Download Disease Coding with IDC-10-CM: The Next Generation

Disease Coding with ICD-10-CM:
The Next Generation
Kyle C. Dennis, Ph.D.
National Audiology and Speech Pathology
Program Office
Department of Veterans Affairs
1
Disclaimer
The opinions expressed herein are those of the
author and do not necessarily reflect the
opinions or official positions of the
Department of Veterans Affairs or the U.S.
Government.
2
Course Overview / Objectives
• This program will provide:
– An overview of the shortcomings of ICD-9-CM
– A brief overview of ICD-10-CM
– A review of diagnosis code changes
– Some examples of disease coding
– Time for discussion of transition issues
– We will not cover ICD-10 procedure coding.
• After completing this program, you will be able to:
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–
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–
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Explain the need to implement ICD-10-CM
Compare ICD-9-CM and ICD-10-CM code systems
Describe basic principles of ICD-10-CM coding
Give at least two examples of major changes in disease coding
Identify at least one transition challenge
3
HHS Final Rules
•
HHS (Federal Register, January 16, 2009, Volume 74, Number 11)
established two final rules:
– Modifications to the Health Insurance Portability and Accountability Act (HIPAA)
– Modifications to Medical Data Code Set Standards to adopt ICD-10-CM and ICD10-PCS
•
First rule replaces the current ASC X12 Version 4010/4010A with ASC X12
Version 5010, standards for electronic transactions under the HIPAA
Administrative Simplification requirements for:
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Health care claims or equivalent encounter information
Health care payment and remittance advice
Coordination of benefits
Eligibility for a health plan
Health care claim status
Enrollment and disenrollment in a health plan
Referral certification and authorization
Health plan premium payments
4
Electronic Transactions
•
Effective January 1, 2012, claims will be submitted electronically
using the ASC X12 Version 5010. Also a prerequisite for
implementing the new ICD-10 codes.
•
HIPAA standards apply to all transactions with all payers, not just
with Fee-for-Service (FFS) Medicare.
•
Claims in 4010A and 5010 formats will be accepted from January
1, 2011 until January 1, 2012.
– Allow providers who are ready to begin using the new standards on January
1, 2011, while providing an additional year for all providers to be ready.
•
Over 99% of Medicare Part A claims and over 95% of Medicare Part B
claims transactions are received electronically and it is imperative that
audiologists and speech-language pathologists be ready for these new
standards.
•
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0904.pdf
5
HHS Final Rules
• The second rule adopted modifications for two of the code
set standards adopted in the Transactions and Code Sets
pursuant to HIPAA.
– Adopts the International Classification of Diseases, 10th Revision,
Clinical Modification (ICD-10-CM) for diagnosis coding and
Official ICD-10-CM Guidelines for Coding and Reporting.
– Adopts the International Classification of Diseases, 10th Revision,
Procedure Coding System (ICD-10-PCS) for inpatient hospital
procedure coding and Official ICD-10-PCS Guidelines for Coding
and Reporting.
• Replaces the ICD-9-CM, Volumes 1 and 2, (diagnoses)
and ICD-9-CM, Volume 3, (inpatient procedure codes)
6
Overview of ICD-9-CM and
ICD-10-CM
7
Overview of ICD-9-CM
• International Classification of Diseases (ICD-9) was
developed by the World Health Organization.
• The clinical modification (ICD-9-CM) was developed by the
Centers for Disease Control and Prevention (CDC). ICD-9CM has been in place since 1983.
• CDC maintains Volume 1 (tabular list) and Volume 2
(index).
• Centers for Medicare and Medicaid Services (CMS)
maintains Volume 3 (inpatient procedures).
8
Overview of ICD-10-CM
• International Statistical Classification of
Diseases and Related Health Problems, also
known as ICD-10.
• Used in many countries for disease
classification.
• Used in the U.S. to classify mortality data
(death certificates) since January 1999.
• ICD-10-CM is the U.S. version of ICD-10.
• ICD-10-CM is maintained by the National
Center for Health Statistics (NCHS), part of
CDC.
9
Overview of ICD-10-CM
• Organized in 21 chapters. Each chapter is uniquely
identified by letter.
– 1st digit—always alphabetic
– 2nd and 3rd digits—always numeric
– 4th, 5th, and 6th digits—may be letters or numbers, or may be
a placeholder (x).
• There is always a decimal after the first three digits.
• First 3 digits—define the code category
• Second three digits—etiology, anatomical site, or
severity
• Seventh digit—‖extension‖ describes the encounter
type (initial, subsequent, sequela).
10
Why Do We Need ICD-10-CM?
11
Limitations of ICD-9-CM
• ICD-9-CM is 30 years old.
• Contains approximately 13,000 diagnostic codes
and 3,000 procedure codes.
• ICD-9-CM functionality is exhausted.
– Unable to expand to accommodate new and changing
medical advancements because there is insufficient room.
– Many chapters are full and in some cases the hierarchical
structure is compromised because codes from other
disease groups are placed in unrelated chapters.
– Never designed to capture the detail necessary for
emerging public health needs such as biosurveillance and
value-based purchasing (pay for performance).
12
Limitations of ICD-9-CM
• ICD-9-CM lacks detail.
–
–
–
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Lacks specificity and difficult to update
Lacks a rich data set and is an impediment to research
Not well suited to electronic health records
Based on outmoded technology and nomenclature
• No longer supported by WHO.
– 138 countries have adopted ICD-10 for mortality data and
99 countries have adopted it for disease coding.
– Lack of comparability and inter-operability with other
countries
• Potential risk in tracking and responding to
international health threats.
13
Description of ICD-10-CM
• 68,000 disease codes
• Substantially increases specificity and expandability.
• Incorporates advances in medicine and technology.
• Codes more detail on socioeconomic and family
factors, problems related to lifestyle, and outcomes
of screening.
• Adds detail on etiology, anatomy, severity, laterality,
and post-procedural disorders.
14
Comparison of Code Sets
ICD-9-CM
ICD-10-CM
3-5 characters
3-7 characters
Approximately 13,000 codes
Approximately 68,000 codes
1st digit may be alpha or numeric; digits 2-5 are
numeric
1st digit is alpha, digits 2 and 3 are numeric;
digits 4-7 may be alpha or numeric
Limited space for new codes
Expandable
Lacks detail
Very specific
Lacks laterality
Has laterality
Difficult to analyze due to non-specific codes
Specificity improves accuracy and data richness
Limited detail for research
Improves accuracy of data for medical research
Not inter-operable with other countries
Inter-operable
15
A Comment on Procedure Codes
• CPT® will continue to be used for
outpatient procedure coding in the U.S.
• ICD-10-PCS will be used for inpatient
procedure coding.
• There is no direct relationship between
ICD-10-PCS and ICD-10-CM. The two
systems have completely different
structures.
• There about 87,000 ICD-10-PCS codes
compared to 3,000 in ICD-9-CM, Volume 3
16
What Are the Benefits?
17
Benefits of ICD-10-CM
•
•
•
•
•
•
Greater specificity
Improved data to track health care services
– Less supporting documentation
– Supports biosurveillance and epidemiological research
– Improvements in claims processing
Increased sensitivity for disease grouping
Updated terminology
Room for expansion
Numerous other benefits:
– Outcomes measurement
– Clinical, financial, and administrative performance measurement
– Provider profiling
– Pay-for-performance programs
– Managing care and disease processes
– Increased use of automated tools to facilitate the coding process
Bowman, Sue. "Why ICD-10 Is Worth the Trouble." Journal of AHIMA 79, No.3 (March
2008): 24-29.
18
Coding Conventions in ICD-10-CM
19
Coding Conventions
• NEC (not elsewhere classified)—Use when there is
no code in the tabular code set.
• NOS (not otherwise specified)—Unspecified codes
when the documentation in the medical record is
insufficient to code the condition.
• Inclusion terms—synonyms or in some cases
examples of conditions. Not an exhaustive list.
• Exclusion terms—two type of exclusion terms:
– Excludes1 = NOT CODED HERE. Codes cannot occur together.
– Excludes2 = NOT INCLUDED HERE. Indicates that the condition is
not part of the coded condition, but the patient may have both
conditions at the same time.
20
Coding Conventions
• Code first—Many conditions specify the
underlying etiology and its manifestations.
Indicates proper sequencing of codes.
• Laterality—For bilateral conditions, the final
character indicates laterality. 1 = RIGHT, 2 =
LEFT, 3 = BILATERAL. Unspecified is coded
as 0 or 9.
• Placeholder character “X”—used as a 5th
character placeholder in certain 6 digit codes
to allow for future expansion. Must be used to
be considered a valid code.
21
General Equivalence Maps
22
Caveats
• The material presented as examples for
illustration only. Use official code sets,
guidance, and maps for reference.
• I have inserted decimal points and
descriptors at the appropriate places to aid
viewing. Decimal points and descriptors are
not in actual GEM tables.
23
Why Do We Need
GEMs?
• ICD-9-CM and ICD-10-CM are very different code
systems—two different code languages.
• ICD-9-CM is the only code system most clinicians
know.
• There is a 30-year generational difference between
ICD-9-CM and ICD-10-CM.
• There is no simple way to map a code set with 13,000
codes to one that has over 68,000 codes.
• GEM is a bi-directional code translational dictionary.
– It is not a crosswalk.
– Facilitates translations between code systems.
24
Purposes of GEMs
• Facilitate conversion projects (replace ICD-9-CM
with ICD-10-CM). Example: updating data systems,
DRG conversion, coding guidelines
• Facilitate mapping (crosswalks) that allow ICD-9CM applications to process ICD-10-CM data.
Example: reimbursement maps
• Improve coding, documentation, and claims
processing
• Facilitate code education and training
• Facilitate research where data may be in both
formats
• Understand translational challenges in particular
coding and clinical areas
25
General Equivalence Maps
• There are two kinds of GEM maps:
– Forward mapping: ICD-9-CM to ICD-10-CM
– Backward mapping: ICD-10-CM to ICD-9-CM
• See handouts for forward and backward GEMs
(one set for audiology and one set for SLP).
26
General Equivalence Maps
•
First column is the source code (ICD-9-CM). Middle column is the target
code (ICD-10-CM) Third column contains equivalence flags.
Example of forward GEM map (Audiology): 38918 H903
10000
Example of forward GEM map (SLP):
•
1=no plausible translation for the source code
0=at least one plausible translation for the source code
Third digit: Combination Flag
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–
•
1= approximate match for the code
0=identical match
Second digit: No Map Flag
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•
00000
First digit: Approximate Flag
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•
78722 R1312
1=requires more than one code from the target code set
0=complete translation with one code from the target code set
Fourth and Fifth digits: Scenario and Choice Flags
–
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Scenario—a collection of codes from the target system containing the necessary codes
that will satisfy the equivalent meaning of a code in the source system
Choice—List of one or more codes in the target system from which one code must be
chosen to satisfy the equivalent meaning of a code in the source system (pick list)
27
General Equivalence Maps
• Mapping can be complicated, but for A&SLP
the equivalence is fairly simple:
– Only three ICD-9-CM audiology codes have a direct
equivalence to ICD-10-CM (digit=0)
– More SLP codes have direct equivalence than audiology codes
– Most A&SLP codes have no direct equivalence but all have
plausible translations (digit=1)
– There are no combination, scenario, or choice flags (digits=0)
28
Where Can I Find GEMs?
• Available on NCHS website:
http://www.cdc.gov/nchs/about/otheract/icd9
/icd10cm.htm
• Also available on CMS website:
http://www.cms.hhs.gov/ICD10/02m_2009_IC
D_10_CM.asp#TopOfPage
29
Diagnosis Reimbursement Maps
• GEMs are translational aids.
• Diagnosis reimbursement maps (DRM) are
“crosswalks” interposed between ICD-10-CM
entry data and ICD-9-CM legacy applications.
• DRMs are always “backward”—mapping from
ICD-10-CM to ICD-9-CM. Assumption: clinicians
will enter 1CD-10-CM data in routine practice.
• DRMs are not part of GEMs. They are separate
files.
http://www.cms.hhs.gov/ICD10/02m_2009_ICD_10_CM.asp#TopOfPage
30
Diagnosis Reimbursement Maps
•
•
•
•
•
On October 1, 2013, health care claims for services on or after
that date will be submitted to payers in ICD-10-CM format for all
provider types.
DRMs provide a temporary but reliable mechanism for
mapping records containing ICD-10-CM diagnoses to
―reimbursement equivalent‖ ICD-9-CM diagnoses.
While systems are being converted to process ICD-10-CM
claims directly, the claims will be processed by the legacy
systems.
ICD-10-CM diagnoses submitted on the claim are mapped, via
the DRM, into ICD-9-CM diagnoses used by the ICD9-based
reimbursement system.
The claim may then be priced using the rules written for ICD-9CM codes.
31
Challenges
•
•
•
•
In GEMs, a single ICD-10-CM code can be translated into two or
more ICD-9-CM codes.
In DRMs, one ICD-10-CM code may translate to a single ICD-9-CM
code, or sometimes many ICD-10-CM codes will translate to a single
ICD-9-CM code.
If one ICD-10-CM code translates to more than one ICD-9-CM code,
the appropriate code must be determined from historical
utilization data:
– Medicare Provider Analysis and Review (MEDPAR) File
– Approximately 4 million inpatient hospital records available from the
California Office of Statewide Health Planning and Development
(OSHPD).
Because claim data comes mainly from claims data for inpatient
hospitals and skilled nursing facilities, the data may not reflect
outpatient utilization. This may be more of an issue for audiology.
32
Audiology DRM Examples
ICD-10-CM
H90.2
H90.3
H90.41
H90.42
H90.5
H90.6
H90.71
H90.72
H90.8
Descriptor
Conductive HL NOS
SNHL, bilateral
SNHL, right
SNHL, left
SNHL, unspecified
Mixed, bilateral
Mixed, right
Mixed, left
Mixed, unspecified
Codes
1
1
1
1
1
1
1
1
1
ICD-9-CM
389.00
389.10
389.10
389.10
389.10
389.22
389.21
389.21
389.20
• Left column: ICD-10-CM
• Center column: number of ICD-9-CM codes
required for complete translation.
• Right column: ICD-9-CM reimbursement code
33
Problems with Maps
• Bilateral SNHL (H90.3) is mapped to
unspecified SNHL (389.10)
• Bilateral tinnitus (H93.13) is mapped to
unspecified tinnitus (388.30)
• What is the impact on reimbursement?
34
SLP Examples
ICD-10-CM
Descriptor
Codes ICD-9-CM
R47.01
R47.1
R47.81
R47.89
R47.9
R48.0
R49.0
R49.1
Aphasia
Dysarthria
Slurred speech
Other speech disturbance
Speech disturbance NOS
Dyslexia
Dysphonia
Aphonia
1
1
1
1
1
1
1
1
784.3
784.5
784.5
784.5
784.5
784.61
784.49
784.41
• Left column: ICD-10-CM
• Center column: number of ICD-9-CM codes
required for complete translation.
• Right column: ICD-9-CM reimbursement code
35
Problems with Maps
•
•
All of the sequelae of cerebrovascular disease are mapped to
unspecified late effects of cerberovascular disease (438.9).
Examples:
– I69.01 Cognitive deficits following nontraumatic subarachnoid
hemorrhage
– I69.02 Speech and language deficits following nontraumatic
subarachnoid hemorrhage
– I69.020 Aphasia following nontraumatic subarachnoid hemorrhage
– Dysarthria following nontraumatic subarachnoid hemorrhage
– I69.091 Dysphagia following nontraumatic subarachnoid
hemorrhage
•
What are the reimbursement implications of mapping these
sequelae to an unspecified code?
36
What’s New in ICD-10-CM
37
What’s New in ICD-10-CM for
Audiology
•
•
•
•
Laterality (right, left, bilateral)
Objective tinnitus is not recognized.
New codes for temporary threshold shift (TTS)
Acoustic trauma (388.12) is recognized, but explosive
acoustic trauma (388.11) does not have a specific code.
• Impairment of auditory discrimination (388.43) is
classified as ―other abnormal auditory perceptions‖
(H93.29).
• Developmental (congenital) (C)APD (315.32) moves
under Other Abnormal Auditory Perceptions, but
acquired (C)APD (388.45) disappears as a separate
code.
38
What’s New in ICD-10-CM for
Speech-Language Pathology
• Speech-language pathology diagnoses are not
found in any one chapter; they are spread
throughout ICD-10-CM.
• Most speech, voice, resonance, and swallowing
conditions are found in Symptoms section (as
they are in ICD-9-CM).
• Extensive revision of non-traumatic and
traumatic intracranial disease sections.
• Concept of “late effect” disappears and is
replaced by sequelae codes (stroke) or an
7th digit extension (TBI).
39
Organization of ICD-10-CM
40
Organization of ICD-10-CM
Audiology
• Chapter 8 in ICD-10-CM
• Every code starts with an H (convenient!)
• Organization:
–
–
–
–
Diseases of external ear (H60-H62)
Disorders of middle ear and mastoid (H65-H75)
Diseases of inner ear (H80-H83)
Other disorders of the ear (H90-H95)
• Hearing loss is organized under Other
Disorders of Ear (H90-H95).
41
Organization of ICD-10-CM
Speech-Language Pathology
•
•
•
•
•
•
•
•
Chapter 2 Neoplasms (C00-D48)
Chapter 5 Mental Disorders (F01-F99)
– F80-F89 Pervasive and specific developmental disorders
Chapter 6 Disease of the Nervous System (G00-G99)
Chapter 9 Diseases of the circulatory system (I00-I99)
– I60-I69 Cerebrovascular diseases
Chapter 10 Diseases of the respiratory system (J00-J99)
Chapter 11 Diseases of the digestive system (K00-K93)
Chapter 18 Symptoms, signs and abnormal clinical and laboratory findings, not
elsewhere classified (R00-R99)
– R10-R19 Symptoms and signs involving the digestive system and abdomen
– R25-R29 Symptoms and signs involving the nervous and musculoskeletal systems
– R40-R46 Symptoms and signs involving cognition, perception, emotional state and
behavior
– R47-R49 Symptoms and signs involving speech and voice
– R50-R69 General symptoms and signs
CHAPTER 19 Injury, poisoning and certain other consequences of external causes
(S00-T98)
– (S00-S09) Injuries to the head
42
Examples of Audiology Coding in
ICD-10-CM
43
Sensorineural Hearing Loss
• There is no classification for sensory and neural
hearing loss in ICD-10-CM.
– Bilateral sensory loss (389.11) coded as bilateral SNHL (H90.3).
– Unilateral sensory loss (389.17) coded as unilateral SNHL (H90.41
or H90.42).
– Bilateral neural loss (389.12) coded as bilateral SNHL (H90.3).
– Unilateral neural loss (389.13) coded as unilateral SNHL (H90.41
or H90.42).
• Asymmetric hearing loss (389.16) has no
representation in ICD-10-CM.
– Coded as H90.5 (unspecified SNHL).
44
Specific Forms of SNHL
• Bilateral SNHL (389.18) coded as H90.3 SNHL,
bilateral
• Unilateral SNHL (389.15) coded as H90.4x
Unilateral SNHL with unrestricted hearing on
opposite side
– H90.41
– H90.42
SNHL, right ear
SNHL, left ear
• H90.5 Unspecified SNHL includes:
–
–
–
–
–
Central hearing loss NOS
Congenital deafness NOS
Neural hearing loss
Sensory hearing loss
Asymmetric hearing loss
45
General Equivalence for SNHL
Forward Equivalence Map:
ICD-9-CM
389.10
389.11
389.12
389.13
389.13
389.14
389.15
389.15
389.16
389.17
389.17
389.18
ICD-10-CM
H90.5
H90.3
H90.3
H90.41
H90.42
H90.5
H90.41
H90.42
H90.5
H90.41
H90.42
H90.3
BILATERAL
RIGHT
LEFT
Backward Equivalence Map:
Map
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
ICD-10-CM
H90.3
H90.3
H90.3
H90.3
H90.3
H90.41
H90.41
H90.41
H90.41
H90.41
H90.42
H90.42
H90.42
H90.42
H90.42
H90.5
H90.5
H90.5
ICD-9-CM
389.11
389.12
389.18
389.14
389.10
389.10
389.13
389.17
389.14
389.15
389.17
389.10
389.14
389.13
389.15
389.14
389.10
389.16
Map
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
HEARING LOSS NOS
46
Ototoxic Hearing Loss
• H91.0 Ototoxic Hearing Loss
–
–
–
–
H91.01 Ototoxic hearing loss, right ear
H91.02 Ototoxic hearing loss, left ear
H91.03 Ototoxic hearing loss, bilateral
H91.09 Ototoxic hearing loss, unspecified ear
• Code first the toxic medication or agent
(T36-T65)
• Example: Sequela of aminoglycoside
otoxicity-- T36.5x1S and H91.03
– Note the placeholder (5th digit) and the extension
(7th digit)
47
Noise Exposure
• Noise effects on the inner ear (H83.3)
–
–
–
–
–
H83.3x1 Noise effects on inner ear, right ear
H83.3x2 Noise effects on inner ear, left ear
H83.3x3 Noise effects on inner ear, bilateral
H83.3x9 Noise effects on inner ear, unspecified ear
Note the placeholder in the 5th digit position
ICD-9-CM
388.10
388.11
388.12
Descriptor
ICD-10-CM
Noise effects NOS
H83.3x9
Acoustic trauma (explosive) H91.8x9
Noise-induced HL
H83.3x9
Mapping
10000
10000*
10000
*Note: blast-related acoustic trauma is not mapped to
noise effects on inner ear.
48
Other Noise Codes
• Z01.12 Encounter for hearing conservation
and treatment
• Z57.0 Occupational exposure to noise
• Z58.0 Exposure to noise (nonoccupational)
49
Examples of Speech-Language
Pathology ICD-10-CM Coding
50
Dysphagia
• Symptoms and signs involving the digestive system
and abdomen (R10-R19)
• The specificity of dysphagia was retained.
R13 Aphagia and dysphagia
R13.0 Aphagia
Excludes1: psychogenic aphagia (F50.9)
R13.1 Dysphagia
Code first, if applicable, dysphagia following cerebrovascular disease (I69.
with final characters -91)
Excludes1: psychogenic dysphagia (F45.8)
R13.10 Dysphagia, unspecified
R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
R13.19 Other dysphagia (Cervical dysphagia, Neurogenic dysphagia)
51
GEM for Dysphagia
There is a direct equivalence between
ICD-9-CM and ICD-10-CM (digit=0), except
for unpsecified dysphagia.
ICD-9-CM
787.20
787.21
787.22
787.23
787.24
787.29
ICD-10-CM
R13.10
R13.11
R13.12
R13.13
R13.14
R13.19
Map
10000
00000
00000
00000
00000
00000
52
Developmental Disorders
•
•
Coded under pervasive and specific developmental disorders
(F80-F89)
F80 Specific developmental disorders of speech and language
– F80.0 Phonological disorder (dyslalia, Functional speech articulation
disorder, lalling, lisping, phonological developmental disorder, speech
articulation developmental disorder)
• Excludes1: speech articulation impairment due to aphasia NOS (R47.01), speech
articulation impairment due to apraxia (R48.2)
• Excludes2: speech articulation impairment due to hearing loss (F80.4), speech
articulation impairment due to mental retardation (F70-F79), speech articulation
impairment with expressive language developmental disorder (F80.1), speech
articulation impairment with mixed receptive expressive language developmental
disorder (F80.2)
– F80.1 Expressive language disorder (Developmental dysphasia or
aphasia, expressive type)
• Excludes1: mixed receptive-expressive language disorder (F80.2), dysphasia and
aphasia NOS (R47.-)
• Excludes2: acquired aphasia with epilepsy [Landau-Kleffner] (F80.3), selective
mutism (F94.0), mental retardation (F70-F79), pervasive developmental disorders
(F84.-)
53
Developmental Disorders
•
•
•
•
•
F80.2 Mixed receptive-expressive language disorder (Developmental
dysphasia or aphasia, receptive type, Developmental Wernicke's aphasia)
– Excludes1: central auditory processing disorder (H93.25), dysphasia or
aphasia NOS (R47.-), expressive language disorder (F80.1), expressive
type dysphasia or aphasia (F80.1), word deafness (H93.25)
– Excludes2: acquired aphasia with epilepsy [Landau-Kleffner] (F80.3),
pervasive developmental disorders (F84.-), selective mutism (F94.0),
mental retardation (F70-F79)
– Developmental central auditory processing disorder (315.32) is NOT
coded under this category. Moves to Auditory Perceptions (H93.25)
F80.3 Acquired aphasia with epilepsy [Landau-Kleffner]
– Excludes1: aphasia NOS (R47.01)
– Excludes2: pervasive developmental disorders (F84.-)
F80.4 Speech and language development delay due to hearing loss
– Code also type of hearing loss (H90.-, H91.-)
F80.8 Other developmental disorders of speech or language
F80.9 Developmental disorder of speech or language, unspecified
54
Memory and Cognition
• Cognitive and memory disorders can be
coded in many ways.
– Associated with or part of mental disorders or
organic brain damage
– Age-related cognitive decline
– Amensia and amnestic syndromes
– Loss of or alteration of consciousness
– Mild cognitive impairment
– Sequelae of cerebrovascular disease
– Sequelae of brain injury
55
Memory and Cognition
• Examples of different ways to code memory and
cognitive disorders:
– Age-related cognitive decline—R41.81
– Altered mental status—R41.82
– Cerebral degeneration—G31.9
– Change in mental status NOS—R41.82
– Cognitive deficits associated with cerebrovascular
disease—I69.01, I69.11, I69.21, I69.31, I69.81,
I69.91
– Memory problems associated with dementia—
F01.-, F02.-, or F03
56
Memory and Cognition
•
Ways to code cognitive disorders due to brain injury:
– Cognitive disorder associated with organic brain damage (frontal lobe
syndrome)—F07.0
– Mild memory disturbance (personality disorder associated with organ brain
damage)—F07.89
– Postconcussional syndrome—F07.81
– Cognitive impairment due to intracranial or head injury—code the
impairment with 7th character is to be added to appropriate injury code in
S06 (A initial encounter, D subsequent encounter, S sequela)
•
Example: cognitive deficit due to mild TBI
–
–
–
–
S06.0x1S
F07.0 cognitive deficit
F07.89 memory deficit
Code also open (S01.-) or closed skull fracture (S02.-)
57
Transition
58
Compliance Date: October 1, 2013
59
Replication and Optimization
• Replication—produce an ICD10-based
application that produces the same results as
the current ICD-9-CM application.
– Short-term goals will be focused on replication to ensure
continuity of disease classification, documentation,
reimbursement, education, and research.
• Optimization—produce an ICD10-based
application that enhances disease
classification takes advantage of the new
features of ICD-10-CM.
– Long-term goals will be focused on improving disease
classification, documentation, reimbursement, education,
and research.
60
Challenges and Opportunities
• Short-term Challenges
– Should replication be a goal?
– Do we want ICD10-based applications to produce the same
results as the current ICD-9-CM applications?
– How do we ensure continuity of data systems (disease
classification, documentation, reimbursement, education,
and research)?
• Long-term Opportunities
– How do we optimize new ICD10-based applications to
improve disease classification, clinical and epidemiological
research, and claims processing to benefit Audiology and
Speech-Language Pathology?
– Are there opportunities to expand audiology and speechlanguage pathology disease codes?
61
Transition Projects
•
Immediate Priorities
–
–
–
•
Short-term Plans—Replication Phase
–
–
–
–
–
•
Study and understand general equivalence maps identify translational improvements.
Study the reimbursement maps for potential impact on audiology and SLP practices,
especially mapping to unspecified diagnosis codes.
Study the impact of transition by practice setting
Assist audiologists and speech-language pathologists in developing ICD10-based
applications that produces the same results as the current ICD-9-CM application to
ensure continuity of disease classification, documentation, reimbursement, education,
and research
Inventory data systems
Convert data systems to ICD-10-CM
Interim code guideline development
Interim training on ICD-10-CM using multiple venues
Long-term Plans—Optimization Phase
–
–
–
–
Assist audiologists and speech-language pathologists to develop ICD10-based
applications and strategies that take advantage of the new features of ICD-10-CM.
Propose new audiology and SLP codes where necessary
Ongoing code guideline development
Ongoing training
62
Transition Projects
•
•
•
•
•
•
Large providers such as institutions and large hospitals are more likely
to require changes to billing, patient record, reporting, and system
interfaces. There could be hundreds of ICD-9-CM elements that must
be converted.
Small providers such as private practices may rely on ―super-bills‖,
home-grown systems, or encounter forms that may only need minor
updates to accommodate ICD-10-CM.
Cost of conversion will depend on the system integration, size of data
systems, need for outside technical assistance, and number of data
systems to be converted.
Should practices convert immediately to ICD-10-CM; or continue to
maintain ICD-9 based systems and use maps to convert data from ICD10 format to ICD-9 format for legacy applications.
GEMs will probably be permanent features.
Sequencing will depend on major payors such as Medicare convert to
ICD-10-CM. You cannot transition until your major customers convert
their systems and are ready to accept your ICD-10-CM data.
63
References
•
http://www.cdc.gov/nchs/icd/icd10cm.htm
•
http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm
•
http://www.cms.hhs.gov/ICD10/05_Educational_Resources.asp
•
http://edocket.access.gpo.gov/2009/E9-740.htm
•
http://edocket.access.gpo.gov/2009/E9-743.htm
•
http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm
•
http://www.cms.hhs.gov/ICD10/02m_2009_ICD_10_CM.asp#TopOfPage
•
http://www.ahima.org/icd10/icd-10-faqs-all.html#cat3
64
Questions
65
Supplemental Material
Audiology
66
Coding Conductive Hearing Loss
in ICD-10-CM
67
Conductive Hearing Loss
•
Unilateral conductive hearing loss (389.05) coded as H90.1x and
bilateral conductive hearing loss (389.06) coded as H90.0.
– H90.1x Unilateral conductive hearing loss with unrestricted hearing on
opposite side
• H90.11 Conductive hearing loss, right ear
• H90.12 Conductive hearing loss, left ear
– H90.0 Conductive hearing loss, bilateral
•
Specific forms of conductive hearing loss in ICD-9-CM are not
recognized in ICD-10-CM and coded as unspecified conductive HL
(H90.2).
– 389.01 Conductive hearing loss, external ear
– 389.02 Conductive hearing loss, tympanic membrane
– 389.03 Conductive hearing loss, middle ear
– 389.04 Conductive hearing loss, inner ear
68
General Equivalence
for Conductive HL
Forward Equivalence Map:
ICD-9-CM
389.00
389.01
389.02
389.03
389.04
389.05
389.05
389.06
389.08
ICD-10-CM
H90.2
H90.2
H90.2
H90.2
H90.2
H90.11
H90.12
H90.0
H90.2
Backward Equivalence Map:
Map
10000
10000
10000
10000
10000
10000
10000
10000
10000
Specific forms of
conductive HL coded as
unspecified conductive HL
(H90.2)
Bilateral
Right
Left
ICD-10-CM
H90.0
H90.0
H90.0
H90.0
H90.0
H90.0
H90.11
H90.11
H90.11
H90.11
H90.11
H90.11
H90.12
H90.12
H90.12
H90.12
H90.12
H90.12
H90.2
ICD-9-CM
389.06
389.08
389.04
389.03
389.02
389.01
389.08
389.05
389.04
389.03
389.02
389.01
389.05
389.03
389.02
389.08
389.04
389.01
389.00
Map
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
10000
69
Coding Mixed Hearing Loss in
ICD-10-CM
70
General Equivalence
for Mixed Hearing Loss
Forward Equivalence Map:
ICD-9-CM
389.20
389.21
389.21
389.22
ICD-10-CM
H90.8
H90.71
H90.72
H90.6
Map
00000
10000
10000
00000
Backward Equivalence Map:
ICD-10-CM
H90.6
H90.71
H90.72
H90.8
ICD-9-CM
389.22
389.21
389.21
389.20
Map
00000
10000
10000
00000
71
Mixed Hearing Loss
• Mixed hearing loss has some of the few direct
equivalences in Chapter 8.
• Mixed hearing loss NOS (389.20) has a direct equivalence
to H90.8 (Unspecified Mixed Conductive and
Sensorineural Hearing Loss)
• Bilateral mixed hearing loss (389.22) has a direct
equivalence to H90.6
• Unilateral mixed hearing loss coded as:
– H90.71 Mixed hearing loss, right ear
– H90.72 Mixed hearing loss, left ear
72
Coding Vestibular Disorders in
ICD-10-CM
73
Vestibular and Balance Disorders
•
•
•
•
•
•
•
H81.0
H81.1
H81.2
H81.31
H81.39
H81.4
H82
• H83
Meniere’s Disease
BPPV
Vestibular neuronitis
Aural vertigo
Other peripheral vertigo (otogenic vertigo)
Central vertigo
Vertiginous syndromes (code first
underlying disease)
Labyrinthitis
74
Other Balance Codes
• R29.6 Repeated falls
• R42 Dizziness and giddiness
• 379.5x Series Nystagmus Codes:
–
–
–
–
–
H55.00 Unspecified nystagmus
H55.01 Congenital nystagmus (379.51)
H55.02 Latent nystagmus (379.52)
H55.04 Dissociated nystagmus (379.55)
H55.09 Other forms of nystagmus. Includes other
nystagmus (379.56) and nytsagmus associated
with vestibular disorders (379.54)
– H55.81 Saccadic eye movements (379.57)
– H55.89 Other irregular eye movements. Includes
other irregular eye movements (379.59) and
smooth pursuit deficits (379.58)
75
Vestibular and Balance Disorders
• H83.2 Labynthine Disorders
–
–
–
–
H83.2x1 Labyrinthine dysfunction, right ear
H83.2x2 Labyrinthine dysfunction, left ear
H83.2x3 Labyrinthine dysfunction, bilateral
H83.2x9 Labyrinthine dysfunction, unspecified ear
• No representation for hyperactive and
hypoactive labyrinth (386.51-386.58).
– Mapped to H83.2x9 (labyrinthine dysfunction, unspecified
ear)
76
Other Disorders in ICD-10-CM
77
Factors Influencing Health Status
and Contact with Health services
•
•
Z00-Z99 codes represent reasons for encounters. A
corresponding procedure code must accompany a Z code if a
procedure is performed. Occasions when circumstances other
than a disease, injury or external cause is recorded as a
"diagnosis" or "problem".
This can arise in two main ways:
– When a person who may or may not be sick encounters the health
services for some specific purpose, such as to receive limited care
or service for a current condition, to donate an organ or tissue, to
receive prophylactic vaccination (immunization), or to discuss a
problem which is in itself not a disease or injury.
– When some circumstance or problem is present which influences
the person's health status but is not in itself a current illness or
injury.
78
Reasons for Encounter
•
Z01.10 Encounter for examination of ears and hearing without
abnormal findings
– Encounter for examination of ears and hearing NOS
•
Z01.11 Encounter for examination of ears and hearing with
abnormal findings
– Z01.110 Encounter for hearing examination following failed hearing
screening
– Z01.118 Encounter for examination of ears and hearing with other abnormal
findings
– Use additional code to identify abnormal findings
•
Z02.1 Encounter for pre-employment examination
•
Z02.3 Encounter for examination for recruitment to armed forces
•
Z02.71 Encounter for disability determination
•
Z13.5 Encounter for screening for eye and ear disorders
79
Fitting and Adjustment
• Z46 Encounter for fitting and adjustment of other
devices
• Z46.1 Encounter for fitting and adjustment of
hearing aid
• Z45.3 Encounter for adjustment and management
of implanted devices of the special senses
– Z45.32 Encounter for adjustment and management of
implanted hearing device
– Z45.320 Encounter for adjustment and management of bone
conduction device
– Z45.321 Encounter for adjustment and management of
cochlear device
– Z45.328 Encounter for adjustment and management of other
implanted hearing device
80
Other History Codes
• Z82.2 Family history of deafness and hearing loss
– Conditions classifiable to H90-H91
• V41.2 Problems with hearing is mapped as H91.90
• V41.3 Other ear problems is mapped as H93.90
• Z86.69 Personal history of other diseases of the
nervous system and sense organs
• F80.4 Speech and language development delay
due to hearing loss
– Code also type of hearing loss (H90.-, H91.-)
81
Presence of Devices
• Z96.2 Presence of otological and audiological
implants
– Z96.20 Presence of otological and audiological implant,
unspecified
– Z96.21 Cochlear implant status
– Z96.22 Myringotomy tube(s) status
– Z96.29 Presence of other otological and audiological
implants
• Presence of bone-conduction hearing device
• Presence of eustachian tube stent
• Stapes replacement
• Z97 Presence of other devices
• Z97.4 Presence of external hearing-aid
82
Supplemental Material
Speech-Language Pathology
83
Coding Aphasia and Dysarthria in
ICD-10-CM
84
Aphasia and Dysarthria
• Symptoms and signs involving speech and voice
(R47-R49)
• R47 Speech disturbances, not elsewhere
classified
– Excludes1: autism (F84.0), cluttering (F98.8), specific
developmental disorders of speech and language
(F80.-), stuttering [stammering] (F98.5)
– R47.0 Dysphasia and aphasia
– R47.01 Aphasia
• Excludes1: aphasia following cerebrovascular disease (I69. with
final characters -20) progressive isolated aphasia (G31.01)
– R47.02 Dysphasia
• Excludes1: dysphasia following cerebrovascular disease (I69.
with final characters -21)
– R47.1 Dysarthria and anarthria
85
GEM for Aphasia and Dysarthria
• There is a direct equivalence for aphasia
(digit=0).
• Dysphasia and dysarthria (other speech
disturbances) have plausible translations
(digit=1)
• Forward equivalence map:
ICD-9-CM
784.3
784.5
784.5
ICD10-CM
R47.01
R47.02
R47.1
Map
00000
10000
10000
86
Coding Speech, Voice, and Resonance
Disorders in ICD-10-CM
87
Speech, Voice, and Resonance
•
•
Speech, voice, and resonance disorders map direclty to the 784 series
in ICD-9-CM.
Examples:
ICD-10-CM
R47.01
R47.02
R47.1
R47.81
R48.0
R48.1
R48.2
R49.0
R49.1
R49.21
R49.22
Descriptor
Aphasia
Dysphasia
Dysarthria
Slurred speech
Dyslexia and alexia
Agnosia
Apraxia
Dysphonia
Aphonia
Hypernasality
Hyponalsaity
ICD-9-CM
784.3
784.5
784.5
784.5
784.61
784.69
784.69
784.49
784.41
784.49
784.49
Descriptor
Aphasia
Other speech disturbance
Other speech disturbance
Other speech disturbance
Alexia and dyslexia
Other symbolic dysfucntion
Other symbolic dysfucntion
Other voice disturbance
Aphonia
Other voice disturbance
Other voice disturbance
88
Speech Disturbances
• R48 Dyslexia and other symbolic dysfunctions,
not elsewhere classified
– Excludes1: specific developmental disorders of scholastic
skills (F81.-)
• R48.0 Dyslexia and alexia
• R48.1 Agnosia Astereognosia (astereognosis)
– Autotopagnosia
• R48.2 Apraxia
– Excludes1: apraxia following cerebrovascular disease (I69.
with final characters -90)
• R48.8 Other symbolic dysfunctions
• R48.9 Unspecified symbolic dysfunctions
(Acalculia, Agraphia)
89
Other Speech Disturbances
• R47.8 Other speech disturbances
– R47.81 Slurred speech
– R47.89 Other speech disturbances
– R47.9 Unspecified speech disturbances
• Forward equivalence map:
ICD-9-CM
784.5
784.5
ICD-10-CM
R47.81
R47.89
Map
10000
10000
90
Coding Laryngeal and Pharyngeal
Disorders in ICD-10-CM
91
Vocal Fold Disorders
•
J38 Diseases of vocal cords and larynx, not elsewhere classified
–
–
•
•
•
•
Use additional code to identify: exposure to environmental tobacco smoke (Z58.7),
exposure to tobacco smoke in the perinatal period (P96.81), history of tobacco use
(Z87.82), occupational exposure to environmental tobacco smoke (Z57.31), tobacco
dependence (F17.-), tobacco use (Z72.0) .
Excludes1: congenital laryngeal stridor (P28.89), obstructive laryngitis (acute) (J05.0)
,postprocedural subglottic stenosis (J95.5), stridor (R06.1), ulcerative laryngitis (J04.0)
J38.00 Paralysis of vocal cords and larynx, unspecified
J38.01 Paralysis of vocal cords and larynx, unilateral
J38.02 Paralysis of vocal cords and larynx, bilateral
J38.1 Polyp of vocal cord and larynx
–
Excludes1: adenomatous polyps (D14.1)
•
•
J38.2 Nodules of vocal cords
J38.3 Other diseases of vocal cords (e.g. abscess of vocal cords, cellulitis of
vocal cords, granuloma of vocal cords, leukokeratosis of vocal cords,
leukoplakia of vocal cords)
•
NOTE THE ABSENCE OF LATERALITY
92
Laryngeal/Pharyngeal Disorders
•
J38.4 Edema of larynx
–
•
•
•
•
J38.5 Laryngeal spasm
J38.6 Stenosis of larynx
J38.7 Other diseases of larynx (e.g. abscess of larynx, cellulitis of larynx, disease of larynx
NOS, necrosis of larynx, pachyderma of larynx, perichondritis of larynx Ulcer of larynx)
J39 Other diseases of upper respiratory tract
–
•
Excludes2: chronic pharyngitis (J31.2), ulcerative pharyngitis (J02.9)
J39.3 Upper respiratory tract hypersensitivity reaction, site unspecified
–
•
•
Excludes1: peritonsillar abscess (J36)
J39.1 Other abscess of pharynx (cellulitis of pharynx, nasopharyngeal abscess)
J39.2 Other diseases of pharynx (cyst of pharynx, edema of pharynx)
–
•
Excludes1: acute respiratory infection NOS (J22), acute upper respiratory infection (J06.9), upper
respiratory inflammation due to chemicals, gases, fumes or vapors (J68.2)
J39.0 Retropharyngeal and parapharyngeal abscess
–
•
•
Excludes1: acute obstructive laryngitis [croup] (J05.0), edematous laryngitis (J04.0)
Excludes1: hypersensitivity reaction of upper respiratory tract, such as: extrinsic allergic alveolitis
(J67.9), pneumoconiosis (J60-J67.9)
J39.8 Other specified diseases of upper respiratory tract
J39.9 Disease of upper respiratory tract, unspecified
93
GEM for Laryngeal/Pharyngeal Disorders
ICD-9-CM
478.20
478.21
478.22
478.24
478.25
478.26
478.29
478.30
478.31
478.32
478.33
478.34
478.4
478.5
478.6
478.70
478.71
478.74
478.75
478.79
Descriptor
Pharyngeal disease NOS
Pharyngeal cellulitis
Pharyngeal abscess
Retropharyngeal abscess
Edema of pharynx
Pharyngeal cyst
Other pharyngeal disease
Vocal fold paralysis NOS
Vocal fold paralysis, unilateral partial
Vocal fold paralysis, unilateral complete
Vocal fold paralysis, bilateral complete
Vocal fold paralysis, bilateral complete
Vocal Polyp
Other vocal fold disease
Laryngeal edema
Disease of larynx NOS
Laryngeal cellulitis
Laryngeal stenosis
Layngeal spasm
Other laryngeal disease
ICD-10-CM
J39.2
J39.1
J39.0
J39.0
J39.2
J39.2
J39.2
J38.00
J38.01
J38.01
J38.02
J38.02
J38.1
J38.3
J38.4
J38.7
J38.7
J38.6
J38.5
J38.7
Map
10000
10000
10000
10000
10000
10000
10000
00000
10000
10000
10000
10000
00000
10000
00000
10000
10000
00000
00000
10000
94
Coding Sequelae of Non-traumatic
Brain Cerebrovascular Disease
in ICD-10-CM
95
I69 Sequelae of Non-traumatic
cerebrovascular disease
•
This category is to be 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.
–
•
•
Excludes1: personal history of cerebral infarction without residual deficit
(Z86.73), personal history of prolonged reversible ischemic neurologic
deficit (PRIND) (Z86.73), personal history of reversible ischemic
neurologcial deficit (RIND) (Z86.73), sequelae of traumatic intracranial
injury (S06.-), transient ischemic attack (TIA) (G45.9)
Replaces the concept of “late effects”.
Categories include the following sequelae:
–
–
–
–
–
–
Unspecified deficits
Cognitive deficits
Speech and language deficits
Aphasia
Dysphasia
Other speech and language deficits (e.g. dysarthria)
96
Categories of Non-traumatic
Brain Disease
• I69.0 Sequelae of nontraumatic subarachnoid
hemorrhage
• I69.1 Sequelae of nontraumatic intracerebral
hemorrhage
• I69.2 Sequelae of other nontraumatic intracranial
hemorrhage
• I69.3 Sequelae of cerebral infarction
• I69.8 Sequelae of other cerebrovascular diseases
• I69.9 Sequelae of unspecified cerebrovascular
diseases
97
GEM for Late Effects of
Cerebrovascular Disease
ICD-9-CM
438.0
438.10
438.11
438.12
438.19
438.81
438.82
Descriptor
Cognitive deficits
Speech and language deficits
Aphasia
Dysphasia
Other speech/language deficits
Apraxia
Dysphagia
ICD-10-CM
I69.91
I69.928
I69.920
I69.921
I69.928
I69.990
I69.991
Map
00000
10000
00000
00000
10000
00000
00000
98
Coding Sequelae of Traumatic
Brain Injury in ICD-10-CM
99
Sequelae of Skull Fracture
• S02 Fracture of skull and facial bones
– Code also any associated intracranial injury (S06.-)
– A fracture not indicated as open or closed should be coded
as closed
• The appropriate 7th character is to be added to
each code from category S02.
–
–
–
–
–
–
A initial encounter for closed fracture
B initial encounter for open fracture
D subsequent encounter for fracture with routine healing
G subsequent encounter for fracture with delayed healing
K subsequent encounter for fracture with nonunion
S sequela
100
Sequelae of Intracranial Injury
• S06 Intracranial injury
– Code also any associated: open wound of head (S01.-), skull
fracture (S02.-)
– Excludes1: head injury NOS (S09.90)
• Stratified by loss of consciousness. Examples:
– S06.0x1 Concussion with loss of consciousness of 30
minutes or less (mild TBI)
– S06.0x2 Concussion with loss of consciousness of 31
minutes to 59 minutes (moderate TBI)
• The appropriate 7th character is to be added to
each code from category S06
– A initial encounter
– D subsequent encounter
– S sequela
101
Organization of Intracranial Injuries
S06.0 Concussion
S06.1 Traumatic cerebral edema
S06.2 Diffuse traumatic brain injury
S06.3 Focal traumatic brain injury
S06.31 Contusion and laceration of right cerebrum
S06.32 Contusion and laceration of left cerebrum
S06.33 Contusion and laceration of cerebrum, unspecified
S06.34 Traumatic hemorrhage of right cerebrum
S06.35 Traumatic hemorrhage of left cerebrum
S06.36 Traumatic hemorrhage of cerebrum, unspecified
S06.37 Contusion, laceration, and hemorrhage of cerebellum
S06.38 Contusion, laceration, and hemorrhage of brainstem
S06.4 Epidural hemorrhage
S06.5 Traumatic subdural hemorrhage
S06.6 Traumatic subarachnoid hemorrhage
S06.8 Other intracranial injuries
S06.9 Unspecified intracranial injury
S07 Crushing injury of head
S09 Other and unspecified injuries of head
102
Other Disorders in ICD-10-CM
103
Food and Fluid Intake
•
R63 Symptoms and signs concerning food and fluid intake
–
•
R63.0 Anorexia
–
•
•
•
Excludes1: excessive weight gain in pregnancy (O26.0-), obesity (E66.-)
R63.6 Underweight
–
–
•
Excludes1: feeding problems of newborn (P92.-), infant feeding disorder of nonorganic
origin (F98.2-)
R63.4 Abnormal weight loss
R63.5 Abnormal weight gain
–
•
Excludes1: anorexia nervosa (F50.0-), loss of appetite of nonorganic origin (F50.8)
R63.1 Polydipsia
R63.2 Polyphagia
R63.3 Feeding difficulties
–
•
•
Excludes1: bulimia NOS (F50.2), eating disorders of nonorganic origin (F50.-),
malnutrition (E40-E46)
Use additional code to identify body mass index (BMI), if known (Z68.-)
Excludes1: abnormal weight loss (R63.4), anorexia nervosa (F50.0-), malnutrition
(E40-E46)
R63.8 Other symptoms and signs concerning food and fluid intake
104
Factors Influencing Health Status
and Contact with Health services
•
•
Z00-Z99 codes represent reasons for encounters. A
corresponding procedure code must accompany a Z code if a
procedure is performed. Occasions when circumstances other
than a disease, injury or external cause is recorded as a
"diagnosis" or "problem".
This can arise in two main ways:
– When a person who may or may not be sick encounters the health
services for some specific purpose, such as to receive limited care
or service for a current condition, to donate an organ or tissue, to
receive prophylactic vaccination (immunization), or to discuss a
problem which is in itself not a disease or injury.
– When some circumstance or problem is present which influences
the person's health status but is not in itself a current illness or
injury.
105
Family History
• Z80 Family history of primary malignant
neoplasm
• Z80.8 Family history of malignant
neoplasm of other organs or systems
– Conditions classifiable to C00-C14, C40-C49,
C69-C79
• Z80.1 Family history of malignant
neoplasm of trachea, bronchus and lung
– Conditions classifiable to C33-C34
106
Personal History
•
Z85 Personal history of primary and secondary malignant
neoplasm
–
–
–
•
•
Z85.01 Personal history of primary malignant neoplasm of
esophagus
Z85.1 Personal history of primary malignant neoplasm of trachea,
bronchus and lung
–
•
•
•
Code first any follow-up examination after treatment of malignant neoplasm (Z08)
Use additional code to identify: alcohol use and dependence (F10.0-), exposure to
environmental tobacco smoke (Z58.7), history of tobacco use (Z87.82), occupational
exposure to environmental tobacco smoke (Z57.31), tobacco dependence (F17.-),
tobacco use (Z72.0)
Excludes2: personal history of benign neoplasm (Z86.01-), personal history of
carcinoma-in-situ (Z86.00-)
Conditions classifiable to C33-C34
Z85.21 Personal history of primary malignant neoplasm of larynx
Z85.810 Personal history of primary neoplasm of tongue
Z85.818 Personal history of primary neoplasm of lip, oral cavity,
and pharynx
107
Reasons for Encounters
• Z43.0 Encounter for attention to
tracheostomy
• Z44 Encounter for fitting and adjustment
of external prosthetic device
– Includes: removal or replacement of external
prosthetic device
– Excludes1: malfunction or other complications of
device - see Alphabetical Index presence of
prosthetic device (Z97.-)
• Z44.8 Encounter for fitting and adjustment
of other external prosthetic devices
108
Other Problems Codes
• V40.1 Problems with communication mapped as
F80.9 Developmental disorder of speech or
language, unspecified
– Note: All communciaiton problems are mapped as
developmental.
• V41.4 Problems with voice mapped as R47.89
Other speech disturbances
– Note: Voice problems are mapped as speech problems.
• V41.16 Problems with swallowing and mastication
is mapped as R13.10 Unspecified dysphagia.
109
Reasons for Encounter
• Z45 Encounter for adjustment and management
of implanted device
• Z45.89 Encounter for adjustment and
management of other implanted devices
• Z46 Encounter for fitting and adjustment of other
devices
• Z46.1 Encounter for fitting and adjustment of
hearing aid
• Z46.89 Encounter for fitting and adjustment of
other specified devices
• Z51.89 Encounter for other specified aftercare
– NOTE: There is no specific code for care involving
rehabilitative procedure (V57.3)
110
Prosthetic Devices
•
•
•
•
•
Z96 Presence of other functional implants
Z96.3 Presence of artificial larynx
Z97.4 presence of external hearing aid
Z97.8 Presence of other specified devices
Z99 Dependence on enabling machines
and devices, not elsewhere classified
– Z99.1 Dependence on respirator or ventilator
– Z99.11 Dependence on respirator [ventilator]
status
111