Your
ICD-10
Guide
Certain Infectious & Parasitic Diseases
Hope you all enjoy!
Three digit categories:
A00 – A09 Intestinal infectious diseases
A80 – A89 Viral infections of the central nervous system
Often additional codes are used in addition to codes in this chapter
Example: Penicillin
-resistant streptoccocal pneumoniae
Code infection first
Example:
Certain infectious & parasitic diseases
Not all diseases are coded here
General notations that pertain to three digit categories are listed prior to their code sets
Example: A00 – B99
§Includes: diseases generally recognized as communicable or transmissible
Exclude 2: infectious and parasitic diseases specific to the perinatal period (P35 – P39)
General notations that pertain to three digit categories are listed prior to their code sets
Example: A00 – B99
§Excludes 1: carrier of suspected carrier of infectious disease (Z22.-) certain localized infections – see body system – related chapters
§Exclude 2: infectious and parasitic diseases specific to the perinatal period (P35 – P39)
Example:
Exclusion notes state respiratory infections should be coded using J00 – J22 and, and exclude most diseases effecting pregnancy, childbirth, and puerperium.
The first set of codes are Intestinal Infectious Diseases
This includes all causes of intestinal infections, including food-borne intoxicants
Cross-Walk Example
ICD-9-CM
002 -Typhoid and paratyphoid fevers
002.0 – Typhoid Fever
002.1 – Paratyphoid fever A
002.2 – Paratyphoid fever B
002.3 – Paratyphoid fever C
002.9 – Paratyphoid fever, unspecified
ICD-10-CM
A01 – Typhoid and paratyphoid fevers
A01.0 – Typhoid fever
Infection due to Salmonella typhi
A01.00 - Typhoid fever, unspecified
A01.01 – Typhoid meningitis
A01.02 - Typhoid fever with heart involvment
Typhoid endocarditis
Typhoid myocarditis
A01.03 –Typhoid pneumonia
A01.04 – Typhoid arthritis
A01.05 – Typhoid osteomyelitis
A01.09 – Typhoid fever with other complications
A01.1 – Paratyphoid fever A
A01.2 – Paratyphoid fever B
A01.3 – Paratyphoid fever C
A01.4 – Paratyphoid fever, unspecified
Example:
A09 – Infectious gastroenteritis and colitis unspecified
Codes include infections due to mycobacterium TB and mycobacterium bovis and exclude congenital TB, any type of pneumoconiosis associated with TB, sequelae TB, and silicotuberculosis
Specific codes also have individuals exclude notations
Example:
TB of “other organs” include:
Certain zoonotic bacterial diseases
Any infectious disease that can be transmitted from animals to humans is considered a zoonotic disease
Of the 1415 known pathogens that effect humans 61% are zoonotic
Zoonotic bacterial diseases are divided as follows:
A28 – Other zoonotic bacterial diseases, NEC
Examples of codes in this chapter include:
In the ICD-9-CM listeriosis was categorized under zoonotic bacterial diseases and was assigned a single code
Listeriosis is categorized in the ICD-10-CM under “Other Bacterial Diseases” and has the following codes:
A32 - Listeriosis
A32.9 – Listerosis, unspecified
Whooping Cough Cross-walk
ICD-9-CM
033 Whooping cough
033.0 – Bordetella pertussis (B. pertussis)
033.1 – Bordetella parapertussis (B. parapertussis)
033.8 – Whooping cough due to other specified organism
033.9 – Whooping cough, unspecified organism
ICD-10-CM
A37 – Whooping Cough
A37.00 – whooping cough due to Bordetella pertussis without pneumonia
A37.01 - whooping cough due to Bordetella pertussis with pneumonia
A37.10 – Whooping cough due to Bordetella parapertussis without pneumonia
A37.11 - Whooping cough due to Bordetella parapertussis with pneumonia
A37.80 – Whooping cough due to other Bordetella species without pneumonia
A37.81 - Whooping cough due to other Bordetella species with pneumonia
A37.90 – Whooping cough, unspecified species, without pneumonia
A37.91 - Whooping cough, unspecified species, with pneumonia
Scarlet fever in the ICD-9-CM was a single code
In the ICD-10-CM scarlet fever is now the following four codes:
In order to select the proper codes it is important to understand how the ICD defines each condition and ensure providers align their terminology with them
Septicemia: refers to a systemic disease associated with the presence of pathological microorganisms or toxins in the blood, which can include bacteria, viruses, fungi, or other organisms
Systemic Inflammatory Disease (SIRS): generally refers to the systemic response to infection, trauma/burns, or other insult (such as cancer) with symptoms including fever, tachycardia, tachypnea, and leukocytosis
Sepsis: generally referred to as SIRS due to infection
Sever Sepsis: sepsis with associated acute organ dysfunction
Urosepsis
In the ICD-9-CM the default code in the index for “urosepsis” was 599.0 (uti)
According to the ICD-10-CM coding guidelines the term urosepsis is a non-specific term with no default code and is not considered synonomous with sepsis. If the term is used by a provider the record must be sent back for clarificaiton
If a patient is diagnosed with sepsis and acute organ dysfunction and/or multiple organ dysfunction (MOD) code according to sever sepsis guidelines
Sever sepsis requires a minimum of two codes
-
Code underlying systemic disease
-
Select the appropriate code from subcatagory R65.2 (sever sepsis)
-
If a organism is not documented assign code A41.9
-
Assign any additional organ dysfunction codes
Coding septic shock:
1) Code first the underlying systemic infection
2) Code R65.21 (this code encompasses sever sepsis as well)
3) Additional organ dysfunction codes
Codes from category R65.2- are never assigned as primary codes
If a patient has sepsis due to a postprocedural infection code:
- Postproccedural infection (ex. T80.2 Infections following infusions and therapeutic infections)
- Code specific infection
- If the documentation supports sever sepsis assign a code from R65.2- as an additional code
Example of codes in this section include:
Terms to watch for when using syphilis codes:
Examples:
A50.05
A51.45
These are diseases caused by a distinct type of bacteria that has a long, coiled cell, which moves in a twisting motion
Examples of Spirochetal Codes:
Other diseases caused by chlamydiae
These codes exclude sexually transmitted chlamydial diseases (A55-A56)
Rickettsioses
Rickettsia is any group of rod-shaped bacteria that live in biting arthropods causing multiple diseases, such as:
Viral Infections of the Central Nervous System
Examples of codes and conditions used here include:
Arthropod-borne viral fevers and viral hemorrhagic fevers
These codes are used to identify viral fevers carried by arthropods such as mosquitoes and ticks.
Examples of codes and conditions included in this category are:
Viral infections characterized by skin and mucous membrane lesions
This category includes:
There is a notation beneath code B03 – Smallpox, which reads
Some codes in this grouping have changed slightly in their descriptions and/or quantity of codes
Example
ICD-9-CM
053 - Herpes Zoster
053.0 – with meningitis
053.1 – With Nervous system complications
053.10 - With unspecified nervous system complication
053.11 – Geniculate herpes zoster
053.12 – Postherpetic trigeminal neuralgia
053.13 – Postherpetic polyneuropathy
053.14 – Herpes zoster myelitis
053.13 - Other
ICD-10-CM
B02 – Zoster [herpes zoster]
B02.0 – Zoster encephalitis
B02.1 - Zoster meningitis
B02.2 – Zoster with other nervous system involvement
B02.21 – Postherpetic geniculate ganglionitis
B02.22 – Postherpetic trigeminal neuralgia
B02.23 – Postherpetic polyneuropathy
B02.24 – Postherpetic myelitis
B02.29 – Other postherpetic nervous system involvement
Some codes in this grouping have changed largely in their descriptions and/or quantity
ICD-9-CM
052 – Chickenpox
052.0 – Postvaricella encephalitis
052.1 – Varicella (hemorrhagic) pneumonitis
052.2 – Postvaricella myelitis
052.7 – With other specified complications
052.8 – With unspecified complications
052.9 – Varicella without mention of complications
ICD-10-CM
B01 – Varicalla [chickenpox]
B01.0 – Varicella meningitis
B01.1 – Varicella encephalitis, myelitis, and encephalomyelitis
B01.11 – Varicella encephalitis and encephalomyelitis
B01.12 – Varicella myelitis
B01.2 – Varicella pneumonia
B01.8 – Varicella with other complications
B01.81 – Vericella keratitis
B01.89 – Other varicella complications
B01.9 – Varacella without complication
These codes exclude
Codes here do include human herpesvirus:
B15 –B19 is used for viral hepatitis
These codes are grouped as follows:
There are a total of 22 specific codes in this catagory
HIV
This is the only code listed for HIV
Guidelines state that is a patient is admitted for HIV related conditions B20 should be the principal diagnosis followed by additional diagnosis of related conditions
If a patient is admitted for an unrelated condition (ex. Trauma), code the unrelated conditions as the principal diagnosis followed by B20 and HIV related conditions
Sequencing is not effected by a new diagnosis vs an established one
If a patient is diagnosed with HIV or has a record of:
But is asymptomatic use code Z21 instead of B20
Do not use code Z21 for the term “AIDS”
A patient who has had an HIV test that is inconclusive uses code R75:
Any patient with a previous record of HIV related illnesses should always be assigned B20 on subsequent records
Once a patient is assigned the B20 code codes R75 and Z21 should never be used for them again.
If a patient is pregnant, giving birth, or post partum and is seen for HIV related illnesses sequencing rules state the HIV code should be first. This scenario is different though.
Use code O98.7x first
Followed by B20
Code from chapter 15 (materninty) ALWAYS take priority sequencing
If a patient is pregnant, giving birth, or post partum and is seen for HIV related illnesses sequencing rules state the HIV code should be first. This scenario is different though.
Use code O98.7x first
Followed by B20
Code from chapter 15 (materninty) ALWAYS take priority sequencing
Patient who are being seen to determine his/her HIV status are assigned code Z11.4
If a patient with signs or symptoms are being screened use additional counseling code
Code Z71.7 is also assigned when a patient returns for test results that are negative
If results are positive either B20 or Z21 is assigned (according to guidelines)
Codes B25- B34 are classified under “other viral diseases”
These include:
B27.00 – B27.99
Viral Conjunctivitis
Other viral disease NEC
Viral Infections Unspecified
Mycoses are coded using B35 – B49
Mycosis (plural: Mycoses) is a fungal infection of animals, including humans. Mycoses are common, and a variety of environmental and physiological conditions and can contribute to the development of fungal diseases. Inhalation of fungal spores or localized colonization of the skin may initiate persistent infections; therefore, mycoses often start in the lungs or on the skin.
These codes exclude hypersensitivity pneumonitis due to organic dust (J67.x) and mycosis fungoides (C84.0x)
Skin related codes (dermatophytosis) utilize code B35 – B38
Examples of codes in this grouping include:
Histoplasmosis – B39
Histoplasmosis (also known as "Cave disease“, "Darling's disease“, "Ohio valley disease”, "Reticuloendotheliosis”, "Spelunker’s Lung”.) This disease is caused by the fungus Histoplasma capulatum . Symptoms of this infection vary greatly, but the disease primarily affects the lungs. Occasionally, other organs are affected; this is called disseminated histoplasmosis, and it can be fatal if left untreated. Histoplasmosis is common among AIDs patients because of their suppressed immune system.
Notations beneath B39 states to first code associated AIDS (B20)
Use additional codes for associated manifestations
Endocatditis – I39
Pericarditis – I32
Protozoal diseases
This category is a new grouping
The ICD-9-CM divided diseases in this grouping under multiple different headings
Malaria
Cross-Walk-Example
ICD-9-CM
084 - Malaria
084.0 - Falciparum malaria
084.1 - Vivax malaria
084.2 - Quartan malaria
084.3 - Ovle malaria
084.5 - mixed malaria
084.6 - Malaria Unspecified
084.7 - Induced Malaria
084.8 - Blackwater fever
084.9 - Other pernicious complications of malaria
ICD-10-CM
B50 – Plasmodium Falciparum Malaria
B50.0 - Plasmodium falciparum malaria with cerebral complicaitons
B50.8 – Other severe and complicated plasmodium falciparum malaria
B50.9 – Plasmodium falciparum malaria, unspecified
B51 – Plasmodia vivax malaria
B51.0 – Plasmodium vivax malaria with ruptured spleen
B51.8 – Plasmodium vivax malaria with other complications
B51.9 – Plasmodium vivax malaria without complication
B52 – Plasmodium malariae malaria
B52.0 – plasmodium malariae malaria with nephropathy
B52.8 – Plasmodium malariae malaria with other complicationd
B52.9 – Plasmodium malariae malaria without complication
B53 – Other specified malaria
B53.0 – Plasmodium ovale malaria
B53.1 – Malaria due to simian plasmodia
B53.8 – Other malaria, NEC
B54 – Unspecified malaria
Helminthiases
Helminthiasis - a macroparasitic human disease of humans and animals in which a part of the body is infested with parasitic worms, such as pinworm, roundworm, or tapeworm. Typically, the worms reside in the gastrointestinal tract but may also burrow into the liver or other organs.
Schistosomiasis
Spreads through contaminated water and effects live and lungs
Fluke Infections
Fluke infections include:
Enchinococcus infections
Examples of other infections listed under the helminthiases grouping include:
Pediculousis, Acariasis, and other infestations
These codes include infestations such as:
Myiasis
Sequelae is a pathological condition resulting from disease, injury, or other trauma.
Codes in this grouping are used to indicate conditions in categories A00 –B89 as the cause of sequelae.
Code first any condition resulting from (sequela), the infections or parasitic disease.
Bacterial and Viral Infectious Agents
Codes in this grouping are to be used as additional or supplementary codes to identify the infectious agent in diseases classified elsewhere.
Examples of other codes in this category include:
Code B99.8 and B99.9
Codes in this chapter can be looked up in the alphabetic index under:
Common notations in this chapter include:
Excludes 2
Exclude 1: Not Coded Here! These two codes can never be reported together
Exclude 2: Not included here. Can be reported in conjunction with other code if supported by documentation.
The ICD-10-CM & Gross Anatomy
The recent buzz surrounding the ICD-10 seems to be about knowing your anatomy.
Because the codes are much more specific coders are going to have to brush up on their gross anatomy, common medical terms, and even some pathology.
This post will be dedicated to pointing out ICD-10-CM and ICD-9-CM cross-walk codes, why knowing your anatomy will be important, and how your physician documentation will need to change.
When thinking about how knowing your anatomy will affect your ICD-10-CM code selection Fracture coding is the first thing that comes to mind.
In the ICD-9-CM fracture codes are located in the 800 series. In the ICD-10-CM they are S codes.
When looking up a fracture code in the ICD-9-CM index you refer to the term “Fracture” and then the anatomical location.
When looking up a fracture code in the ICD-10-CM index there are two options:
~“Fracture, Pathological”
~“Fracture, Traumatic”
A pathological fracture is a fracture that occurs in a weakened area of a bone, and is often caused by pressure or stress. Pathological fractures are also called compression fractures or stress fractures.
A traumatic fracture is a fracture caused by a sudden (acute) blow, crush, or impact that results in the breaking of a bone.
Weather a fracture is pathological or traumatic is something physicians will need to document clearly.
Example:
Looking up the anatomical term “acetabulum” under “Fracture” in the ICD-9-CM we are provided with the following options:
Fracture
Acetabulum (with visceral injury) (closed) 808.0
Open 808.1
Looking up the anatomical term “acetabulum” under “Fracture, Traumatic” in the ICD-10-CM we are provided with the following options:
Fracture, Traumatic
Acetabulum S32.409
Column
Anterior (displaced) (iliopubic) S32.409
Nondisplaced S32.44-
Posterior (displaced) (ilioscial) S32.443
Nondisplaced S32.44-
Dome (displaced) S32.48
Nondisplaced S32.48
Specified NEC S32.49-
Transverse (displaced) S32.45-
With associated posterior wall fracture (displaced) S32.46-
Nondisplaced S32.46-
Nondisplaced S32.45-
Wall
Anterior (displaced) S32.41-
Nondisplaced S32.41
Medial (displaced) S32.47-
Nondisplaced S32.47-
Posterior (displaced) S32.42
With associated transverse fracture (displaced) S32.46-
Nondisplaced S32.46 –
Nondisplaced S32.42 –
We can see that in order to select the proper fracture code we will need to know more about the anatomy of our acetabulum, such as what is the dome? what is the column? etc. The physician will need to document the specifics about the fracture more clearly as well.
The majority of the fracture codes are similar to this example. But what about other organ systems?
Sprains and Strains and also more specific to the ligament or tendon that was injured.
Example:
Looking up the anatomical term “ankle” under “Sprain, strain” in the ICD-9-CM we are provided with the following options:
Ankle 845.00
And foot 845.00
Looking up the anatomical term “ankle” under “Sprain” in the ICD-10-CM we are provided with the following options:
Ankle S93.409
Calcaneofibular ligament S93.41-
Deltoid ligament S93.42-
Internal collateral ligament – see sprain, ankle, specified ligament NEC
Specified ligament NEC – S93.49-
Talofibular ligament – see Sprain, ankle, specified ligament NEC
Tibofibular ligament – S93.43-
Although I hate to repeat myself, this too is going to require more specific documentation and a greater knowledge of anatomy.
Disease codes are also more anatomically specific
Example
If a physician documents a patient having Paget’s Disease of the bone we would look up the term “Paget’s disease” and indented beneath it we would locate the term “bone” (in the ICD-9-CM). Doing this we would be provided with the following options:
Paget’s Disease (osteitis deformans) 731.0
Bone (731.0)
Osteosarcoma in (M9184/3) see Neoplasm, bone, malignant
In the ICD-10-CM we would also look up the term “Paget’s Disease” and indented beneath it we would locate the term “bone”. Doing this we would be provided with the following options:
Paget’s Disease
Bone M88.9
Carpus M88.84-
Clavicle M88.81-
Femur M88.85-
Fibula M88.86-
Finger M88.84-
Humerus M88.82-
Ilium M88.85-
In neoplastic disease – see Osteitis, deformans, in neoplastic disease
Ischium M88.85-
Metacarpus M88.84-
Metatarsus M88.87-
Multiple sites M88.89
Neck M88.88
Radius M88.83-
Rib M88.88
Scapula M88.81-
Skull M88.0
Tarsus M88.87-
Tibia M88.86-
Toe M88.87-
Ulna M88.83-
Vertebra M88.88
Given these options make selecting a code more tricky in two ways.
1) A physician may not document anything other than “bone”. In this scenario we would either be forced to submit an unspecified code (M88.9) which may be rejected by the insurance company, or we can request more specific documentation from the physician.
2) A physician may document something like “Paget’s disease of the acromion”. In this scenario you would need to know on which bone the acromion is located since it is not an option on our list. (The acromion is the summit of the shoulder and part of the scapula) and then select the proper code (M88.0).
Another example of how diseases and conditions may be more specific to anatomical locations is "meningococcal infection of the heart".
Looked up in the ICD-9-CM under “Infection, Meningococcal” you are provided with the following options:
Infection
Meningococcal (see also condition) 036.9
Brain 036.1
Cerebrospinal 036.0
Endocardium 036.42
Generalized 036.2
Meninges 036.0
Meningococcemia 036.2
Specified site NEC 036.89
Since there is not a specific code for the heart we would use code 036.89, (specified site NEC).
Looked up in the ICD-10-CM under “Infection, Meningococcal” you are provided with these options:
Infection
Meningococcal (see also condition) A39.9
Adrenals A39.1
Brain A39.81
Cerebrospinal A39.0
Conjunctiva A39.89
Endocardium A39.51
Heart
Endocardium A39.51
Myocardium A39.52
Pericardium A39.53
Joint A39.83
Meninges A39.0
Meningococcemia A39.4
Acute A39.2
Chronic A39.3
Myocardium A39.52
Pericardium A39.53
Retrobulbar neuritis A39.82
Specified site NEC A39.89
The anatomical location “heart” is available in these choices but in addition you will need to know which specific part of heart is infected; the Endocardium (inner most layers of tissue lining the heart chambers), the Myocardium (striated cardiac muscle that makes up the walls of the heart), or the Pericardium (the two layered fluid filled sac surrounding the heart).
Another example is Kissing spine.
When looking up kissing spine in the ICD-9-CM there are three options under “Kissing”
Kissing
Osteophyte 721.5
Spine 721.5
Vertebra
When looking up kissing spine in the ICD-10-CM you would look up “Kissing Spine” instead of just “Kissing” with an indent. “Kissing Spine” provides the following options.
Kissing Spine M48.20
Cervical region M48.22
Cervicothoracic region M48.23
Lumbar region M48.26
Lumbrosacral region M48.27
Occipito-atlanto-axilia region M48.21
Thoracic region M48.24
Thoraciclumbar region M48.25
In order to select the correct code here you would not only need adequate documentation but also know that there are 24 vertebra in the body; 7 cervical (C1 – C7), 12 thoracic (T1 –T12), 5 lumbar (L1 – L5), 5 sacral (S1- S5), and 3-5 coccygeal (fused to form tailbone). In addition you would also need to know that names like cervicothoracic pertain to both the cervical and thoracic vertebra and therefore should only be used when both types of vertebra are documented as being affected.
Some codes in the ICD-10-CM are just simply new and anatomically specific.
Examples of these codes include:
Pyogenic infection of the occipito-atlanto-axial region M46.31
*Occipito-atlanto is a joint articulation that joins the atlas and the occipital bone, the atlanto-axial is a joint articulation that joins the atlas with the axis (C1 and C2).
Congenital malformation of the corpus callosum Q04.0
*The corpus callosum, also known as the colossal commissure, is a wide, flat bundle of neural fibers beneath the cortex in the eutherian brain eutherian at the longitudinal fissure. It connects the left and right cerebral hemispheres and facilitates interhemisphic communication.
Tentorial tear due to birth injury P10.4
* The tentorium cerebelli or cerebellar tentorium, is an extension of the dura that separates the cerebellum from the inferior portion of the occipital lobes.
While numerous examples can be found in the ICD-10-CM, the point is that there is a need for coders to brush up on some gross anatomy.
While coders who are already certified through the AAPC will need to take a comprehensive exam over the ICD-10 once, the daily need to know the entire structure of the human body is unlikely.
I suggest making a list of common ICD-9-CM codes that you use on a daily basis in your specific specialty.
Next, make your own cross-walk for those codes creating a second list for ICD-10 codes. Read over your ICD-10-CM list and look up each code’s definition in the tabular. Highlight and/or make a list of any anatomical term that you do not recognize.
Finally, do some surfing in the web or pull out some anatomy books and do some research. Find out what is included in the description of each code on your ICD-10 list.
If you are in a specialty that has extensive details consider purchasing some detailed, specialty specific, anatomical charts.
Signs & Symptoms: Comparing the ICD-9-CM to the ICD-10-CM
“Symptoms, Signs, and Ill-Defined Conditions” in the ICD-9-CM is code range:
~ 780.xx – 799.xx
Codes in the ICD-9-CM are grouped as follows:
~ General S&S
~ Organ system
Codes loosely follow the progression of:
~ From the top of the body down
Ex. Code regarding S&S of the head are listed before S&S regarding shoulders
~ From the outside of the body in
Ex. Codes regarding S&S of the skin are listed before codes for S&S of the muscles
Examples of existing ICD-9-CM codes in this chapter :
General
Hallucinations – 780.1
Coma – 780.01
Vertigo – 780.4
Fever – 780.60
Fatigue – 780.79
Nervous & Musculoskeletal system
Abnormal Gait – 781.2
Lack of Coordination – 781.3
Facial Weakness – 781.94
Integumentary
Rash – 782.1
Cyanosis – 782.5
Flushing – 782.62
Metabolic S&S
Anorexia – 783.1
Failure to Thrive – 783.41
Polydipsia – 783.5
Headache – 784.0
Throat pain- 784.1
Aphasia – 784.3
Cardiovascular
Palpitations – 785.1
Tachycardia – 785.0
Respiratory
Wheezing – 786.07
Hyperventilation – 786.0
Painful Respiration – 786.52
Digestive
N/V – 787.01
Heartburn – 787.1
Fecal incontinence – 787.60
Urinary
Renal colic – 788.0
Dyuria – 788.1
Polyuria – 788.42
S&S of the Abdomen and Pelvis
LLQ abdominal pain – 789.03
Splenomegaly – 789.2
Abnormal Finding
Elevated fasting glucose – 790.21
Abnormal EKG – 794.31
In the ICD-9-CM the chapter title is “Symptoms, Signs, and Ill Defined Conditions”. This title has been changed in the ICD-10-CM to “Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified”.
Although the title no longer includes the words “ill defined conditions”, ill defined condition codes are still classified in this chapter.
Chapter Organization
S&S that point definitely to a given diagnosis have been removed from this grouping and have been reassigned to other categories.
The guideline that codes must follow in order to be under this chapter grouping in the ICD-10-CM is:
If a sign, symptom, or ill defined condition point equally to two or more possible diagnosis, which cannot be determined without a case study, they will be listed under this heading.
Example: Upper Limb Swelling
In the ICD-9-CM this was code 729.81 and was under “disease of the musculoskeletal system”
In the ICD-10-CM this codes was relocated under S&S because limb swelling can be caused by multiple aliments (DVT, trauma, CHF, etc.)
The ICD-10-CM Code range for S&S
~ R00.xxxx – R99.xxxx
In order for Codes R00 – R69 to be assigned as a diagnosis in a medical record it must meet at least one of the following six rules:
1) Cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated.
2) S&S existing at the time of initial encounter that proved to be transient and whose cause could not be determined.
3) Provisional diagnosis in a patient who failed to return for further investigation or care.
4) Cases referred elsewhere for investigation or treatment before the diagnosis was made.
5) Cases in which a more precise diagnosis was not available for any other reason.
6) Certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.
Three digit categories in this section are as follows:
“Signs and Symptoms involving the…”
R00-R09: Circulatory & Respiratory systems
R10-R19: Digestive System and Abdomen
R20-R23: Skin and Subcutaneous Tissue
R25-R29: Nervous & Musculoskeletal Systems
R30-R39: Urinary System
R40-R46: Cognition, Perception, Emotional State, and Behavior
R47-R49:Speech and Voice
R50-R69: General Signs & Symptoms
The next category is “Abnormal findings on examination of…..”
R70-R79: Blood, without diagnosis
R80-R82: Urine, without diagnosis
R83-R89: Other body fluids, substances, and tissues, without diagnosis
R90-R94: Diagnostic imaging and function studies, without diagnosis
The final catagories are Miscellaneous catagories
R97: Abnormal tumor markers
R99: ill Defined and unknown cause of mortality
Each three digit category is further subdivided into 4th, 5th, 6th, and 7th digit codes specific to that three digit category.
Ex. Three digit category R06 – Abnormalities of Breathing
~ Specific 5th digit code R06.02 – Shortness of Breath
Beneath each three digit category will be any general guidelines pertaining to all codes within that three digit catagory or code range.
Ex. Three digit category R10 – “Abdominal and Pelvic Pain” had the following notations
Excludes 1: Renal Colic (N23)
Excludes 2: Dorsalgia (M54), flatulance and related conditions (R14)
These two notations are to be used on the code range
R10.xxxx – R10.84xx
Codes specific notations will be listed directly beneath the code or with a convention to its left.
General Code Informaiton
Many of the codes are straight forward and similar to the ICD-9-CM codes in how they are looke up and in their code descriptions.
Examples:
Palpitations – R00.2
SOB – R06.02
Wheezing – R06.2
Painful Respiration – R07.1
Dysuria – R30.0
Vertigo – R42
Syncope – R55
Some things have changed in codes though and may include one or more of the following:
~ Multiple, more specific, codes for what use to be a single code
~ Additional digits
~ Use of the dummy place holder “x”
~ Exclude 1 & 2 notations
The Codes in Detail
The major difference in abdominal codes (pain, tenderness, rigidity, and swelling
is that in the ICD-9-CM the codes all shared a 5th digit box used for describing the location (ex. LLQ, RUQ, etc), and all 4 digit codes referred back to the box. In the ICD-10-CM the locations are generally the same but each location has a specific code instead of a shared digit.
Example: Abdominal Pain (R10)
R10.1 – Pain localized to the upper abdomen
R10.10 – Upper abdominal unspecified
R10.11 – RUQ
R10.12 – LUQ
R10.13 - Epigastric
R10.3 –Pain localized to other parts of lower abdomen
R10.30 – Lower abdominal pain, unspecified
R10.31 – RLQ
R10.33 – LLQ
R10.33 – Periumbilical pain
The 9 abdominal tenderness codes in the ICD-9 are now the following18 codes in the ICD-10.
Examples:
R10.81 Abdominal Tenderness
R10.811- RUQ tenderness
R10.812 – LUQ tenderness
R10.813 – RLQ tenderness
R10.814 – LLQ tenderness
R10.815 – Periumbilical tenderness
R10.816 – Epigastic tenderness
R10.817 Generalized tenderness
R10.819 – Abdominal tenderness unspecified
R10.82 – Rebound tenderness
R10.821 – RUQ rebound tenderness
R10.822 – LUQ rebound tenderness
R10.823 – RLQ rebound tenderness
R10.824 – LLQ rebound tenderness
R10.825 – Periumbilical rebound tenderness
R10.826 – Epigastic rebound tenderness
R10.827 – Generalized rebound tenderness
R10.828 – Rebound tenderness unspecified
Abdominal rigidity is coded similar to pain and tenderness.
Code R19.3x is used and 5th digits are used to specify the specific location
Example: R19.33 RLQ rigidity
The number of codes in the ICD-9 (9) for abdominal rigidity is the same number in the ICD-10-Cm (9).
Swelling of the abdomen in similar to abdominal pain, tenderness, and rigidity codes.
The ICD-9-CM provides one code (789.3x) with a 5th digit for location (Ex. RUQ, etc.)
The ICD-10-CM has 9 codes, one for each location
Ex. R19.06 – Epigastric swelling, mass, or lump
Some codes were divided from one code into multiple codes.
Example 1:
ICD-9-CM code 787.3 is used to describe “flatulence, eructation, and gas pain”
The ICD-10-CM has a code for each descriptor:
R14. - Gas pain
R14.2 - Eructation
R14.3 - Flatulence
Example 2:
Dyspenea – 786.09
This single code in the ICD-9 is used to describe:
Painful breathing
Respiratory distress
Respiratory insufficiency
Tachypnea NEC
Difficulty Breathing
Other unspecified respiraroty abnormalities
Dyspnea in the ICD-10-CM cross-walks to the following codes:
R06.00 – Dyspnea NOS
R06.09 – Other forms of Dyspnea
R06.89 – Abnormalities of breathing
R06.82 - Tachypnea
R06.89 - Respiratory Insufficiency
R07.1 - Painful respirations
R06.00 - Respiratpry Distress
Example 3:
Disturbance of skin sensation – 782.0
This code in the ICD-9 is used for all of the following:
Anesthesia of skin
Burning or prickling sensation
Hyperesthesia
Hypoesthesia
Numbness
Paresthesia
Tingling
Disturbance of the skin unspecified
The ICD-10-CM divides this one code into the following codes:
R20.0 – Anesthesia of skin
Numbness
Tingling
R20.1 – Hypoesthesia of skin
R20.2 – Paresthesia of skin
R20.3 – Hypersthesia of skin
R20.8 – Other disturbances of the skin
Burning sensation
R20.9 – Unspecified disturbances of the skin
Some codes will require more detailed documentation due to their more detailed descriptions.
Example :
ICD-9-CM: Swelling, Limb – 729.81
ICD-10-CM codes for swelling of the limb:
R22.30 - Localized swelling, mass, and lump, upper limb, unspecified side
R22.31- Localized swelling, mass, and lump, upper limb, right limb
R22.32 - Localized swelling, mass, and lump, upper limb, left limb
R22.33 - Localized swelling, mass, and lump, upper limb, bilateral
** Codes continue in the same fashoion for lower extremities as well**
Coma scale codes:
~ new
~ utilize a seventh digit box
~ codes are all six digits in length (so they do not need the “x” place holder)
Coma scale codes are used primarily for trauma registry and research and not adjudication.
These codes are used to document:
~ If and why the eyes opened
~ If there was a verbal response and what the response was to
~ Motor responses
Seventh digit options are used to describe where the assessment was conducted
7th digits for coma scale codes include:
0 – unspecified time
1- in the field (EMT or ambulance)
2 – at the arrival to ED
3 – at hospital admission
4 – 24 hours or more after hospital admission
Examples of Coma Scale Eye codes:
R40.21 – Coma scale, eyes open
R40.211x – never
R40.212x – to pain
R40.213x to sound
R40.214x – spontaneous
**Add additional 7th digit describing the location the assessment was conducted**
Examples of Coma Scale Verbal Response codes:
R40.22 – Coma scale, best verbal response
R40.221x – none
R40.222x – incomprehensible words
R40.223x – inappropriate words
R40.224x – confused conversation
R40.225x – oriented
**Add additional 7th digit describing the location the assessment was conducted.**
Examples of Coma Scale Motor Response codes:
R40.23 – Coma scale, best motor response
R40.231x – none
R40.232x – extension
R40.233x – abnormal
R40.234x – flexion withdrawal
R40.235x – localizes pain
R40.236x – obeys commands
** Add additional 7th digit describing the location the assessment was conducted**
There are now codes available in this chapter for “S&S involving a patient’s emotional state”.
The codes are as follows:
R45.0 – nervousness
R45.1 – Restlessness and agitation
R45.2 – unhappiness
R45.3 – demoralization and apathy
R45.4 – irritability and anger
R45.5 – hostility
R45.6 – violent behavior
R45.7 – Emotional shock/stress
R45.81 – low self-esteem
R45.82 – worries
R45.83 – excessive crying, any age
There are also codes in this code range for “S&S involving appearance”and they are as follows:
R46.0 – Very low level of personal hygiene
R46.1 – Bizarre personal appearance
R46.2 - Strange and inexplicable behavior
R46.3 - Overactivity
R46.4 – Slow and poor responsiveness
R46.5 – Suspiciousness and marked evasiveness
R46.6 - Undue concern and preoccupation with stressful events
R46.7 – Verbosity and circumstantial detail obscuring reason for contact
R46.81 – Obsessive-compulsive behavior
R46.89 – Other S&S involving appearance & behavior
Another set of codes new to this grouping are the R65 codes for SIRS and Sepsis, which replace the 995 codes from the ICD-9.
The codes are as follows:
Three digit category R65 “Symptoms and Signs specifically associated with systemic inflammation and infection”
Systemic inflammatory response syndrome (SIRS) of Non-infectious origin
~ W/O organ dysfunction (R65.10)
~ With organ dysfunction (R65.11)
Severe Sepsis
~ W/O septic shock (R65.20)
~ With septic shock (R65.21)
Other codes that have been re-assigned into the S&S chapter include:
~ Dry mouth
527.7 to R68.2
~ Acquired clubbing of fingers
736.29 to R68.3
Other code changes include:
~ Projectile vomiting (new)
R11.2
~ Paralytic gait and ataxic gait are now separated into their own codes
R26.1 and R26.0
~ Unsteadiness on feet (new)
R26.81
~ Twitching now has it’s own code instead of being bundled into “Abnormal movements”
R25.3
~ Repeat Falls:
at risk for falling - Z91.8
history of falling - Z91.81
Falling or tendency to fall – R29.6
Abnormal clinical and laboratory findings make up the second portion of this chapter
~ R70 – R97
In the ICD-9-CM these codes ranged between 790.xx – 796.xx
Examples of these codes in the ICD-9-CM include:
Abnormal glucose – 790.2
Bacteremia – 790.7
Ketonuria – 791.6
Abnormal findings in Amniotic fluid – 792.3
Abnormal findings in EKG – 794.31
Abnormal reflex – 796.1
Elevated cancer antigen 125 (CA 125) – 795.82
The ICD-10-CM divides these codes first into the substance being tested or the test type:
~ Blood
~ Urine
~ Other body fluids
~ Imaging studies
The first grouping is under the title “Abnormal findings on examination of blood, without diagnosis”
~ R70.xxxx – R79.9xxx
ICD-10-CM code Examples:
Blood cell abnormalities
~ R71.0 – Precipitous drop in hematocrit
Blood glucose levels and glucose testing
~ R73.0 – Abnormal Glucose
~ R73.02 – Impaired fasting glucose
Immunological findings
~ R76.0 – Raised antibody titer
Abnormalities in plasma
~ R77.1 – Abnormality of globulin
Findings of drugs and other substances
~ R78.2 - cocaine
Abnormal blood chemistry
~ R789.1 – Abnormal coagulation profile
The next grouping is under the following title “Abnormal findings on examination of urine, without diagnosis”
~ R80 – R82
Examples of ICD-10-CM codes in this section include:
R80.0 - isolated proteinuria
R81 – Glycosuria
R82.3 – Hemoglobinuria
R82.5 – Elevated urine levels of drugs, medicaments and biological substances
The next grouping title is “Abnormal findings on examination of other body fluids, substances, and tissues, without diagnosis”
~ R83 – R89
The following fluids, substances, and tissues listed under this heading are:
~ CSF
~ Respiratory organs
~ Digestive organs
~ Male genitals
~ Female genitals
Examples of codes in this grouping include:
R83.1 – Abnormal levels of hormones in CSF
R84.0 – Abnormal level of enzymes in specimens from respiratory organs.
R85.6 – abnormal cytological findings in specimens from digestive organs
R86.5 – Abnormal microbiological findings in specimens from male genital organs.
R87.610 – Atypical squamous cells of undetermined significance in cytological smear of cervix (ASC-US)
The next title “Abnormal findings of diagnostic imaging and in function studies, without diagnosis” includes nonspecific abnormal findings in diagnostic images by:
~ CAT scan
~ MRIs
~ PET scans
~ Thermography
~ Ultrasound / Echogram
~ X-ray
Codes under this grouping include the following examples:
R90.81 – abnormal echoencephalogram
R92.1 – mammographic calcification found on diagnostic imaging of the breast
R93.9 – diagnostic imaging inconclusive due to excess body fat of patient
R94.113 – Abnormal oculomotor study
R94.2 - abnormal pulmonary function study
The last grouping in this chapter is “abnormal tumor markers”
~ R97
There are four codes under this grouping that are used to describe specific antigens
Ex: R97.1 – Elevated cancer antigen 125 (CA 125)
The final code in this chapter is R99, which is used to describe “ill-defined and unknown cause of mortality” (AKA: unexplained death)
Using the ICD-10-CM
~ Codes are looked up in the alphabetic index and confirmed in the tabular
~The index may have one term under several names that cross-reference one another
~The majority of the conventions and coding guidelines have stayed the same
~When confirming a code in the tabular be sure to:
1) Read any notations beneath the three digit category
2) Note any 7th digit boxes below the three digit category
3) Read code specific notations beneath the codes selected
4) Look for conventions beside the code selection
Exclude 1 and Exclude 2 notations: These can be extensive as well as provide useful cross-references and guidelines for when to use a particular and when not to.
Exclude 1: NOT coded here; Notes when two conditions cannot be coded together under any circumstance
Ex. A congenital form and an acquired form of a single disease should not be coded together
Exclude 2: not included here; the excluded condition is not part of the condition it is excluded from, but if a patient has both conditions they can be coded together
Ex. Abnormal finding in the urine and hematuria
Testing Your Skills
Office Note
DISCHARGE DIAGNOSES:
1. Chest pain
2. Elevated liver enzymes, etiology uncertain for an outpatient follow-up
3. Dyspnea
TEST DONE: EKG, abnormal results
HOSPITAL COURSE: This 32-year-old established patient with a family history of premature coronary artery disease came in for evaluation of recurrent chest pain. He states the pain is intermittent and dull. It started two days ago and has gotten increasingly worse. The patient complains of light headedness during the onsets, slight tingling in his arms, blurred vision, and nausea. He denies vomiting, syncope, and incontinence. All other systems are negative unless noted otherwise.
Upon examination I note that his mucosas are dry and eyes are slightly sunken. His O2 saturation is at 94% with both atypical and typical features of ischemia. The patient is noted to have a BP of 165/95. Pulses are rapid and strong. Heart: RRR; Respirations: 16, no wheezing or stridor; GI: Normal gastrointestinal sounds; Integumentary: Cyanosis, minor;
The patient was ruled out for a myocardial infarction. An EKG was performed and gave abnormal results, however, and a full nuclear stress test was scheduled for later in the week. The patient is stable upon discharge and will return for the nuclear stress test as schedules.
ICD-9-CM
- Chest pain – 786.50
- Elevated Liver Enzymes – 790.5
- Dyspnea – 786.09
- Light Headedness – 780.4
- Tingling – 782.0
- Nausea – 787.02
- Cyanosis – 782.5
- Abnormal EKG – 794.31
Example ICD-10-CM answers
1) Chest Pain – when looked up in the index this is what you would see
Pain, Chest (central) – R07.9
anterior wall – R07.89
atypical – R07.89
ischemia – I20.9
musculoskeletal – R07.89
non-cardiac – R07.89
on breathing – R07.1
pleurodenia – R07.81
precordial – R07.2
wall (anterior) – R07.89
When verifying in the tabular this is what you would see
R07.9 – chest pain unspecified
2) Elevated liver enzyme in a function study - when looked up in the index this is what you would see.
Findings, abnormal
function study NEC R94.8
bladder – R94.8
endocrine NEC – R94.7
thyroid – R94.6
kidney – R94.4
liver – R94.5
pancreas – R94.8
placenta – R94.8
pulmonary – R94.2
spleen – R94.8
When verifying in the tabular this is what you would see
R94.5 – abnormal results of liver function studies
3) Dypnea - when looked up in the index this is what you would see
Dyspnea (nocturnal) (paroxysmal) - R06.00
asthmatic (bronchial) - J45.909
**additional asthmatic codes are not listed here**
cardiac – see Failure, ventricular, left
functional – F45.8
hyperventilation – R06.4
hysterical – F45.8
newborn – P22.1
orthopnea – R06.01
psychogenic – F45.8
SOB – R06.02
specified type NEC – R06.09
uremic – N19
When verifying in the tabular this is what you would see
R06.00 – Dyspnea NOS
4) Light headedness
There is no listing or cross-reference under light-headedness (like in the ICD-9-CM), instead look directly under dizziness. When looked up in the index this is what you would see.
Dizziness - R42
hysterical – F44.89
psychogenic – F45.8
When verifying in the tabular this is what you would see
R42 – Dizziness and Giddiness
Includes: light-headedness
Vertigo NOS
5) Tingling - when looked up in the index this is what you would see
Tingling Sensation (skin) R20.2
When verifying in the tabular this is what you would see
R20.2 – Paresthesia of skin
Formication
Pins and Needles
Tingling skin
6) Nausea- when looked up in the index this is what you would see
Nausea – R11.1
with vomiting – R11.0
epidemic – A08.1
gravidarum – see hyperemisis, gravidarum
marina – T75.3
navalis – T75.3
When verifying in the tabular this is what you would see
R11.1 – Nausea alone
7) Cyanosis- when looked up in the index this is what you would see
Cyanosis – R23.0
due to
patent foramen botalli – Q21.1
persistent foramen ovale – Q21.1
entergenous – D74.8
paroxysmal digital – see Raynaud’s disease
with gangrene – I73.01
retina, retinal – H35.89
When verifying in the tabular this is what you would see
R23.0 - Cyanosis
8) Abnormal EKG
This is no found under “findings, abnormal, electrocardiogram” (like in the ICD-9-CM). Instead look under the words “Abnormal, electrocardiogram”. When this is looked up in the index this is what you would see.
Abnormal, electrocardiogram [ECG][EKG] – R94.31
When verifying in the tabular this is what you would see
R94.31 – Abnormal, electrocardiogram [ECG][EKG]
Not Everything is Changing
There is a lot of focus on how the ICD-10-CM is different from the ICD-9-CM and many are feeling nervous about the change. I thought to help calm some anxiety and to provide a clearer picture, that this post would focus on things that are going to stay the same during the transition.
General:
The ICD-10-CM is the replacement of the ICD-9-CM volumes I and II. The ICD-10-CM is still divided into two main portions: the alphabetic index and the tabular index. Codes are still looked up in the alphabetic index and additional digits are still verified in the tabular. There is still a table of drugs and chemicals for poisonings, a neoplasm table, and an external causes index.
Structure will remain in a similar fashion as well. Guidelines and conventions are located in the front of the manual. General guidelines are listed first and then chapter specific guidelines and listed next. Codes are still broken down by classifications and anatomical locations and placed into chapters with three digit categories and multiple digit subcategories.
Chapters and categories still progress by following the loose structure by listing codes effecting the outside of the body first and progressing inward, and listing codes effecting from the top of the body and moving down.
Example: Integumentary codes are listed before musculoskeletal codes (outside of the body inward) and codes regarding the head are generally listed before codes regarding the shoulders (top of the body down).
Conventions:
Many of the coding conventions that we are familiar with will stay the same and transition from the ICD-9-CM to the ICD-10-CM. Items that will remain include:
1) Brackets [ ] indicating “code first”
2) Parentheses ( ) providing “non-essential modifiers”
3) Colons :
4) NEC
5) NOS
6) “Includes” notes
7) Inclusion terms
8) “Classified Elsewhere”
9) “Code also” or “use additional code”
10) “Code first”
11) “in dieses classified elsewhere”
12) The term “and” can still be interpreted as “and/or”
13) When with or without are the two options for the final character the default for with is either fifth or sixth digit “1” and for “without” the fifth digit “0” or sixth digit “9” is the default.
14) “see” and “see also”
General Guidelines:
1) Signs and symptoms that are associated routinely with a disease process are still not coded in addition to the diagnosis, and signs and symptoms that are not usually associated are still coded in addition.
2) The “ABC” rule: Acute conditions are still coded before chronic conditions
3) Multiple codes for a single condition are still coded using the same rules, using “additional codes” as secondary assignments and “code first” codes as primary assignments.
4) Combination codes that describe two diagnosis under a single code still exist
5) Late effect codes (sequel) are still utilized under the same general guidelines
6) Impending and threatening conditions are coded under the same guidelines
Miscellaneous
General coding rules like “if it’s not written and legible in the medical record by the physician that it didn’t happen” will not change when transitioning from the ICD-9-cm to the ICD10-CM. Codes will still need to be supported by documentation; documentation will just need to be more detailed to meet the needs of the more detailed code sets. Unspecified and not elsewhere specified codes will still be available for use but due to the large availability of codes provided by the ICD-10-CM insurance companies are going to be more skeptical of these code selections and may deny these claims for lack of adjudication.
On a side note: There have been quite a few individuals asking how they should start preparing for the ICD-10 transition. My suggestion is to invest in an ICD-10-CM draft and start reading the guidelines and looking up codes that you use on a general basis. As you become more familiar with the ICD-10 you will begin to have more specific questions for payers, you will have less anxiety about the transition, and you will be able to help your provider and office staff more adequately.
Injury, Poisoning and Certain other Consequences of External Causes
Finally! The long awaited 2nd post. I’d like to thank all of those who have visited and re-visited the ICD-10-CM blog and who have been so patient. This past year seemed to be dedicated to too many other pressing issues and unfortunately the icd-10-cm blog was placed on the back burner. However, with the New Year comes a new post! Moving forward we hope to have one in deapth post each month.
Thanks again and enjoy!
ICD-10-CM: Injury, Poisoning and Certain other Consequences of External Causes
In the ICD-9 we think of "Accident and Injury Codes" as the 800 and 900 code sets, in the ICD-10-CM they are “S” Codes. S codes are located in chapter 19 along with T codes (poisoning).
The full title of chapter 19 is: Injury, Poisoning and Certain other Consequences of External Causes,
and the codes range from three digit category S00 to T88.9
In this post we will only be looking at the first half of this chapter. Codes will focus only on Injury and Certain other Consequences of External Causes (S codes) and we will leave poisoning codes (T codes) for another post.
S Code Range: S00.00x – S99.929
S codes (like 800 and 900 codes)cover injuries such as:
-
Traumatic Injuries by Site
-
Contusions
-
Open Wounds
-
Crushes
-
Superficial Injuries
-
Fractures
-
Concussions
-
Avulsions / Amputations
-
Dislocations/Subluxations
-
Sprain/Strains
-
Injuries to Multiple Body Region
-
Injuries NEC and NOS
-
Foreign Bodies
-
Burns
-
Poisonings
-
Adverse Effects
-
External Causes (which include):
~ Effects of Radiation, Treatments, and/or Environmental Elements
~ Asphyxiation
~ Abuse
~ Electrocution
~ Neglect
~ Anaphylactic Reactions
~ Early Complications of Trauma
~ Early Complications from Medical Care
~ Adhesions
~ Perforations
~ “Complications”
Three digit categories in the ICD-10-CM are similar to three digit categories in the ICD-9 in their order (codes are usually listed starting at the top of the body and working down, and from the outside of the body inwards).
S code three digit categories are:
S00-S09: Injuries to Head
S10-S19: Injuries to Neck
S20-S29: Injuries to Thorax
S30-S39: Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals
S40-S49: Injuries to the Shoulder and Upper Arm
S50-S59: Injuries to the Elbow and Forearm
S60-S69: Injuries to the Wrist and Hand
S70-S79: Injuries to the Hip and Thigh
S80-S89: Injuries to the Knee and Lower Back
S90-S99: Injuries to the Ankle and Foot
Each three digit category is further divided by injury type for that specific body region
Example
The three digit category for Head Injuries are sub-divided into:
~ Superficial Injury (of the head);
~ Open Wound (of the head)
~ Fracture (of the head)
Then the three digit category for Neck Injuries would follow and be divided into the same way
~ Superficial Injury (of the neck)
~ Open Wound (of the neck)
~ Fracture (of the neck)
Most of the three digit categories listed are further sub-divided into the following injury types
~Open Wounds
~Fractures
~Dislocations / Subluxaitons
~Sprains / Strains
~Traumatic Injuries
~Avulsions/Amputations
~Nerve Injuries
~Vessel Injuries
~Organ/Tissue Injuries
~Crushing injuries
Each three digit category may also include an area specific to that set of codes
Example: Injuries to the head include a code set for concussions
General Guidelines
7th digits describing the encounter are commonly required among the S codes
The 7th digit is usually one of the following letters:
A – Initial Encounter
D – Subsequent Encounter
S – Sequela
When an S code only has 5 or 6 digits available to code and requires a 7th digit encounter letter a dummy place holder “x” must be used for each space that does not already have an assigned digit
Examples:
S00.01xA – Abrasion of scalp, initial encounter
S03.4 xxD– Sprain of jaw, subsequent encounter
Excludes 1 and Excludes 2 notations are frequently used among S codes
The Exclude 1 notation indicates that any diagnosis listed beside the notation is not coded using these S codes and cannot be coded in combination with these S codes
Example: For all S codes the Excludes 1 note applies : Birth Trauma (P10-P15)
The Exclude 2 notation indicates that any diagnosis listed beside the notation is not coded using these S codes, but the diagnosis may be used in combination with these S codes if it is supported by the medical record
Example: Beside contusion of the eyelid is the excludes 2 note: contusion of the eyeball
A Closer Look
Each three digit category is subdivided into a more specific type of injury, for instance, a three digit category may depict the head, this can be subdivided into injury types like lacerations, fractures, etc. Below we discuss how each injury type may also be further divided.
Superficial injuries include:
~Abrasions~Blisters (nonthermal)
~Contusions
~External constrictions
~Superficial FB
~Non-venomous insect bites
~Other Superficial bites
~Superficial Injuries
Codes are much more specific and include much more detail
Example:
ICD-9-CM has a single code for an abrasion located on the cheek, ear, gum, lip, nose, or throat
910.0
The ICD-10-CM has 12 codes, a specific code for each specific location; Abrasion, initial encounter
S00.01xA – Scalp
S00.31xA – Nose
S00.411A – Right Ear
S00. 412A – Left Ear
S00.419A – Unsp. Ear
S00.511A – Lip
S00.512A – Oral Cavity
S00.81xA – Other part of head
S00.91xA – Unsp. Part of head
S10.11xA – Throat
S10.81xA – Other part of neck
S10.91xA – Unsp. Part of neck
Superficial injury codes may be looked up in the index under these terms:
~Injury
~Superficial
~Anatomical location
~Type of injury
A code or a cross-reference may be given
Example: For an abrasion of the elbow
Injury, superficial, elbow, abrasion - see abrasion, elbow (cross-reference)
Abrasion, elbow – S50.31 -
Open Wounds
Open wounds now have specific codes for puncture wounds, they are also no longer need to be coded as complicated or not complicated
Code the following in addition to the wound code when appropriate:
~Infections
~Nerve injuries
~Muscle/tendon injuries
~Open Wounds
~Open wound codes may be specific to
~With FB
~Without FB
~Left
~Right
Examples
S01.121A – Laceration with foreign body of right eyelid and periocular area, initial encounter
S01.131D – Puncture wound without foreign body of right eyelid and periocular area, subsequent encounter
Open wounds may be referenced in the alphabetic index under:
Wound, open, anatomical location, type
A code or cross-reference may be given
Example: Wound, open, knee
S81.00-
Bite – see Bite Knee
Laceration – see Laceration Knee
Puncture – see Puncture Knee
Open Wounds
Open wounds can also be looked up in the index under:
- Wound type, anatomical location, specifics (ex. right/left)
Example: Laceration, Knee – S81.019
With FB – S81.029
Left – S81.012
Left w/ FB – S81.022
Right – S81.011
Right w/FB – S81.021
Fractures
The majority of fractures are coded according to the following rules:
~ A fracture not indicated as displaced or non-displaced should be coded as displaced
~A fracture not identified as open or closed should be coded as closed
(See three digit categories for individual notations)
Fracture codes indicate:
~Traumatic or non-traumatic
~Displaced or nondisplaced
~Type of fracture
~Specific bone
~Specific location on a specific bone
Almost all fracture codes require a 7th digit encounter letter
Code Examples:
S02.110A – Type I occipital condyle fracture, initial encounter
S02.64xD – Fracture of the ramus of the mandible, subsequent encounter
S12.430A – Unspecified traumatic displaced spondylolosthesis of fifth cervical vertebra, initial encounter
S42.221D – 2-part displaced fracture of the surgical neck of the right humerus, subsequent encounter
Looking up fractures in the alphabetic index will begin by locating the term “fracture” and then the anatomical site
Example: Fracture, ankle; Fracture, radius; Fracture, foot
Once an anatomical location is selected several options will be indented beneath that term describing fracture types
Example: Fracture, foot:
~Astragalus
~Calcaneus
~Cuboid
~Cuneiform
~Metetarsal
~Navicular
~Talus
~Tarsal
~Toe
~Fractures
Each indented term may have a code or a cross-reference specific to that location. Also, some fractures can be located by specific names but it is not that common
Example: Fracture, bucket handle - See Tear, Meniscus
Dislocations / Subluxations
Dislocation and Subluxation codes are specific to weather the injury is:
~A dislocation or a subluxation
~Left or Right on bilateral body parts
~Anterior, posterior, or inferior
~Percentage of displacement
~Congenital or pathological
Most codes do require a 7th digit encounter letter. It is also important to know the difference between a dislocation and a Subluxation, in order to select the correct code.
Subluxation: A partial dislocation where the articular surfaces of a joint are partially displaced
Dislocation: A more severe injury where the articular surfaces of a joint are no longer in contact
Code Examples
S43.121A – Dislocation of right acromioclavicular joint, 100%- 200% displacement, initial encounter
S43.011A – Anterior subluxation of right humerus, initial encounter
Codes can be found in the alphabetic index under either:
Dislocation, anatomical site
Subluxation, anatomical site
Codes may be given or may be further referenced by specifics
Sprains / Strains
Sprains and strains are differentiated in the ICD-10-CM more than they are in the ICD-9 so it is important to know the difference between these two as well.
Sprain: An injury to a ligament
Examples: Ankle; Knee; Wrist
Strain: An injury to a muscle or tendon
Examples: Back; Neck; Muscle unspec.
Sprain and strain codes now reference either the left or right side and may be more specific to an exact location
Example:
The ICD-9-CM
Sprain, Shoulder
840.9
ICD-10-CM
Sprain, Shoulder (initial encounter)
S43.401A – Rt shoulder joint
S43.402A – Lt shoulder joint
S43.409A – Unsp. Side, shoulder joint
S43.90xA – Sprain, unspec. Parts of the shoulder girdle, unspec. Side
S43.91xA – Sprain, unspec. Parts of the shoulder girdle, Rt shoulder
S43.92xA – Sprain, unspec. Parts of the shoulder girdle, Lt shoulder
Both sprains and strains can be referenced in the alphabetic index by their term and anatomical location
Example:
Sprain, Ankle – S93.409
Calcaneofibular ligament – S93.41-
Deltoid ligament – S93.42-
Injuries
Each body region has an injuries section and each injuries section is further divided by the injury type:
~Nerve Injury
~Vessel Injury
~Organ/Tissue Injury
~Crushing injury
~Amputations
~Injuries NEC and NOC
Many injury codes will require the 7th digit encounter letter and Excludes 1 and 2 notations should be watched for as well.
Examples
S44.11xA – Injury of median nerve at upper arm level, right arm, initial encounter
S06.822A – Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, initial encounter
Injuries
S27.312A – Primary blast injury of lung, bilateral, initial encounter
S47.1xxA – Crushing injury of right shoulder and upper arm, initial encounter
S68.422A – Partial traumatic amputation of left hand at wrist level, initial encounter
Injury codes can be looked up in the alphabetic index by: Injury, type, anatomical location
Example: Injury, nerve, arm
Example 2: Injury, blood vessel, femoral, artery
Injuries can also be looked up under “Injury, anatomical location, type”
Example:
Injury, arm -
Blood vessel
Contusion
Fracture
Lower
Muscle
Nerve
Open
Specified type NEC
Superficial
Welcome
As many of us know, in 2013 our familiar ICD-9-CM will be replaced by the ICD-10 nationwide. Volumes I and II of the ICD-9-CM will be replaced by the ICD-10-CM, and volume III of the ICD-9-CM will be replace by a second book, the ICD-10-PCS.
This is a brief introduction to some of the major changes that will be discussed further in depth in future entries.
Size and Volume: EX. **The following is a list of how ICD-10-CM codes are classified according to their three digit catagory** 1 - Obstetrics 0 - Central Nervous System Third digits indicate the specific type of operation and are as follows:
Ex. Three digit catagory 001: Medical and Surgical, Central Nervous System, Bypass
The ICD-9-CM has about 14,025 code while the ICD-10-CM alone has over 68,000 and ICD-10-PCS has over 87,000. Code descriptions are also much more detailed and code have been created for future expansion.
Code Structure:
ICD-9-CM codes are tradditionaly 3-5 digits long, and with the exception of V and E codes, are mainly numeric. The ICD-10-CM codes are 7 digits in length and all begin with an alpha charecter. Digits 2 and 3 are numeric, and digits 4-7 can be either an alpha charecter or numeric in nature.
The ICD-10-PCS are also 7 digits in length and are alphanumeric. These codes do not utilize I and O though and are multi-axial.
Ex.
ICD-10-PCS code 0PQJ04Z - Repair of a fracture, radius w/internal fixation device:
Another interresting change to the codes structure is the "dummy place holder" which is represented by the letter X. The X allows for future expansion of codes.
The guidelines state that if a code has an available 6th digit it must be used and must always reside in the 6th digit placement. This poses a problem for codes that are only 4 digits in length and have an available 6th digit option. In this case you would code the first four digits, place the "X" as the fifth digit place holder, and then select the proper 6th digit.
T39.8X2 - Poisoning by other nonopioide, analgesics, and antipyretics, NEC, intentional self harm.
~ Note that the "X" is holding the 5th digit allowing the 2 to hold the 6th digit placement~
1.A00-B99: Certain Infectious and Parasitic Diseases
2.C00-D49: Neoplasms
3.D50-D89: Diseases of the Blood and Blood Forming Organs and Certain Disorders Involving the Immune Mechanism
4.E00-E89: Endocrine, Nutritional and Metabolic Disease
5.F01-F99: Mental and Behavioral Disorders
6.G00-G99: Disease of the Nervous System
7.H00-H59: Diseases of the Eye and Adnexa
8.H60-H95: Diseases of the Ear and Mastoid Process
9.I00-I99: Diseases of the Circulatory System
10.J00-J99: Diseases of the Respiratory System
11.K00-K94: Diseases of the Digestive System
12.L00-L99: Diseases of the Skin and Subcutaneous Tissue
13.M00-M99: Diseases of the Musculoskeletal System and Connective Tissue
14.N00-N99: Diseases of the Genitourinary System
15.O00-O9A: Pregnancy, Childbirth, and the Puerperium
16.P00-P96: Certain Conditions Originating in the Perinatal Period
17.Q00-Q99: Congenital Malformations, Deformations, and Chromosomal Abnormalities
18.R00-R99: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, NEC
19.S00-T88: Injury, Poisoning and Certain other Consequences of External Causes
20.V01-Y95: External Causes of Morbidity
21.Z00-Z99: Factors Influencing Health Status and Contact with Health Services
Other structural changes within the ICD-10-CM book include the deletion of hypertension table and additional, revised, and deleted guidelines.
The ICD-10-CM is still divided into an alphabetic index and a tabular index and still requirse propper look up and cross-referencing.
The ICD-10-PCS is divided following a different structure. Each digit in a three digit catagory is assigned a specific meaning.
First digits are used to assign sections and are as follows:
0 - Medical and Surgical
2 - Placement
3 - Administration
4 - Measurement and Monitoring
5 - Extracorporeal Assistance and Performance
6 - Extracorporeal Therapies
7 - Osteopathic
8 - Other Procedures
9 - Chiropractic
B - Imaging
C - Nuclear Medicine
D - Radiation Oncology
F - Physical Rehabilitation and Diagnostic Audiology
G - Mental Health
H - Substance Abuse Treatment
Second digits indicate the specific body system and are as follows:
1 - Peripheral Nervous System
2 - Heart and Great Vessels
3 - Upper Arteries
4 - Lower Arteries
5 - Upper Veins
6 - Lower Veins
7 - Lymphatic and Hemic Systems
8 - Eye
9 - Ear, Nose, Sinus
B - Respiratory System
C - Mouth and Throat
D - Gastrointestinal System
F - Hepatobiliary System and Pancreas
G - Endocrine System
H - Skin and Breast
J - Subcutaneous Tissue and Fascia
K - Muscles
L - Tendons
M - Bursae and Ligaments
N - Head and Facial Bones
P - Upper Bones
Q - Lower Bones
R - Upper Joints
S - Lower Joints
T - Urinary System
U - Female Reproductive System
V - Male Reproductive System
W - Anatomical Regions, General
X - Anatomical Regions, Upper Extremities
Y - Anatomical Regions, Lower Extremities
0 - Alteration: Modifying the anatomic structure of a body part without affecting the function of the body part
1 - Bypass: Altering the route of passage of the contents of a tubular body part
2 - Change: Taking our ot off a device from the body part and putting back an identical or similar device in or on the same body part without cutting or puncturing the skin or mucous membrane
3 - Medication Management: Monitoring and adjusting the use of medications for the treatment of a mental health disorder
4 - Group Counseling: The application of psychological methods to treat two or more individuals with addictive behavior
5 - Destruction: Physical eradication of all or a portion of a body part by the direct use of energy, force, or a destructive agent
6 - Counseling: The application of psychological methods to treat an individual with normal developmental issues and psychological problems in order to increase function, improve well-being, alleviate distress, maladjustment or resolve crises
7 - Dilation: Expanding an orifice or the lumen of a tubular body part
8 - Division: Cutting into a body part, without draining fluids and/or gases from the body part, in order to separate or transect a body part
9 - Drainage: Taking or letting out fluids and/or gases from a body part
B - Excision: Cutting out or off, without replacement, a portion of a body part
C - Extirpation: Taking or cutting out solid matter from a body part
D - Extraction: Pulling or stripping out or off all or a portion of a body part by the use of force
F - Fragmentation: Breaking solid matter in a body part into pieces
G - Narcosynthesis: Administration of intravenous barbiturates in order to release suppressed or repressed thoughts
H - Insertion: Putting in a nonbiological appliance that monitors, assists, performs, or prevents a physiological function but does not physically take the place of a body part
J - Inspection: Visually and/or manually exploring a body part
K - Map: Locating the route of passage of electrical impulses and/or locating functional areas in a body part
L - Occlusion: Completely closing an orifice or the lumen of a tubular body part
M - Reattachment: Putting back in or on all or a portion of a separated body part to its normal location or other suitable location
N - Release: Freeing a body part from an abnormal physical constraint
P - Removal: Taking out or off a device from a body part
Q - Repair: Restoring, to the extent possible, a body part to its normal anatomic structure and function
R - Replacement: Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
S - Reposition: Moving to its normal location, or other suitable location, all or a portion of a body part
T - Resection: Cutting out or off, without replacement, all of a body part
U - Supplement: Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part
V - Restriction: Partially closing an orifice or the lumen of a tubular body part
W - Revision: Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device
X - Revision: Correcting, to the extent possible, a portion of a malfunctioning device or the position of a displaced device
Y - Transplantation: Putting in or on all or a portion of a living body part taken from another individual or animal to physically take the place and/or function of all or a portion of a similar body part
The remaining digits 4-7 are used to indicate body part, approach, device, and qualifier
Many of the ICD-9-CM guidelines are also in the ICD-10, including "code first", "use additional", "see also", "includes", ect. There are also new guidelines that have been added as well. The traditional "excludes" notation has been divided into two, "exclude 1" and "exclude 2". There are also guidelines for the dummy place holder X , bilateral indications, and more.
