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UnlockingCombina.onCodesinICD-10-CM

Training for all Healthcare Employees


WhatWe’llCoverToday

Today’sObjec.ves Objec'ves:�  ProvideanoverviewofselectedICD-10-CMguidelines�  Iden'fyvariousdiagnosesthatarecombina'oncodes�  Iden'fyvariouswaysofcodingdifferentscenarios�  Understandhowtoreportcombina'oncodesinICD-10�  Recognizecombina'oncodesthatcarryhigherspecificityandcarry

morevalueinriskadjustmentmodels.


ICD-10BasicsandReminders


NewICD-10Features�  ThereweremanynewfeaturesinICD-10-CMØ Combina'onCodesØ ExpandedCodesØ LateralityØ 7thCharacterØ 2typesofExcludesnotes


NewICD10Feature:Combina.onCodes

�  Combina'onscodesallowformorespecificcodeselec'onforcondi'onswithsymptomsormanifesta'ons(theserequiredmorethanonecodeinICD-9-CM)

E10.21,TypeIDiabetesMellituswithDiabe'cNephropathyI25.110,Atherosclero'cheartdiseaseofna'vecoronaryarterywithunstableanginapectorisK50.112,Crohn’sdiseaseoflargeintes'newithintes'nalobstruc'on

�  Combina'onsarealsofoundtodescribepoisoningsandtheirexternalcauses

T36.0x1D,Poisoningbypenicillin's,accidental(uninten'onal),subsequentencounterT42.4x5A,Adverseeffectofbenzodiazepines,ini'alencounter


NewICD10Feature:Laterality(Right,LeM,Unspecified)

� Whenappropriate,codesspecifyanatomicalloca'onofissue/problemaspertainingtotherightside,le`side,orunspecified

�  “Right”sideisusuallycharacter“1”and“Le`”isusually“2”,“Bilateral”isusually“3”,“Unspecifiedisusuallya“0”or“9”,dependingifa5thor6thcharacter(somesitua'onsdonotfollowthis)

H60.332,Swimmer’sear,leMearM94.211,Chondromalacia,rightshoulderS40.259A,Superficialforeignbodyofunspecifiedshoulder,ini'alencounter


NewICD10Feature:ExpandedCodes

�  Expandedcodesallowformorecomplexcondi'onstobedescribedinfull.Theyareseenindiabetes,alcoholandsubstanceabuse,injuries,andpostopera'vecomplica'ons

E11.341,Type2diabetesmellituswithseverenonprolifera'vediabe'cre'nopathywithmacularedema

F14.221,Cocainedependencewithintoxica'ondelirium

K91.71,Accidentalpunctureandlacera'onofadiges'vesystemorganorstructureduringadiges'vesystemprocedure


NewICD10Feature:7thCharacter(EpisodeOfCare,Staging,Trimester,etc.)

�  7thcharacterextensionsareusedtocommunicatetheepisodeofcare(sequelae)injuries,andexternalcausesofinjuries

�  The7thcharactersaredifferentforeachchapterthatusesthem,forexampleinglaucoma,theyareusedtoshowstage,andinOBtheyshowtrimester

�  Ifa7thcharacterextensionisused,itmustalwaysbethe7thandlastcharacterofthecode.Ifthecodeislessthan7characters,thenplaceholder‘x’mustbeusedtofillanyemptycharacter(s)

M80.051A,Age-relatedosteoporosiswithcurrentpathologicalfracture,rightfemur,ini.alencounterforfractureS06.0x1A,Concussionwithlossofconsciousnessof30minutesorless,ini.alencounterS52.132B,Displacedfractureofneckofle`radius,ini.alencounterforopenfractureTypeIorIIorini.alencounterforopenfracture,NOS


NewICD10Feature:Useof7thCharacter

•  Obstetrics

•  Injuries

•  External Causes of Injuries

•  Alpha or numeric

•  Placeholder ‘x’

•  Character meaning varies in each chapter

Injury & External Causes of Injury: 7th Character Identifies Injury

INITIAL

Receiving active

treatment

SUBSEQUENT

Receiving

routine care during healing

or recovery, AFTER active

treatment

SEQUELA

Complications or conditions arising as a result of a condition


X X X X

Category

. Etiology, anatomic

site, severity

Added 7th character for obstetrics,

injuries, and external causes

of injuries

ICD-10-CMCodeStructure

X X X A M S 0 2 6 . 5 x A

Additional Characters

Alpha (Except U)

2 Numeric 3-7 Numeric or Alpha


NECvs.NOS�  NotElsewhereClassified

(NEC):

Thisprovidesacodefor“other”or“otherspecified”

H26.8OtherspecifiedcataractI25.89Otherformsofchronicischemicheartdisease*No'ce4thdigit“8”

�  NotOtherwiseSpecified(NOS):

Thisprovidesacodewhenthedocumenta.onisinsufficienttoassignamorespecificcode

H40.9UnspecifiedglaucomaJ12.9Viralpneumonia,unspecified

*No'ce4thdigit“9”


OtherandUnspecified

�  The4thcharacter8,whenplaceda`eradecimalpoint,isusedtoindicatesome“other”specifiedcategory

�  The4thcharacter9,whenplaceda`eradecimalpoint,isusedtoindicateand“unspecified”condi'on

�  Thishelpsgivenumberstorepresentthedifferencebetween(NEC)(notelsewhereclassified)and(NOS)(nototherwisespecified).InICD-10-CM,the“otherspecified”and“unspecified”eachhavetheirowncode

�  Theabbrevia'onNOS(NotOtherwiseSpecified)intheTabularListisequalto“unspecified”

A04.9Bacterialintes'nalinfec'on,unspecifiedBacterialenteri'sNOSK52.89,Otherspecifiednoninfec'vegastroenteri'sandcoli'sK52.9,Non-infec'vegastroenteri'sandcoli's,unspecified


Withvs.Without

�  When“with”and“without”arethechoicesforthefinalcharacterofanICD-10-CMcode,thedefaultisalways“without”

�  Whenthereisa5charactercode,a“0”asthefi`hcharacterrepresents“without”and“1”represents“with”

�  Whenthereisa6charactercode,a“1”asthesixthcharacterrepresents“with”anda“9”represents“without”

G40.501Epilep'cseizuresrelatedtoexternalcauses,notintractable,withstatusepilep.cusG40.509Epilep'cseizuresrelatedtoexternalcauses,notintractable,withoutstatusepilep.cus


Parentheses()

�  Punctua.on-()Parenthesesareusedtoenclosesupplementalwordsthatmayormaynotbedocumentedanddoesnotaffectcodeselec'on.Termsintheparenthesesarecallednonessen'almodifiers

Anemia(essen'al)(general)(hemoglobindeficiency)(infan'le)(primary)(profound)Diabetes,diabe'c(mellitus)(sugar)Hemophilia(classical)(familial)(hereditary)H44.611,Retained(old)magne'cforeignbodyinanteriorchamber,righteyeI10Essen'al(primary)hypertensionK51.011,Ulcera've(chronic)pancoli'swithrectalbleeding


Brackets[]

�  Punctua.on-[]Bracketsenclosesynonyms,alterna'vewordings,orexplanatoryphrasesinthetabularlistandiden'fymanifesta'oncodesinthealphabe'calindex

Index:Disease,Alzheimer’sG30.9[F02.80]Nephrosis,inamyloidosisE85.4[N08]Tabular:B06,Rubella[GermanMeasles]J00,Acutenasopharyngi's[commoncold]


Colons:

�  Punctua.on-:Colonsareusedinthetabulara`eranincompletetermwhichneedsoneormoreofthemodifiersfollowingthecolontomakethecodecomplete.Thecolonisusedwithbothincludesandexcludesnotes,inwhichthewordsthatprecedethecolonarenotconsideredcompletetermsandmustbeappendedbyoneofthemodifiersindentedunderthestatementbeforethecondi'oncanbeassignedthecorrectcode

G73.7MyopathyindiseaseclassifiedelsewhereExcludes1:myopathyin: rheumatoidarthri's(M05.32) sarcoidosis(D86.87) scleroderma(M34.82) siccasyndrome[Sjögren](M35.03) systemiclupuserythematosus(M32.19)


Combina.onCode

�  Onlyu'lizeacombina'oncodewhenthecodefullydescribesthecondi'onsdocumentedorwhenICD-10-CMdirectstheiruse.Wheneveranycombina'oncodelacksanyrequiredelementsorspecificity,anaddi'onalcodeshouldbeusedasasecondarycode

�  Acombina'oncodeisasinglecodeusedtodescribe:�  Twodiagnoses,or�  Adiagnosiswithanassociatedsecondaryprocess(manifesta'on),or�  Adiagnosiswithanassociatedcomplica'on


Combina.onCode�  Guidelinesstatethatmul'plecodesshouldnotbeusedwhenyouclearlyhaveacombina'oncodethatiden'fiesalloftheelementsinthediagnosis

� Whenyoususpectthatacombina'oncodemaybeapplicable,butsuppor'ngdocumenta'onislackingquerythephysician


ICD-10-CMConven.ons

�  Instruc.onalNotes:

Variousformsofinstruc'onalnotesareusedinICD-10-CMsuchas“codefirst,”“useaddi'onalcode,”andcrossreferencenotes

�  Includes:

Itisimportanttorememberthatthelistofinclusionstermsisnotexhaus'veandmayincludediagnosesnotlistedintheinclusionnote.Theword“Includes”willappearatthebeginningofachapter,sec'onorcategory,howeveritwillnotappearinalistoftermsfoundunderthecodeinthetabular


ICD-10-CMConven.ons

�  Includesexamples:

K25GastricUlcer

Includes: erosion(acute)ofstomach pylorusulcer(pep'c) stomachulcer(pep'c)

K31.5 Obstruc.onofduodenum

Constric.onofduodenumDuodenalileus(chronic)StenosisofduodenumStrictureofduodenumVolvulusofduodenum


NewFeature:2ExcludesNotes�  2typesof“Excludes”notestodifferen'atebetween

whentwocodesMAYbeusedtogetheriftheyarebothpresentvs.whentwocodescanNEVERbeusedtogetherbecauseitwouldbeclinicallyimpossible.

Excludes1noteindicatesnotcodedhere.Thecodebeingexcludedcanneverbeusedwiththecodeabovebeingchosenbecauseitwouldbeclinicallyimpossible.[Ex.B06,Rubella(Germanmeasles)hasanexclusion1ofcongenitalrubella(P35.0).]Therewasaguidanceupdatethatyoumaycodebothiftheyareunrelated.

Excludes1=Therecanonlybeone

Excludes2noteindicatesnotincludedhere.Thecodewiththisexclusionisnotalreadybeingrepresentedbythecodeabovebeingchosenanditisacceptabletousebothcodesiftheyarebothtrueforthepa'ent.[ex.J04.0,Acutelaryngi'shasanExcludes2ofChroniclaryngi's(J37.0).]

Excludes2=Meanstherecanbetwo


TheRubricorFamilyCode

�  Thefirst3charactersofanyICDcodearecalledthe“rubric”oryoucanthinkofthemasa“codefamily.”

�  Thisishighlyimportant,especiallyinICD-10-CM,aswhenreviewingcodes,onemaybeseveralpagesawayfromtherootfamilycode.

�  Thereareimportantincludesandexcludesnotesthataresome'mesfounddirectlyunderyourcode,butalsosome'mesfoundunderthefamily,rubric,rootcode.

�  Alwaysgobacktotheroot/rubric.


2017ICD-10Changes&Updates


2017Changes&Updates�  A.Conven.onsfortheICD-10-CM12.ExcludesNotesa.   Excludes1Atype1Excludesnoteisapureexcludesnote.Itmeans“NOTCODEDHERE!”AnExcludes1noteindicatesthatthecodeexcludedshouldneverbeusedatthesame'measthecodeabovetheExcludes1note.AnExcludes1isusedwhentwocondi'onscannotoccurtogethersuchasacongenitalformversusanacquiredformofthesamecondi'on.Anexcep.ontotheExcludes1defini.onisthecircumstancewhenthetwocondi.onsareunrelatedtoeachother.Ifitisnotclearwhetherthetwocondi.onsinvolvedinanExcludes1notearerelatedornot,querytheprovider.


2017Changes&Updates�  A.Conven.onsfortheICD-10-CM14.Documenta.onforBMI,DepthofNon-pressureulcers,PressureUlcerStages,ComaScale,andNIHStrokeScale

FortheBodyMassIndex(BMI),depthofnon-pressurechroniculcers,pressureulcerstage,comascale,andNIHstrokescale(NIHSS)codes,codeassignmentmaybebasedonmedicalrecorddocumenta'onfromclinicianswhoarenotthepa'ent’sprovider(i.e.physicianorotherqualifiedhealthcareprac''onerlegallyaccountableforestablishingthepa'ent’sdiagnosis),sincethisinforma'onistypicallydocumentedbyothercliniciansinvolvedinthecareofthepa'ent(e.g.,adie'ciano`endocumentstheBMI,anurseo`endocumentsthepressureulcerstages,andanemergencymedicaltechnicianoMendocumentsthecomascale).However,theassociateddiagnosis(suchasoverweight,obesity,acutestroke,orpressureulcer)mustbedocumentedbythepa'ent’sprovider.Ifthereisconflic'ngmedicalrecorddocumenta'on,eitherfromthesameclinicianordifferentclinicians,thepa'ent'sarendingprovidershouldbequeriedforclarifica'on.TheBMI,comascale,andNIHSScodesshouldonlybereportedassecondarydiagnoses.


2017Changes&Updates�  A.Conven.onsfortheICD-10-CM15.“With”

Theword“with”shouldbeinterpretedtomean“associatedwith”or“dueto”whenitappearsinacode'tle,theAlphabe'cIndex,oraninstruc'onalnoteintheTabularList.Theclassifica.onpresumesacausalrela.onshipbetweenthetwocondi.onslinkedbythesetermsintheAlphabe.calIndexorTabularList.Thesecondi.onsshouldbecodedasrelatedevenintheabsenceofproviderdocumenta.onexplicitlylinkingthem,unlessthedocumenta.onclearlystatesthatthecondi.onsareunrelated.Forcondi.onsnotspecificallylinkedbytheserela.onaltermsintheclassifica.on,providerdocumenta.onmustlinkthecondi.onsinordertocodethemasrelated.


2017Changes&Updates�  A.Conven.onsfortheICD-10-CM19.CodeAssignmentandClinicalCriteriaTheassignmentofadiagnosiscodeisbasedontheprovider’sdiagnos.cstatementthatthecondi.onexists.Theprovider’sstatementthatthepa.enthasapar.cularcondi.onissufficient.Codeassignmentisnotbasedonclinicalcriteriausedbytheprovidertoestablishthediagnosis.


2017Changes&Updates�  B.GeneralCodingGuidelines13.Laterality

Whenapa.enthasabilateralcondi.onandeachsideistreatedduringseparateencounters,assignthe“bilateral”code(asthecondi.ons.llexistsonbothsides),includingfortheencountertotreatthefirstside.ForthesecondencounterfortreatmentaMeronesidehaspreviouslybeentreatedandthecondi.onnolongerexistsonthatside,assigntheappropriateunilateralcodeforthesidewherethecondi.onss.llexists(e.g.,cataractsurgeryperformedoneacheyeinseparateencounters).Thebilateralcodewouldnotbeassignedforthesubsequentencounter,asthepa.entnolongerhasthecondi.oninthepreviouslytreatedsite.Ifthetreatmentonthefirstsidedidnotcompletelyresolvethecondi.on,thenthebilateralcodewoulds.llbeappropriate.


2017Changes&Updates�  Chapter9:DiseasesoftheCirculatorySystem(I00-I99)a.HypertensionTheclassifica.onpresumesacausalrela.onshipbetweenhypertensionandheartinvolvementandbetweenhypertensionandkidneyinvolvement,asthetwocondi.onsarelinkedbytheterm“with”intheAlphabe.cIndex.Thesecondi.onsshouldbecodedasrelatedevenintheabsenceofproviderdocumenta.onexplicitlylinkingthem,unlessthedocumenta.onclearlystatesthecondi.onsareunrelated.Forhypertensionandcondi.onsnotspecificallylinkedbyrela.onaltermssuchas“with,”“associatedwith,”or“dueto”intheclassifica.on,providerdocumenta.onmustlinkthecondi.onsinordertocodethemasrelated.


2017Changes&Updates�  Chapter18:Symptoms,signs,andabnormalclinical

andlaboratoryfindings,notelsewhereclassifiedi.   NIHSSStrokeScaleTheNIHstrokescale(NIHSS)codes(R29.7--)canbeusedinconjunc.onwithacutestrokecodes(I63)toiden.fythepa.ent’sneurologicalstatusandseverityofthestroke.ThestrokescalecodesshouldbesequencedaMertheacutestrokediagnosiscode(s).Ataminimum,reporttheini.alscoredocumented,Ifdesired,afacilitymaychoosetocapturemul.plestrokescalescores.


2017Changes&Updates�  Chapter19:Injury,poisoning,andcertainother

consequencesofexternalcausesa.   Applica.onof7thCharactersinChapter19…..7thcharacter“A,”ini'alencounterisusedforeachencounterwherethepa'entisreceivingac'vetreatmentforthecondi'on.7thcharacter“D”subsequentencounterisusedforencountersa`erthepa'enthascompletedac'vetreatmentofthecondi'onandisreceivingrou'necareforthecondi'onduringthehealingorrecoveryphase.…...


2017Changes&Updates�  Sec.onIV.Diagnos.cCodingandRepor.ngGuidelinesforOutpa.entServices

�  P.Encountersformedicalexamina.onswithabnormalfindings

Anexamina.onwithabnormalfindingsreferstoacondi.on/diagnosisthatisnewlyiden.fiedorachangeinseverityofachroniccondi.on(suchasuncontrolledhypertension,oranacuteexacerba.onofchronicobstruc.vepulmonarydisease)duringarou.nephysicalexamina.on.


SelectedCombina.onCodes


DisseminatedCandidiasis�  CandidalSepsisB37.7

Disseminatedcandidiasis

Systemiccandidiasis

q TheB37familyisforCandidiasis.UseoftheB37.7codestatesbothcandidiasisalongwithrelatedsepsisarepresent,notetheinclusionofdisseminatedandsystemicontheinclusivewording.


Combina.oncodesthatincludeMRSA

�  PneumoniaduetoMRSAJ15.212

�  DonotcodeB95.62withJ15.212Codefirstassociatedinfluenza,ifapplicable

Codealsoassociatedabscess,ifapplicable


SickleCellDisease�  SickleCellDiseasewithoutcrisisD57.1

SickleCellAnemia,Disease,orDisorder,NOSHb-SSdiseasewithoutcrisis

q UseoftheD57.1codeisforsicklecellwithoutcrisis.NotethereareothermorespecificcodesforspecifictypesofSSdisease.

� Hb-SSDiseasewithcrisisD57.0-D57.01withacutechestsyndromeD57.02withsplenicsequestra'on


DMwOphthalmicManifesta.ons� DMwithophthalmicmanifesta.onsincludesthefollowingcodes:E10.311–E10.349(TypeI)E11.311–E11.349(TypeII)

(non-prolifera'vere'nopathy,withorwithoutmacularedema)� DMwithprolifera.vere.nopathy,includesthefollowingcodes:E10.351(E11.351)“withmacularedema”E10.359(E11.359)“withoutmacularedema”


DMwCirculatoryComplica.ons�  E10.5(E11.5)DMwithCirculatoryComplica.ons�  E10.51(E11.51)“DMwithdiabe'cperipheralangiopathywithoutgangrene”(default)

�  E10.52(E11.52)“DMwithdiabe'cperipheralangiopathy“withgangrene”


DiabetesCodingClinic®2016�  TheCodingClinic®issuedguidanceinQuarter1andQuarter2regardingthecodingofdiabetesandmanifesta'ons.

�  Theword“with”maybeunderstoodasDMwithamanifesta'onandprovidersdonotneedtostatethecauseandeffect.

�  “Thesecondi,onsshouldbecodedasrelatedevenintheabsenceofproviderdocumenta,onexplicitlylinkingthem,unlessthedocumenta,onclearlystatesthecondi,onsareunrelatedandduetosomeotherunderlyingcausebesidesdiabetes.“


HypertensiveCKD&HeartDisease

Hypertension Type ICD-9-CM ICD-10-CM

HTN (primary, benign, essential, malignant) 401.x I10“with” Heart Disease *Must Document Cause & Effect

402.xx I11.x

“with” CKD [Cause & Effect are Assumed] 403.xx I12.x“with” Heart & Kidney Disease *Must Document Cause & Effect for Heart Disease

404.xx I13.x

Hypertension, secondary 405.xx I15.x


HypertensiveHeartDisease�  I11.0Hypertensiveheartdiseasewithheartfailure(hypertensiveheartfailure)Includescondi,onsI51.4-I51.9Useaddi,onalcodetoiden,fytypeofheartfailure(I50.-)

�  I11.9HypertensiveheartdiseasewithoutheartfailureIncludescondi,onsI51.4-I51.9HypertensiveheartdiseaseNOS


HypertensiveCKD�  I12.0HypertensivechronickidneydiseasewithStage5CKDorESRDArteriosclerosisofkidney,Arteriosclero,cnephri,s,Hypertensivenephropathy,NephrosclerosisIncludescondi,onsN18&N26duetoHTNUseaddi,onalcodetoiden,fystageofCKD(N18.5,N18.6)

�  I12.9Hypertensivechronickidneydiseasewithstage1–stage4CKD,orunspecifiedCKDHypertensivechronickidneydiseaseNOSHypertensiverenaldiseaseNOSUseaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)


HypertensiveCKD&HeartFailure�  I13.0Hypertensiveheart&chronickidneydiseasewithheartfailure&stage1-4CKD Anycondi,oninI11.1-withanycondi,oninI11.2.-Cardiorenaldisease,CardiovascularrenaldiseaseUseaddi,onalcodetoiden,fytypeofheartfailure(I50.-)Useaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)

�  I13.2Hypertensiveheart&chronickidneydiseasewithheartfailure&stage5CKDorESRDAnycondi,oninI11.1-withanycondi,oninI11.2.-Cardiorenaldisease,CardiovascularrenaldiseaseUseaddi,onalcodetoiden,fytypeofheartfailure(I50.-)Useaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)


HypertensiveCKDw/oHeartFailure�  I13.10Hypertensiveheart&chronickidneydiseasewithoutheartfailure&stage1-4CKDAnycondi,oninI11.1-withanycondi,oninI11.2.-Cardiorenaldisease,CardiovascularrenaldiseaseUseaddi,onalcodetoiden,fytypeofheartfailure(I50.-)Useaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)

�  I13.11Hypertensiveheart&chronickidneydiseasewithoutheartfailure&stage5CKDorESRDAnycondi,oninI11.1-withanycondi,oninI11.2.-Cardiorenaldisease,CardiovascularrenaldiseaseUseaddi,onalcodetoiden,fytypeofheartfailure(I50.-)Useaddi,onalcodetoiden,fystageofCKD(N18.1-4,N18.9)


CADw/Angina�  I25.1familyisforAtherosclero.cheartdiseaseofna.vecoronary

artery(noteweassumena.veifnoCABGintheDOSbeingreviewed)Thisalsoincludes:Atherosclero.ccardiovasculardisease,Coronary(artery)Atheroma,Coronary(artery)atherosclerosis,Coronary(artery)disease[AKA:CAD],Coronaryarterysclerosis*Useaddi,onalcodetoiden,fy…....(smoking,exposure,calcifiedlesions,lipidrichplaque,etc.)

I25.11-Atherosclero.cheartdiseaseofna.vecoronaryarterywithanginapectoris�  I25.110Atherosclero.cheartdiseaseofna.vecoronaryarterywith

unstableanginapectoris�  I25.111Atherosclero.cheartdiseaseofna.vecoronaryarterywith

anginapectoriswithdocumentedspasm�  I25.118Atherosclero.cheartdiseaseofna.vecoronaryarterywith

otherformsofanginapectorispectoris�  I25.119Atherosclero.cheartdiseaseofna.vecoronaryarterywith

unspecifiedanginapectoris


EmbolismswAcuteCorPulmonale�  I26.01Sep.cpulmonaryembolismwithacutecor

pulmonaleCodefirstunderlyinginfec'on

�  I26.02Saddleembolusofpulmonaryarterywithacutecorpulmonale

�  I26.09OtherpulmonaryembolismwithacutecorpulmonaleAcutecorpulmonaleNOS

q TheI26.0familyisforPulmonaryembolismwithacutecorpulmonale.


Atherosclerosisextremi.eswUlcer�  Codesforatherosclerosisofextremi.eswithulcera.onarealsocombina.oncodesUseaddi'onalcodetoiden'fyseverityofulcer(L97.-)

�  I70.23-Atherosclerosisofna.vearteriesofrightlegwithulcera.on

�  I70.24-Atherosclerosisofna.vearteriesofleMlegwithulcera.on

�  I70.25Atherosclerosisofna.vearteriesofotherextremi.eswithulcera.on


AtherosclerosisbypassgraMwUlcer�  CodesforbypassgraMofextremi.eswithulcera.onarealsocombina.oncodes

�  ExamplesfoundonnextslideintableUseaddi'onalcodetoiden'fyseverityofulcer(L97.-)


Athe

rosclerosisb

ypass

graM

wUlcer

Code Type Location

I70.33- unspecified type of bypass graft(s) Right

I70.34- unspecified type of bypass graft(s) Left

I70.35 unspecified type of bypass graft(s) Other

I70.43- autologous vein bypass graft(s) Right

I70.44- autologous vein bypass graft(s) Left

I70.45 autologous vein bypass graft(s) Other

I70.53- nonautologous biological bypass graft(s) Right

I70.54- nonautologous biological bypass graft(s) Left

I70.55 nonautologous biological bypass graft(s) Other

I70.63- nonbiological bypass graft(s) Right

I70.64- nonbiological bypass graft(s) Left

I70.65 nonbiological bypass graft(s) Other

I70.73- Other type of bypass graft(s) Right

I70.74- Other type of bypass graft(s) Left

I70.75 Other type of bypass graft(s) Other


Crohn’sdiseasewobstruc.on�  CodesforCrohn’sdisease(regionalenteri.s)with

obstruc.onarealsocombina.oncodesUseaddi'onalcodetoiden'fymanifesta'ons,suchas:pyodermagangrenosum(L88)

�  K50.012Crohn’sdiseaseofsmallintes.newithintes.nalobstruc.on

�  K50.112Crohn’sdiseaseoflargeintes.newithintes.nalobstruc.on

�  K50.812Crohn’sdiseaseofbothsmallandlargeintes.newithintes.nalobstruc.on

�  K50.912Crohn’sdisease,unspecified,withintes.nalobstruc.on


Ulcera.vecoli.swobstruc.on�  Codesforulcera.vecoli.swithobstruc.onarealsocombina.on

codesUseaddi'onalcodetoiden'fymanifesta'ons,suchas:pyodermagangrenosum(L88)

�  K51.012Ulcera.ve(chronic)pancoli.swithintes.nalobstruc.on�  K51.212Ulcera.ve(chronic)proc..swithintes.nalobstruc.on�  K51.312Ulcera.ve(chronic)rectosigmoidi.swithintes.nal

obstruc.on�  K51.412Inflammatorypolypsofcolonwithintes.nalobstruc.on�  K51.512LeMsidedcoli.swithintes.nalobstruc.on�  K51.812Otherulcera.vecoli.swithintes.nalobstruc.on�  K51.912Ulcera.vecoli.s,unspecified,withintes.nalobstruc.on


Rheumatoidarthri.swpolyneuropathy� NotethatinICD-10thereisadifferen.a.onbetweenRAwithrheumatoidfactor(M05.-)andRheumatoidarthri.swithoutrheumatoidfactor(M06.-),andwhenindoubtourdefaultis“without.”

� M05.5-Rheumatoidpolyneuropathywithrheumatoidarthri.s


Systemiclupuserythematosus(SLE)� NotethatinICD-10,SLENOS=M32.9Thisincludes:systemiclupuserythematosusNOS,Systemiclupuserythematosuswithoutorganinvolvement

� M32.13Lunginvolvementinsystemiclupuserythematosus


Dermatopolymyosi.swlunginvolvement� M33Dermatopolymyosi.s:familyofmyosi's

disordersthatincludespolymyosi's&dermatomyosi's

� M33.01Juveniledermatopolymyosi.swithrespiratoryinvolvement

� M33.11Otherdermatopolymyosi.swithrespiratoryinvolvement

� M33.21Polymyosi.swithrespiratoryinvolvement� M33.91Dermatopolymyosi.s,unspecifiedwith

respiratoryinvolvement


Scleroderma/Siccawlunginvolvement� M34Systemicsclerosis(scleroderma):Autoimmunediseasewithhardeningoftheskin.(canaffectorganswhensevere)

� M35.0Siccasyndrome(SjÖgren):Autoimmunediseasethataracksexocrineglands,specificallysalivaandtears.

� M34.81.Systemicsclerosis(scleroderma)withlunginvolvement

� M35.02Siccasyndromewithlunginvolvement


Condi.onsduetodrugs,medica.ons,andbiologicalsubstances

�  ICD-10-CMcombina'oncodesdenotewhetherthepa'enthasexperiencedapoisoning,adverseeffect,orunderdosingaswellasthespecificsubstanceresponsiblefortheoutcome.

�  Pa'entpresentswithaccidentalcocaineoverdoseT40.5X1-


Summary

Youshouldnowbeabletounderstandthefollowing:

•  SomeofthebasicsICD-10-CMguidelines•  Someofthecombina'oncodesfoundinICD-10•  Howtomaximizelookingatbaserubric/familycodes•  Theimportanceofreviewingincludesandexcludesforthe

codeaswellasthecodefamily/rubric


TakeAway�  Knowingthatthereisacombina'oncodecanbeoneofthemostchallengingaspects

�  ScanallthechaptersoftheICD-10andhighlightcodesthatyoufrequentlyreportthatwerepreviouslyreportedwith2ICD-9codes

�  USEYOURBOOKcheckthealphabe.candtabularindicestolookforanyinstruc.onalnotesthatmaybeapplicable


TakeAway

�  Takeyour'meandreviewthediagnos'cstatementcarefully,incorrectcodingaffectsdataqualityandreimbursementcouldbeatrisk

�  Youneedongoingeduca.onwithrespecttoanatomy,physiologyandthee'ologyofdiseases

�  Ifthephysiciandoesn’tlinktwocondi'onsyoushouldbeabletorecognizethatthesearetypicallyrelatedandquerythephysician


TakeAway�  Includeyourphysiciansintheeduca'onalprocesswheneverpossible.


FundamentalsQuiz


ApplyingConceptsQuiz

1.  ExpandedCodesallowformoreComplexcondi'onstobedescribedinfull.

TrueorFalse


1.  Answer:True

Ra,onale:TheycapturemoredetailsuchasC50.511,malignantneoplasmoflower-outerquadrantofrightfemalebreast

Applying Concepts Quiz


2.  Whichstatementistrueaboutthe7thCharacter:a)  Itisusedtocommunicateinjuryb)  Ifyouarenotsurewhattheepisodeofcareisuse“X”asyour7th

characterc)  Areusedtocommunicatetheepisodeofcareforinjuriesand

externalcausesofinjuries

ApplyingConceptsQuiz


2.  Answer:c)Areusedtocommunicatetheepisodeofcareforinjuriesandexternalcausesofinjuries

Ra,onale:“X”isusedasaplaceholderifthecodeislessthan7characters.



3.  ()Parenthesesareusedtoenclosewordsthatmustbedocumented:

TrueorFalse



3.  Answer:False.

Ra,onale:theyareusedtoenclosesupplementalwordsthatmayormaynotbedocumentedanddoesnotaffectcodeselec,on.Theyarecallednonessen8almodifiers.



4.  ARubricis:a)  Acubeb)  Notimportantitdoesnothaveallofthenecessarycharactersc)  Mayhaveimportantincludesandexcludesnotes



4.  Answer:c)Mayhaveimportantincludesandexcludesnotes

Ra,onale:TheRubricisthethefirst3charactersofanyICDcode.Andsome,meshaveimportantincludesandexcludesnotesdirectlyunderthefamily,rubricrootcode.



5.  NOSisanabbrevia'onfor:a)  Notonsiteb)  Neveronceseenc)  NotOtherwiseSpecified



5.  Answer:c)NotOtherwiseSpecifiedRa,onale:NOS(NotOtherwiseSpecified)intheTabularListisequalto“unspecified”



6.  Whenadiagnosiscodeselec'oniseitherwithorwithout.Withisthedefault.TrueorFalse



6.  Answer:False

Ra,onale:Thedefaultisalways“without”



7.  Youcanuseeithermul'plecodesoracombina'oncode,bothaccuratelydescribethediagnosis

TrueorFalse



7.  Answer:False

Ra,onale:Guidelinesstatethatwhenyouclearlyhaveacombina,oncodethatiden,fiesalloftheelementsinthediagnosisyoushouldusemul,plecodes.



8.  Excludes1hasaguidanceupdatethatyoucancodebothiftheyareunrelated

TrueorFalse



8.  Answer:True

Ra,onale:Therewasanupdatepleasebesurethatthe2diagnosiscodesareunrelated.



9.  Whatdoyoucodewhenthediagnosisisbilateralbutthecodeselec'ondoesnothaveanop'onforbilateral:a)  Usebothrightandle`diagnosiscodesb)  UsetheNOSop'onc)  Onlycodeeitherrightorle`



9.  Answer:a)UsebothoftherightandleMcodes

Ra,onale:PerCodingGuidelines



10.  SignsandSymptomsthatareassociatedrou'nelywithadiseaseprocessshouldnotbeassignedasaddi'onalcodes,unlessotherwiseinstructedbytheclassifica'on.

TrueorFalse



10. Answer:True

Ra,onale:Percodingguidelines

Whatis/arethepropercode(s)fortheassessmentabove?a)  305.1,272.4,401.9,250.00b)  272.4,401.9,250.00c)  272.4,401.9

d)  401.9



CodingClinicTosubmitaques'ontothecodingclinicgotothesitebelow.

hrp://www.codingclinicadvisor.com/

ForAHACodingClinicWebinarsgoto:

hrp://www.ahacentraloffice.org/codes/webinars.shtml


Ques.ons/Feedback


DisclaimerForIllustra.ve,Educa.onalandDiscussionPurposesOnlyThisprogrammaycontainreferencesorlinkstostatutes,regula'ons,orotherpolicymaterials.Theinforma'onprovidedisintendedonlytobeageneralsummary.Itisnotintendedtotaketheplaceofeitherthewrirenlaworregula'ons.Weencouragereaderstoreviewthespecificstatutes,regula'onsandotherinterpre'vematerialsforafullandaccuratestatementoftheircontents.


Thanksforyourawen.on.

ThankYou


Contact

BrianBoyce,BSHS,CPC,CPC-I,CRC,CTPRPCEO,Proprietor,andManagingConsultant2112W.LaburnumAve.Suite109Richmond,VA23227www.linkedin.com/in/boycebrian/[email protected]

www.ionHealthcare.com

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