ICD-10 Orientation In Post Acute Care (Part III)Rhonda Anderson, RHIA

Anderson Health Information Systems, Inc.

Location, Date, Time

•Northern CaliforniaFairfield Post Acute Rehab

March 20, 2014

9:00am – 3:00pm

• Southern CaliforniaGarden View Post Acute Rehab

April 9, 2014

9:00am – 3:00pm2

Presenters

• Staci LePage, RHIT

Email: stacilepage@comcast.net

Mobile: 916-202-5797

•Khaleelah Wagner, RHIA

Email: khaleelahwagner@hotmail.com

Mobile: 909-717-71023

Chapter 6 – Diseases Of The Nervous System G00-G99•Alzheimer’s moved to this chapter (was in

mental disorder category) G30.• Expanded to include early and late onset of

Alzheimer’s• Requires a second code for Alzheimer’s

dementia with or without behaviors• Paralytic syndromes now include laterality

in addition to dominant and non-dominant4

Paralytic Syndrome Coding

• If the affected side is documented, but not specified as dominant or nondominant:• For ambidextrous patients, the default should be

dominant• Left side affected, the default is nondominant• Right side affected, the default is dominant• Example: Hemiplegia, unspecified, affecting

right dominant side G81.91• *excludes hemiplegia d/t sequela of CVD 5

Seizures/Convulsions

• Convulsions or seizures, NOS code to R56.-• Seizure disorder, code to G40.-• If “disorder” is not documented by provider,

but resident is receiving medications for seizures, should query provider

6

Coding Pain

• Pain, not elsewhere classified - G89.• Used in conjunction with codes from other

categories to provide more detail about acute or chronic pain, neoplasm pain, or post-procedural pain• Can be listed as principal diagnosis• When pain control or pain mgmt is reason for

admit, the underlying cause and site of pain should be reported as additional dx, if known.

7

More Pain Coding…

• Chronic pain syndrome G89.4 vs. Chronic pain G89.2• Provider must specifically document the

condition• Need to know:• if Alzheimer’s; early or late onset + if associated

dementia• if paralytic syndrome; laterality, dominant/non-

dominant status8

Chapter 7 – Diseases Of Eye And Adnexa H00-H59•Assigning glaucoma codes:• Assign as many codes from category H40, as

needed, to identify the type of glaucoma, the affected eye, and the glaucoma stage.• Need to know:• which eye (right, left or bilateral) • type of glaucoma (open-angle, primary angle-closure,

glaucoma 2nd to trauma, drugs, or other eye disorders)• Stage of glaucoma (mild, moderate, severe,

indeterminate)9

Chapter 8 – Diseases of the Ear and Mastoid Process H60-H95• Separate chapter in ICD-10-CM• Need to know if disease is in right, left or

bilateral ears

10

Chapter 9 – Diseases Of The Circulatory System I00-I99 •No more hypertension table in index

(malignant, benign, unspecified are all the same code now)•Artery and vein diseases are broken down

by laterality, in addition to the location• Combination Codes for Conditions and

Common Symptoms or Manifestations

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Chapter 9 – Diseases Of The Circulatory System I00-I99 -2 • Example: I25.110 - Arteriosclerotic heart

disease of native coronary artery with unstable angina pectoris

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Hypertension Coding

• I11 Hypertension with Heart Disease• Heart conditions classified to I50 or I51.4-I51.9

are also assigned to, a code from category I11 when a causal relationship is stated (due to hypertension) or implied (hypertensive)• Use an additional code to identify type of heart

failure I50., if known• Need to know: with or without heart failure

13

More Hypertension Coding

• I12 Hypertensive chronic kidney disease• Cause and effect relationship is presumed• Need add’l code to identify the stage of CKD• Need to know: CKD stage

• I13 Hypertensive heart and CKD• Causal relationship for HTN and heart dx must

be doc’d by provider• Need to know: stage and with or without heart

failure 14

Sequelae of Cerebrovascular Diseases I69• I69.0 Nontraumatic subarachnoid

hemorrhage• I69.1 Nontraumatic intracerebral

hemorrhage• I69.2 Other nontraumatic intracranial

hemorrhage• I69.3 Sequelae of cerebral infarction• I69.8 Sequelae of other cerebrovascular

diseases15

Sequelae of Cerebrovascular Diseases I69 -2

• I69.9 Sequelae of unspecified cerebrovascular diseases

16

Sequelae of Cerebrovascular Diseases• Sequelae of cerebrovascular disease I69• Used to indicate conditions in I60-I67 as the

cause of sequelae. The “sequelae” include conditions specified as such, or as residuals which may occur at any time after the onset of the causal condition• Need to know: type of CVD, what the residual

condition is, if paralytic syndrome – right or left, dominant or non-dominant• if tPA/rtPA given within 24 hrs, code Z92.82 17

Acute Myocardial Infarction (AMI)

•Myocardial Infarctions now have subcategories for ST elevation/STEMI and non-ST elevation/NSTEMI• Time frame change from eight weeks old to

four weeks (28 days) or less from onset• Separate code for a subsequent MI within

four weeks (28 days) of a previous MI

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Acute Myocardial Infarction

• I21 For encounters occurring while the AMI is equal to, or less than, four weeks old, including transfers to another acute setting or a post-acute setting and pt requires continued care for the AMI

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Acute Myocardial Infarction -2

• I22 Subsequent MI• When a pt who has suffered an MI, has a new MI

within the 4 wk time frame of the initial MI, code I22 in conjunction with I21 code• Need to know for both I21 or I22 if STEMI or

NSTEMI and site of MI

20

Complications Following MI’s

• I23 Certain current complications following STEMI and NSTEMI MI within 28 day period• a code from category I23 must be used in

conjunction with a code from category I21 or category I22

• Still use a different code for old MI (greater than 28 days after initial MI onset) I25.2

21

Atrial Fibrillation and Flutter I48

•More specific than ICD-9:• I48.0 Paroxysmal atrial fibrillation• I48.1 Persistent atrial fibrillation• I48.2 Chronic atrial fibrillation• I48.3 Typical atrial flutter/type I• I48.4 Atypical atrial flutter/type II• I48.9- Unspecified atrial fibrillation/flutter• Need to know type

22

Congestive Heart Failure/CHF I50

• Same organization as ICD-9• Need to know:• type of heart failure (left, systolic, diastolic,

combined)• acute, chronic, acute on chronic

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Chapter 10 – Diseases Of Respiratory System (J00-J99)• J44 Other Chronic Obstructive Pulmonary

Disease (COPD)• Includes asthma with COPD• Organized differently than in ICD-9• J44.0 COPD with acute lower resp infection• J44.1 COPD with acute exacerbation • J44.9 COPD, unspecified

• Acute exacerbation is a worsening or a decompensation of a chronic condition

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Asthma J45

•Asthma is now in subcategories of:• J45.2 Mild intermittent• J45.3 Mild persistent• J45.4 Moderate persistent• J45.5 Severe persistent• J45.9 Unspecified • J45.901 Unspecified asthma with exacerbation• J45.902 Unspecified asthma with status asthmaticus• J45.909 Unspecified asthma, uncomplicated 25

Asthma J45 -2

•Asthma is now in subcategories of:• J45.99_ Other asthma• Need to know type and if complicated

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Influenza

• J09 Influenza due to certain identified influenza viruses • J10 Influenza d/t other identified influenza

virus• J11 Influenza d/t unidentified influenza

virus• Need to know what the influenza is due to

and if any manifestations27

Pneumonia

• J12 Viral pneumonia, not elsewhere classified• J13 Pneumonia d/t Streptococcus

pneumoniae• J14 Pneumonia d/t H. influenzae• J15 Bacterial pneumonia, not elsewhere

classified• J16 Pneumonia d/t other infectious

organisms, not elsewhere classified28

Pneumonia -2

• J17 Pneumonia in disease classified elsewhere• J18 Pneumonia, unspecified organism• J69 Pneumonitis d/t solids and liquids• Need to know type of virus/bacteria

29

Respiratory Failure J96

• J96.0 Acute respiratory failure• J96.1 Chronic respiratory failure• J96.2 Acute and chronic respiratory failure• J96.9 Respiratory failure, unspecified• Need to know: for all of above acute or

chronic and if with hypoxia or hypercapnia•Hypoxia: a condition in which the body or a

region of the body is deprived of adequate oxygen supply

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Respiratory Failure J96 -2

•Hypercapnia: a condition of abnormally elevated carbon dioxide (CO2) levels in the blood

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Chapter 11- Diseases of the Digestive System K00-K95• Increase in sections from seven (in ICD-9)

to ten (in ICD-10)• Expanded breakdown of all types of ulcers

and colitis• Need to know for ulcers, type and

with/without hemorrhage and/or perforation

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Non-Infective Enteritis and Colitis K50-K52 •K50 Crohn’s disease•K51 Ulcerative colitis •K52 Other and unspecified noninfective

gastroenteritis and colitis

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Non-Infective Enteritis and Colitis K50-K52 -2

• Need to know if associated manifestation of:• Rectal bleeding• Intestinal obstruction• Fistula• Abscess • Other complication

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Chapter 12 – Diseases Of Skin& Subcutaneous Tissue L00-L99• L89 codes for Pressure Ulcer are

combination codes that identify the site as well as the stage of the ulcer and also have added laterality•Assignment of the pressure ulcer stage

should be guided by clinical documentation of the stage•Assign code for the highest stage reported

for that site 35

Chapter 12 – Diseases Of Skin& Subcutaneous Tissue L00-L99 -2

• Need to know for pressure ulcer coding site (including laterality) and stage

36

Non-Pressure Chronic Ulcers of Lower Limbs L97• Expanded breakdown of this section to

include level of severity:• Limited to breakdown of skin• With fat layer exposed• With necrosis of muscle• With necrosis of bone• With unspecified severity

• Need to know for chronic ulcer coding, site, laterality, level of severity 37

Chapter 13 – Diseases Of Musculoskeletal (M00-M99)•Gout now in this section• Site and laterality needed • Represents the bone, joint or muscle involved• Where more than one bone, joint or muscle is

involved, such as osteoarthritis, use the assigned “multiple sites” code; if not available, use multiple codes to indicate the sites • Bone vs. Joint – Certain conditions where the

bone may be affected at the upper & lower end; site designation will be the bone, not the joint

38

Chapter 13 – Diseases Of Musculoskeletal (M00-M99) -2

• Bone, joint or muscle conditions that are the result of a healed injury are coded to this chapter• Chronic or recurrent conditions are also

coded to this chapter• Pathologic fractures are coded with 7th

character of “D” for subsequent encounters after active treatment is completed, if routine healing is occurring 39

Osteoarthritis M15-M19

•M15 Polyosteoarthritis *new for multiple sites•M16 Osteoarthritis of hip•M17 Osteoarthritis of knee•M18 Osteoarthritis of first carpometacarpal

joint•M19 Other and unspecified osteoarthritis

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Osteoarthritis M15-M19 -2

• Need to know joint site, laterality and underlying condition, and whether primary or secondary osteoarthritis

41

Back Pain

• Low back pain was under disorders of muscle, now is under category of M54 Dorsalgia• M54.0- Panniculitis of neck and back• M54.1- Radiculopathy• M54.2 Cervicalgia• M54.3- Sciatica• M54.4- Lumbago with sciatica• M54.5 Low back pain• M54.6 Pain in thoracic spine

42

Osteoporosis

•M80 Osteoporosis with current pathological fracture is used for any patient with known osteoporosis who has a fracture, even if patient had minor fall or trauma, if that fall would not usually break a normal bone•M81 Osteoporosis without current

pathological fracture is used for patients who do not currently have a pathologic fracture d/t osteoporosis, even if they have had a fracture in the past

43

Osteoporosis -2

• Need to know if current pathological fx, site and laterality

44

Chapter 14 – Diseases Of Genitourinary (N00-N99)• Still need stage of chronic kidney disease

(CKD) – stages 1-5 N18.1-N18.5• If both a stage of CKD and ESRD are

documented, then assign code N18.6 only • Code first any associated disease:• Diabetic chronic kidney disease • Hypertensive chronic kidney disease

• Need to know stage and any associated dx45

Renal Disease

•N17 Acute kidney failure•N18 Chronic kidney disease•N19 Unspecified kidney failure•N28.9 Disorder of kidney and ureter,

unspecified• Includes Renal disease (acute), NOS• Includes Renal insufficiency (acute)

• Need to know if condition is acute or chronic

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