthma, if applicable (J45.-)AAPC All Rights Reserved4221
Chronic Respiratory Diseases493.0493.1ICD-9-CMExtrinsic asthmaIntrinsic asthma493.2Chronic obstructive asthma493.81 Exercise induces bronchospasm493.82 caugh variant asthma493.9ICD-10-CMAsthma, mild, intermitent, NOSAsthma, mild, intermitent, with (acute)exacerbationJ45.22 Asthma, mild, intermitent, with statusasthmaticusJ45.30 Asthma, mild, persistent, NOSJ45.31 Asthma, mild, persistent, with (acute)exacerbationJ45.32 Asthma, mild, persistent, with statusasthmaticusJ45.40 Asthma, moderate, persistent, NOSJ45.41 Asthma, moderate, persistent, with (acute)exacerbationJ45.42 Asthma, moderate, persistent, with statusasthmaticusJ45.50 Asthma, severe, persistent, NOSJ45.51 Asthma, severe, persistent, with (acute)exacerbationJ45.52 Asthma,severe, persistent, with statusasthmaticusJ45.901 Asthma, unspecified with (acute) exacerbationJ45.20J45.21Asthma, NOS Finally, asthma theway HEDIS collects it No more extrinsic orintrinsicJ45.902 Asthma, unspecified with status asthmaticusAAPC All Rights Reserved43Review ICD-10-CM will improve the ability to collectuseful asthma data In ICD-10-CM asthma will be split by:––––Mild intermittentMild persistentModerate persistentSevere persistent And by:– Uncomplicated– With (acute) exacerbation– With status asthmaticusAAPC All Rights Reserved4422
Injuries, Unintentional Motor vehicle accidents (MVAs) Falls– In sports– Elderly Struck by falling object Striking against or struck accidently byobjects or personsAAPC All Rights Reserved45Injuries, Unintentional Codes in the 800-999 Acute – actively treating injury Aftercare – still healing, suture checks,changing casts Follow-up – after it is healedAAPC All Rights Reserved4623
Injuries Significantly more data collected in ICD10-CM– Right, left, unspecified– 7th character helps sequence encounters A – initial encounter D – subsequent encounter S – sequelaAAPC All Rights Reserved47Injuries 7th character for fractures– A – initial encounter for closed fracture– B – initial encounter for open fracture– D – subsequent encounter for fracture with routinehealing– G – subsequent encounter for fracture with delayedhealing– K – subsequent encounter for fracture with nonunion– P – subsequent encounter for fracture with malunion– S – sequelaAAPC All Rights Reserved4824
Injuries, Unintentional ICD-10-CM has difference codes for burns(thermal) and corrosions (chemical) For the External causes of injury, ICD-10CM has a 7th character of– A – initial encounter– D – subsequent encounter– S - sequelaAAPC All Rights Reserved49Injuries, Unintentional Codes not to be used for normal healing surgicalwounds or complications of surgical wounds Don’t code superficial injuries when more severeinjuries of same site are present When injury results in nerve damage, code theinjury, then an additional code from 950-957 Multiple fractures are coded in order of severity Burns need two codes, depth (e.g., 1st degree,2nd degree), and body surface involvedAAPC All Rights Reserved5025
Review From initial treatment through totallyhealed, the applicable codes are:– E-code, traumatic fracture, pathologicalfracture– 800-999, aftercare, follow-up– A initial; D subsequent encounter;S sequela– Greenstick, transverse, spiral, compound,comminutedAAPC All Rights Reserved51Diabetes The new 249 Secondary Diabetes Mellitusmade a significant change in ICD-9-CMand moved us much closer to ICD-10-CMICD-9-CM249 Secondary diabetes mellitus250 Diabetes mellitus5th digit 0 type 2 or NOS5th digit 1 type 15th digit 2 type 2, uncontrolled5t digit 3 type 1, uncontrolledE08E09E10E11E12ICD-10-CMDiabetes mellitus due to underlying conditionDrug or chemical induced diabetes mellitusType 1 diabetes mellitusType 2 diabetes mellitusunusedE13 Other specified diabetes mellitusAAPC All Rights Reserved5226
Diabetes Code diabetes complicating pregnancy andgestational diabetes with codes from thepregnancy section (648.0x, 648.8x) Use of insulin does not mean a patient is type 1diabetic For patients who routinely use insulin, codeV58.67, Long-term (current) use of insulin– Don’t use if insulin is given temporarily to bring a type2 patient’s blood sugar under control during anencounterAAPC All Rights Reserved53Diabetes ICD-9-CM For manifestations, code the 249/250 codefirst, manifestation second For secondary diabetes (249),– If encounter is for cause (e.g., malignantneoplasm of pancreas) of diabetes, the causeis principal, with the secondary diabetessecondary– If encounter is for diabetes, the diabetes isprincipal with the cause secondaryAAPC All Rights Reserved5427
Diabetes ICD-10-CME08 Diabetes mellitus due to underlying conditionE09 Drug or chemical induced diabetes mellitusE10 Type 1 diabetes mellitusE11 Type 2 diabetes mellitusE13 Other specified diabetes mellitusDM sequenced after underlyingconditionDM sequenced after underlyingconditionDM sequenced firstDM sequenced firstDM sequenced first Examples of underlying conditions include:– Congenital rubella, Cushing’s syndrome, cystic fibrosis,malignant neoplasm, malnutrition, pancreatitisAAPC All Rights Reserved55Diabetes If only symptoms are documented, codethe symptom 790.21 Impaired fasting glucose (elevatedfasting glucose) 790.22 Impaired glucose tolerance test(oral) 790.29 Other abnormal glucose– Pre-diabetes, NOSAAPC All Rights Reserved5628
Review In ICD-9-CM, for secondary diabetes,sequencing was based on why the patientpresented for care In ICD-10-CM, for Diabetes Mellitus due toUnderlying Condition (E08) and Drug orChemical Induced Diabetes Mellitus (E09),always list the cause as principal, thenE08 or E09 as secondaryAAPC All Rights Reserved57Review Five differences in ICD-9-CM and ICD-10-CMinclude:– Essential hypertension only has one code – I10– Asthma is collected with Mild intermittentMild persistentModerate persistentSevere persistent– Collects dominate and non-dominate monoplegia– ICD-10-CM has more space to expandAAPC All Rights Reserved5829
Review Five differences in ICD-9-CM and ICD-10CM include:– Diabetes mellitus collected due to underlyingcondition, drug or chemical induced, type 1,type 2, and other specified– Injuries are coded with 7th character indicationwhich encounter in the continuum of care(e.g., initial, subsequent, sequela)– When applicable, collect right, left,unspecifiedAAPC All Rights Reserved59Review If a NSTEMI progresses to a STEMI– Code the STEMI first with the NSTEMI as asecondary code– Code only the NSTEMI– Code only the STEMI– Code the Unspecified Acute myocardialinfarctionAAPC All Rights Reserved6030
Review Hypertension in ICD-9-CM has threecodes, 401.0 malignant, 401.1 benign, and401.9 unspecified. In ICD-10-CMhypertension can be coded:––––I10 - .0 arterial, .1 benign, .9 essentialI10 - .0 benign, .1 malignant, .9 NOSI10 - .0 primary, .1 systemic, .9 NOSI10 Essential HypertensionAAPC All Rights Reserved61Review TIAs are coded in the cerebrovascularsection 435 in ICD-9-CM. Where are theycoded in ICD-10-CM?– In the cerebrovascular area– In the neurologic area– In the signs and symptoms area– In the V12 codesAAPC All Rights Reserved6231
Review In ICD-10-CM asthma will be split by:– Extrinsic, Intrinsic, Chronic Obstructive,Exercise Induced– Extrinsic, Intrinsic, Chronic Obstructive,Cough Variant– Extrinsic, Intrinsic, Exercise Induced, CoughVariant– Mild intermittent, Mild persistent, Moderatepersistent, Severe persistentAAPC All Rights Reserved63Review In ICD-10-CM asthma will be split by:– Uncomplicated, With (acute) exacerbation, Withstatus asthmaticus– Caused by strong emotions, environmental factorssuch as air borne, chemical exposures, temperaturevariations– 0-5 years of age; 6-10 years of age; 11-18 years ofage; greater than 18 years of age– Family history of asthma; exposure to secondhandsmoke; living in area with more than 5 red pollutiondays per year; low birth weight; being overweightAAPC All Rights Reserved6432
Review From initial treatment through totallyhealed, the applicable codes are:– E-code, traumatic fracture, pathologicalfracture– 800-999, aftercare, follow-up– A initial; D subsequent encounter;S sequela– Greenstick, transverse, spiral, compound,comminutedAAPC All Rights Reserved65Review The neoplasm table should be referencedfirst when you see the words:– Malignant, in-situ, benign, neoplasm– Mass, lump, cyst, lesion– Lymphoma, carcinoma, adenoma, seroma– Sarcoma, rhabdomyoma, paraganglioma,lipomaAAPC All Rights Reserved6633
Review Two basic types of myocardial infarctionsare:– STEMI and NSTEMI– Chronic and Acute– Arterial and Venous– Embolism and ThrombusAAPC All Rights Reserved67Review When coding a neoplasm which hasunlimited growth, invasion andmetastases, it will be:– Benign– In-Situ– Malignant– Uncertain Histologic Behavior– UnspecifiedAAPC All Rights Reserved6834
Review Codes from the following ICD-10-CMdiabetes category is always listed as asecondary diagnosis– Type 1 diabetes mellitus– Type 2 diabetes mellitus– Other specified diabetes mellitus– Drug or chemical induced diabetes mellitusAAPC All Rights Reserved69Questions? http://www.cms.hhs.gov/ICD10/03 ICD 10 -10 2nd ed icd9/icd10cm.htm Good web sites for ICD-10-CM informationAAPC All Rights Reserved7035
Hypertension – Code to 401 – Only use 401.0 Malignant, or 401.1 Benign, if documentation supports – In ICD-10-CM –only one Essential (primary) Hypertension code I10 –Essential Hypertension – Includes hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic); high blood pressure Hypertension with Heart .
ICD-9 724.02 ICD-10 M48.06 Spinal stenosis, lumbar region ICD-9 720.2 ICD-10 M46.1 Sacroiliitis, not elsewhere classified ICD-9 724.8 ICD-10 R29.898 Other symptoms and signs involving the ** musculoskeletal system ICD-9 721.42 ICD-10 M47.16 Other spondylosis with myelopathy, lumbar region ICD-9 723.1 ICD-10 M54.2 Cervicalgia ICD
More on ICD-10. ICD-10-PCS replaces ICD-9-CM inpatient procedure coding: ICD-9-CM procedure codes 3 to 4 numeric digits ICD-10-CM codes 7 alphanumeric digits ICD-10-PCS code format substantially different from ICD -9 Unlike ICD-9, ICD-10
ICD-10 Tips from PHCS The Road to ICD-10 Flyer AMA ICD-10 Project Plan Template Educational Tools Folder Precyse University ICD-10 Physician Office Solution Brochure Precyse Catalog of ICD-10 Courses ICD-10 Precyse Apps for Physicians Resources Folder Free Resources ICD-9 to ICD-10 Crosswalk of Most Common ICD-9 .
Chapter 2 – Introduction to ICD-10-CM and ICD-10-PCS Coding 135 Chapter 3 – ICD-10-CM and ICD-10-PCS Coding Conventions 138 Chapter 4 – Chapter-Specific Coding Guidelines: ICD-10-CM Chapters 1–10 141 Chapter 5 – Chapter-Specific Coding Guidelines: ICD-10-CM Chapters 11–21 143
ICD-10 replaces the ICD-9 code sets and includes updated medical terminology and classification of diseases . ICD-10 CM/PCS consists of two parts: ICD-10-CM for diagnosis coding in all health care settings ICD-10-PCS for inpatient procedure coding in hospital settings . CPT coding for outpatient and office procedures is not
Dec 14, 2010 · ICD-9. ICD-10. ICD-9. ICD-10. Inactive. Active. Combined Code Set. Core Technologies. ICD-9 and ICD-10 code values are unique. Generally, the industry is taking one of two approaches as it relates to the ICD-10 transition: Remediation: Modify/expand all systems and processes to accommodate ICD-
ICD-10 to ICD-10-CM Based on FY2017 ICD-10-CM codes Category and subcategory codes are shaded in grey and marked with an Cells shaded in pink and marked with an *indicate the preferred code when a single code maps to multiple codes (see Introduction) Reportable Neoplasms . Type of Code ICD-10 Category Chapter II (Neoplasms) ICD-10 Term . ICD .
of the previous ICD-9 coding system. The volume of ICD-10 codes as compared to ICD-9 codes is significant because in ICD-10, the code size has been expanded, code values and interpretations have been redefined and specificity has been further improved. Global ICD-10 adoption The current version of ICD is ICD-10, which was adopted by the World .
