unlocking combina.on codes in icd-10-cmaapcperfect.s3.amazonaws.com/a3c7c3fe-6fa1-4d67... ·...
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UnlockingCombina.onCodesinICD-10-CM
Training for all Healthcare Employees
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WhatWe’llCoverToday
Today’sObjec.ves Objec'ves:� ProvideanoverviewofselectedICD-10-CMguidelines� Iden'fyvariousdiagnosesthatarecombina'oncodes� Iden'fyvariouswaysofcodingdifferentscenarios� Understandhowtoreportcombina'oncodesinICD-10� Recognizecombina'oncodesthatcarryhigherspecificityandcarry
morevalueinriskadjustmentmodels.
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ICD-10BasicsandReminders
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NewICD-10Features� ThereweremanynewfeaturesinICD-10-CMØ Combina'onCodesØ ExpandedCodesØ LateralityØ 7thCharacterØ 2typesofExcludesnotes
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NewICD10Feature:Combina.onCodes
� Combina'onscodesallowformorespecificcodeselec'onforcondi'onswithsymptomsormanifesta'ons(theserequiredmorethanonecodeinICD-9-CM)
E10.21,TypeIDiabetesMellituswithDiabe'cNephropathyI25.110,Atherosclero'cheartdiseaseofna'vecoronaryarterywithunstableanginapectorisK50.112,Crohn’sdiseaseoflargeintes'newithintes'nalobstruc'on
� Combina'onsarealsofoundtodescribepoisoningsandtheirexternalcauses
T36.0x1D,Poisoningbypenicillin's,accidental(uninten'onal),subsequentencounterT42.4x5A,Adverseeffectofbenzodiazepines,ini'alencounter
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NewICD10Feature:Laterality(Right,LeM,Unspecified)
� Whenappropriate,codesspecifyanatomicalloca'onofissue/problemaspertainingtotherightside,le`side,orunspecified
� “Right”sideisusuallycharacter“1”and“Le`”isusually“2”,“Bilateral”isusually“3”,“Unspecifiedisusuallya“0”or“9”,dependingifa5thor6thcharacter(somesitua'onsdonotfollowthis)
H60.332,Swimmer’sear,leMearM94.211,Chondromalacia,rightshoulderS40.259A,Superficialforeignbodyofunspecifiedshoulder,ini'alencounter
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NewICD10Feature:ExpandedCodes
� Expandedcodesallowformorecomplexcondi'onstobedescribedinfull.Theyareseenindiabetes,alcoholandsubstanceabuse,injuries,andpostopera'vecomplica'ons
E11.341,Type2diabetesmellituswithseverenonprolifera'vediabe'cre'nopathywithmacularedema
F14.221,Cocainedependencewithintoxica'ondelirium
K91.71,Accidentalpunctureandlacera'onofadiges'vesystemorganorstructureduringadiges'vesystemprocedure
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NewICD10Feature:7thCharacter(EpisodeOfCare,Staging,Trimester,etc.)
� 7thcharacterextensionsareusedtocommunicatetheepisodeofcare(sequelae)injuries,andexternalcausesofinjuries
� The7thcharactersaredifferentforeachchapterthatusesthem,forexampleinglaucoma,theyareusedtoshowstage,andinOBtheyshowtrimester
� Ifa7thcharacterextensionisused,itmustalwaysbethe7thandlastcharacterofthecode.Ifthecodeislessthan7characters,thenplaceholder‘x’mustbeusedtofillanyemptycharacter(s)
M80.051A,Age-relatedosteoporosiswithcurrentpathologicalfracture,rightfemur,ini.alencounterforfractureS06.0x1A,Concussionwithlossofconsciousnessof30minutesorless,ini.alencounterS52.132B,Displacedfractureofneckofle`radius,ini.alencounterforopenfractureTypeIorIIorini.alencounterforopenfracture,NOS
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NewICD10Feature:Useof7thCharacter
• Obstetrics
• Injuries
• External Causes of Injuries
• Alpha or numeric
• Placeholder ‘x’
• Character meaning varies in each chapter
Injury & External Causes of Injury: 7th Character Identifies Injury
INITIAL
Receiving active
treatment
SUBSEQUENT
Receiving
routine care during healing
or recovery, AFTER active
treatment
SEQUELA
Complications or conditions arising as a result of a condition
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X X X X
Category
. Etiology, anatomic
site, severity
Added 7th character for obstetrics,
injuries, and external causes
of injuries
ICD-10-CMCodeStructure
X X X A M S 0 2 6 . 5 x A
Additional Characters
Alpha (Except U)
2 Numeric 3-7 Numeric or Alpha
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NECvs.NOS� NotElsewhereClassified
(NEC):
Thisprovidesacodefor“other”or“otherspecified”
H26.8OtherspecifiedcataractI25.89Otherformsofchronicischemicheartdisease*No'ce4thdigit“8”
� NotOtherwiseSpecified(NOS):
Thisprovidesacodewhenthedocumenta.onisinsufficienttoassignamorespecificcode
H40.9UnspecifiedglaucomaJ12.9Viralpneumonia,unspecified
*No'ce4thdigit“9”
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OtherandUnspecified
� The4thcharacter8,whenplaceda`eradecimalpoint,isusedtoindicatesome“other”specifiedcategory
� The4thcharacter9,whenplaceda`eradecimalpoint,isusedtoindicateand“unspecified”condi'on
� Thishelpsgivenumberstorepresentthedifferencebetween(NEC)(notelsewhereclassified)and(NOS)(nototherwisespecified).InICD-10-CM,the“otherspecified”and“unspecified”eachhavetheirowncode
� Theabbrevia'onNOS(NotOtherwiseSpecified)intheTabularListisequalto“unspecified”
A04.9Bacterialintes'nalinfec'on,unspecifiedBacterialenteri'sNOSK52.89,Otherspecifiednoninfec'vegastroenteri'sandcoli'sK52.9,Non-infec'vegastroenteri'sandcoli's,unspecified
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Withvs.Without
� When“with”and“without”arethechoicesforthefinalcharacterofanICD-10-CMcode,thedefaultisalways“without”
� Whenthereisa5charactercode,a“0”asthefi`hcharacterrepresents“without”and“1”represents“with”
� Whenthereisa6charactercode,a“1”asthesixthcharacterrepresents“with”anda“9”represents“without”
G40.501Epilep'cseizuresrelatedtoexternalcauses,notintractable,withstatusepilep.cusG40.509Epilep'cseizuresrelatedtoexternalcauses,notintractable,withoutstatusepilep.cus
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Parentheses()
� Punctua.on-()Parenthesesareusedtoenclosesupplementalwordsthatmayormaynotbedocumentedanddoesnotaffectcodeselec'on.Termsintheparenthesesarecallednonessen'almodifiers
Anemia(essen'al)(general)(hemoglobindeficiency)(infan'le)(primary)(profound)Diabetes,diabe'c(mellitus)(sugar)Hemophilia(classical)(familial)(hereditary)H44.611,Retained(old)magne'cforeignbodyinanteriorchamber,righteyeI10Essen'al(primary)hypertensionK51.011,Ulcera've(chronic)pancoli'swithrectalbleeding
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Brackets[]
� Punctua.on-[]Bracketsenclosesynonyms,alterna'vewordings,orexplanatoryphrasesinthetabularlistandiden'fymanifesta'oncodesinthealphabe'calindex
Index:Disease,Alzheimer’sG30.9[F02.80]Nephrosis,inamyloidosisE85.4[N08]Tabular:B06,Rubella[GermanMeasles]J00,Acutenasopharyngi's[commoncold]
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Colons:
� Punctua.on-:Colonsareusedinthetabulara`eranincompletetermwhichneedsoneormoreofthemodifiersfollowingthecolontomakethecodecomplete.Thecolonisusedwithbothincludesandexcludesnotes,inwhichthewordsthatprecedethecolonarenotconsideredcompletetermsandmustbeappendedbyoneofthemodifiersindentedunderthestatementbeforethecondi'oncanbeassignedthecorrectcode
G73.7MyopathyindiseaseclassifiedelsewhereExcludes1:myopathyin: rheumatoidarthri's(M05.32) sarcoidosis(D86.87) scleroderma(M34.82) siccasyndrome[Sjögren](M35.03) systemiclupuserythematosus(M32.19)
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Combina.onCode
� Onlyu'lizeacombina'oncodewhenthecodefullydescribesthecondi'onsdocumentedorwhenICD-10-CMdirectstheiruse.Wheneveranycombina'oncodelacksanyrequiredelementsorspecificity,anaddi'onalcodeshouldbeusedasasecondarycode
� Acombina'oncodeisasinglecodeusedtodescribe:� Twodiagnoses,or� Adiagnosiswithanassociatedsecondaryprocess(manifesta'on),or� Adiagnosiswithanassociatedcomplica'on
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Combina.onCode� Guidelinesstatethatmul'plecodesshouldnotbeusedwhenyouclearlyhaveacombina'oncodethatiden'fiesalloftheelementsinthediagnosis
� Whenyoususpectthatacombina'oncodemaybeapplicable,butsuppor'ngdocumenta'onislackingquerythephysician
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ICD-10-CMConven.ons
� Instruc.onalNotes:
Variousformsofinstruc'onalnotesareusedinICD-10-CMsuchas“codefirst,”“useaddi'onalcode,”andcrossreferencenotes
� Includes:
Itisimportanttorememberthatthelistofinclusionstermsisnotexhaus'veandmayincludediagnosesnotlistedintheinclusionnote.Theword“Includes”willappearatthebeginningofachapter,sec'onorcategory,howeveritwillnotappearinalistoftermsfoundunderthecodeinthetabular
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ICD-10-CMConven.ons
� Includesexamples:
K25GastricUlcer
Includes: erosion(acute)ofstomach pylorusulcer(pep'c) stomachulcer(pep'c)
K31.5 Obstruc.onofduodenum
Constric.onofduodenumDuodenalileus(chronic)StenosisofduodenumStrictureofduodenumVolvulusofduodenum
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NewFeature:2ExcludesNotes� 2typesof“Excludes”notestodifferen'atebetween
whentwocodesMAYbeusedtogetheriftheyarebothpresentvs.whentwocodescanNEVERbeusedtogetherbecauseitwouldbeclinicallyimpossible.
Excludes1noteindicatesnotcodedhere.Thecodebeingexcludedcanneverbeusedwiththecodeabovebeingchosenbecauseitwouldbeclinicallyimpossible.[Ex.B06,Rubella(Germanmeasles)hasanexclusion1ofcongenitalrubella(P35.0).]Therewasaguidanceupdatethatyoumaycodebothiftheyareunrelated.
Excludes1=Therecanonlybeone
Excludes2noteindicatesnotincludedhere.Thecodewiththisexclusionisnotalreadybeingrepresentedbythecodeabovebeingchosenanditisacceptabletousebothcodesiftheyarebothtrueforthepa'ent.[ex.J04.0,Acutelaryngi'shasanExcludes2ofChroniclaryngi's(J37.0).]
Excludes2=Meanstherecanbetwo
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TheRubricorFamilyCode
� Thefirst3charactersofanyICDcodearecalledthe“rubric”oryoucanthinkofthemasa“codefamily.”
� Thisishighlyimportant,especiallyinICD-10-CM,aswhenreviewingcodes,onemaybeseveralpagesawayfromtherootfamilycode.
� Thereareimportantincludesandexcludesnotesthataresome'mesfounddirectlyunderyourcode,butalsosome'mesfoundunderthefamily,rubric,rootcode.
� Alwaysgobacktotheroot/rubric.
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2017ICD-10Changes&Updates
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2017Changes&Updates� A.Conven.onsfortheICD-10-CM12.ExcludesNotesa. Excludes1Atype1Excludesnoteisapureexcludesnote.Itmeans“NOTCODEDHERE!”AnExcludes1noteindicatesthatthecodeexcludedshouldneverbeusedatthesame'measthecodeabovetheExcludes1note.AnExcludes1isusedwhentwocondi'onscannotoccurtogethersuchasacongenitalformversusanacquiredformofthesamecondi'on.Anexcep.ontotheExcludes1defini.onisthecircumstancewhenthetwocondi.onsareunrelatedtoeachother.Ifitisnotclearwhetherthetwocondi.onsinvolvedinanExcludes1notearerelatedornot,querytheprovider.
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2017Changes&Updates� A.Conven.onsfortheICD-10-CM14.Documenta.onforBMI,DepthofNon-pressureulcers,PressureUlcerStages,ComaScale,andNIHStrokeScale
FortheBodyMassIndex(BMI),depthofnon-pressurechroniculcers,pressureulcerstage,comascale,andNIHstrokescale(NIHSS)codes,codeassignmentmaybebasedonmedicalrecorddocumenta'onfromclinicianswhoarenotthepa'ent’sprovider(i.e.physicianorotherqualifiedhealthcareprac''onerlegallyaccountableforestablishingthepa'ent’sdiagnosis),sincethisinforma'onistypicallydocumentedbyothercliniciansinvolvedinthecareofthepa'ent(e.g.,adie'ciano`endocumentstheBMI,anurseo`endocumentsthepressureulcerstages,andanemergencymedicaltechnicianoMendocumentsthecomascale).However,theassociateddiagnosis(suchasoverweight,obesity,acutestroke,orpressureulcer)mustbedocumentedbythepa'ent’sprovider.Ifthereisconflic'ngmedicalrecorddocumenta'on,eitherfromthesameclinicianordifferentclinicians,thepa'ent'sarendingprovidershouldbequeriedforclarifica'on.TheBMI,comascale,andNIHSScodesshouldonlybereportedassecondarydiagnoses.
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2017Changes&Updates� A.Conven.onsfortheICD-10-CM15.“With”
Theword“with”shouldbeinterpretedtomean“associatedwith”or“dueto”whenitappearsinacode'tle,theAlphabe'cIndex,oraninstruc'onalnoteintheTabularList.Theclassifica.onpresumesacausalrela.onshipbetweenthetwocondi.onslinkedbythesetermsintheAlphabe.calIndexorTabularList.Thesecondi.onsshouldbecodedasrelatedevenintheabsenceofproviderdocumenta.onexplicitlylinkingthem,unlessthedocumenta.onclearlystatesthatthecondi.onsareunrelated.Forcondi.onsnotspecificallylinkedbytheserela.onaltermsintheclassifica.on,providerdocumenta.onmustlinkthecondi.onsinordertocodethemasrelated.
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2017Changes&Updates� A.Conven.onsfortheICD-10-CM19.CodeAssignmentandClinicalCriteriaTheassignmentofadiagnosiscodeisbasedontheprovider’sdiagnos.cstatementthatthecondi.onexists.Theprovider’sstatementthatthepa.enthasapar.cularcondi.onissufficient.Codeassignmentisnotbasedonclinicalcriteriausedbytheprovidertoestablishthediagnosis.
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2017Changes&Updates� B.GeneralCodingGuidelines13.Laterality
Whenapa.enthasabilateralcondi.onandeachsideistreatedduringseparateencounters,assignthe“bilateral”code(asthecondi.ons.llexistsonbothsides),includingfortheencountertotreatthefirstside.ForthesecondencounterfortreatmentaMeronesidehaspreviouslybeentreatedandthecondi.onnolongerexistsonthatside,assigntheappropriateunilateralcodeforthesidewherethecondi.onss.llexists(e.g.,cataractsurgeryperformedoneacheyeinseparateencounters).Thebilateralcodewouldnotbeassignedforthesubsequentencounter,asthepa.entnolongerhasthecondi.oninthepreviouslytreatedsite.Ifthetreatmentonthefirstsidedidnotcompletelyresolvethecondi.on,thenthebilateralcodewoulds.llbeappropriate.
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2017Changes&Updates� Chapter9:DiseasesoftheCirculatorySystem(I00-I99)a.HypertensionTheclassifica.onpresumesacausalrela.onshipbetweenhypertensionandheartinvolvementandbetweenhypertensionandkidneyinvolvement,asthetwocondi.onsarelinkedbytheterm“with”intheAlphabe.cIndex.Thesecondi.onsshouldbecodedasrelatedevenintheabsenceofproviderdocumenta.onexplicitlylinkingthem,unlessthedocumenta.onclearlystatesthecondi.onsareunrelated.Forhypertensionandcondi.onsnotspecificallylinkedbyrela.onaltermssuchas“with,”“associatedwith,”or“dueto”intheclassifica.on,providerdocumenta.onmustlinkthecondi.onsinordertocodethemasrelated.
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2017Changes&Updates� Chapter18:Symptoms,signs,andabnormalclinical
andlaboratoryfindings,notelsewhereclassifiedi. NIHSSStrokeScaleTheNIHstrokescale(NIHSS)codes(R29.7--)canbeusedinconjunc.onwithacutestrokecodes(I63)toiden.fythepa.ent’sneurologicalstatusandseverityofthestroke.ThestrokescalecodesshouldbesequencedaMertheacutestrokediagnosiscode(s).Ataminimum,reporttheini.alscoredocumented,Ifdesired,afacilitymaychoosetocapturemul.plestrokescalescores.
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2017Changes&Updates� Chapter19:Injury,poisoning,andcertainother
consequencesofexternalcausesa. Applica.onof7thCharactersinChapter19…..7thcharacter“A,”ini'alencounterisusedforeachencounterwherethepa'entisreceivingac'vetreatmentforthecondi'on.7thcharacter“D”subsequentencounterisusedforencountersa`erthepa'enthascompletedac'vetreatmentofthecondi'onandisreceivingrou'necareforthecondi'onduringthehealingorrecoveryphase.…...
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2017Changes&Updates� Sec.onIV.Diagnos.cCodingandRepor.ngGuidelinesforOutpa.entServices
� P.Encountersformedicalexamina.onswithabnormalfindings
Anexamina.onwithabnormalfindingsreferstoacondi.on/diagnosisthatisnewlyiden.fiedorachangeinseverityofachroniccondi.on(suchasuncontrolledhypertension,oranacuteexacerba.onofchronicobstruc.vepulmonarydisease)duringarou.nephysicalexamina.on.
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SelectedCombina.onCodes
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DisseminatedCandidiasis� CandidalSepsisB37.7
Disseminatedcandidiasis
Systemiccandidiasis
q TheB37familyisforCandidiasis.UseoftheB37.7codestatesbothcandidiasisalongwithrelatedsepsisarepresent,notetheinclusionofdisseminatedandsystemicontheinclusivewording.
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Combina.oncodesthatincludeMRSA
� PneumoniaduetoMRSAJ15.212
� DonotcodeB95.62withJ15.212Codefirstassociatedinfluenza,ifapplicable
Codealsoassociatedabscess,ifapplicable
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SickleCellDisease� SickleCellDiseasewithoutcrisisD57.1
SickleCellAnemia,Disease,orDisorder,NOSHb-SSdiseasewithoutcrisis
q UseoftheD57.1codeisforsicklecellwithoutcrisis.NotethereareothermorespecificcodesforspecifictypesofSSdisease.
� Hb-SSDiseasewithcrisisD57.0-D57.01withacutechestsyndromeD57.02withsplenicsequestra'on
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DMwOphthalmicManifesta.ons� DMwithophthalmicmanifesta.onsincludesthefollowingcodes:E10.311–E10.349(TypeI)E11.311–E11.349(TypeII)
(non-prolifera'vere'nopathy,withorwithoutmacularedema)� DMwithprolifera.vere.nopathy,includesthefollowingcodes:E10.351(E11.351)“withmacularedema”E10.359(E11.359)“withoutmacularedema”
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DMwCirculatoryComplica.ons� E10.5(E11.5)DMwithCirculatoryComplica.ons� E10.51(E11.51)“DMwithdiabe'cperipheralangiopathywithoutgangrene”(default)
� E10.52(E11.52)“DMwithdiabe'cperipheralangiopathy“withgangrene”
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DiabetesCodingClinic®2016� TheCodingClinic®issuedguidanceinQuarter1andQuarter2regardingthecodingofdiabetesandmanifesta'ons.
� Theword“with”maybeunderstoodasDMwithamanifesta'onandprovidersdonotneedtostatethecauseandeffect.
� “Thesecondi,onsshouldbecodedasrelatedevenintheabsenceofproviderdocumenta,onexplicitlylinkingthem,unlessthedocumenta,onclearlystatesthecondi,onsareunrelatedandduetosomeotherunderlyingcausebesidesdiabetes.“
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HypertensiveCKD&HeartDisease
Hypertension Type ICD-9-CM ICD-10-CM
HTN (primary, benign, essential, malignant) 401.x I10“with” Heart Disease *Must Document Cause & Effect
402.xx I11.x
“with” CKD [Cause & Effect are Assumed] 403.xx I12.x“with” Heart & Kidney Disease *Must Document Cause & Effect for Heart Disease
404.xx I13.x
Hypertension, secondary 405.xx I15.x
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HypertensiveHeartDisease� I11.0Hypertensiveheartdiseasewithheartfailure(hypertensiveheartfailure)Includescondi,onsI51.4-I51.9Useaddi,onalcodetoiden,fytypeofheartfailure(I50.-)
� I11.9HypertensiveheartdiseasewithoutheartfailureIncludescondi,onsI51.4-I51.9HypertensiveheartdiseaseNOS
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HypertensiveCKD� I12.0HypertensivechronickidneydiseasewithStage5CKDorESRDArteriosclerosisofkidney,Arteriosclero,cnephri,s,Hypertensivenephropathy,NephrosclerosisIncludescondi,onsN18&N26duetoHTNUseaddi,onalcodetoiden,fystageofCKD(N18.5,N18.6)
� I12.9Hypertensivechronickidneydiseasewithstage1–stage4CKD,orunspecifiedCKDHypertensivechronickidneydiseaseNOSHypertensiverenaldiseaseNOSUseaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)
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HypertensiveCKD&HeartFailure� I13.0Hypertensiveheart&chronickidneydiseasewithheartfailure&stage1-4CKD Anycondi,oninI11.1-withanycondi,oninI11.2.-Cardiorenaldisease,CardiovascularrenaldiseaseUseaddi,onalcodetoiden,fytypeofheartfailure(I50.-)Useaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)
� I13.2Hypertensiveheart&chronickidneydiseasewithheartfailure&stage5CKDorESRDAnycondi,oninI11.1-withanycondi,oninI11.2.-Cardiorenaldisease,CardiovascularrenaldiseaseUseaddi,onalcodetoiden,fytypeofheartfailure(I50.-)Useaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)
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HypertensiveCKDw/oHeartFailure� I13.10Hypertensiveheart&chronickidneydiseasewithoutheartfailure&stage1-4CKDAnycondi,oninI11.1-withanycondi,oninI11.2.-Cardiorenaldisease,CardiovascularrenaldiseaseUseaddi,onalcodetoiden,fytypeofheartfailure(I50.-)Useaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)
� I13.11Hypertensiveheart&chronickidneydiseasewithoutheartfailure&stage5CKDorESRDAnycondi,oninI11.1-withanycondi,oninI11.2.-Cardiorenaldisease,CardiovascularrenaldiseaseUseaddi,onalcodetoiden,fytypeofheartfailure(I50.-)Useaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)
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CADw/Angina� I25.1familyisforAtherosclero.cheartdiseaseofna.vecoronary
artery(noteweassumena.veifnoCABGintheDOSbeingreviewed)Thisalsoincludes:Atherosclero.ccardiovasculardisease,Coronary(artery)Atheroma,Coronary(artery)atherosclerosis,Coronary(artery)disease[AKA:CAD],Coronaryarterysclerosis*Useaddi,onalcodetoiden,fy…....(smoking,exposure,calcifiedlesions,lipidrichplaque,etc.)
I25.11-Atherosclero.cheartdiseaseofna.vecoronaryarterywithanginapectoris� I25.110Atherosclero.cheartdiseaseofna.vecoronaryarterywith
unstableanginapectoris� I25.111Atherosclero.cheartdiseaseofna.vecoronaryarterywith
anginapectoriswithdocumentedspasm� I25.118Atherosclero.cheartdiseaseofna.vecoronaryarterywith
otherformsofanginapectorispectoris� I25.119Atherosclero.cheartdiseaseofna.vecoronaryarterywith
unspecifiedanginapectoris
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EmbolismswAcuteCorPulmonale� I26.01Sep.cpulmonaryembolismwithacutecor
pulmonaleCodefirstunderlyinginfec'on
� I26.02Saddleembolusofpulmonaryarterywithacutecorpulmonale
� I26.09OtherpulmonaryembolismwithacutecorpulmonaleAcutecorpulmonaleNOS
q TheI26.0familyisforPulmonaryembolismwithacutecorpulmonale.
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Atherosclerosisextremi.eswUlcer� Codesforatherosclerosisofextremi.eswithulcera.onarealsocombina.oncodesUseaddi'onalcodetoiden'fyseverityofulcer(L97.-)
� I70.23-Atherosclerosisofna.vearteriesofrightlegwithulcera.on
� I70.24-Atherosclerosisofna.vearteriesofleMlegwithulcera.on
� I70.25Atherosclerosisofna.vearteriesofotherextremi.eswithulcera.on
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AtherosclerosisbypassgraMwUlcer� CodesforbypassgraMofextremi.eswithulcera.onarealsocombina.oncodes
� ExamplesfoundonnextslideintableUseaddi'onalcodetoiden'fyseverityofulcer(L97.-)
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Athe
rosclerosisb
ypass
graM
wUlcer
Code Type Location
I70.33- unspecified type of bypass graft(s) Right
I70.34- unspecified type of bypass graft(s) Left
I70.35 unspecified type of bypass graft(s) Other
I70.43- autologous vein bypass graft(s) Right
I70.44- autologous vein bypass graft(s) Left
I70.45 autologous vein bypass graft(s) Other
I70.53- nonautologous biological bypass graft(s) Right
I70.54- nonautologous biological bypass graft(s) Left
I70.55 nonautologous biological bypass graft(s) Other
I70.63- nonbiological bypass graft(s) Right
I70.64- nonbiological bypass graft(s) Left
I70.65 nonbiological bypass graft(s) Other
I70.73- Other type of bypass graft(s) Right
I70.74- Other type of bypass graft(s) Left
I70.75 Other type of bypass graft(s) Other
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Crohn’sdiseasewobstruc.on� CodesforCrohn’sdisease(regionalenteri.s)with
obstruc.onarealsocombina.oncodesUseaddi'onalcodetoiden'fymanifesta'ons,suchas:pyodermagangrenosum(L88)
� K50.012Crohn’sdiseaseofsmallintes.newithintes.nalobstruc.on
� K50.112Crohn’sdiseaseoflargeintes.newithintes.nalobstruc.on
� K50.812Crohn’sdiseaseofbothsmallandlargeintes.newithintes.nalobstruc.on
� K50.912Crohn’sdisease,unspecified,withintes.nalobstruc.on
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Ulcera.vecoli.swobstruc.on� Codesforulcera.vecoli.swithobstruc.onarealsocombina.on
codesUseaddi'onalcodetoiden'fymanifesta'ons,suchas:pyodermagangrenosum(L88)
� K51.012Ulcera.ve(chronic)pancoli.swithintes.nalobstruc.on� K51.212Ulcera.ve(chronic)proc..swithintes.nalobstruc.on� K51.312Ulcera.ve(chronic)rectosigmoidi.swithintes.nal
obstruc.on� K51.412Inflammatorypolypsofcolonwithintes.nalobstruc.on� K51.512LeMsidedcoli.swithintes.nalobstruc.on� K51.812Otherulcera.vecoli.swithintes.nalobstruc.on� K51.912Ulcera.vecoli.s,unspecified,withintes.nalobstruc.on
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Rheumatoidarthri.swpolyneuropathy� NotethatinICD-10thereisadifferen.a.onbetweenRAwithrheumatoidfactor(M05.-)andRheumatoidarthri.swithoutrheumatoidfactor(M06.-),andwhenindoubtourdefaultis“without.”
� M05.5-Rheumatoidpolyneuropathywithrheumatoidarthri.s
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Systemiclupuserythematosus(SLE)� NotethatinICD-10,SLENOS=M32.9Thisincludes:systemiclupuserythematosusNOS,Systemiclupuserythematosuswithoutorganinvolvement
� M32.13Lunginvolvementinsystemiclupuserythematosus
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Dermatopolymyosi.swlunginvolvement� M33Dermatopolymyosi.s:familyofmyosi's
disordersthatincludespolymyosi's&dermatomyosi's
� M33.01Juveniledermatopolymyosi.swithrespiratoryinvolvement
� M33.11Otherdermatopolymyosi.swithrespiratoryinvolvement
� M33.21Polymyosi.swithrespiratoryinvolvement� M33.91Dermatopolymyosi.s,unspecifiedwith
respiratoryinvolvement
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Scleroderma/Siccawlunginvolvement� M34Systemicsclerosis(scleroderma):Autoimmunediseasewithhardeningoftheskin.(canaffectorganswhensevere)
� M35.0Siccasyndrome(SjÖgren):Autoimmunediseasethataracksexocrineglands,specificallysalivaandtears.
� M34.81.Systemicsclerosis(scleroderma)withlunginvolvement
� M35.02Siccasyndromewithlunginvolvement
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Condi.onsduetodrugs,medica.ons,andbiologicalsubstances
� ICD-10-CMcombina'oncodesdenotewhetherthepa'enthasexperiencedapoisoning,adverseeffect,orunderdosingaswellasthespecificsubstanceresponsiblefortheoutcome.
� Pa'entpresentswithaccidentalcocaineoverdoseT40.5X1-
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Summary
Youshouldnowbeabletounderstandthefollowing:
• SomeofthebasicsICD-10-CMguidelines• Someofthecombina'oncodesfoundinICD-10• Howtomaximizelookingatbaserubric/familycodes• Theimportanceofreviewingincludesandexcludesforthe
codeaswellasthecodefamily/rubric
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TakeAway� Knowingthatthereisacombina'oncodecanbeoneofthemostchallengingaspects
� ScanallthechaptersoftheICD-10andhighlightcodesthatyoufrequentlyreportthatwerepreviouslyreportedwith2ICD-9codes
� USEYOURBOOKcheckthealphabe.candtabularindicestolookforanyinstruc.onalnotesthatmaybeapplicable
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TakeAway
� Takeyour'meandreviewthediagnos'cstatementcarefully,incorrectcodingaffectsdataqualityandreimbursementcouldbeatrisk
� Youneedongoingeduca.onwithrespecttoanatomy,physiologyandthee'ologyofdiseases
� Ifthephysiciandoesn’tlinktwocondi'onsyoushouldbeabletorecognizethatthesearetypicallyrelatedandquerythephysician
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TakeAway� Includeyourphysiciansintheeduca'onalprocesswheneverpossible.
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FundamentalsQuiz
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ApplyingConceptsQuiz
1. ExpandedCodesallowformoreComplexcondi'onstobedescribedinfull.
TrueorFalse
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1. Answer:True
Ra,onale:TheycapturemoredetailsuchasC50.511,malignantneoplasmoflower-outerquadrantofrightfemalebreast
Applying Concepts Quiz
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2. Whichstatementistrueaboutthe7thCharacter:a) Itisusedtocommunicateinjuryb) Ifyouarenotsurewhattheepisodeofcareisuse“X”asyour7th
characterc) Areusedtocommunicatetheepisodeofcareforinjuriesand
externalcausesofinjuries
ApplyingConceptsQuiz
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2. Answer:c)Areusedtocommunicatetheepisodeofcareforinjuriesandexternalcausesofinjuries
Ra,onale:“X”isusedasaplaceholderifthecodeislessthan7characters.
Applying Concepts Quiz
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3. ()Parenthesesareusedtoenclosewordsthatmustbedocumented:
TrueorFalse
Applying Concepts Quiz
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3. Answer:False.
Ra,onale:theyareusedtoenclosesupplementalwordsthatmayormaynotbedocumentedanddoesnotaffectcodeselec,on.Theyarecallednonessen8almodifiers.
Applying Concepts Quiz
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4. ARubricis:a) Acubeb) Notimportantitdoesnothaveallofthenecessarycharactersc) Mayhaveimportantincludesandexcludesnotes
Applying Concepts Quiz
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4. Answer:c)Mayhaveimportantincludesandexcludesnotes
Ra,onale:TheRubricisthethefirst3charactersofanyICDcode.Andsome,meshaveimportantincludesandexcludesnotesdirectlyunderthefamily,rubricrootcode.
Applying Concepts Quiz
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5. NOSisanabbrevia'onfor:a) Notonsiteb) Neveronceseenc) NotOtherwiseSpecified
Applying Concepts Quiz
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5. Answer:c)NotOtherwiseSpecifiedRa,onale:NOS(NotOtherwiseSpecified)intheTabularListisequalto“unspecified”
Applying Concepts Quiz
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6. Whenadiagnosiscodeselec'oniseitherwithorwithout.Withisthedefault.TrueorFalse
Applying Concepts Quiz
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6. Answer:False
Ra,onale:Thedefaultisalways“without”
Applying Concepts Quiz
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7. Youcanuseeithermul'plecodesoracombina'oncode,bothaccuratelydescribethediagnosis
TrueorFalse
Applying Concepts Quiz
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7. Answer:False
Ra,onale:Guidelinesstatethatwhenyouclearlyhaveacombina,oncodethatiden,fiesalloftheelementsinthediagnosisyoushouldusemul,plecodes.
Applying Concepts Quiz
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8. Excludes1hasaguidanceupdatethatyoucancodebothiftheyareunrelated
TrueorFalse
Applying Concepts Quiz
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8. Answer:True
Ra,onale:Therewasanupdatepleasebesurethatthe2diagnosiscodesareunrelated.
Applying Concepts Quiz
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9. Whatdoyoucodewhenthediagnosisisbilateralbutthecodeselec'ondoesnothaveanop'onforbilateral:a) Usebothrightandle`diagnosiscodesb) UsetheNOSop'onc) Onlycodeeitherrightorle`
Applying Concepts Quiz
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9. Answer:a)UsebothoftherightandleMcodes
Ra,onale:PerCodingGuidelines
Applying Concepts Quiz
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10. SignsandSymptomsthatareassociatedrou'nelywithadiseaseprocessshouldnotbeassignedasaddi'onalcodes,unlessotherwiseinstructedbytheclassifica'on.
TrueorFalse
Applying Concepts Quiz
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10. Answer:True
Ra,onale:Percodingguidelines
Whatis/arethepropercode(s)fortheassessmentabove?a) 305.1,272.4,401.9,250.00b) 272.4,401.9,250.00c) 272.4,401.9
d) 401.9
Applying Concepts Quiz
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CodingClinicTosubmitaques'ontothecodingclinicgotothesitebelow.
hrp://www.codingclinicadvisor.com/
ForAHACodingClinicWebinarsgoto:
hrp://www.ahacentraloffice.org/codes/webinars.shtml
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Ques.ons/Feedback
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DisclaimerForIllustra.ve,Educa.onalandDiscussionPurposesOnlyThisprogrammaycontainreferencesorlinkstostatutes,regula'ons,orotherpolicymaterials.Theinforma'onprovidedisintendedonlytobeageneralsummary.Itisnotintendedtotaketheplaceofeitherthewrirenlaworregula'ons.Weencouragereaderstoreviewthespecificstatutes,regula'onsandotherinterpre'vematerialsforafullandaccuratestatementoftheircontents.
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Thanksforyourawen.on.
ThankYou
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Contact
BrianBoyce,BSHS,CPC,CPC-I,CRC,CTPRPCEO,Proprietor,andManagingConsultant2112W.LaburnumAve.Suite109Richmond,VA23227www.linkedin.com/in/boycebrian/[email protected]
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