icd-10 for beginners four-part series · l97.32 non-pressure chronic ulcer of left ankle l97.321...

2016 JLU Health Record Systems 1

ICD-10 for Beginners

Four-Part Series

© 2016 JLU Health Records Systems

www.jluhealth.com 1


www.jluhealth.com 2

Understanding Common

Diagnostic Areas - Where

Coding Mistakes Occur: Part 2

PRESENTER:

Joan L. Usher, BS, RHIA, COS-C ACE

AHIMA Approved ICD-10-CM Trainer

JLU HEALTH RECORD SYSTEMS

TEL: (781) 829-9632 FAX: (781) 829-9636

www.jluhealth.com

http://www.jluhealth.com/



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Learning Objectives:

Understand common home health

coding areas under ICD-10

Including: Skin & Subcutaneous Tissue/Ulcers

Musculoskeletal System

Wounds

Injuries

Aftercare

Diseases of the Skin

& Subcutaneous

Tissue

L00-L99

Review coding guidelines for

ulcers


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Types of Ulcers

Pressure Ulcers L89.-

Also known as decubitus ulcers or bedsores, are localized injuries to the

skin and/or underlying tissue that usually occur over a bony prominence

as a result of pressure, or pressure in combination with shear and/or

friction.

Non-Pressure Ulcers L97-

Lower-limb ulceration are many different types of ulcers with several causes. The

most prevalent are those due to vascular disease, of which venous is the most

common, accounting for over two-thirds of all types of ulcers. There are also

many other causes for ulceration such as malignancy, infections, and skin, drug-

induced, and autoimmune diseases.

Stasis Ulcers I83- or I87-

Venous ulcers (stasis ulcers, varicose ulcers) are wounds that are thought to

occur due to improper functioning of venous valves, usually of the legs (hence

leg ulcers). They are the major occurrence of chronic wounds, occurring in 70%

to 90% of leg ulcer cases. Venous ulcers develop mostly along the medial distal

leg, and can be very painful.


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Pressure Ulcer Stages

Codes from category L89, Pressure ulcer, are

combination codes that identify the site of the

pressure ulcer as well as the stage of the ulcer

Location

Stage

Assign as many codes from category L89 as

needed to identify all the pressure ulcers the

patient has

L89.513 Pressure ulcer, ankle, right, stage 3

L89.612 Pressure ulcer, heel, right, stage 2


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Ulcer, pressure

- pressure (pressure area) L89.9-

- - ankle L89.5-

- - back L89.1-

- - buttock L89.3-

- - coccyx L89.15-

- - contiguous site of back, buttock, hip L89.4-

- - elbow L89.0-

- - face L89.81-

- - head L89.81-

- - heel L89.6-

- - hip L89.2-

- - sacral region (tailbone) L89.15-

- - specified site NEC L89.89-

- - stage 1 (healing) (pre-ulcer skin changes limited to persistent focal edema)

- - - ankle L89.5-

- - - back L89.1-

- - - buttock L89.3-

- - - coccyx L89.15-

4th character

Location

7

Ulcer Lower Limb (Non-

pressure)

lower limb (atrophic) (chronic) (neurogenic)

(perforating) (pyogenic) (trophic) (tropical) L97.909

- - with

- - - bone necrosis L97.904

- - - exposed fat layer L97.902

- - - muscle necrosis L97.903

- - - skin breakdown only L97.901


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L97 Non-pressure chronic ulcer

of lower limb, not elsewhere

classified

Code first any associated underlying condition, such as:

any associated gangrene (I96)

atherosclerosis of the lower extremities (I70.23-, I70.24-, I70.33-,

I70.34-, I70.43-, I70.44-, I70.53-,I70.54-, I70.63-, I70.64-, I70.73-,

I70.74-)

chronic venous hypertension (I87.31-, I87.33-)

diabetic ulcers (E08.621, E08.622, E09.621, E09.622, E10.621,

E10.622, E11.621, E11.622, E13.621,E13.622)

postphlebitic syndrome (I87.01-, I87.03-)

postthrombotic syndrome (I87.01-, I87.03-)

varicose ulcer (I83.0-, I83.2-)


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Unspecified Codes-

Non Pressure Ulcer

Unspecified Codes

Non-pressure ulcer of

ankle

L97.309 Non-pressure

chronic ulcer of unspecified

ankle with unspecified

severity

Missing laterality

Missing depth

More Specificity

Non-pressure ulcer of left

ankle with fat layer

exposed L97.322


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Non-Pressure Chronic Ulcer,

Ankle

L97.32 Non-pressure chronic ulcer of left ankle

L97.321 Non-pressure chronic ulcer of left ankle limited

to breakdown of skin

L97.322 Non-pressure chronic ulcer of left ankle with

fat layer exposed


necrosis of muscle


necrosis of bone


unspecified severity



Documentation for BMI, Non-pressure

Ulcers and Pressure Ulcer Stages

For the Body Mass Index (BMI), depth of non-pressure chronic

ulcers and pressure ulcer stage codes, code assignment may be

based on medical record documentation from clinicians who are not

the patient’s provider (i.e., physician or other qualified healthcare

practitioner legally accountable for establishing the patient’s

diagnosis), since this information is typically documented by other

clinicians involved in the care of the patient (e.g., a dietitian often

documents the BMI and nurses often documents the pressure ulcer

stages).

However, the associated diagnosis (such as overweight, obesity, or

pressure ulcer) must be documented by the patient’s provider. If

there is conflicting medical record documentation, either from the

same clinician or different clinicians, the patient’s attending provider

should be queried for clarification




Stasis Ulcer

Ulcer,

stasis (venous) —see

Varix, leg, with, ulcer

- - without varicose

veins I87.2

Chronic (peripheral)

Venous Insufficiency

Varix, - leg (asymptomatic) I83.90

- - with

- - edema I83.899

- - - inflammation I83.10

- - - - with ulcer —see Varix, leg,

with, ulcer, with inflammation by

site

- - - pain I83.819

- - - specified complication NEC

I83.899

- - - swelling I83.899

- - - ulcer I83.009

- - - - with inflammation I83.209



Varix

- - - ulcer I83.009

- - - - with inflammation I83.209

- - - - ankle I83.003

- - - - - with inflammation I83.203

- - - - calf I83.002


- - - - foot NEC I83.005


- - - - heel I83.004


- - - - lower leg NEC I83.008


- - - - midfoot I83.004


- - - - thigh I83.001


Use additional code

to identify severity of

ulcer (L97.-)




Test Your Knowledge

1. Pressure ulcer left elbow stage 1, sacrum stage 2

2. Bilateral pressure ulcers stage 3 buttocks

3. Diabetic toe right ulcer with necrosis to the bone

4. Stasis ulcer (venous insufficiency) of left calf with

skin breakdown



Answers

1. Pressure ulcer of left elbow (stage 1) L89.021

Pressure ulcer of sacral region (stage 2) L89.152

2. Pressure ulcer of right buttock (stage 3) L89.313

Pressure ulcer of left buttock (stage 3) L89.323

3. Type 2 diabetes mellitus with foot ulcer E11.621

Non-pressure chronic ulcer of other part of right foot

with necrosis of bone L97.514

4. Venous insufficiency (chronic) (peripheral) I87.2

Non-pressure chronic ulcer of left calf limited to

breakdown of skin L97.221




Diseases of the

Musculoskeletal

System

M00-M99



Pathological Fractures

3 Types (all require laterality)

Due to neoplastic disease M84.5- - D

M84.551D Pathological fracture in neoplastic disease, right

femur

Code also underlying neoplasm

Due to Osteoporosis M80.8- -D

M80.021D Osteoporosis with pathological fracture humerus

Age related

Other

Osteoporosis without pathological fracture

Due to specified disease M84.6- -D

Code also underlying condition




Arthritis

Arthritis NOS M19.90

Osteoarthritis NOS M19.90

Needs site and laterality

Requires 6 characters for laterality

Rheumatoid Arthritis M06.9

Need site & laterality

Requires 6 characters for laterality



Test Your Knowledge

1. Bilateral OA of hip from hip dysplasia

2. RA

3. RA with polyneuropathy of right elbow




Answers

1. Bilateral osteoarthritis resulting from hip

dysplasia M16.2

2. Rheumatoid arthritis, unspecified M06.9

3. Rheumatoid polyneuropathy with rheumatoid

arthritis of right elbow M05.521



Injury Coding

Contained in the Injury, Poisoning and Certain Consequences of External Causes

Fractures, dislocations, superficial and internal injuries, open wounds, and burn S00-T34




Injuries

When coding injuries, assign separate codes for

each injury unless a combination code is

provided, in which case the combination code is

assigned.

Traumatic injury codes (S00-T14.9) are not to

be used for normal, healing surgical wounds or

to identify complications of surgical wounds

Injuries are grouped by body part first, then type

of injury in the tabular listing



7th

Character Extensions

Injuries will need 7th character extensions to identify the

encounter

A = initial encounter is used while the patient is receiving

active treatment for the condition

D = subsequent encounter is used for encounters after

the patient has received active treatment of the condition

and is receiving routine care for the condition during the

healing or recovery phase.

S = sequela, is for use for complications or conditions

that arise as a direct result of a condition, such as scar

formation after a burn. The scars are sequelae of the

burn




Fractures

A Traumatic fracture is due to an accident or injury.

A Pathological fracture occurs because a patient’s bones are

weakened by disease such as osteoporosis or cancer.

Pathological fracture coding is part of the Musculoskeletal chapter.

Each fracture is to be coded separately and sequencing of multiple

fractures should be listed in accordance to severity.

Acute fractures refer to the condition that is the primary reason for

the episode of care. Acute fractures are treated at the hospital as

the initial episode of care.

The initial encounter is for active treatment and subsequent is for

patient’s whose active treatment has completed and is now receiving

routine care during recovery and/or healing.



Fractures

The subsequent episode for the healing of a traumatic fracture is

coded in post acute care.

Examples of fractures for subsequent care include:

care provided during the healing and recovery phase,

follow-up visits,

medication adjustment.

Official Coding Guidelines state that fractures are coded using the

appropriate 7th character for subsequent care for encounters after

the patient has completed active treatment of the fracture and is

receiving routine care for the fracture during the healing or recovery

phase.

In order to code a fracture, the coder must be able to identify if the

fracture is closed or opened.

A fracture not indicated as open or closed should be coded to closed.

A fracture not indicated as displaced or non-displaced should be coded

to displaced.




Gustilo Open Fracture Classification

Gustilo type Definition

I Open fracture, clean wound, wound <1 cm in length

II Open fracture, wound > 1 cm in length without extensive soft-tissue damage, flaps,

avulsions

III

Open fracture with extensive soft-tissue laceration, damage, or loss or an open

segmental fracture. This type also includes open fractures caused by farm injuries,

fractures requiring vascular repair, or fractures that have been open for 8 h prior to

treatment

IIIA Type III fracture with adequate periosteal coverage of the fracture bone despite the

extensive soft-tissue laceration or damage

IIIB

Type III fracture with extensive soft-tissue loss and periosteal stripping and bone

damage. Usually associated with massive contamination. Will often need further soft-

tissue coverage procedure (i.e. free or ratational flap)

IIIC Type III fracture associated with an arterial injury requiring repair, irrespective of degree

of soft-tissue injury.



Test Your Knowledge

1. Aftercare fracture left femur with fractured

leg, left

2. Aftercare fracture hip, NOS

3. Fracture hip (M1011 Inpatient Code)




Answers

1. Unspecified fracture of left femur, subsequent

encounter for closed fracture with routine healing

S72.92xD

Unspecified fracture of left lower leg, subsequent

encounter for closed fracture with routine healing

S82.92xD

2. Fracture of unspecified part of neck of unspecified

femur, subsequent encounter for closed fracture with

routine healing S72.009D

3. Fracture of unspecified part of neck of unspecified

femur, initial encounter for closed fracture S72.009A



Anatomy of a Wound Code

Characters1-3 Type of injury by body site

Character 4 Specific body part

Character 5 Type of Wound

Character 6 Laterality

Character 7 Encounter



ICD-10-CM Format

Category Alpha Etiology, Anatomical

Site, Severity

Extension

X X X X X X X


Wounds, Open

ICD-9

Same code

Laceration

Puncture

Bite (human)

ICD-10

Different 5th character

in the code

Laceration

Puncture wound

Bite



Infected Open Wounds

Code also any associated wound infection

Example: Right shoulder wound,

subsequent episode S41.001D

Infection MRSA B95.62




Foreign Body in Open

Wounds

Codes to either laceration with or without foreign

body

Codes to either puncture wound with or without

foreign body

Example: Right shoulder laceration with foreign body,

subsequent episode S41.021D

Example: Right shoulder puncture wound with foreign

body, subsequent episode S41.041D



Build a Code:

Puncture wound to left foot without

foreign body

ICD-10-CM Format

Category

Alpha

Etiology, Anatomical

Site, Severity

Extension

X X X X X X X

S 9 1

S 9 1 3 S 9 1 3 3 2

S 9 1 3 3 2

D




Test Your Knowledge

1. Skin tear to right shin, subsequent

episode

2. Puncture wound to left heel with a foreign

body, splinter, subsequent episode



Answers

1. Laceration without foreign body, right

lower leg, subsequent encounter

S81.811D

2. Puncture wound with foreign body, left

foot, subsequent encounter S91.342D




Cellulitis of Toe with Open

Wound

Code wound

Code cellulitis

L03.03- Cellulitis of toe

L03.031 Cellulitis of right toe

L03.032 Cellulitis of left toe

L03.039 Cellulitis of unspecified

toe

L03.04 Acute lymphangitis of toe

Hangnail with lymphangitis of toe

L03.041 Acute lymphangitis of

right toe

L03.042 Acute lymphangitis of left

toe

L03.049 Acute lymphangitis of

unspecified toe



Aftercare

Coding

Z40-Z53

Aftercare codes are a subset of the Z codes

Categories Z40-Z53 are intended for use to indicate a reason for care. They may be used for patients who have already been treated for a disease or injury, but who are receiving aftercare or prophylactic care, or care to consolidate the treatment, or to deal with a residual state




Aftercare Following Surgery

Z48.81- Encounter for surgical aftercare following

surgery on specified body systems.

These codes identify the body system requiring aftercare.

They are for use in conjunction with other aftercare codes

to fully explain the aftercare encounter. The condition

treated should also be coded if still present.

Excludes1:

aftercare for injury- code the injury with 7th character D

aftercare following surgery for neoplasm (Z48.3)

Excludes2:

aftercare following organ transplant (Z48.2-)

orthopedic aftercare (Z47.-)



Z48.810 Encounter for surgical aftercare following surgery on the sense organs

Z48.811 Encounter for surgical aftercare following surgery on the nervous system

Excludes2: encounter for surgical aftercare following surgery on the sense organs(Z48.810)

Z48.812 Encounter for surgical aftercare following surgery on the circulatory system

Z48.813 Encounter for surgical aftercare following surgery on the respiratory system

Z48.814 Encounter for surgical aftercare following surgery on the teeth or oral cavity

Z48.815 Encounter for surgical aftercare following surgery on the digestive system

Z48.816 Encounter for surgical aftercare following surgery on the genitourinary system

Excludes1: encounter for aftercare following sterilization reversal (Z31.42)

Z48.817 Encounter for surgical aftercare following surgery on the skin and subcutaneous tissue

Aftercare Following Surgery






Other Aftercare Codes

Z46.6 Fitting & Adjustment of urinary

Device

Z43.1 Encounter for attention to

gastrostomy

Z48.01 Encounter for change or removal

of surgical wound dressing



Test Your Knowledge

1. Aftercare following surgery, circulatory

2. Gastrostomy (attention to)

3. Long term use aspirin




Answers

1. Encounter for surgical aftercare following

surgery on the circulatory system

Z48.812

2. Encounter for attention to gastrostomy

Z43.1

3. Long term (current) use of aspirin Z79.82



Aftercare

Orthopedic




Aftercare Joint

Aftercare for Joint replacement Z47.1

Use additional code to identify joint (Z96.6-)

Shoulder, elbow, wrist, hip, knee, ankle,

finger, other (5th character)

Requires laterality (6th character)



Test Your Knowledge

1. Aftercare for joint replacement right hip




Answers

1. Aftercare following joint replacement

surgery Z47.1

2. Presence of right artificial hip joint

Z96.641



Z73.2 Lack of Relaxation & Leisure

Before Day of Coding After Day of Coding






Questions????



Class Companion:

Rapid Reference Guide

Available for beginners & for quick reference.

Allows for easy look-up of home health codes. Pages are organized how clinicians think and by medical abbreviation. Book includes coding updates for 2016.

Cost is for Webinar participants only is $74 (5% discount) including s/h. Offer valid until September 15, 2016.

To download order blank, go to www.jluhealth.com Use discount code NH.



Resources

Coding

Coding Guidelines

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

10cm.htm

CMS Materials

https://www.cms.gov/Medicare/

Coding/ICD10/Downloads/ICD1

0ListservCodingResources.pdf

Rapid Reference Guide © 2016

www.jluhealth.com

OASIS

HHA Final Rule 2016 CMS-1625-F

https://www.cms.gov/Medicare/Medi

care-Fee-for-Service-

Payment/HomeHealthPPS/Home-

Health-Prospective-Payment-

System-Regulations-and-Notices-

Items/CMS-1625-F.html

Home Health Agency Center

https://www.cms.gov/center/provide

r-Type/home-Health-Agency-HHA-

Center.html

OASIS Manual

https://www.cms.gov/Medicare/Qual

ity-Initiatives-Patient-Assessment-

Instruments/OASIS/index.html



ABOUT THE SPEAKER:

JOAN L. USHER, BS, RHIA, ACE, President,

JLU Health Record Systems, Pembroke, MA

Degree in Health Information Management

Certified OASIS and Coding Specialist over 9

years

AHIMA Approved ICD-10-CM Trainer

Author, Rapid Reference Coding Guide, 2016

edition www.jluhealth.com © 2016

Author, Online ICD Coding Courses in

partnership with Libman Education 2012-2016

http://www.libmaneducation.com/healthcare-

education-training/home-health-coding/

Author, ICD-10 Essentials for Home Care:

Your Guide to Preparation & Implementation

www.hcmarketplace.com © 2011

Author, ICD-10 for Home Health: A Guide to

Medical Necessity and Payment

http://www.beaconhealth.org © 2014

Author/Editor Online E-Learning Coding

Courses: Home Health Diagnostic Coding;

Home Health Reimbursement Methods, Home

Health Documentation & Health Record

Requirements AHIMA www.ahimastore.org

© 2011

Contributing editor, Schraffenberger/Keuhn, Effective Mgmt of Coding Services, AHIMA, © 2009

Editor & Contributing Author, MaHIMA, Medicio- Legal Guide to Health Record Information, © 2004, Contributing Author © 2016

Massachusetts Health Information Management Association (MaHIMA), BOD 2004-2011

President , 2006, under her leadership, MA received 4 national awards from AHIMA in Continuing Education Programs, Support for Accredited HIM Education Programs, Legislative Advocacy and Electronic Communications

Co-Chair ICD-10 Task Force 2013-2015

Professional Achievement Award Recipient, MaHIMA, 2008

American Health Information Management Association (AHIMA) delegate 2002-2006

Taught ICD coding for over 20 years and has educated over 17,000 people nationwide

Home Care Alliance of MA, Board of Director 2012-2017, member QI Committee, Facilitator ICD-10 Group 2013-2016

Hospice & Palliative Care Federation MA, Board of Director 2008-2017

©2016 JLU Health Record Systems


http://www.cdc.gov/nchs/icd/icd10cm.htm



https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10ListservCodingResources.pdf





https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulations-and-Notices-Items/CMS-1625-F.html































https://www.cms.gov/center/provider-Type/home-Health-Agency-HHA-Center.html













https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/OASIS/index.html












http://www.libmaneducation.com/healthcare-education-training/home-health-coding/









http://www.hcmarketplace.com/

http://www.beaconhealth.org/

http://www.beaconhealth.org/

http://www.ahimastore.org/

icd-10 for beginners four-part series · l97.32 non-pressure chronic ulcer of left ankle l97.321...

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