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Download Specific Areas of Change ICD-9 to ICD-10-CM
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Presented by: Dorothy D. Steed, CCS, CPC-H, CPCO, CPUM, CPUR, CPHM, CPMA, ACS-OP, CCS-P, RCC, RMC, CEMC, CPC-I, CFPC, PCS, FCS, CPAR AHIMA Approved ICD-10-CM & CM/PCS Trainer ICD-9-CM ICD-10-CM Three to five characters Three to seven characters First digit is numeric but can be alpha First character always alpha (E or V) 2–5 are numeric All letters used except U Always at least three digits Character 2 always numeric: 3–7 can be alpha or numeric Decimal placed after the first three characters (or with E codes, placed after the first four characters) Always at least three digits Alpha characters are not casesensitive Decimal placed after the first three characters Alpha characters are not casesensitive 2 Alpha (Except U) M A X S X 0 X 2 Category 2 Numeric 3-7 Numeric or Alpha . X 6 X 5 X x Etiology, anatomic site, severity 3–7 Characters Additional Characters A X Added 7th character for obstetrics, injuries, and external causes of injury 3 Coding and Use of Seventh Character •Obstetrics •Injury •External cause •Either alpha or numeric •Placeholder X •Meanings vary 4 Injury and External Cause Identifies Injury Initial – Receiving active treatment Subsequent – Sequela – Receiving Complications routine care or conditions during healing arising as or recovery result of a (after active condition treatment) Aftercare Z codes are not used for aftercare for injuries Combination codes for poisonings and external cause (accidental, intentional self-harm, assault, undetermined) Chapter 15 – represents fetus in multiple gestation affected by condition being coded 5 Includes diseases generally recognized as communicable or transmissible Use additional code to identify resistance to antimicrobial drugs (Z16) New section called infections with a predominantly sexual mode of transmission (A50–A64) A primary malignant neoplasm overlapping two or more contiguous (next to each other) sites should be classified to the subcategory/code .8 (overlapping lesion), unless the combination is specifically indexed elsewhere. For multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast, codes for each site should be assigned. Diabetes Combination codes No longer classified as controlled or uncontrolled Inadequately, out of control or poorly controlled coded by type with hyperglycemia Body Mass Index Report when coding for obesity Unique codes for alcohol and drug use, abuse, and dependence Continuous or episodic no longer classified History of drug or alcohol dependence coded as “in remission” Combination codes Blood alcohol level (Y90.-) Coding Note: ICD-10-CM provides a code to indicate blood alcohol level. Under the category F10, there is a "use additional code" note for blood alcohol level. Blood alcohol level can be indexed in the Index to External Causes Epilepsy terminology updated Localization-related idiopathic Generalized idiopathic Special epileptic syndromes Provides specificity for Seizures of localized onset Complex partial seizures Intractable Status epilepticus New chapters in ICD-10-CM No longer included in Nervous section Concept of laterality Right Left Bilateral Unspecified If bilateral is not available, assign code for right and left Chapter note states to use an external cause code following the code for ear condition, if applicable to identify the cause of the ear condition. Type of hypertension not used as an axis Acute MI codes changed from 8 weeks to 4 weeks or less AMI I21 – Initial AMIs I22 – Subsequent AMIs • A code from category I22 must be used in conjunction with a code from category I21. • Category I22 is never used alone. • The sequencing of the I22 and I21 codes depends on the circumstances of the encounter Patient admitted with AMI Previous MI? I21 – Initial MI No I21 – Initial MI Yes Yes Older than 28 days? No I25.2 – Old MI I22 – Subsequent MI I21 – Initial MI Note: Sequencing depends on circumstances of admission 13 New terminology for asthma Respiratory condition in more than 1 site (not specifically indexed) classified to lower anatomic site Coding Note: In the Tabular there is an Excludes2 note under category J45 for asthma with chronic obstructive pulmonary disease. By definition, when an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together if the patient has both conditions at the same time Teaching Tip: Discuss the stages of intermitent, mild persistent, moderate persistent, and severe persistent asthma. The following table provides one comparison in children. Asthma Severity Intermittent Frequency of Daytime Symptoms Less than or equal to 2 times per week Mild Persistent More than 2 times per week Moderate Persistent Daily. May restrict physical activity Severe Persistent Throughout the day. Frequent severe attacks limiting ability to breathe. 15 Source: Worldallergy.org Coding Note: Hernia with both gangrene and obstruction is classified to Hernia with gangrene. Coding Note: ICD-10-CM provides combination codes for complications commonly associated with Crohn’s disease. These combination codes can be found under subcategory K50.0 Pressure ulcers Site, laterality, and severity specified in single code Severity identified as stage 1–4 Non-pressure chronic ulcers Site, laterality, and severity Important note – category L97 Spontaneous rupture Occurs when normal force is applied to tissues that are inferred to have less than normal strength Fragility fracture Sustained with trauma no more than a fall from a standing height or less occurring under circumstances that would not cause a fracture in a normal healthy bone Coding Note:ICD-10-CM has three different categories for pathologic fractures – due to neoplastic disease, due to osteoporosis, and due to other specified disease. Pathological or Stress Fracture Seventh Characters A • Initial encounter D • Subsequent – routine healing G • Subsequent – delayed healing K • Subsequent – nonunion P • Subsequent – malunion S • Sequela Genitourinary System Additional Codes Required N17 • Code also underlying condition N18 • Code first etiology N30 • Additional code infectious agent N31 • Additional code urinary incontinence N33 • Code first underlying disease N40.1 • Additional code for associated symptoms 20 Trimester axis of classification rather than episode of care Not all conditions include codes for all 3 trimesters Trimesters 1st Less than 14 weeks 0 days 2nd 14 weeks 0 days to less than 28 weeks 0 days 3rd 28 weeks 0 days until delivery Codes from this chapter are for use only on maternal records, never on newborn records Codes from this chapter are for use for conditions related to or aggravated by the pregnancy, childbirth, or by the puerperium (maternal causes or obstetric causes) Category Z3A – Weeks of Gestation, added to identify specific week of pregnancy Abortion vs. fetal death 20 weeks instead of 22 Early vs. late vomiting 20 weeks instead of 22 Preterm labor 37 completed weeks of gestation Numbered by order of delivery Coding Note: ICD-10-CM provides a combination code for obstructed labor incorporating the obstructed labor with the reason for the obstruction into one code. Codes from this chapter are for use on newborn records only, never on maternal records and include conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs later For use when the listed maternal conditions are specified as the cause of confirmed morbidity or potential morbidity that have their origin in the perinatal period For use for newborns who are suspected of having an abnormal condition resulting from exposure from the mother or the birth process, but without signs or symptoms, and which after examination and observation, is found not to exist May be used even if treatment is begun for a suspected condition that is ruled out When both birth weight and gestational age of the newborn are available, both should be coded with birth weight sequenced before gestational age. When no unique code is available, assign additional code(s) for any manifestations When the code assignment specifically identifies the malformation, deformation, or chromosomal abnormality, manifestations that are an inherent component of the anomaly should not be coded separately Additional codes should be assigned for manifestations that are not an inherent component If congenital malformation has been corrected, a personal history code used Although present at birth, abnormality may not be identified until later in life, and if diagnosed by physician, assign a code from codes Q00-Q99 Primarily for use by trauma Coma Scale Used with traumatic brain injury or sequelae of cerebrovascular disease codes registries and research use, but may be used in any setting Sequenced after the diagnosis code(s) One from each subcategory (R40.21, R40.22, R40.23) needed Seventh character indicates when - should 0recorded Unspecified time match 1 In field (EMT or ambulance) 2 At arrival to ER 3 At hospital admission 4 24 hours after admission Codes identify SIRS of non- SIRS Category R65 infectious origin with and without acute organ dysfunction and severe sepsis with and without septic shock Instructional note indicates underlying condition or infection should be coded first Sepsis not classified to R65 coded to infection. e.g., A41.9 assigned for sepsis, unspecified 28 Encompasses 2 alpha characters S Injuries related to body region T Injuries to unspecified region Poisonings, external causes Note: Use secondary code(s) from Chapter 20 to indicate cause of injury Codes within T section that include the external cause do not require an additional external cause code 29 Fractures Greater specificity Type of fracture Specific anatomical site Displaced vs nondisplaced Laterality Routine vs delayed healing Nonunion Malunion Type of encounter Initial Subsequent Sequela 30 Fracture Seventh Character 31 A – Initial closed B – Initial open D– Subsequent routine G– Subsequent delayed K– Subsequent nonunion P– Subsequent malunion S - Sequela Fractures 32 Some fracture categories provide for seventh characters to designate the specific type of open fracture based on the Gustilo open fracture classification A fracture not indicated as displaced or nondisplaced should be coded to displaced A fracture not designated as open or closed should be coded to closed Initial encounter The patient is receiving active treatment for the condition Surgical treatment Emergency department encounter Evaluation and treatment by a new physician 33 Subsequent encounter After patient received active treatment for the condition and receiving routine care during healing or recovery phase Cast change or removal Removal of external or internal fixation device Medication adjustment Other aftercare and follow-up visits following injury treatment 34 Sequela Complications or conditions that arise as a direct result of a condition Scar formation after burn Use both the injury code that precipitated sequela and code for sequela S added only to injury code, not sequela code S identifies injury responsible for sequela Specific type of sequela (like scar) sequenced first, followed by injury code 35 Poisoning, Adverse Effect, Underdose 36 Poisoning Adverse effect Overdose of substances Wrong substance given or taken in error “Hypersensitivity,” “reaction,” or correct substance properly administered Underdosing Taking less of medication than is prescribed or instructed by manufacturer either inadvertently or deliberately Poisoning, Adverse Effect, Underdose 37 Use additional code(s) for manifestations of poisoning Assign code for the nature of the adverse effect followed by code for the drug Use additional code for intent of underdosing: Failure in dosage during medical and surgical care (Y63.61, Y63.8-Y63.9) Patient's underdosing of medication regime (Z91.12-, Z91.13-) Poisoning, Adverse Effect, Underdose 38 Combination codes for poisonings/ external cause (accidental, intentional self-harm, assault, undetermined) Table of Drugs and Chemicals groups all poisoning columns together Followed by adverse effect and underdosing When no intent of poisoning is indicated, code to accidental Undetermined intent is only for use when there is specific documentation in record that intent cannot be determined External cause code may be used with any code in range A00.0-T88.9, Z00-Z99, that is health condition due to external cause Encompasses alpha characters V, W, X, and Y Assign external cause code, with appropriate seventh character for each encounter for which injury or condition is being treated Initial encounter Subsequent encounter Sequela Use additional code to identify Airbag injury (W22.1) Type of street or road (Y92.4-) Use of cellular telephone at time of transport accident (Y93.C-) Assign Y99, External cause status, to indicate work status Military activity Non-military person was at work An individual including a student or volunteer was involved in a non-work activity Assign with other external cause codes, such as transport accidents and falls Are not applicable to poisonings, adverse effects, misadventures, or late effects Do not assign a code from category Y99 if no other external cause codes (cause, activity) are applicable for the encounter Do not assign code Y99.9, Unspecified external cause status, if status is not stated Coding Note: The seventh character must always be the seventh character in the data field. If a code that requires a seventh character is not six characters, a placeholder X must be used to fill in the empty characters. Questions? Thank you! Resources: ICD-10-CM AHIMA ICD-10-CM Training Program
