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ICD-9 to ICD-10
Prep (Parts I-IV)
PART I (5/5/14)
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Objectives
 Participants will:
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Correctly assign diagnoses to ICD-9-CM codes
Correctly identify primary/secondary diagnoses
Identify correct sequence of diagnoses for coding assignment
Identify documentation needed for ICD-10-CM coding
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ICD-9 and ICD-10 History
 The 9th revision was published in 1977. The U.S.
National Center for Health Statistics (NCHS) and CMS
are responsible for maintaining ICD-9-CM.
 The World Health Organization (WHO) adopted ICD-10
(International Classification of Diseases, Tenth Revision)
in 1990 and it came into use in 1994 by other countries.
 The ICD-10-CM (International Classification of
Diseases, Tenth Revision, Clinical Modification) was
developed under the oversight of National Center for
Health Statistics in 1997 and has undergone several
modifications since then.
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2014 ICD-9-CM and ICD-10-CM Availability
 http://www.cdc.gov/nchs/icd/icd9cm.htm
 http://www.cdc.gov/nchs/icd/icd10cm.htm or
http://www.cms.hhs.gov/ICD10
● 2014 ICD-10-CM Index to Diseases and Injuries
● 2014 ICD-10-CM Tabular List of Diseases and Injuries
o Instructional Notations
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2014 Official Guidelines for Coding and Reporting
2014 Table of Drugs and Chemicals
2014 Neoplasm Table
2014 Mapping ICD-9-CM to ICD-10-CM and
ICD-10-CM to ICD-9-CM”
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ICD-9-CM and ICD-10-CM Coding Guidelines
 The guidelines are approved by four organizations:
● American Hospital Association (AHA)
● American Health Information Management Association
(AHIMA)
● Centers for Medicare and Medicaid Services (CMS), and
● National Center for Health Statistics (NCHS)
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Coding to Support Need for Medicare
 The principal diagnosis and secondary top 8 diagnoses are
entered onto the UB-04.
 Accurate reporting of ICD-9 CM codes effect:
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Medicare billing
Quality measures
Data collected
Overall accuracy of MDS/RUG categories
 The main benefit of correct coding is validation of service
delivered and reduced compliance risk.
 The industry is using more checks and balances to reject
claims and review for fraud and abuse
 Inaccurate codes will lead to rejection of claims and services
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Coding Conventions
and Guidelines
ICD-9-CM
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Coding from ICD-9-CM to ICD-10-CM
ICD-9-CM
ICD-10-CM
Three to five characters
Three to seven characters
First digit is numeric but can be alpha
(E or V)
First character always alpha
2–5 are numeric
All letters used except U
Always at least three digits
Character 2 always numeric: 3–7 can
be alpha or numeric
Decimal placed after the first three
characters (or with E codes, placed after
the first four characters)
Always at least three digits
Alpha characters are not case-sensitive
Decimal placed after the first three
characters
Alpha characters are not case-sensitive
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Alphabetic Index -2
 Main terms in boldface
font are listed in
alphabetic order. Then,
indented beneath the main
term, any applicable
subterm or essential
modifier will be shown in
alphabetical order. The
indented subterm is
always read in
combination with the
main term.
Pneumonia 486 (J18.9)
aspiration 507.0 (J69.0)
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due to food
507.0(J69.0)
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Alphabetic Index -3
 Nonessential modifiers
appear in parentheses ( )
and do not affect the code
number assigned.
Amblyopia (congenital) (ex
anopsia) (partial) (suppression)
368.00 (H53.00-)
deprivation 368.02 (H53.01-)
 The “-” at end of an index
entry indicates that
additional characters are
required (ICD-10)
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Alphabetic Index -4
 Manifestation codes are
included in the alphabetic
index by including a
second code, shown in
brackets [ ] directly
after the underlying or
etiology code which
should always be reported
first.
Chorioretinitis – see also
inflammation chorioretinal
Tuberculosis 017.3 [363.13]
Egyptian B76.9 [D63.8]
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Tabular List
 Most but not all categories are subdivided into four or
five character subcategories, e.g. (496 COPD or I10 –
Hypertension)
 The fourth character when placed after the decimal point
of:
● 8 - (.8) is used to indicate “other specified”, and
● 9 - (.9) is usually reserved for “unspecified”
 365.89 Other specified glaucoma
365.9 Unspecified glaucoma
K52.89 Other specified noninfective gastroenteritis and colitis
K52.9 Noninfective gastroenteritis and colitis, unspecified
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Tabular List -4
 (NEC) – “not elsewhere classified”
 (NOS) – “not otherwise specified”
 Both NEC and NOS have their own codes
 Five and six character codes provider greater specificity
or more information about the condition
 Codes must be assigned to the highest number of
characters available or to the highest level of
specificity, or bills will be rejected
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Coding Convention Abbreviations
 Not Elsewhere Classified “NEC” – A residual category,
subdivision, or subclassification that provides a location
for “other” types of specified conditions that have not
been classified anywhere else in the code set. These
residual codes may also contain the term “NEC” as part
of their descriptor.
276.9 Electrolyte and fluid disorders,
not elsewhere classified
E87.8 Other Disorder of electrolyte and fluid
balance, not elsewhere classified
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Tabular List Notes
 Pertinent coding information is located at the beginning
of chapters or any subdivisions that follow and apply to
all the categories within it.
Beginning of the chapter – 780-799 or R00-R99
Beginning of a subchapter – 235-238 or D37-D48
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Coding Convention Abbreviations -2
 Not Otherwise Specified “NOS” - for use when the
documentation of the condition identified by the provider
is insufficient to assign a more specific code.
294.20 Unspecified dementia without behavioral
disturbance or Dementia, NOS
F03.90 Unspecified dementia without behavioral
disturbance – Dementia, NOS
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Coding Conventions Punctuation
 ( ) Parentheses – supplemental words that may or may
not be present.
401.9 Hypertension (essential) (primary)
I10 – Essential (primary) hypertension
 [ ] - Brackets – synonyms, alternative workings or
explanatory phrases.
814.02 Fracture of lunate [semilunar]
S62.12 Fracture of lunate [semilunar]
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Coding Conventions Punctuation -2
 Colon ( : ) – used after an incomplete term which needs
one or more of the modifiers following the colon. Used
in both “includes” and “excludes” notes in which the
words that precede the colon are not considered complete
terms and therefore must be appended by one of the
modifiers indented under the statement.
359.6 Symptomatic inflammatory myopathy in
diseases classified elsewhere
Code first underlying disease, as:
malignant neoplasm (140.0-208.9)
rheumatoid arthritis (714.0)
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Coding Conventions Punctuation -3
 Dashes ( - ) in the Alphabetic Index, dashes at the end of
a code indicates an incomplete code *ICD-10 only
Fracture, pathological
ankle M84.47- carpus M84.44 In the Tabular List, a dash preceded by a decimal point
(.-) indicates an incomplete code *ICD-10 only
J43 Emphysema
Excludes 1: emphysematous (obstructive) bronchitis
(J44.-)
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Coding Convention Instructional Notes
 Includes notes – used to clarify the condition included
within a particular chapter, section, category, subcategory
or code. They are not exhaustive and may include
diagnoses not listed in the inclusion note. The word
“includes” is not preceded by the list of terms at the code
level.
531 Gastric ulcer
Includes: ulcer, stomach
K25 Gastric ulcer
Includes: stomach ulcer (peptic)
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Coding Convention Instructional Notes -2
 Excludes 1 – not coded here. Used when two codes
cannot occur together *ICD-10
 Excludes – terms excluded from the code are to be coded
elsewhere *ICD-9
355.9 Mononeuritis of unspecified site
Excludes:
Causalgia, upper/lower limb (355.71/354.4)
G59 Mononeuropathy in disease classified elsewhere
Excludes 1:
Diabetic mononeuropathy (E09 – E14 with .41)
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Coding Convention Instructional Notes -3
 Excludes 2 – not included here. Used when the condition
excluded is not part of the condition represented by the
code, but a patient may have both conditions at the same
time *ICD-10 only
J01 Acute Sinusitis
Excludes 1 – Sinusitis NOS (J32.9)
Excludes 2 – Chronic Sinusitis (J32.0 – J32.8)
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Coding Conventions
Code First & Use Additional Code
 Certain conditions have both an underlying etiology and
multiple body system manifestations due to the
underlying etiology. The underlying condition is
sequenced first followed by the manifestation. The “use
additional code” note appears at the etiology and a “code
first” note at the manifestation code.
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Coding Conventions
Code First & Use Additional Code -2
331.0 Alzheimer’s disease
Use additional code to identify…
294 Persistent mental disorders due to conditions classified
elsewhere
Code first underlying condition
G30 Alzheimer’s disease
Use additional code to identify:
dementia with behavioral disturbance (F02.81)
dementia without behavioral disturbance (F02.80)
F02 Dementia in other diseases classified elsewhere
Code first the underlying physiological condition,
such as:
Alzheimer’s (G30.-)
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Coding Conventions
Cross Reference Notes
 Cross reference notes are used in the Alphabetic Index to
advise the coding professional to look elsewhere before
assigning a code. There are three terms used: see, see
also, see condition
Hemorrhage, cranial – see Hemorrhage, intracranial
Labyrinthitis (circumscribed) (destructive) (diffuse)
(inner ear) (latent) (purulent) (suppurative)
– see also subcategory H83.0
Hematoma (traumatic) (skin surface intact) (see also
Contusion)
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Coding Conventions
Relational Terms
 And – should be interpreted to mean “and/or” when it
appears in the code title within the Tabular List.
451 Phlebitis and thrombophlebitis
I80 Phlebitis and thrombophlebitis
453 Other venous embolism and thrombosis
I82 Other venous embolism and thrombosis
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Coding Conventions
Relational Terms -2
 With – should be interpreted to mean “associated with”
or “due to” when it appears in the code title, the
Alphabetical Index, or an instructional note in the
Tabular List. The term “with” in the Alphabetical Index
is sequenced immediately following the main term, not
in alphabetical order.
Asthma, asthmatic
with chronic obstructive pulmonary disease 493.2/J44.9
493.2 Chronic obstructive asthma
J44 Other chronic obstructive pulmonary disease
Includes asthma with COPD
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General Coding Guidelines
Signs and Symptoms
 Codes that describe symptoms and signs, as opposed to
diagnoses, are acceptable for reporting purposes when a
related definitive diagnosis has not been established
(confirmed) by the provider
 Chapter 16 of ICD-9-CM contains many, but not all
codes for symptoms
 Chapter R00 – R99, for ICD-10-CM, Symptoms, Signs
and Abnormal Clinical and Laboratory Findings, Not
Elsewhere Classified contains many, but not all codes for
symptoms
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General Coding Guidelines
Integral Part of a Disease
 Signs and symptoms that are associated routinely with a
disease process should not be assigned as additional
codes, unless otherwise instructed by the classification.
Examples:
Altered Mental Status due to UTI
-599.0/N39.0
COPD with Shortness of Breath
-496/J44.9
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General Coding Guidelines
Not an Integral Part of Disease -2
 Signs and symptoms that may not be associated routinely
with a disease process should be coded when present.
Resident has a culture that returned difficile. The
resident has diarrhea with additional symptoms of
malaise, low-grade fever and frequent diarrhea. The
resident was started on Flagyl. The resident is weak,
dehydrated, and needs IV fluids.
Infection, Clostridium, difficile, food borne (disease)
008.45/A04.7
Dehydration 276.51/E86.0
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General Coding Guidelines
Multiple Coding
 In addition to the
etiology/manifestation convention
that requires two codes, there are
other single conditions that also
require more than one code. See
“Use additional code” notes in the
Tabular List at the code level.
These are sequenced secondary to
the condition code.
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General Coding Guidelines
Multiple Coding -2
 “Code first” notes are under certain codes that are not
specifically manifestation codes but may be due to an
underlying cause. When there is a “code first” note and
an underlying condition is present, the underlying
condition is sequenced first.
 “Code if applicable, any causal condition” notes indicate
that this code may be assigned as a principal diagnosis
when the causal condition is unknown or not applicable.
 If the causal condition is known, then the code for that
condition should be sequenced as the principal diagnosis
or first-listed diagnosis.
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General Coding Guidelines
Multiple Coding Example
 Multiple codes may be needed for sequela conditions.
See Guideline #10.
E. coli urinary tract infection
Infection, Urinary (tract) 599.0/N39.0
Use additional code to identify infectious organism/agent
Infection, bacterial, Escherichia coli [E. coli] (see also
Escherichia coli) 041.04/B96.20
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General Coding Guidelines
Acute and Chronic Conditions
 If the same condition is described as both acute
(subacute) and chronic and separate subentries exist in
the Alphabetic Index at the same indention level, code
both and sequence the acute (subacute) code first
Acute and chronic bronchitis
Bronchitis, acute or subacute (with bronchospasm or
obstruction) 466.0/J20.9
Bronchitis, chronic 491.9/J42
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General Coding Guidelines
Combination Code
 A combination code is a single code used to classify:
● Two diagnoses, or
● A diagnosis with an associated secondary manifestation, or
● Type 2 diabetes with other specified complication
250.80/E11.69
o Use additional code to identify complication
● A diagnosis with an associated complication
o Acute Bronchitis with COPD 491.22/J44.0
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General Coding Guidelines
Combination Code -2
 Assign only the combination code that fully identifies the
diagnostic conditions involved or when directed by the
Alphabetical Index
 Multiple coding should not be used when the
classification provides a combination code that clearly
identifies all the elements documented in the diagnosis
 When a combination code lacks necessary specificity in
describing the manifestation or complication, an
additional code should be used as a secondary code
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General Coding Guidelines
Late Effects/Sequela
 “A residual effect (condition produced) after the acute
phase of an illness or injury has terminated.”
 There is no time limit for the late effect or sequela code
 The residual may be apparent early or years later
 Generally requires two codes:
● The condition or nature of the late effect/sequela – first
o 438.5/I69.16 Other paralytic syndrome following intracerebral
hemorrhage
● The late effect/sequela code – second
o 344.00/G82.5- Quadriplegia
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General Coding Guidelines
Sequela
 Exceptions to above guideline.
● In instances where the code for the late effect/sequela is
followed by a manifestation code identified in the Tabular List
and title, or the late effect/sequela code has been to include the
manifestation.
Example: 438/I69 Late Effects/Sequela of Cerebrovascular
Disease
● The code for the acute phase of an illness or injury that led to
the late effect/sequela is never used with a code for the late
effect.
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General Coding Guidelines
Reporting Same Dx More than Once
 Each unique ICD-10-CM code may be reported only
once for an encounter
 This applies to bilateral conditions when there are no
distinct codes for laterality or two different conditions
classified to the same ICD-9-CM or ICD-10-CM
diagnosis code
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General Coding Guidelines
Laterality *ICD-10 only
 Laterality Guidelines
● For bilateral sites, the final character of the codes indicates
laterality.
● An unspecified site code is also provided should the side not be
identified in the medical record.
● If no bilateral code is provided and the condition is bilateral,
assign separate codes for both the left and right side
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General Coding Guidelines
Documentation of BMI and Pressure Ulcer Stages
 Body Mass Index (BMI) and pressure ulcer stage codes
may be based on the medical record documentation from
clinicians who are not the patient’s provider, such as a
dietician for BMI or licensed nurse for pressure ulcer
staging.
 Associated conditions (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.
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General Coding Guidelines
Syndromes
 Follow the Alphabetical Index for guidance when coding
syndromes
 If there is no guidance in the Alphabetical Index assign
codes for the documented manifestations of the
syndrome
Look for the syndrome by its name in the
alphabetical index first and then if
not there, under syndrome
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Coding Guidelines
Complications
 “Code assignment is based on the provider's
documentation of the relationship between the condition
and the care or procedure.”
 The guideline extends to any complications of care,
regardless of the chapter the code is located in.
 Note: not all conditions that occur during or following
medical care or surgery are classified as complications.
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Coding Guidelines
Complications -2
 There must be a cause-and-effect relationship between
the care provided and the condition, and an indication in
the documentation that it is a complication. If the
complication is not clearly documented, query the
provider for clarification.
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INFECTIOUS AND PARASITIC DISEASES
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HIV Infections
Code Only Confirmed Cases
 Code only confirmed cases of HIV
 “Confirmation” does not require documentation of
positive serology, the provider’s diagnostic statement that
the patient is HIV positive is sufficient
 Asymptomatic HIV is to be applied when the patient
without documentation of symptoms is listed as being
“HIV Positive”. Do not use this code if the terms AIDS
is used or if the patient is treated for any HIV-related
illness.
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Infectious Agents
 Certain infections are classified in chapters other than
Chapter 1 and no organism is identified as part of the
infection code
 An additional code from Chapter 1 should be used to
identify the organism:
● 041/B95 Streptococcus, Staphylococcus, and Enterococcus
● 041.8/B96, Other bacterial agents
● 079/B97 Viral agents
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Infectious Agents -2
 An instructional note will be found at the infection code
advising that an additional organism code is required
Use an additional code
to identify infectious agent
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Examples
 UTI with hematuria due
to E.coli
● 599.0, 599.70 UTI,
hematuria, or
N30.91, Cystitis unspecified
with hematuria
● 041.4 Escherichia coli, or
B96.2, Escherichia coli [E.
coli] as the cause of diseases
classified elsewhere
 Pneumonia due to
streptococcus group B
with sepsis
● 482.32, or
J15.3, Pneumonia due to
streptococcus, group B
● 995.91, or
A41.9 Sepsis, unspecified
organism Septicemia NOS
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Infections Resistant to Antibiotics
 Infections Resistant to Antibiotics
● Identify all infections documented as antibiotic resistant
 Assign code V09.9-/Z16
● Infection with drug-resistant microorganisms following the
infection code
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Septicemia, SIRS, Sepsis, Severe Sepsis, and Septic
Shock
 Septicemia and sepsis are often used interchangeably, but
they are NOT considered synonymous terms.
● Septicemia refers to a systemic disease associated with the
presence of toxins in the blood
● Systemic inflammatory response syndrome/SIRS refers to
the systemic response to infection with symptoms of fever,
tachycardia, tachypnea and leukocytosis
● Sepsis refers to SIRS d/t infection
● Severe sepsis refers to sepsis with associated acute organ
dysfunction
● Septic shock refers to circulatory failure associated w/severe
sepsis
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Coding of SIRS, Sepsis and Severe Sepsis
 Requires a minimum of 2 codes:
● A code for the underlying cause (such as infection; if
unspecified septicemia, code 038.9) *sequence first
● And a code from subcategory 995.9- *sequence second
 Severe sepsis requires an additional code for the
associated acute organ dysfunction
 Either the term sepsis or SIRS must be documented to
assign a code from subcategory 995.9-
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Urosepsis Guidelines
ICD-9-CM
Alpha Index
Urosepsis
599.0
meaning sepsis
995.91
meaning
urinary tract
infection 599.0
Urosepsis cannot be
coded in ICD-10-CM
Guideline states: “The
term urosepsis is a
nonspecific term. It is
not to be considered
synonymous with sepsis.
It has no default code in
the Alphabetic Index.
Should a provider use
this term, he/she must be
queried for clarification.”
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ICD-10-CM
Alpha Index
Urosepsis –
code to
condition
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Sepsis documentation to look for…
Or query MD for…
 Streptococcal sepsis
 Sepsis d/t Staphylococcus aureus
 Sepsis d/t other Gram-negative organisms
 Severe sepsis
 Sepsis d/t MRSA
 Sepsis d/t MSSA
 d/t joint prosthesis (complication)
 d/t catheter (complication)
 Other organism??
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Severe Sepsis Coding Example
ICD-9-CM
ICD-10-CM
• Severe sepsis due to
hemophilus influenza with
septic shock and acute renal
failure
• 038.41 (Hemophilus
influenza septicemia)
• 995.92 (Severe sepsis)
• 785.52 (Septic shock)
• 584.9 (Acute renal failure)
• Severe sepsis due to
hemophilus influenza with
septic shock and acute renal
failure
• A41.3 (Hemophilus
influenza sepsis)
• R65.21 (Severe sepsis with
septic shock)
• N17.9 (Acute renal failure)
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Coding Note: In ICD-10-CM,
when coding an infection due
to an indwelling urinary
catheter, the coding
professional is instructed to
use an additional code to
identify the infection (besides
coding the complication
996.31). Additionally, if the
infectious agent is also
known, this should be
assigned as an additional
diagnosis.
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Methicillin Resistant Staphylococcus Aureus
(MRSA) Conditions
 Selection and sequencing of MRSA codes
● (a) Combination codes for MRSA infection – when an infection
due to MRSA has a combination code that includes the causal
organism assign the appropriate combination code
o Do not code B95.62 MRSA infection as the cause of diseases elsewhere or
Z16.11 Resistance to penicillin as additional codes
● (b) Other codes for MRSA infection – when there is a current
infection and that infection does not have a combination code
that includes the causal organism, assign the appropriate code to
identify the condition along with code B95.62
o Do not use Z16.11 Resistance to penicillin
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Methicillin Resistant Staphylococcus Aureus (MRSA)
Conditions -2
 Selection and sequencing of MRSA codes
● c) Methicillin susceptible Staphylococcus aureus (MSSA) and
MRSA colonization- means that MSSA or MSRA is present on
or in the body without necessarily causing illness
o Assign code Z22.322 Carrier or suspected carrier of MRSA, or
Z22.321 Carrier or suspected carrier of MSSA
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Neoplasms
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General Neoplasm Guidelines
 The Neoplasm Table in the Alphabetic Index should be
referenced first. However, if the histological term is
documented, that term should be referenced first, rather
than going immediately to the Neoplasm Table, in order
to determine which column in the Neoplasm Table is
appropriate.
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Neoplasm Table
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Neoplasm Table -2
 Malignant – Primary
●
●
●
●
Original site of cancer
2 primary sites may be coded, if indicated
Alphabetic Instructions will indicate if malignant
Primary site unknown or unspecified
o Use 199.1/C80.1, Malignant (primary) neoplasm, unspecified
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Neoplasm Table -3
 Malignant – Secondary
● The site where the cancer spreads to (metastasizes)
● Primary cancer that spreads to a secondary site may be stated
as:
o Primary site with metastasis to secondary site
o Secondary site with metastasis from primary site
o Secondary site due to metastatic primary site
● If secondary site unknown - use 199.1/C79.9, secondary
malignant neoplasm of unspecified site
ICD-9 TO ICD-10 PREP (PARTS I-IV)
64
Neoplasm Table -4
 Ca in situ
● Atypical malignancy; encapsulated – has not spread
● Physician must indicate “in situ” or index will instruct you to
code this type
 Benign
● Not malignant
● Does not metastasize
ICD-9 TO ICD-10 PREP (PARTS I-IV)
65
Neoplasm Table -5
 Uncertain
● Alphabetic index will instruct to use this type if appropriate –
See neoplasm, by site, uncertain behavior
● Not used if it is the coder that is uncertain of the behavior
 Unspecified Behavior
● Not specified as malignant or benign
● Index instructions will direct here as appropriate – See
neoplasm, by site, unspecified behavior
ICD-9 TO ICD-10 PREP (PARTS I-IV)
66
Current vs. History of
Neoplasm is coded as a
current condition if
being actively treated
• Diagnosed but no treatment
administered
• Has been removed
surgically but treatment is
still being administered (for
example,
chemotherapy/radiation)
Neoplasm is coded as a
“history of” if
• Site has ben surgically
removed and/or treatment
has been completed AND
• There is no mention of
recurrence
• Use V10/Z85 category to
indicate a personal history
of neoplasm
ICD-9 TO ICD-10 PREP (PARTS I-IV)
67
Diseases of the
Blood and
Blood-Forming
Organs and
Certain Disorders
Involving the Immune
Mechanism
ICD-9 TO ICD-10 PREP (PARTS I-IV)
68
Anemia Defined
 A condition in which your blood has a reduced number
of circulating red blood cells usually defined as an
abnormally low hemoglobin or hematocrit level.
 Caused by:
●
●
●
●
●
Disease (malignancy, kidney failure, immunity)
Blood loss
Decreased blood formation or destruction of cells
Nutritional Deficiency
Drug induced
ICD-9 TO ICD-10 PREP (PARTS I-IV)
69
Anemia, Due to
 D50.0 – Iron deficiency secondary to blood loss (chronic
blood loss)
 D50.9 – Iron deficiency Anemia
 D51.0 – Vitamin B12 deficiency anemia
 D53.0 – Protein deficiency anemia
 D62 – Acute blood loss
 D63.1 – Anemia in chronic kidney disease
 D63.8 – Anemia in neoplastic disease
 D64.81 – Anemia due to antineoplastic chemotherapy
ICD-9 TO ICD-10 PREP (PARTS I-IV)
70
Anemia Associated with Malignancy
 Coding Guideline I.C.2.c.1. Anemia Associated with
Malignancy
 When admission/encounter is for management of an
anemia associated with the malignancy, and the treatment
is only for anemia, the appropriate code for the
malignancy is sequenced as the principal or first-listed
diagnosis followed by the appropriate code for the
anemia (such as D63.0, Anemia in neoplastic disease).
ICD-9 TO ICD-10 PREP (PARTS I-IV)
71
PART II (5/5/14)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
72
ENDOCRINE, NUTRITIONAL AND
METABOLIC DISEASES
ICD-9 TO ICD-10 PREP (PARTS I-IV)
73
Diabetes Combination Codes
 Documentation needs to include type of diabetes
●
●
●
●
Type I
Type II
Secondary
Other specified
 Is there a body system affected:
●
●
●
●
●
Kidney
Ophthalmic
Neurological
Circulatory
Other specified (diabetic ulcer, etc.)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
74
Diabetes Combination Codes -2
 What is the specific complication affecting the
system(s)?
ICD-9 TO ICD-10 PREP (PARTS I-IV)
75
DIABETES
DIABETES
TYPE I
TYPE II
ICD-9 TO ICD-10 PREP (PARTS I-IV)
76
Diabetes Types
Age Not Sole Factor Determining Type
Diabetes, Type I
Diabetes, Type II
• Cause: Absent or
insufficient insulin
production
• 10% of diabetics
• Usually juvenile onset
• Does not respond to oral
anti-glycemic agents
• Always requires insulin
• Cause: Improper
utilization of insulin
• 90% adult onset (age
40>, but being seen
more in younger
population)
• Responds to oral antiglycemic agents
• May require insulin
ICD-9 TO ICD-10 PREP (PARTS I-IV)
77
Secondary Diabetes
 Due to another underlying condition
● Cystic Fibrosis
● Malignant Neoplasm of Pancreas
● Pancreatectomy
 Drug or chemical induced
● Adverse effect of drug
● Poisoning
*Follow coding directions at the beginning of each category!
ICD-9 TO ICD-10 PREP (PARTS I-IV)
78
Diabetes Type Not Documented?
DEFAULT
Default
= Type II Diabetes
ICD-9 TO ICD-10 PREP (PARTS I-IV)
79
Q: Do I always use an
additional code for
long term use of
insulin when ordered?
A: No
ICD-9 TO ICD-10 PREP (PARTS I-IV)
80
Diabetes and Use of Insulin
 Type I: Do NOT code long term use of insulin
 Type II: Code long term use of insulin
 Secondary to underlying condition: Code use of insulin
 Drug/Chemical induced: Code use of insulin
ICD-9 TO ICD-10 PREP (PARTS I-IV)
81
Obesity
 Obesity means having too much body fat. It is different
from being overweight, which means weighing too much.
The weight may come from muscle, bone, fat, and/or
body water. Both terms mean that a person's weight is
greater than what's considered healthy for his or her
height.
 Type of obesity
● Morbid/severe
● Due to excess calories
● Drug-induced obesity
 Vs. Overweight (code for this too)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
82
Gout
 Gout is a kind of arthritis. It can cause an attack of
sudden burning pain, stiffness, and swelling in a joint,
usually a big toe.
 Types: acute, chronic or secondary
●
●
●
●
●
Idiopathic
Gouty bursitis
Drug-induced gout
Due to renal impairment
Other secondary gout
 Specify joint site/laterality
ICD-9 TO ICD-10 PREP (PARTS I-IV)
83
Dehydration
 The excessive loss of body water with an accompanying
disruption of metabolic processes
 Note: make sure this is a current condition that is being
actively treated upon admission to your facility,
otherwise do NOT code
ICD-9 TO ICD-10 PREP (PARTS I-IV)
84
Hypothyroidism
 Often called underactive thyroid, it is a common
endocrine disorder in which the thyroid gland does not
produce enough thyroid hormone. It can cause a number
of symptoms, such as tiredness, poor ability to tolerate
cold, and weight gain
 Acquired or congenital?
 Due to:
●
●
●
●
Iodine deficiency
Post-irradiation therapy
Post-surgery
Other
ICD-9 TO ICD-10 PREP (PARTS I-IV)
85
Hypercholesterolemia
 Hypercholesterolemia is the presence of high levels of
cholesterol in the blood. It is a form of “hyperlipidemia"
(elevated levels of lipids in the blood) and
"hyperlipoproteinemia" (elevated levels of lipoproteins in
the blood).
 Does documentation show:
● With hyperglyceridemia (an elevated concentration of
glycerides in the blood), or
● With dietary counseling (use additional code)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
86
Hyperlipidemia
 Abnormally elevated levels of any or all lipids and/or
lipoproteins in the blood. It is the most common form of
dyslipidemia (which includes any abnormal lipid levels).
 Specified type:
● Combined (also known as "Multiple-type
hyperlipoproteinemia” )
o Familial combined hyperlipidemia
● Group
o A, B, C or D
● Mixed
● Other specified type
● Lipoprotein deficiency
ICD-9 TO ICD-10 PREP (PARTS I-IV)
87
Anemia
 ICD-9/Diseases of the blood – Anemia, NOS 285.9
 ICD-10/Endocrine, Nut’l, Metabolic diseases D58-D64
● Chapter change
 Anemia has three main causes: blood loss, lack of red
blood cell production, or high rates of red blood cell
destruction.
ICD-9 TO ICD-10 PREP (PARTS I-IV)
88
Anemia -2
 Specified type
● General = unspecified
● Acquired hemolytic *caused by high rates of red blood cell
destruction
● Chronic blood loss *such as chronic posthemorrhagic anemia
● Iron *fewer red blood cells made or red blood cells that are too
small
● Nutritional *such as simple chronic anemia
● In chronic diseases *such as neoplastic disease, CKD,
hypothyroidism
ICD-9 TO ICD-10 PREP (PARTS I-IV)
89
Mental and Behavioral Disorders
ICD-9 TO ICD-10 PREP (PARTS I-IV)
90
Dementia
 Specific type
● Vascular/multi-infarct *a result of infarction of the brain due to
vascular disease, including hypertensive cerebrovascular
disease. Code 1st underlying condition (CVD, etc.)
● In diseases classified elsewhere code 1st underlying condition
(Alzheimer’s, Parkinson’s, etc.)
● Senile *separate code in ICD-9, but dementia unspecified in
ICD-10
● Delirium superimposed on dementia *ICD-10 only, code 1st
underlying condition
● Unspecified
ICD-9 TO ICD-10 PREP (PARTS I-IV)
91
Dementia -2
 With or without behavioral disturbance
● Aggressive, combative, violent behavior
 Old code 294.8 *should NOT be using anymore, invalid
 Additional code for wandering Z91.83 *ICD-10 only
 If psychotherapeutic drugs given, check guidelines
ICD-9 TO ICD-10 PREP (PARTS I-IV)
92
Episodic Mood Disorders/Bipolar Disorder
*also known as Manic-depressive Illness
 Bipolar and Major depression have separate categories in
ICD-10
 Bipolar disorder, severe *with or without psychotic
features
ICD-9 TO ICD-10 PREP (PARTS I-IV)
93
Episodic Mood Disorders/Bipolar Disorder
*also known as Manic-Depressive Illness -2
 Specify type
ICD-9 Single or Recurrent w/
• Subchronic
• Chronic
• Subchronic w/acute
exacerbation
• Chronic w/acute exacerbation
• In remission
ICD-10
•
•
•
•
•
•
Hypomanic
Manic
Depressed
Mixed
In remission
Other
 If psychotherapeutic drugs given, check guidelines
ICD-9 TO ICD-10 PREP (PARTS I-IV)
94
Major Depression
 Has its own category in ICD-10
 In ICD-10, Depression, NEC is coded to Major
depressive disorder, single episode, unspecified
 Specify type
● Major depressive disorder, single episode
● Major depressive disorder, recurrent
● Major depressive disorder, recurrent, in remission
 Specify intensity: mild, moderate or severe
 If severe: with or without psychotic features
 If psychotherapeutic drugs given, check guidelines
ICD-9 TO ICD-10 PREP (PARTS I-IV)
95
Schizophrenia
 Specify type
●
●
●
●
●
●
●
●
●
Paranoid
Disorganized
Catatonic
Undifferentiated *atypical
Residual
Schizophreniform disorder
Schizotypal disorder *borderline, latent, etc.
Schizoaffective disorder *bipolar, depressive, other – ICD-10
Other
 In ICD-10, 5th digit of chronic, in remission, etc. is gone
 If psychotherapeutic drugs given, check guidelines
ICD-9 TO ICD-10 PREP (PARTS I-IV)
96
Psychosis
 If d/t a known mental disorder, code to that condition
● Delusional disorder *includes paranoia, paranoid state
● Mood disorder w/psychotic symptoms *includes Manic episode,
Bipolar disorder, Major depressive disorder
● Brief psychotic disorder *includes paranoid reaction
● Shared psychotic disorder *includes induced paranoid disorder
● Unspecified mental disorder d/t known physiological condition
*includes OBS, NOS; mental disorder NOS , *code 1st
underlying physiological condition
● Unspecified psychosis NOT d/t known physiological condition
*includes Psychosis, NOS
ICD-9 TO ICD-10 PREP (PARTS I-IV)
97
Psychosis -2
 If d/t a known mental disorder, code to that condition
(cont.)
● Other psychotic disorder NOT d/t known physiological
condition * includes chronic hallucinatory psychosis
● Mental disorder, NOS *includes mental illness, NOS
 If psychotherapeutic drugs given, check guidelines
ICD-9 TO ICD-10 PREP (PARTS I-IV)
98
Anxiety
 Specify type
● Panic disorder *includes panic attack, panic state
● Generalized anxiety disorder *includes anxiety reaction, anxiety
state
● Other mixed anxiety disorders *suffer from both anxiety and
depressive symptoms
● Other specified anxiety disorders *includes anxiety depression
 If psychotherapeutic drugs given, check guidelines
ICD-9 TO ICD-10 PREP (PARTS I-IV)
99
Diseases
of the
Nervous
System
ICD-9 TO ICD-10 PREP (PARTS I-IV)
100
Hemiplegia
 These codes are only to be used when the paralytic
syndrome is specified w/o further specification, or is
stated to be old but unspecified cause
 This category is also for use in multiple coding to
identify the specific type of hemiplegia resulting from
any cause *flaccid or spastic
*ICD-10 only
ICD-9 TO ICD-10 PREP (PARTS I-IV)
101
Hemiplegia -2
 Should the affected side be documented, but not
specified as dominant or non-dominant, and the
classification system does not indicate a default, code
selection is as follows:
● For ambidextrous (using both sides equally) patient, the default
should be dominant
● If the left side is affected, the default is non dominant
● If the right side is affected, the default is dominant
ICD-9 TO ICD-10 PREP (PARTS I-IV)
102
Dementia with Parkinson’s Disease vs.
Parkinsonism
 Parkinson's disease (PD) belongs to a group of
conditions called motor system disorders, which are the
result of the loss of dopamine-producing brain cells
*code 332.0/G20, with dementia add 294.1-/F02. Parkinsonism shares symptoms found in Parkinson’s
disease, from which it is named; but Parkinsonism is a
symptom complex, and differs from Parkinson’s disease
which is a progressive neurodegenerative illness
*code 331.82/G31.83 *same as Lewy body dementia
*ICD-10 only
ICD-9 TO ICD-10 PREP (PARTS I-IV)
103
Alzheimer’s Disease
 Identify type
●
●
●
●
Alzheimer’s disease with early onset
Alzheimer’s disease with late onset
Other Alzheimer’s disease
Alzheimer’s disease, unspecified
 Use additional code to identify
● Dementia w/behavioral disturbance
● Dementia w/o behavioral disturbance
● Delirium , if applicable
*ICD-10 requires the use of both the Alzheimer and
dementia codes
ICD-9 TO ICD-10 PREP (PARTS I-IV)
104
Seizure Disorder vs. Convulsions
 Epilepsy/seizure disorder is a spectrum of brain
disorders ranging from severe, life-threatening and
disabling, to ones that are much more benign
 Convulsion is a medical condition where body muscles
contract and relax rapidly and repeatedly, resulting in an
uncontrolled shaking of the body
 If seizures repeatedly continue after the underlying
problem is treated, the condition is called epilepsy
(resident is usually on a routine med for seizures)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
105
Epilepsy, Recurrent Seizures and Migraines
The following terms
are equivalent to
intractable:
pharmacoresistent
(pharmacologically
resistant), treatment
resistant, refractory
(medically), and poorly
controlled.
ICD-9 TO ICD-10 PREP (PARTS I-IV)
106
Coding of Epilepsy
 Identify if epilepsy or seizure disorder, or just
convulsion, NOS
 Specify type
●
●
●
●
Intractable
Not intractable
With status epilepticus
Without status epilepticus
ICD-9 TO ICD-10 PREP (PARTS I-IV)
107
Peripheral Neuropathy
 Specify type
● Polyneuropathy in diseases classified elsewhere
ICD-9
ICD-10
• Diabetes 250.6- +
357.2
• Malignant dx
• CA code + 357.3
• Diabetes, type 2
E11.42
• Neoplasm
• Code CA + G63
ICD-9 TO ICD-10 PREP (PARTS I-IV)
108
Diseases
of the Eye
and adnexa
ICD-9 TO ICD-10 PREP (PARTS I-IV)
109
Coding Note
 Use additional external cause code, if applicable, to identify
the cause of the eye condition
 Glaucoma types:
●
●
●
●
●
Borderline glaucoma
Open-angle glaucoma
Primary angle-closure glaucoma
Corticosteroid-induced glaucoma
Glaucoma asso w/congenital anomalies, dystrophies, and systemic
syndromes *includes glaucoma d/t diabetes 250.50, 365.44
● Glaucoma associated with disorders of the lens
● Glaucoma associated with other ocular disorders
● Other specified forms of glaucoma
*Where do you get this information from?
ICD-9 TO ICD-10 PREP (PARTS I-IV)
110
Combination Codes & Laterality
ICD-9-CM
ICD-10-CM
• Diabetic Retinopathy
with Macular
Degeneration needs
three codes: 250.50,
362.01, 362.50
• Cystic Macular
Degeneration 362.54
• Combination Code:
• Diabetic Retinopathy with
Macular Degeneration
uses a combination code:
E08.351
• Laterality:
• Macular cyst, hole, right
eye H35.341
ICD-9 TO ICD-10 PREP (PARTS I-IV)
111
ICD-10 Glaucoma Coding Changes
 Identify the type of glaucoma, the affected eye, and the
glaucoma stage.
 A 7th character is to be assigned to designate the stage of
glaucoma: mild, moderate, severe, indeterminate, or
unspecified
ICD-9 TO ICD-10 PREP (PARTS I-IV)
112
ICD-10 Cataract Terms
 ICD-10 CM uses the terms “age-related” cataract and
“senile cataract” interchangeably.
 There are also terms for “age-related”, “infantile &
juvenile cataract”, “traumatic cataract”, “complicated
cataract”, “drug-induced cataract”, and “secondary
cataract”.
 Within the age-related/senile category there are cortical,
subcapsular, incipient, nuclear, and morgagnian cataracts.
*Similar terminology to ICD-9
ICD-9 TO ICD-10 PREP (PARTS I-IV)
113
Blindness and Low Vision Definitions
 Visual impairment refers to a functional limitation of the
eye
 Visual disability indicates a limitation of the abilities of
the individual
 For international reporting, WHO, defines blindness as
profound impairment
 The definition of legal blindness as a severe impairment
is used in the USA
ICD-9 TO ICD-10 PREP (PARTS I-IV)
114
ICD-10 Terms for Blindness
 In the case of blindness, the code H54 has a note: Code
first any associated underlying cause of blindness.
 Blindness codes include laterality.
 Example:
● H54.52, which is low vision left eye, normal vision right eye.
ICD-9 TO ICD-10 PREP (PARTS I-IV)
115
Diseases
of the
Circulatory System
ICD-9 TO ICD-10 PREP (PARTS I-IV)
116
Cardiac dysrhythmias
 427.0 Paroxysmal supraventricular tachycardia
 427.1 Paroxysmal ventricular tachycardia
 427.2 Paroxysmal tachycardia, unspecified
 427.3- Atrial fibrillation and flutter
*ICD-10 Includes a code for chronic a-fib
 427.4- Ventricular fibrillation and flutter
 427.5 Cardiac arrest
 427.6- Premature beats
 427.8- Other specified cardiac dysrhythmias
● Sick sinus syndrome
ICD-9 TO ICD-10 PREP (PARTS I-IV)
117
Heart Failure
 428.0 Congestive heart failure, unspecified
 428.1 Left heart failure
 428.2- Systolic heart failure **
 428.3- Diastolic heart failure **
 428.4- Combined systolic and diastolic heart failure **
 Code, if applicable, heart failure d/t HTN 1st
*if supporting MD documentation
**these codes also need to know if acute, chronic or
acute on chronic (ICD-10 will need for CHF too)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
118
Acute Myocardial Infarction (AMI)
 Myocardial infarction or acute
myocardial infarction (AMI) is
the medical term for an event
commonly known as a heart
attack. It happens when blood
stops flowing properly to part
of the heart and the heart
muscles are injured due to not
receiving enough oxygen.
ICD-9 TO ICD-10 PREP (PARTS I-IV)
119
Acute Myocardial Infarction (AMI) -2
 Usually this is because one of
the coronary arteries that
supplies blood to the heart
develops a blockage due to a
buildup of white blood cells,
cholesterol and fat. The event
is called "acute" if it is sudden
and serious
ICD-9 TO ICD-10 PREP (PARTS I-IV)
120
Acute MI
 STEMI or NSTEMI?
 Occurred 8 weeks or less?
 5th digit needed
● 2 = Subsequent episode of care *appropriate
code for SNF, if treated 1st at hospital
ICD-10 Code changes:
 I21 – Initial AMIs
 I22 – Subsequent AMIs
*New for ICD-10
ICD-9 TO ICD-10 PREP (PARTS I-IV)
121
Atherosclerotic Coronary Artery
Disease and Angina
 Atherosclerosis (hardening of the arteries)
● can slowly narrow and harden the arteries throughout the body
● when atherosclerosis affects the arteries of the heart, it’s
referred to as coronary artery disease
 Coronary artery disease is the No. 1 killer of Americans.
Most of these deaths are from heart attacks, caused by
sudden blood clots in the heart’s arteries.
ICD-9 TO ICD-10 PREP (PARTS I-IV)
122
Atherosclerotic Coronary Artery
Disease and Angina
 Atherosclerosis is a blood clot
causing an acute coronary syndrome.
 Two things can happen:
● Unstable angina - the clot doesn't totally
block the blood vessel and then
dissolves without causing a heart attack
● Myocardial infarction (heart attack) - the
coronary artery is blocked by the clot
o the heart muscle, starved for nutrients and
oxygen, dies
ICD-9 TO ICD-10 PREP (PARTS I-IV)
123
Coding Coronary Artery Disease/CAD
 Should be coding to 414.01, unless a CABG has been
done or MD specifies otherwise
 Differentiate between coding of coronary arteries 414
and of the extremities 440…
ICD-9 TO ICD-10 PREP (PARTS I-IV)
124
ICD-10 Coding of Arteriosclerosis
 4th digit
● Vessel: Native, bypass graft, autologous vein bypass graft, nonautologous biological bypass graft, non-biological bypass graft
 5th digit
● Symptom: claudication, rest pain, ulcer and with gangrene.
 6th digit
● Extremities: right, left, bilateral, other, unspecified
● Site of leg: thigh, calf, ankle, heel, mid-foot, foot, other.
*ICD-10 will also have a combination code for CAD with
angina
ICD-9 TO ICD-10 PREP (PARTS I-IV)
125
Cerebrovascular System
ICD-9 TO ICD-10 PREP (PARTS I-IV)
126
CVA Versus TIA
CVA
● Brain infarction or
hemorrhage usually
associated with permanent
or temporary neurologic
deficits; includes transient
focal neurological deficits
lasting longer than 24 hours
● Persistent neurological
deficit >24 hours
● Positive image study
(MRI/CT)
TIA
● A brief period of focal
neurologic deficit lasting
less than 24 hours (usually
less than one hour) due to
temporarily blocked blood
flow to a specific area of the
brain
● Symptoms resolve in 24
hours (usually < 1 hour)
● No infarction or hemorrhage
● Negative MRI/CT
ICD-9 TO ICD-10 PREP (PARTS I-IV)
127
Coding Post CVA
 Once cerebrovascular disease/CVD has been treated at
the hospital, just the late effects/sequelae are being
treated, if any.
 Category 438 is used to indicate conditions/residuals that
have occurred any time after the onset of CVD.
 Use a separate code for each residual effect.
 Should NOT be coding 436.
 If no residual effects should code V12.54
ICD-9 TO ICD-10 PREP (PARTS I-IV)
128
Hypertension
 Hypertension, also referred
to as high blood pressure, it
is a condition in which the
arteries have persistently
elevated blood pressure.
Every time the human heart
beats, it pumps blood to the
whole body through the
arteries.
ICD-9 TO ICD-10 PREP (PARTS I-IV)
129
ICD-10 Hypertension Coding Changes
 Type of hypertension (benign, malignant, unspecified) is
not used as an axis for the ICD-10-CM hypertension
codes, there is only one code for essential hypertension
(I10)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
130
Types of Hypertension
 401 Essential hypertension
 402
Hypertensive heart disease
*MD must document causal relationship
 403 Hypertensive chronic kidney disease
*implied relationship if both diagnoses documented, also need to
code CKD to indicate the stage 585.-
 404
Hypertensive heart and chronic kidney disease
*if resident has all three diagnoses/AKA cardiorenal – MD must
still indicate heart dx and hypertension have causal relationship
 405 Secondary hypertension
*is high blood pressure that's caused by another medical condition
ICD-9 TO ICD-10 PREP (PARTS I-IV)
131
Peripheral Vascular Disease
 443.81 Peripheral angiopathy in diseases classified
elsewhere *code 1st underlying disease
*ICD-10 will have a combo code for DM w/PVD
 443.9 Peripheral/arterial/vascular disease
*Excludes atherosclerosis of the extremities
ICD-9 TO ICD-10 PREP (PARTS I-IV)
132
Venous Embolism and Thrombosis
 453.40 DVT, NOS is coded to acute venous embolism and
thrombosis of deep vessels of the lower extremity
 453.41 DVT of proximal lower extremity
 453.42 DVT of distal lower extremity
 453.5- Chronic DVT *also code V58.61 for long term use of
anticoagulants
*if vein specified, make sure have correct code
*make sure treatment is currently being given and is NOT for
prophylactic measures (Coumadin tx)
*if no current treatment given, code V12.51 for hx of DVT
ICD-9 TO ICD-10 PREP (PARTS I-IV)
133
Diseases of the
Respiratory
System
(J00-J99)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
National Cancer Institute
134
Asthma Terminology for ICD-10
 Terminology used to describe asthma has been updated
to reflect the current clinical classification of asthma
 The following terms have been added to describe asthma:
● Mild intermittent, and
● Three degrees of persistent
o mild, moderate, severe
ICD-9 TO ICD-10 PREP (PARTS I-IV)
135
Symptoms
 Stage 1: mild
● Possible chronic cough and sputum production
 Stage 2: moderate
● Shortness of breath on exertion
● Possible chronic cough and sputum production
 Stage 3: Severe
●
●
●
●
Shortness of breath
Fatigue
Multiple exacerbations
Reduced exercise tolerance
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Symptoms -2
 Stage IV: Very severe
● Respiratory failure
● Elevation of jugular venous pressure
● Pitting ankle edema.
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137
Current Asthma Coding
 493.0- Extrinsic asthma
 493.1- Intrinsic asthma
 493.2- Chronic obstructive asthma
*includes asthma w/COPD and chronic asthmatic
bronchitis
 5th digit for:
● Status asthmaticus, and
● Acute exacerbation
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Pneumonia
 Remember, if you know the organism code it!
 Default code = 486 Pneumonia, unspecified organism
 480- Viral pneumonia
 481 Pneumococcal pneumonia (includes lobar)
 482- Other bacterial pneumonia
 483- Pneumonia d/t other specified organism
 484- Pneumonia in infectious disease classified elsewhere
 485 Bronchopneumonia, organism unspecified
 507.0 Aspiration pneumonia d/t inhalation food/vomitus
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COPD - 496
 This code is not to be used with any code from categories
491.- 493. (bronchitis, emphysema, asthma)
 COPD w/emphysema 492.8
 COPD w/bronchitis:
● Acute 491.22
● Chronic 491.20
 COPD w/exacerbation 491.21
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Other Diseases of the Lung – 518.8 Acute respiratory failure - can develop quickly and may
require emergency treatment and is usually treated in an
intensive care unit
 Acute respiratory insufficiency - condition in which the
lungs cannot take in sufficient oxygen or expel sufficient
carbon dioxide to meet the needs of the cells of the body.
 Chronic respiratory failure - develops more slowly and
lasts longer. Chronic respiratory failure can be treated at
home or at a long-term care center
 Acute on chronic respiratory failure – pt exhibits severe
pulmonary impairment as a baseline characteristic which may
require hospitalization and mechanical ventilation
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141
PART III (6/1/14)
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142
Diseases of the
Digestive System
National Cancer Institute
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143
Esophageal Reflux Disease
 530.81 Esophageal reflux/GERD
● Includes acid reflux
● Excludes reflux esophagitis 530.11
● Excludes hemorrhage d/t esophageal varices 456.-
 Esophageal w/esophagitis 530.11
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Constipation
 564.0- Constipation
● Slow transit - there is a prolonged delay in the transit of stool
through the colon.
● Outlet dysfunction - difficulty or inability to expel the stool
● Other – atonic, neurogenic, spastic
 564.1 Irritable bowel syndrome
● sometimes alternating bouts of constipation and diarrhea
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Gastrointestinal Hemorrhage
 578.0 Hematemesis – vomiting of blood
 578.1 Blood in stool – melena
 578.9 Hemorrhage of GI tract, unspecified
 Excludes: that with mention of:
●
●
●
●
diverticulitis of lg and sm intestine,
diverticulosis of lg and sm intestine,
gastritis and duodenitis, and
stomach ulcers
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146
Diseases of the
Skin and
Subcutaneous
Tissue
National Cancer Institute
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147
Cellulitis and Abscess
 682.0 Face
 682.1 Neck
 682.2 Trunk
 682.3 Upper arm/forearm
 682.4 Hand, except fingers and thumb (681.0-)
 682.5 Buttock
 682.6 Leg, except foot
 682.7 Foot, except toes (681.1-)
 682.8 Other specified sites
 682.9 Unspecified site
Use additional code to identify organism
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Chronic Ulcer of Skin
 707.0- Pressure ulcer (elbow, upper back, lower back, hip,
buttock, ankle, heel, other)
 707.1- Ulcer of lower limb, except pressure ulcer (lower
limb, thigh, calf, ankle, hell and midfoot, other part of ft)
*code any causal condition first
 707.2- Pressure ulcer stages (I-IV, unstageable)
*must use this code after coding 707.0-
*should NOT be using an “unspecified site” code 707.9
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VISUAL GUIDE TO SOME
FREQUENTLY SEEN SKIN
PROBLEMS
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150
Pressure Ulcer Stage I
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151
Pressure Ulcer Stage II
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152
Pressure Ulcer Stage III
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153
Pressure Ulcer Stage IV
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154
Suspected Deep Tissue Injury
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155
Unstageable Pressure Ulcer
ICD-9 TO ICD-10 PREP (PARTS I-IV)
156
Diabetic Ulcer
ICD-9 TO ICD-10 PREP (PARTS I-IV)
157
Vascular Ulcers
ICD-9 TO ICD-10 PREP (PARTS I-IV)
158
Cellulitis
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159
Diseases of the
Musculoskeletal
System and
Connective Tissue
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160
Arthropathy vs. Arthritis
vs. Osteoarthritis
 Arthropathy = disease of the joints
 Arthritis = inflammation of the joints
 Osteoarthritis = degeneration of cartilage and its
underlying bone within a joint as well as bony
overgrowth
*Arthritis is a form of Arthropathy
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Osteoarthritis/OA
Arthropathy/DJD
 715.0- Osteoarthrosis, generalized
 715.1- Osteoarthrosis, localized, primary
 715.2- Osteoarthrosis, localized, secondary
 715.3- Osteoarthrosis, localized, not specified whetehr
primary or secondary
 715.8- Osteoarthrosis involving, or with mention of
more than one site/polyarthritis
 715.9- Osteoarthrosis, unspecified whether generalized
or localized
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5th digits for Osteoarthrosis
 0 – site unspecified
 1 – shoulder region
 2 – upper arm *use for elbow
 3 – forearm *use for wrist
 4 – hand
 5 – pelvic region and thigh *use for hip
 6 – lower leg *use for knee
 7 – ankle and foot
 8 – other specified sites
 9 – multiple sites
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Other Derangement of Joint
 718.1- Loose body in joint *Loose bodies are fragments
of bone and/or cartilage that freely float in the joint
space
 718.3- Recurrent dislocation of joint
 718.4- Contracture of joint *a permanent shortening of a
joint
 718.5- Ankylosis of joint *stiffness of a joint due to
abnormal adhesion and rigidity of the bones of the joint,
which may be the result of injury or disease
 718.8- Other joint derangement, NEC *instability of joint
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Osteoporosis
 733.00 Osteoporosis, unspecified
 733.01 Senile osteoporosis *a geriatric syndrome with a
particular pathophysiology
 733.03 Disuse osteoporosis *bone loss that results from
not enough stress or pressure on the bones. Bones
become brittle and weak, causing them to fracture easily.
 Use additional code to identify personal hx of pathologic
fracture V13.51
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Definition of Terms
 Spontaneous rupture
● Occurs when normal force
is applied to tissues that are inferred to have less than
normal strength
 Fragility fracture
● Sustained with trauma no more than a fall from a standing
height or less occurring under circumstances that would not
cause a fracture in a normal healthy bone
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Pathologic Fracture
 733.11 Pathologic fracture of humerus
 733.12 Pathologic fracture of distal radius/ulna
 733.13 Pathologic fracture of vertebrae
 733.14 Pathologic fracture of neck of femur
 Includes chronic fracture, spontaneous fracture
 Excludes stress fracture, traumatic fracture
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Other and Unspecified Disorders
of Joint/Gait disorders
 719.7 Difficulty in walking
 781.2 Abnormality of gait/ataxic/gait
disturbance/paralytic/spastic/staggering gait
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Other Disorders of the Back
 724.1 Pain in thoracic spine
 724.2 Lumbago/low back pain/lumbalgia
 724.3 Sciatica *neuralgia or neuritis of sciatic nerve
 724.5 Backache
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Muscle Weakness/
Muscle Wasting and Disuse Atrophy
 728.87 Muscle weakness (generalized)
*different than generalized weakness/malaise and fatigue
780.79
 728.2 Muscular wasting and disuse atrophy
 728.3 Other specific muscle disorders
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170
Diseases of the
Genitourinary
System
ICD-9 TO ICD-10 PREP (PARTS I-IV)
National Cancer Institute Alan Hoofring
171
Acute and Chronic Kidney Failure
 584.- Acute kidney failure - develops rapidly over a few
hours or a few days, can be fatal and requires intensive treatment.
Acute kidney failure is most common in people who are already
hospitalized, particularly in critically ill people who need intensive
care.
 585.- Chronic kidney disease/CKD
● 4th digit for stage
● ESRD is 585.6 *includes stage V requiring dialysis
*code first any associated condition:
diabetic chronic kidney disease 250.4hypertensive chronic kidney disease 403.-, 404.-
 586 Renal failure, unspecified
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Stages of Chronic Kidney Disease/CKD
585.1/N18.1
• CKD, Stage 1
585.2/N18.2
• CKD, Stage 2 (mild)
585.3/N18.3
• CKD, Stage 3 (moderate)
585.4/N18.4
• CKD, Stage 4 (severe)
585.5/N18.5
• CKD, Stage 5
585.6/N18.6
• End Stage Renal Disease (CKD
requiring chronic dialysis)
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CKD and
Kidney Transplant Status
Following kidney transplant, a patient may
continue to have some form of CKD, because
the kidney transplant may not fully restore
kidney function.
The presence of CKD alone does not
constitute a transplant complication.
Assign the appropriate code for the stage
of CKD & code kidney transplant status.
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174
Urinary Tract Infection
 599.0 is the code for site not specified, if site is known
this would be an incorrect code:
-bladder – see cystitis
-kidney – see infection, kidney
-urethra – see urethritis
• Use additional code to identify organism, if known
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Hyperplasia/Enlarged Prostate
 Includes BPH 600.0 Subcategories for enlarged and nodular:
● 600.00 Enlarged prostate without lower urinary tract
symptoms/LUTS (incomplete bladder emptying, nocturia,
straining on urination, urinary freq, urinary hesitancy, urinary
incont, urinary obstruction, urinary retention, urinary urgency
weak urinary stream)
● 600.01 Enlarged prostate with LUTS
● 600.10 Nodular prostate without LUTS *
● 600.11 Nodular prostate with LUTS *
*a nodular = a "bump" that can be felt in the prostate
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Symptoms,
Signs and
Abnormal
Clinical and
Laboratory Findings
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177
Codes Used For
a
• No more specific diagnosis can be made even after all facts have been
investigated
b
• Signs or symptoms existing at time of initial encounter - transient and causes
not determined
c
d
e
f
• Provisional diagnosis in patient failing to return
• Referred elsewhere before diagnosis made
• More precise diagnosis not available
• Certain symptoms, for which supplementary information is provided, that
represent important problems in medical care in their own right
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178
 Signs and symptoms associated routinely with a disease
process should not be assigned as additional codes,
unless otherwise instructed by the code book.
● Examples:
o
o
o
o
SOB in COPD
Edema in CHF
Fever in strep throat
Urinary urgency in UTI
 In LTC, often symptoms are used as therapy treatment
diagnoses. Code as long as therapy is treating.
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179
Superficial injuries, such as
abrasions or contusions are
not coded when associated
with more severe injuries
of the same site.
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180
Coding from Lab/X-Ray Reports
 Attending physician must document the significance of
any abnormal finding
 Can use lab/x-ray reports to further define documented
diagnoses, but not to code a new diagnosis when the
provider has not documented
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181
Common Signs and Symptoms
 780.2 Syncope and collapse/fainting
 780.79 Other malaise and fatigue/gen. weakness
 799.3 Debility *weak and feeble
 780.96 Generalized pain *site?
 780.97 Altered mental status *on ER report
 780.99 Other general symptoms *??
 783.7 Adult failure to thrive *a descriptive, non-specific
term that encompasses "not doing well"
 782.3 Edema
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182
Common Signs and Symptoms -2
 786.05 Shortness of breath
 786.2 Cough
 787.01 Nausea with vomiting
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183
Insomnia
 780.50 Sleep disturbance, unspecified
 780.51 Insomnia with sleep apnea, unspecified
 780.52 Insomnia, unspecified
 780.57 Unspecified sleep apnea
 327.01 Insomnia d/t medical condition classified
elsewhere *code first underlying condition
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184
Common Therapy Treatment Diagnoses
 781.2 Abnormality of gait *excludes ataxic gait, difficulty walking
 781.3 Lack of coordination/muscular incoordination
 781.92 Abnormal posture
 784.3 Aphasia *if following CVA, code 438.11
 784.60 Symbolic dysfunction may experience a lack of ability to initiate
and/or terminate a conversation, as well as difficulty with other forms of
communication
 787.2- Dysphagia *identify phase of dysphagia after eval
*if d/t CVA, code first 438.82
 799.52 Cognitive communication deficit *and characteristic that acts as
a barrier to the cognition process
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185
PART IV (6/1/14)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
186
Factors
Influencing
Health Status &
Contact with
Health Services
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187
Amputations
 Traumatic = due to an incident
 An amputation not identified as partial or complete
should be coded to complete
 Use the appropriate 7th character:
“D” subsequent encounter
“S” sequela
 If acquired amputation, go to Absence, by site, acquired
(Z89)
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188
Acute Fractures vs. Aftercare
 Traumatic fractures are coded using the acute fracture
codes (800-829) while the patient is receiving active
treatment for the fracture.
 Examples of active treatment are: surgical treatment,
emergency department encounter, and evaluation and
treatment by a new physician.
 Fractures are coded using the aftercare codes (V54) 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.
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189
V Codes
 Represent reasons for encounters
● When person who may or may not be sick encounters health
services for some specific purpose, i.e. to receive limited care
or service for current condition, donate an organ or tissue,
receive prophylactic vaccination, discuss problem
● When some circumstance or problem is present which
influences person’s health status but is not a current illness or
injury
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190
V Codes Represent Reasons for Encounters
 Identify significant past health histories
 Identify services provided following an acute care
episode
 Identify services related to the provision of aftercare
 Identify delivery of specific healthcare services:
screening, tests & vaccinations
 Identify presence of problem influencing health status
but which is not a current illness (history of)
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Use of V Codes in any Healthcare Setting
 V codes are for use in any healthcare setting
 V codes may be used as either first-listed or secondary
diagnosis, depending on the circumstances of the
encounter
 Certain V codes may only be used as first-listed or
principal diagnosis
● *See the Official Coding Guidelines for a list of these codes
I.C.21.c.16.
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Categories of V Codes
 There are numerous categories for V Codes
 We will define the categories most frequently seen in
post-acute care
 We will explore examples of the common codes from
frequently used categories in LTC.
 We will practice coding conditions found in this chapter.
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193
V01 Contact / Exposure
 These codes are for patients who do not show any signs
or symptoms of a disease but are suspected to have been
exposed to it by close personal contact or are in an area
where a disease is epidemic.
 This category also indicates contact with and suspected
exposures hazardous to health
 *may be used as a first-listed or secondary code
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V03 – V06 Inoculations and Vaccinations
 Codes are for encounters for inoculations and
vaccinations
 It indicates that a patient is being seen to receive a
prophylactic inoculation against a disease
 There is only one code for inoculations, and if coded,
need an additional procedure code to identify the vaccine
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195
Status Codes
 Status codes indicate that a patient is either a carrier of a
disease or has the residual of a past disease or condition
 Includes presence of prosthetic or mechanical devices
resulting from past treatment
 A status code is informative, because the status may
affect the course of treatment or its outcome
 A status code is distinct from a history code (history code
indicates that patient no longer has the condition)
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196
Resistance to Antimicrobial Drugs V09
 NOTE: The codes in this category are provided for use
as additional codes to identify the resistance and non
responsiveness of a condition to antimicrobial
drugs.
 Exclude 1:
Code first the infection:
MRSA infections
(038.12)
MSSA infections
(038.11)
MRSA pneumonia
(482.42)
ICD-9 TO ICD-10 PREP (PARTS I-IV)
NOTE
Carrier of Infectious Disease/V02
 V02 Carrier of Infectious Disease
Colonization status
Suspected carrier
 Example:
V02.54
Carrier or (suspected) carrier of
Methicillin resistant Staphylococcus
aureus MRSA colonization
Carrier = person that harbors the specific organisms of a disease
without manifest symptoms and is capable of transmitting the
infection
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198
Long Term (current) Drug Therapy V58.6 Codes from this category indicate a patient’s
continued use of a prescribed drug for the long term
treatment of a condition or for prophylactic use.
 Not used for patients with addictions to drugs
 Used for patients receiving a medication for an
extended period of time
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Long Term (current) Drug Therapy
 Includes:
Long term (current) drug use for
prophylactic purposes
 Exclude 1:
Code also any therapeutic drug level
monitoring (V58.83)
 V58.61 Long term (current) use of anticoagulants
 V58.66 Long term (current) use of aspirin
 V58.62 Long term (current) use of antibiotics
 V58.67 Long term (current) use of insulin
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200
200
V49.- Acquired Absence of Limb
V45.7 Acquired Absence of Organ
Examples:
 V49.75
Amputation status below knee
 V49.76
Amputation status above knee
 V45.71 Acquired absence breast and nipple
 V45.73
Acquired absence of kidney
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201
V44 Artificial Opening Status
V42 Transplanted Organ Status
Examples:
 V44.1
Gastrostomy status
 V44.3
Colostomy status
 V44.0
Tracheostomy status
 V42.0
Kidney transplant status
 V42.5
Corneal transplant status
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202
Organ Or Tissue Replaced By Other Means
Examples:
 V43.1
Presence of intraocular lens
(s/p cataract removal surgery)
 V43.64
Presence of artificial hip joint
(s/p joint replacement)
 V43.21
Presence of heart assist device
(cardiac shunt, etc.)
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203
V45.- Other Postprocedural Status
Examples:
 V45.61
Cataract extraction status
 V45.87
Transplant organ removal status
 V45.11
Dependence on renal dialysis
 V45.12
Noncompliance with renal dialysis
 V45.01
Cardiac pacemaker status
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History (of)
 Two types, family and personal
 A history codes indicate that a patient no longer has the
condition, and is no longer receiving any treatment, but
has the potential for recurrence, and therefore may
require continued monitoring
 History codes are acceptable on any medical record, as
the history of an illness is important information that
may alter the type of treatment ordered
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205
History (of), Personal
 V10.3
Personal history breast cancer
 V12.04
Personal history MRSA infection
 V12.51
Personal hx of venous thrombosis/embolism
 V13.51
Personal hx pathological fx
 V15.51
Personal hx traumatic fracture (healed)
 V15.88
Personal history of falling
*at risk for falling
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206
History Allergy to Drugs and Other Substances
Examples:
 V14.0
Allergy status to penicillin
 V14.5
Allergy status to narcotic drugs
 V15.01
Peanut allergy status
 V15.06
Insect allergy status
 V15.07
Latex allergy status
 V15.08
Radiographic dye allergy status
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207
Personal History of Medical Treatment
 V87.41
Personal history of antineoplastic
chemotherapy
 V87.43
Personal history of estrogen therapy
 V87.44
Personal history of inhaled steroid therapy
 V87.45
Personal history of systemic steroid therapy
 V15.3
Personal history of irradiation
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208
Aftercare
 Aftercare visit codes cover situations when the initial
treatment of a disease has been performed and the patient
requires continued care during the healing or recovery
phase, or for the long-term consequences of the disease.
 The aftercare V code should not be used if treatment is
directed at a current, acute disease or injury.
 Aftercare codes are generally first listed to explain the
specific reason for the encounter.
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209
Aftercare + Status Codes
 Status Z codes may be used with aftercare Z codes to
indicate the nature of the aftercare or to indicate the
surgery for which the aftercare is being performed
 Example:
● V58.73 Encounter for surgical aftercare following surgery on
the circulatory system
● V45.81 Aortocoronary bypass status – “CABG” status
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Aftercare Categories
V55 Attention to artificial openings
V54 Orthopedic aftercare
V57 Care involving the use of rehabilitation
procedures
*code that may only be principal/first-listed dx
*only use one code in this category (if > one
therapy, code multiple therapy V57.89)
V58 Aftercare following surgery
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211
V55 Attention to Artificial Openings
V58 Encounter for Other Aftercare
 V55.0
Attention to tracheostomy
 V55.3
Attention to colostomy
*includes toileting/cleansing
 V58.31
Attention to surgical dressings
 V58.32
Attention to sutures
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V54 Orthopedic Aftercare
 V54.13
Aftercare for healing traumatic fracture of hip
 V54.81
Aftercare following joint replacement
*Use additional code to identify the joint
(V43.-)
 V54.82
Aftercare following explanation of joint
prosthesis
 V54.09
Other aftercare involving internal fixation
device
 V54.89
Other orthopedic aftercare
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Aftercare Following Surgery for Neoplasm
 V58.42
Aftercare following surgery for Neoplasm
*Use additional code to identify the neoplasm
 *If an organ was removed, in total or partial, use a code
for acquired absence of the organ
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214
Aftercare following Surgery
on Specified Body Systems V58.7 NOTE:
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.
 Excludes Aftercare following organ transplant V58.44
 Excludes Aftercare following surgery for neoplasm
V58.42
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Aftercare Following Surgery to Specified Body
Systems
 V58.71
 V58.73
 V58.75
 V58.78
Sense organs
*conditions classifiable to 360-379, 380-389
Circulatory system
*conditions classifiable to 390-459
Teeth, oral cavity and digestive system
*conditions classifiable to 520-579
Musculoskeletal system
*conditions classifiable to 710-739
*Should not need to use V58.49 Other specified aftercare following
surgery **get those operative reports!
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Encounter for Care Involving Renal
Dialysis and Miscellaneous
 V56.1 Encounter for fitting/adjustment of dialysis
catheter -includes cleansing of renal dialysis catheter
*Use additional code to identify the associated condition
*Use additional code for current dialysis status V45.11
 V66.7 Encounter for palliative care
 V66.2 Convalescence following chemotherapy
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Tips for Correct Coding
 Use code book!
 Always count the number of digits and compare with the
number of digits required
*use tabular listing in code book
 Avoid unspecified codes
*Remember: payers may reject payment based on missing
digits
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 Questions?
 Thanks for coming!!
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