Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 9 USING ICD-10-CM

Copyright Copyright ©© 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1

CHAPTER 9CHAPTER 9

USING ICD-10-CMUSING ICD-10-CM


ICD-10-CM Official GuidelinesICD-10-CM Official Guidelines

• Official Guidelines for Coding and Official Guidelines for Coding and ReportingReporting

• Developed by Cooperating PartiesDeveloped by Cooperating Parties

– AHAAHA

– CMSCMS

– NCHSNCHS

(Cont’d ...)(Cont’d ...)


ICD-10-CM Official GuidelinesICD-10-CM Official Guidelines(Cont’d …)(Cont’d …)

• Arranged in sectionsArranged in sections

– Section I, structure, conventions, general Section I, structure, conventions, general guidelinesguidelines

– Section II and III, inpatient PDX (principal Section II and III, inpatient PDX (principal diagnosis) and additional DXdiagnosis) and additional DX

– Section IV, outpatient Section IV, outpatient

• Outpatient also reference Sections I, II, and IIIOutpatient also reference Sections I, II, and III


Index and TabularIndex and Tabular

• Example of the Use of Both the Example of the Use of Both the Alphabetic Index and Tabular List Alphabetic Index and Tabular List

1.1. Diagnosis: Diagnosis: Hodgkin’s DiseaseHodgkin’s Disease

Index:Index: Hodgkin (main term)Hodgkin (main term) disease (subterm) - disease (subterm) - see see Lymphoma, Hodgkin C81.90Lymphoma, Hodgkin C81.90

Tabular:Tabular: C81 Hodgkin’s disease [category code]C81 Hodgkin’s disease [category code]C81.9 UnspecifiedC81.9 Unspecified Hodgkin’s disease [subcategory code]Hodgkin’s disease [subcategory code]C81.90 Unspecified Hodgkin’s disease, unspecified site C81.90 Unspecified Hodgkin’s disease, unspecified site

(subclassification code)(subclassification code)

Code:Code: C81.90 Unspecified Hodgkin’s disease, unspecified siteC81.90 Unspecified Hodgkin’s disease, unspecified site


Level of SpecificityLevel of Specificity

• Report highest character availableReport highest character available

• Cannot report 5Cannot report 5thth character if 6 character if 6thth character availablecharacter available

• Highest level of specificity 7 charactersHighest level of specificity 7 characters

– M48.49xA (A= initial encounter)M48.49xA (A= initial encounter)

– No 6No 6thth character for M48.49, but there is a character for M48.49, but there is a 77thth, x = placeholder, x = placeholder


Integral ConditionsIntegral Conditions

• Diagnosis stated: Do not report signs Diagnosis stated: Do not report signs and symptoms separatelyand symptoms separately

– Fever and shortness of breath due to Fever and shortness of breath due to pneumoniapneumonia

– Report only pneumoniaReport only pneumonia

– Fever and shortness of breath = symptoms Fever and shortness of breath = symptoms of pneumoniaof pneumonia


Not Integral ConditionNot Integral Condition

• Sign or symptom NOT part of disease Sign or symptom NOT part of disease condition = report separatelycondition = report separately

• Pneumonia and dehydrationPneumonia and dehydration

– J18.9, PneumoniaJ18.9, Pneumonia

– E86.0, DehydrationE86.0, Dehydration

– Not all patients with pneumonia have Not all patients with pneumonia have dehydrationdehydration

– Dehydration was not stated to be due toDehydration was not stated to be due to


Etiology and ManifestationEtiology and Manifestation

• Diabetic retinopathyDiabetic retinopathy

– Diabetes = etiology (cause)Diabetes = etiology (cause)

– Retinopathy = manifestation (symptom)Retinopathy = manifestation (symptom)

– Combination code Combination code

• E10.319 Type 1 diabetic retinopathyE10.319 Type 1 diabetic retinopathy

• Staphylococcal aureus cellulitis of faceStaphylococcal aureus cellulitis of face

– Multiple CodeMultiple Code

• L03.211 (Cellulitis) and B95.6 (Staph)L03.211 (Cellulitis) and B95.6 (Staph)


Acute and ChronicAcute and Chronic

• Same condition, both acute and Same condition, both acute and chronic, with separate, same level of chronic, with separate, same level of indention in Index, report acute firstindention in Index, report acute first

Figure: 9.1Figure: 9.1

I-10 Index entry Pancreatitis (From Buck CJ: I-10 Index entry Pancreatitis (From Buck CJ: 2010 ICD-10-CM Standard 2010 ICD-10-CM Standard Edition DRAFT (Softbound)Edition DRAFT (Softbound), St. Louis, 2010, Saunders. ), St. Louis, 2010, Saunders. )


Combination CodesCombination Codes

• Reports Reports

– Two diagnoses Two diagnoses

– Diagnosis with manifestationDiagnosis with manifestation

– Diagnosis with associated complicationDiagnosis with associated complication

• K80.00 Acute cholecystitis with K80.00 Acute cholecystitis with cholelithiasischolelithiasis


Residual and CauseResidual and Cause

• Sequela or ResidualSequela or Residual

– Malunion of fracture—Residual Malunion of fracture—Residual

– Late effect of fracture—Cause Late effect of fracture—Cause

• Report residual as first-listed diagnosisReport residual as first-listed diagnosis

• Followed by late effects codeFollowed by late effects code

• Some combination codes report 1 Some combination codes report 1 code, others require 2 codescode, others require 2 codes


LateralityLaterality

• Left/Right = extensive in I-10Left/Right = extensive in I-10

Figure: 9.4Figure: 9.4

Laterality of codes in I-10. (From Buck CJ: Laterality of codes in I-10. (From Buck CJ: 2010 ICD-10-CM Standard Edition 2010 ICD-10-CM Standard Edition DRAFT (Softbound)DRAFT (Softbound), St. Louis, 2010, Saunders. ), St. Louis, 2010, Saunders. )


ConclusionConclusionCHAPTER 9CHAPTER 9

USING the ICD-10-CMUSING the ICD-10-CM

Documents

Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 9 USING ICD-10-CM