Guidelines Applying ICD-10-CM Guidelines Sample
2021ICD-10 ESSENTIALSemplIllustrated guide and practical examples ofICD-10-CM coding guidelines and conventionsSaApplying ICD-10-CMGuidelinesApplying ICD-10-CMGuidelines2 0 21optum360coding.com
ContentsCase Studies .viiCase Studies (Alphabetical Listing) .xvFigures .xxiiiTables . xxveIntroduction . 1How to Use ICD-10 Essentials: Applying ICD-10-CM Guidelines . 1ICD-10-CM Guidelines . 2Illustrations . 2AHA Coding Clinics . 3Practical Application for Guidelines . 4Beyond the Guidelines. 5Official ICD-10-CM Resources . 5mpl10 Steps to Correct Coding . 7Follow the 10 steps below to correctly code encounters for health care services. . 7Official Coding and Reporting Guidelines: Section I.A. Conventions for the ICD-10-CM . 13A. Conventions for the ICD-10-CM .13Official Coding and Reporting Guidelines: Section I.B. General Coding Guidelines . 19B. General Coding Guidelines .19SaChapter 1: Certain Infectious and Parasitic Diseases (A00–B99) . 25Human Immunodeficiency Virus (HIV) Infections (I.C.1.a) .26Infectious Agents As the Cause of Diseases Classified to Other Chapters (I.C.1.b) .40Infections Resistant to Antibiotics (I.C.1.c) .41Sepsis, Severe Sepsis, and Septic Shock (I.C.1.d) .43Methicillin Resistant Staphylococcus aureus (MRSA) Conditions (I.C.1.e) .67Zika Virus Infections (I.C.1.f) .71Chapter 2: Neoplasms (C00–D49) . 75General Guidelines .77Treatment Directed at the Malignancy (I.C.2.a) .84Treatment of Secondary Site (I.C.2.b) .85Coding and Sequencing of Complications (I.C.2.c) .87Primary Malignancy Previously Excised (I.C.2.d) .93Admissions/Encounters Involving Chemotherapy, Immunotherapy and Radiation Therapy (I.C.2.e) .96Admission/Encounter to Determine Extent of Malignancy (I.C.2.f) .102Symptoms, Signs, and Abnormal Findings Listed in Chapter 18 Associated with Neoplasms (I.C.2.g) .104Admission/Encounter for Pain Control/Management (I.C.2.h) .105Malignancy in Two or More Noncontiguous Sites (I.C.2.i) .106Disseminated Malignant Neoplasm, Unspecified (I.C.2.j) .108Malignant Neoplasm Without Specification of Site (I.C.2.k) .109Sequencing of Neoplasm Codes (I.C.2.l) .110Current Malignancy Versus Personal History of Malignancy (I.C.2.m) .117Leukemia, Multiple Myeloma, and Malignant Plasma Cell Neoplasms in Remission VersusPersonal History (I.C.2.n) .119Aftercare Following Surgery for Neoplasm (I.C.2.o) .121Follow-up Care for Completed Treatment of a Malignancy (I.C.2.p) .122 2020 Optum360, LLCiii
ContentsICD-10 Essentials: Applying ICD-10-CM GuidelinesProphylactic Organ Removal for Prevention of Malignancy (I.C.2.q) . 124Malignant Neoplasm Associated with Transplanted Organ (I.C.2.r) . 126Chapter 3: Disease of the Blood and Blood-forming Organs and Certain Disorders Involvingthe Immune Mechanism (D50–D89) .129Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00–E89) .131Diabetes Mellitus (I.C.4.a) . 133Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01–F99) .157Pain Disorders Related to Psychological Factors (I.C.5.a) . 158Mental and Behavioral Disorders Due to Psychoactive Substance Use (I.C.5.b) . 160Factitious Disorder (I.C.5.c) . 169Chapter 6: Diseases of the Nervous System (G00–G99) .175Dominant/Nondominant Side (I.C.6.a) . 176Pain—Category G89 (I.C.6.b) . 180eChapter 7: Diseases of the Eye and Adnexa (H00–H59) .197Glaucoma (I.C.7.a) . 198Blindness (I.C.7.b) . 207mplChapter 8: Diseases of the Ear and Mastoid Process (H60–H95) .217Chapter 9: Diseases of the Circulatory System (I00–I99) .219Hypertension (I.C.9.a) . 222Atherosclerotic Coronary Artery Disease and Angina (I.C.9.b) . 245Intraoperative and Postprocedural Cerebrovascular Accident (I.C.9.c) . 248Sequelae of Cerebrovascular Disease (I.C.9.d) . 252Acute Myocardial Infarction (AMI) (I.C.9.e) . 258SaChapter 10: Diseases of the Respiratory System (J00–J99) .275Chronic Obstructive Pulmonary Disease [COPD] and Asthma (I.C.10.a) . 276Acute Respiratory Failure (I.C.10.b) . 282Influenza Due to Certain Identified Influenza Viruses (I.C.10.c) . 287Ventilator Associated Pneumonia (I.C.10.d) . 289Chapter 11: Diseases of the Digestive System (K00–K95) .293Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00–L99) .295Pressure Ulcer Stage Codes (I.C.12.a) . 297Non-Pressure Chronic Ulcers (I.C.12.b) . 308Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00–M99) .317Site and Laterality (I.C.13.a) . 319Acute Traumatic Versus Chronic or Recurrent Musculoskeletal Conditions (I.C.13.b) . 325Coding of Pathologic Fractures (I.C.13.c) . 328Osteoporosis (I.C.13.d) . 330Chapter 14: Diseases of Genitourinary System (N00–N99) .341Chronic Kidney Disease (I.C.14.a) . 345Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00–O9A) .355General Rules for Obstetric Cases (I.C.15.a) . 358Selection of OB Principal or First-listed Diagnosis (I.C.15.b) . 370Pre-existing Conditions versus Conditions Due to the Pregnancy (I.C.15.c) . 385Pre-existing Hypertension in Pregnancy (I.C.15.d) . 388Fetal Conditions Affecting the Management of the Mother (I.C.15.e) . 390HIV Infection in Pregnancy, Childbirth and the Puerperium (I.C.15.f) . 393iv 2020 Optum360, LLC
ICD-10 Essentials: Applying ICD-10-CM GuidelinesContentsDiabetes Mellitus in Pregnancy (I.C.15.g) .395Long-Term Use of Insulin and Oral Hypoglycemics (I.C.15.h) .396Gestational (Pregnancy Induced) Diabetes (I.C.15.i) .397Sepsis and Septic Shock Complicating Abortion, Pregnancy, Childbirth and the Puerperium (I.C.15.j) .401Puerperal Sepsis (I.C.15.k) .403Alcohol, Tobacco and Drug Use During Pregnancy, Childbirth and the Puerperium (I.C.15.l) .405Poisoning, Toxic Effects, Adverse Effects and Underdosing in a Pregnant Patient (I.C.15.m) .407Normal Delivery, Code O80 (I.C.15.n) .409The Peripartum and Postpartum Periods (I.C.15.o) .411Code O94, Sequelae of Complication of Pregnancy, Childbirth, and the Puerperium (I.C.15.p) .415Termination of Pregnancy and Spontaneous Abortions (I.C.15.q) .416Abuse in a Pregnant Patient (I.C.15.r) .422mpleChapter 16: Certain Conditions Originating in the Perinatal Period (P00–P96) .423General Perinatal Rules (I.C.16.a) .424Observation and Evaluation of Newborns for Suspected Conditions Not Found (I.C.16.b) .438Coding Additional Perinatal Diagnoses (I.C.16.c) .441Prematurity and Fetal Growth Retardation (I.C.16.d) .444Low Birth Weight and Immaturity Status (I.C.16.e) .447Bacterial Sepsis of Newborn (I.C.16.f) .449Stillbirth (I.C.16.g) .452Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00–Q99) .453Congenital Malformations, Deformations, and Chromosomal Abnormalities (I.C.17) .454SaChapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, NotElsewhere Classified (R00–R99) .467Use of Symptom Codes (I.C.18.a) .472Use of a Symptom Code with a Definitive Diagnosis Code (I.C.18.b) .475Combination Codes That Include Symptoms (I.C.18.c) .479Repeated Falls (I.C.18.d) .481Coma Scale (I.C.18.e) .482SIRS due to Non-Infectious Process (I.C.18.g) .486Death NOS (I.C.18.h) .488NIHSS Stroke Scale (I.C.18.i) .489Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00–T88) .491Chapter 20: External Causes of Morbidity (V00–Y99) .503Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00–Z99) .511Official Coding and Reporting Guidelines: Section II. Selection of Principal Diagnosis .531Official Coding and Reporting Guidelines: Section III. Reporting Additional Diagnoses .535Official Coding and Reporting Guidelines: Section IV. Diagnostic Coding and ReportingGuidelines for Outpatient Services .537Official Coding and Reporting Guidelines: Appendix I. Present on Admission Reporting Guidelines .541 2020 Optum360, LLCv
Case Studies (Alphabetical Listing)SampleAbortion with Liveborn Fetus . 418Abortion, Elective with Complications Leading to and Following Termination . 421Abortion, Failed Attempt with Retained Products of Conception with Complications . 420Abortion, Spontaneous with Retained Products of Conception . 420Abortion, Threatened . 363Abuse and Dependence, Alcohol . 165Abuse, Alcohol . 166Abuse, Alcohol with Use, Cannabis . 165Acute Respiratory Failure and Acute Idiopathic Pulmonary Hemorrhage in Infants . 478Adenocarcinoma .82Adenoma, Pituitary .81AIDS Patient Admitted with Cholelithiasis .31Altered Mental Status . 473Alveolar Abscess with MSSA Positive Swab .70Amblyopia . 215Amblyopia Suspect . 215Antimycobacterial-Resistant Primary Pulmonary Tuberculosis .42Atherosclerosis, Native and Bypass Graft with Angina . 247Bipolar Disorder, Manic, Moderate . 172Bipolar Type 1, Manic with Psychosis . 173Blindness . 209Blindness, Bilateral . 209Blindness, Right Eye . 209Bone vs Joint Right Humerus . 324Bone vs Joint Right Shoulder . 324Cataract with Neovascularization . 212Cataract, Drug-Induced . 213Cataract, Senile Cortical . 212Cerebral Infarction and Ruptured Aneurysm Sequela . 255Cerebral Infarction, Acute, and History with Residual Conditions . 256Cerebral Infarction, History . 257Cerebrovascular Accident (CVA), Postprocedural . 250Chronic Obstructive Asthma Exacerbation . 280Chronic Renal Impairment . 346CKD Following Kidney Transplant . 348CKD, Stage 4 with ESRD . 346CKD, Stage 5 . 346Compartment Syndrome, Nontraumatic . 327Congenital Auditory Stricture . 459Congenital Cleft Palate and Lip . 461Congenital Condition, Marfan’s Syndrome . 463Congenital Condition, Noonan Syndrome . 462Congenital Cytomegalovirus . 431Congenital Hypothyroidism and Down Syndrome . 465Congenital Mycoplasma Pneumonia . 432Congenital Patent Foramen Ovale or Atrial Septal Defect . 460Congenital Rieger’s Anomaly . 458Congenital Spina Bifida . 457Congenital Testicular Torsion and Cryptorchism . 462Congenital Zika Infection in 6-Month-Old .73Contact-Induced Edema . 210COPD and Emphysema . 281 2020 Optum360, LLCxv
IntroductionICD-10 Essentials: Applying ICD-10-CM Guidelines is a new coding reference for ICD-10-CM focusingon the correct application of the ICD-10-CM coding guidelines. This book provides a comprehensivelook at ICD-10-CM guidelines along with supporting examples, case studies, and in-depth codingrationales designed to ensure accurate application of the guideline in real-life coding situations.New and veteran coding professionals will find this book to be a valuable resource that explains andclarifies key coding concepts related to ICD-10-CM.The coding guidance found in ICD-10 Essentials: Applying ICD-10-CM Guidelines is based on theofficial version of the ICD-10-CM Official Guidelines for Coding and Reporting (ICD-10-CM), effectiveOctober 1, 2019.eChanges reflecting the dynamic world of coding are ongoing, and Optum360 would welcomereaders’ input on what should be included in future editions of the book.How to Use ICD-10 Essentials: Applying ICD-10-CMGuidelinesmplThe organization of ICD-10 Essentials: Applying ICD-10-CM Guidelines follows the format ofICD-10-CM Official Guidelines for Coding and Reporting. There is a chapter devoted to each of thetopics covered in the guidelines, as follows:Certain infectious and parasitic diseases Neoplasms Endocrine, nutritional, and metabolic diseases Mental, behavioral, and neurodevelopmental disorders Diseases of the nervous system Diseases of the eye and adnexa Diseases of the circulatory system Diseases of the respiratory system Diseases of the skin and subcutaneous tissue Diseases of the musculoskeletal system and connective tissue Diseases of the genitourinary system Pregnancy, childbirth, and the puerperium Certain conditions originating in the perinatal period Congenital malformations, deformations, and chromosomal abnormalities Symptoms, signs, and abnormal clinical and laborat
Applying ICD-10-CM Guidelines Applying ICD-10-CM Guidelines Illustrated guide and practical examples of ICD-10-CM coding guidelines and conventions 2 0 2 1 optum360coding.com
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 .
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 .
7/13/2015 1 Tonya Mitchell, RHIT July 17, 2015 Objectives Review the History of ICD‐10 Discuss the Myths and Facts of ICD‐10 Discuss GlGeneral DttiDocumentation CtConcepts Review ICD‐10 Documentation Concepts Analyze Documentation for Top Diagnosis in ICD‐10 WHY CHANGE FROM ICD‐9 TO ICD‐10? ICD‐9 was developed in the 1970s and cannot support current
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 .
According to CMS, GEMs are “a tool to assist with the conversion of ICD-9-CM codes to ICD-10 and the conversion of ICD-10 codes back to ICD-9-CM. The GEMs are forward and backward mappings between the ICD-9-CM and ICD-10 coding systems.” Watch out: Although you’ll see the term “cr
