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Combination Codes
HS317b – Coding &
Classification of Health Data
Combination Codes
Dagger/Asterisk Dual Combination
 Combination Code
 Two codes to explain disease process

 Diagnosis
Type 3
Possible combinations
Infections
 Pneumonia
 Septicemia
 HIV
 Musculoskeletal

Infection Dual Combination

Identify infectious organism & manifestation in a
local system chapter.
 Both
must be used together
 Example: Ms. B was diagnosed with a candidial
infection of the vulva and vagina


B37.3† Candidiasis of vulva and vagina (N77.1*)
N77.1* Vaginitis, vulvitis and vulvovaginitis in infectious and
parasitic diseases classified elsewhere
Infection Combination Code
One code will indicate manifestation and
organism
 Example:

 Patient
was diagnosed with streptococcal
pharyngitis

J02.0 Streptococal pharyngitis
Infection – Two Codes
Use two codes to identify disease and
infectious organism
 Example: patient was confirmed to have
acute cystitis caused by E.Coli

 N30.0 Acute
Cystitis
 B96.2(3) Escherichia coli
 (any
Dx between B95-B97 = Dx Type 3)
Human Immunodeficiency Virus
MRDx must be B24 HIV disease
 Manifestation that is being treated will be
sequenced immediately following B24

 B24
HIV
 F02.4* Dementia in human immunodeficiency
virus [HIV] disease
HIV Mutually Exclusive
B24
Human immunodeficiency virus
[HIV] disease (never use Dx Type 2)
 Z21 asymptomatic human
immunodeficiency virus [HIV] infection
status
 R75 nonconclusive serologic evidence of
HIV

Anemia & Neoplasms

D63.0* Anaemia in neoplastic disease
(C00-D48†)
 Use
only if anemia is unspecified.
Pneumonia & COPD
Combination Code
 Patient comes into hospital with COPD
and pneumonia (or any other acute lower
respiratory tract infection)

 J44.0
Chronic obstructive pulmonary disease
with acute lower respiratory infection
FYI - COPD




J44.0
Chronic obstructive pulmonary disease
with acute lower respiratory infection
J44.1
Chronic obstructive pulmonary disease
with acute exacerbation, unspecified
J44.8
Other specified chronic obstructive
pulmonary disease
J44.9
Chronic obstructive pulmonary
disease, unspecified
Pneumonia & COPD
 When
infection is a significant condition in its
own right an additional code must be used to
specify the type of infection for
epidemiological purposes. The condition
must be assigned to a diagnosis type 1
 J18.9 (1) Pneumonia, unspecified
Example
A 68 year old man with severe COPD
contracted the common cold. His
condition worsened and he was admitted.
Chest X-ray revealed pneumonia. He was
subsequently admitted for COPD
exacerbation and pneumonia.
Example
M
- J44.0 Chronic obstructive pulmonary
disease with acute lower respiratory infection
 1 - J18.9
Pneumonia, unspecified
Sepsis & Pneumonia
Patient was being treated in ICU for
pneumonia and staphylococcus aureus
septicemia
 Folio lookup – pneumonia – septicemia
 septicemia A41
J17.0* (note: even though
A41 does not have a dagger it is considered a
dagger/asterisk relationship)
Lobar Pneumonia

Lobar pneumonia = when pneumonia is
documented as complete consolidation of an
entire lobe.
 Apical,

basilar and massive
J18.1 Lobar pneumonia, unspecified when
organism is unknown.
 If
organism identified code to pneumonia with
organism
 Combination Code, i.e. J13 Pneumonia due to
Streptococcus pneumonia
Bronchopneumonia
When inflammation is scattered here and
there throughout the lungs, often with
bilateral involvement.
 Terms: catarrhal, confluent, diffuse,
disseminated (focal), lobular (segmental)
and patchy
 J18.0
Bronchopneumonia, unspecified

ARDS & Respiratory Failure

Acute respiratory failure (J96.0) is an
inherent part of the J80 Adult respiratory
distress syndrome.
 Syndrome:
can include sepsis, systemic
inflammatory response syndrome
 One code J80 needs to be coded
Mechanical Ventilation
Mandatory to code if duration is > 96
hours.
 Indicate through procedure code with
attribute ‘extended’ for > 96 hours

 1.GZ.31.CA-ND
– - EX
Bleeding Esophageal Varices

Patient with known alcoholic cirrhosis of
the liver admitted with bleeding
esophageal varices
Bleeding Esophageal Varices
Varix
 esophagus (ulcerated) I85.9
 – – bleeding I85.0
 – – congenital Q27.8
 – – in (due to)
 – – – alcoholic liver disease K70† I98.2*
 – – – cirrhosis of liver K74† I98.2*
 – – – schistosomiasis B65 I98.2*
 – – – toxic liver disease K71† I98.2*
K70.3 Alcoholic cirrhosis of liver
 I98.2* Oesophageal varices in diseases
classified elsewhere
 K92.0 Haematemesis

Gastrointestinal Bleeding
Look for combination codes
 If no combination, code disease and add
as Diagnosis type 3:
 K92.0 Haematemesis
 K92.1 Melena
 K92.2 Gastrointestinal haemorrhage,
unspecified

Pathological Fractures
No known traumatic injury
 Documented as a result of an underlying
disease (neoplasm, osteoporosis, Paget’s
disease or an endocrine disorder)

Fracture
 bone T14.2
 – – in (due to) neoplastic disease NEC
(see also Neoplasm) (8000/1) D48.0†
M90.7*
 M90.7*
Fracture of bone in neoplastic
disease (C00-D48†)
Spinal disease & myopathy
Displacement
-vertebra
 – – lumbar, lumbosacral (with) M51.2
 – – – myelopathy M51.0† G99.2*
 – – – neuritis, radiculitis, radiculopathy or
sciatica M51.1† G55.1*
Sandwiching Codes

Peritonitis due to peritoneal dialysis
catheter exit site infection. The physician
ordered skin and peritoneal fluid cultures
(positive for staphylococcus) to confirm the
cause of the peritonitis
Codes
T85.7 Infection and inflammatory
reaction due to other internal prosthetic
devices, implants and grafts
 K65.9 Peritonitis, unspecified
 B95.3 Streptococcus pneumoniae as the
cause of diseases classified to other
chapters
 Y84.1 Kidney dialysis

Classification based on MRDx
MCC 4 Diseases and Disorder of the
Respiratory System
 MCC 16 Blood and blood forming organs
and Immunological Disorders
 MCC 18 Multisystemic or unspecified site
infections
 MCC 24 HIV Infections (AIDS)

 No
complexity assigned
MCC 4 Respiratory System

Factors that can influence CMG
assignment
 Tuberculosis,
Respiratory Failure or
respiratory infections and inflammations
associated with Cystic Fibrosis
(Dagger/asterisk codes) (CMG 487 CF)
 CMG 135 Tracheostomy
MCC HIV

Assignment of CMG based on
manifestation diagnosis
 Respiratory
Disorders will assign case to
CMG 860 Respiratory Tract Disorders with
HIV
 No complexity level assigned