2012 ICD-10-CM. Your Presenters Today

Transcription

1 2012 ICD-10-CM Session IV: Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99) Chapter 6: Diseases of the Nervous System (G00-G99) Your Presenters Today Barbara Flynn, RHIA, CCS AHIMA Approved ICD-10-CM/PCS Trainer & Ambassador Vice President/Health Information and Denial Management Services Florida Hospital Association Management Corporation 307 Park Lake Circle, Orlando, FL p and Linda Renn, RHIT, CCS, CPC, CPC-H, HITPro TR AHIMA Approved ICD-10-CM/PCS Trainer & Ambassador Vice President, Education & Communications STAT Solutions, Inc. P.O. Box 0397 New Port Richey FL

2 Speaker Introductions Barbara Flynn, RHIA, CCS, is the Vice President for Health Information Management Services and Denial Management Services for the Florida Hospital Association Management Corporation (FHAMC). Barbara joined the professional staff of the Florida Hospital Association (FHA) in January 1991, where she developed service lines to assist member hospitals with HIM staffing, coding and billing compliance, interim management, educationalprograms programs, documentation improvement programs, andinsuranceandrac denial appeals. Barbara developed Denial Management Services in January 2008, to mitigate and assist member hospitals to appeal RAC coding and medical necessity denials. Barbara became an AHIMA ICD 10 CM/PCS Trainer and Ambassador in March Linda L. Renn, RHIT, CCS, CPC, CPC H, HIT Pro TR is the Vice President of Education and Communication for STAT Solutions, Inc. and Professional Outsourcing, Inc. She serves FHIMA as the Advocacy Chair., and she currently holds RHIT, CCS, CPC, CPC H and HIT Pro TR credentials. Additionally, Linda is an AHIMA approved ICD 10 CM/PCS Trainer and Ambassador, as well as a HITECH Trainer from the Office of the National Coordinator. Her 37 years in HIM has led her to work in various roles, domains and clinical aspects of inpatient, outpatient and physician practice settings. 3 Preparation is Your Key to Success Course Objectives Understand the mechanism of the disease process Understand and Apply Chapter-Specific Coding Guidelines for: Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99) Chapter 6: Diseases of the Nervous System (G00- G99) General coding guidelines for specific diagnoses 4 2

3 Preparation is Your Key to Success Course Objectives (continued) Identify the Anatomy, Function and Common Diseases and Disorders of the Nervous System Identify Common Mental and Behavioral Disorders Correctly Assign ICD 10 CM Codes for Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99) Correctly Assign ICD 10 CM Codes for Diseases of the Nervous System (G00-G99) 5 Review Your Understanding of the ICD-10-CM/PCS Compliance Date 6 3

4 CMS Delays ICD-10 Compliance Date by One Year Friday, August 24, 2012 The Centers for Medicare & Medicaid Services (CMS) one-year delay in implementation of ICD-10- CM/PCS to October 1, Applies to both diagnosis and procedure codes - ICD-10-CM and ICD-10-PCS.* 7 Introduction to Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99) 8 4

5 Chapter 5: Terms to Know (F01-F99) Abuse is the problematic use of drugs or alcohol but without dependence. Dependence is the increased tolerance to drugs or alcohol with a compulsion to continue taking the substance despite the cost; withdrawal symptoms often occur upon cessation. Somatoform disorder is a chronic, but fluctuating, neurotic disorder that begins early in life, characterized by recurrent and multiple l somatic complaints for which medical attention is sought, but are not due to any apparent physical illness. 9 Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99) Mental disorders of all types are classified in Chapter 5 of ICD-10-CM Remember Although coding assignments for mental disorders are made according to ICD-10- CM, Psychiatrists ordinarily state diagnoses in accordance with the nomenclature used in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (DSM- IV-TR) (1) 10 5

6 Chapter 5: Categories (F01-F99) Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders contains 11 code families with the first character F and are arranged in the following blocks: F01-F09 Mental disorders due to known physiological conditions F10-F19 Mental and behavioral disorders due to psychoactive substance use F20-F29 Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders Cont 11 Chapter 5: Categories (F01-F99) - F30-F39 Mood [affective] disorders - F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders - F50-F59 F59 Behavioral syndromes associated with physiological disturbances and physical factors - F60-F69 Disorders of adult personality and behavior - F70-F79 Intellectual disabilities - F80-F89 Pervasive and specific developmental disorders - F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence - F99-F99 Unspecified mental disorder 12 6

7 Chapter 5: Category Restructuring (F01-F99) Chapter 5 underwent a number of revisions, including expansion of the number of subchapters and code groupings (i.e., sections, blocks). (1) The next slide illustrates how the ICD-10-CM code families listed contrast with the current ICD-9-CM classifications below: Psychoses Organic psychotic conditions Other psychoses Neurotic disorders, personality disorders, and other nonpsychotic mental disorders Mental retardation 13 Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders ICD 9 CM Psychoses Organic psychotic conditions Other 299 psychoses Neurotic disorders, personality disorders, and other nonpsychotic mental disorders Mental retardation ICD 10 CM F01 F09 Mental disorders due to known physiological conditions F10 F19 F19 Mental and behavioral disorders due to psychoactive substance use F20 F29 Schizophrenia, schizotypal, delusional, and other non mood psychotic disorders F30 F39 Mood [affective] disorders F40 F48 Anxiety, dissociative, stress related, somatoform and other nonpsychotic mental disorders F50 F59 Behavioral syndromes associated with physiological disturbances and physical factors F60 F69 Disorders of adult personality and behavior F70 F79 Intellectual disabilities F80 F89 Pervasive and specific developmental disorders F90 F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence F99 F99 Unspecified mental disorder 14 7

8 Chapter 5: Organizational Adjustments (F01-F99) When comparing ICD-9-CM to ICD-10-CM, some codes have been added, deleted, combined, and moved. The code for tension headache was found in ICD-9- CM chapter 5 under the subchapter Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders ( ). The code for this condition has been moved in ICD-10- CM and is now located in Chapter 6, Diseases of the Nervous System. (1) Cont 15 Chapter 5: Organizational Adjustments (F01-F99) For example: ICD-9-CM Chapter 5. Mental Disorders ( ) 307 Special symptoms or syndromes, not elsewhere classified Pain disorders related to psychological factors Tension headache ICD-10-CM Chapter 6. Diseases of the Nervous System (G00-G99) G44 Other headache syndromes G44.2 Tension-type headache G44.20 Tension type headache, unspecified G44.21 Tension type headache, unspecified, intractable G Tension type headache, unspecified, nonintractable Tension headache NOS 16 8

9 Chapter 5: Organizational Adjustments (F01-F99) For example: (1) ICD-9-CM CM Chapter 5. Mental Disorders ( ) 315 Specific delays in development Developmental speech or language disorder Mixed receptive expressive language disorder Central auditory processing disorder ICD-10-CM Chapter 8. Diseases of the Ear and Mastoid Process (H60-H95) H93 Other disorders of ear, not elsewhere classified H93.25 Central auditory processing disorder Congenital auditory imperception Word deafness 17 Chapter 5: Organizational Adjustments (F01-F99) For example: (1) ICD-9-CM CM Psychogenic dysmenorrhea ICD-10-CM F45.8 Other somatoform disorders Psychogenic dysmenorrhea Psychogenic dysphagia, including globus hystericus Psychogenic pruritus Psychogenic torticollis Somatoform autonomic dysfunction Teeth grinding 18 9

10 Coding Guidance: Pain Disorders Related to Psychological Factors Pain Disorders Related to Psychological Factors (1) Assign code F45.41 for pain that is exclusively psychological. Draft official guidelines state that code F45.41 should be assigned following the appropriate code from category G89 Pain, not elsewhere classified, if a psychological component is documented for a patient with acute or chronic pain. An instructional note at code F45.42 states to code also any associated acute or chronic pain (G89.-) An instructional note at category G89 Pain, not elsewhere classified states to also code related psychological factors associated with pain (F45.42). 19 Coding Guidance: Psychoactive Substance Use, Abuse & Dependence Psychoactive Substance Use, Abuse and Dependence (1) Drug and alcohol l abuse and dependence d codes no longer identify continuous or episodic use. Instead, other data have been identified of greater value of reporting purposes. Combination codes for drug and alcohol use include associated conditions (e.g., withdrawal, sleep disorders and psychosis) Unique classification subcategories exist for specific status: use, abuse, and dependence. History of drug or alcohol dependence is classified as in remission. An additional code is necessary to report blood alcohol level (Y90.-), when documented

11 Coding Guidance: Psychoactive Substance Use, Abuse & Dependence Code block F10-F19 Mental and behavioral disorders due to psychoactive substance use, includes the following code categories. F10 Alcohol related disorders F11 Opioid related disorders F12 Cannabis related disorders F13 Sedative, hypnotic, or anxiolytic related disorders F14 Cocaine related disorders F15 Other stimulant related disorders F16 Hallucinogen related disorders F17 Nicotine dependence F18 Inhalant related disorders F19 Other psychoactive substance related disorders (1) 21 Coding Guidance: Psychoactive Substance Use, Abuse & Dependence Where applicable, sixth-place characters further specify the presence of certain complications, including: Delirium Delusions Hallucinations Perceptual disturbance (1) Cont 22 11

12 Coding Guidance: Psychoactive Substance Use, Abuse & Dependence When the provider documentation refers to use, abuse and dependence of the same psychoactive substance, report only one code as documented, per substance in accordance with the highest degree of clinical hierarchy. In those circumstances where the provider does not document abuse or dependence, the condition is classified to the use subcategory, as appropriate. Substance use may progress to substance abuse, which may result in dependence. Substance use status lies at the lowest severity end of the substance status scale, with dependence at the highest level of severity. (1) 23 Coding Guidance: Psychoactive Substance Use, Abuse & Dependence Excludes 1 notes are listed at each subcategory level, to indicate that use, abuse, and dependence of the same substance (classified within a subcategory) is not allowed. Note that an Excludes 1 notes may be interpreted as not coded here. (1) 24 12

13 Coding Guidance: Psychoactive Substance Use, Abuse & Dependence For example: Diagnosis: Chronic alcohol abuse with dependence F10.20 Alcohol dependence, uncomplicated Since dependence represents a disease progression in severity from abuse to dependence, only the dependence is reported. (1) 25 Coding Guidance: Psychoactive Substance Use, Abuse & Dependence For example: Diagnosis: Cannabis abuse with cannabis-induced anxiety disorder. F Cannabis abuse with cannabis-induced anxiety disorder. Since abuse represents a disease progression in severity from use to abuse, only the abuse is reported. (1) 26 13

14 Coding Guidance: Mental & Behavioral Disorders Due to Psychoactive Substance Use Mental and Behavioral Disorders Due to Psychoactive Substance Use: Codes for psychoactive substance use should only be assigned when supported by provider documentation, and when the substance use meets the definition of a reportable diagnosis. (1) According to coding guidelines, codes F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, and F16.9- should only be reported when the physician documents an association between the psychoactive substance and a mental or behavioral disorder. (2) 27 Coding Guidance: Mental Retardation Mental Retardation: ICD-10-CM instructional notes state a change in sequencing of mental retardation codes (F70-F79) from previous ICD-9-CM instruction. (1) For Example: ICD-9-CM Mental Retardation ( ): Use additional code(s) to identify any associated psychiatric or physical condition ICD-10-CM Mental Retardation (F70-F79): Code first any associated physical or developmental disorders 28 14

15 Coding Guidance: Level of Detail in Coding Chapter 5 As in ICD-9-CM, diagnosis codes are to be used and reported to the highest degree of specificity available. ICD-10-CM provides, in the majority of cases, an exponentially increased level of specificity than ICD-9-CM. In Chapter 5, this code expansion is intended to facilitate identification of specific types or manifestations of disease that are now separately identifiable. 29 Illustration 1: (1) ICD 9 CM ICD 10 CM Sleep arousal disorder F51.3 Sleepwalking [somnambulism] F51.4 Sleep terrors [night terrors] Illustration 2: (2) ICD 9 CM Other isolated or specific phobias ICD 10 CM F Arachnophobia F Other animal type phobia F Fear of thunderstorms F Other natural environmental type phobia F Fear of blood F Fear of infections and transfusions 30 15

16 Coding Guidance: Multiple Coding Instructional notes appear throughout the text to provide sequencing instruction ti when more than one code is necessary to report the diagnosis incompletion. Many codes classified to Chapter 5 either necessitate or require the assignment of more than one code to report the condition in its entirety. (1) 31 Coding Guidance: Multiple Coding For example: F01 Vascular dementia Code first the underlying physiological i l condition or sequelae of cerebrovascular disease F02 Dementia in other diseases classified elsewhere Code first the underlying physiological condition, such as:» Alzheimer s» Cerebral lipidosis (E75.4)» Creutzfeldt-Jakob disease (A81.0-) F04 Amnestic disorder due to known physiological condition Code first the underlying physiological condition 32 16

17 Chapter 5: Mental, Behavioral, & Neurodevelopmental Disorders (F01-F99) Coding Guideline I.C.5.a Pain disorders related to psychological factors Excludes1 note under category G89 Should not be assigned with code F45.41 F45.42 used with a code from category G89 Psychological component for a patient with acute or chronic pain 33 Chapter 5: Mental, Behavioral, & Neurodevelopmental Disorders (F01-F99) New Codes: F03.90 Unspecified dementia without behavioral disturbance F03.91 Unspecified dementia with behavioral disturbance 34 17

18 Chapter 5: Mental, Behavioral, & Neurodevelopmental Disorders (F01-F99) Wording change in categories (F70-F79) F70 Mild intellectual disabilities F71 Moderate intellectual disabilities F72 Severe intellectual disabilities F73 Profound intellectual disabilities F78 Other intellectual disabilities F79 Unspecified intellectual disabilities 35 Mental Disorders Due To Known Physiological Conditions Categories F01 through F09, Mental disorders due to known physiological i l conditions, include a range of mental disorders grouped together on the basis of having a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The cerebral dysfunction may be primary or secondary. (1) 36 18

19 Mental Disorders Due To Known Physiological Conditions: Organic Brain Syndrome Organic brain syndrome is an older general term used to describe decreased mental function due to a medical disease other than a psychiatric illness. (1) Organic brain syndrome, not otherwise specified, is coded to F09, Unspecified mental disorder due to known physiological condition. The underlying physiological condition should be coded first. Posttraumatic organic brain syndrome is coded to F07.81, Postconcussional syndrome, with an additional code to identify any associated posttraumatic headache. 37 Mental Disorders Due To Known Physiological Conditions: Organic Anxiety Disorder Organic anxiety disorder is a transient organic psychosis characterized by clinically significant anxiety. It is considered to be the direct physiological effect of a general medical condition. (1) 38 19

20 Mental Disorders Due To Known Physiological Conditions: Dementia in Other Diseases Classified Elsewhere Subcategory F02.8, Dementia in other diseases classified elsewhere, specifically identifies the presence of or absence of behavioral disturbances such as aggressive behavior, violent behavior, wandering off, or combative behavior. The dementia classified in subcategory F02.8 is due to direct physiological effects of a general medical condition. (1) 39 Altered Mental State An alteration in level of consciousness not associated with delirium i or another identified d condition is classified to category R40 in Chapter 18 of ICD-10-CM. Category R40 is further subdivided to indicate whether it is identified as somnolence (R40.0), stupor (R40.1), coma (R40.2-), persistent vegetative state (R40.3), or transient alteration of awareness (R40.4). (1) 40 20

21 Transient Global Amnesia Transient global amnesia is a distinct form f amnesia of unknown etiology, characterized by a sudden loss of memory function. During an episode, the patient is unable to form memories or remember recent events and may ask the same question over and over because no memories of previous answers are formed. (1) 41 Schizophrenic Disorders Schizophrenia is a severe mental illness characterized by a variety of symptoms including, but not limited to: Loss of contact with reality Bizarre behavior Disorganized thinking Disorganized speech Decreased emotional expressiveness Diminished or loss of contact with reality Diminished or total social withdrawal 42 21

22 43 Schizophrenic Disorders Schizophrenic disorders are classified in category F20, with a fourth character indicating the type of schizophrenia as follows: F20.0 Paranoid schizophrenia (1) F20.1 Disorganized schizophrenia (2) F20.2 Catatonic schizophrenia (3) F20.3 Undifferentiated schizophrenia (4) F20.5 Residual schizophrenia (5) F20.8 Other schizophrenia F20.81 Schizophreniform disorder (6) F20.89 Other schizophrenia (7) F20.9 Schizophrenia, unspecified (8) 44 22

23 Affective Disorders Affective disorders are common mental diseases with multiple l aspects, including biological, i l behavioral, social, and psychological factors. Major depressive disorder, bipolar disorders, and anxiety disorders are the most common affective disorders. Affective disorders d can result in symptoms ranging from the mild and inconvenient to the severe and life threatening. (1) 45 Major Depressive Disorder Major depressive disorder (MDD) is also known as monopolar depression or unipolar affective disorder. (1) MDD is classified in ICD-10-CM as: F32.- Major depressive disorder, single episode F33.- Major depressive disorder, recurrent Categories F32 and F33 are further subdivided with fourth characters (or fifth characters) to provide information about the current severity of the disorder (2) 46 23

24 Bipolar Affective Disorder Bipolar affective diseases are divided into various types according to the symptoms displayed. (1) ICD-10-CM classifies bipolar disorders under the following categories/codes: F30.- Manic episode (includes bipolar disorder, single manic episode, and mixed affective episode) F31.- Bipolar disorder (includes manic-depressive illness, manic-depressive psychosis, and manicdepressive reaction F34.- Persistent mood [affective] disorders (includes cyclothymic disorder and dysthymic disorder) F39 Unspecified mood [affective] disorder (includes affective psychosis not otherwise specified) (2) 47 Four Basic Types of Bipolar Disorder Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically y lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior. Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes. Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior. Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder

25 Nonpsychotic Mental Disorder A variety of anxiety, dissociative, stress related, somatoform, and other nonpsychotic mental disorders are classified in categories F40 through F48. These include such conditions as phobic anxiety disorders, reaction to stress, dissociative and conversion disorders, somatoform disorders, and other nonpsychotic mental disorders. (1) 49 Anxiety Disorders Anxiety disorders are common psychiatry disorders and are considered to be one of the most undertreated and overlooked health problems. (1) F40 Phobic anxiety F41 Other anxiety disorders F42 Obsessive-compulsive i disorderd 50 25

26 51 Reaction to Stress ICD-10-CM provides category F43 for coding reaction to severe stress and adjustment t disorders. Code F43.0, Acute stress reaction, classifies acute reaction to stress, including acute crisis reaction, combat fatigue, crisis state, and psychic shock. (1) 52 26

27 Posttraumatic Stress Disorder Posttraumatic stress disorder (PTSD) is classified in ICD-10-CM CM to subcategory F43.1, with fifth characters for unspecified, acute, or chronic. PTSD is a severe anxiety disorder that can develop after exposure to any event resulting in psychological trauma. (1) 53 Adjustment Disorders Adjustment disorders are a psychological response to an identifiable stressor or group of stressors that cause(s) significant emotional or behavioral symptoms. (1) The following situations fall into this category: F43.21 Patient depressed over death of son F43.24 Child adopted d from a foreign country, suffering from culture shock with conduct disturbance 54 27

28 Dissociative and Conversion Disorders ICD-10-CM classifies dissociative and conversion disorders d to category F44. (1) F44.0 Dissociative amnesia F44.1 Dissociative fugue F44.2 Dissociative stupor F44.81 Dissociative identity disorder (2) F44.4 Conversion disorder with motor symptom or deficit F44.5 Conversion disorder with seizures or convulsions F44.6 Conversion disorder with sensory symptom or deficit F44.7 Conversion disorder with mixed symptom presentation In addition, two codes are available for other (F44.89) and unspecified (F44.9) dissociative and conversion disorders 55 Somatoform Disorders Somatoform disorders are mental disorders characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause. (1) F45.8 Psychogenic diarrhea F45.8 Psychogenic dysmenorrhea F45.20 Hypochondriacal disorder (2) For pain that is exclusively l psychological, l assign code F45.41, Pain disorder exclusively related to psychological factors

29 Behavioral Syndromes Associated with Physiological Disturbances and Physical Factors Categories F50 through F59 are devoted to behavioral syndromes associated with physiological disturbances and physical factors. (1) F50.- Eating disorders (such as anorexia nervosa and bulimia nervosa) F51.- Sleep disorders not due to a substance or known physiological condition F52.- Sexual dysfunction not due to a substance or known physiological condition F53.- Puerperal psychosis F54 Psychological and behavioral factors associated with disorders or diseases classified elsewhere F55.- Abuse of nonpsychoactive substances F59 Unspecified behavioral syndromes associated with physiological disturbances and physical factors (2) 57 Substance Abuse Disorders Substance abuse and dependence are classified as mental disorders d in ICD-10-CM. CM These disorders are classified to categories F10 through F19. Although the terms abuse and dependence may be used interchangeably in certain treatment programs, they are different conditions and are coded differently in ICD-10-CM

30 Alcohol Dependence and Abuse Alcohol-related disorders are classified in ICD-10-CM to category F10. An additional code for blood alcohol level may be assigned, if applicable (Y90.-). Alcohol abuse refers to the recurring use of alcoholic beverages despite negative consequences. Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis describing a condition in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship. (1) 59 Alcohol 38 y/o 17 years of heavy weekend use Underside surface views Front surface view Marked overall decreased activity on all views 60 30

31 Alcohol Dependence and Abuse Alcohol abuse is classified in ICD-10-CM under subcategory F10.1, 1 Alcohol l abuse, while alcohol l dependence is classified under subcategory F10.2, Alcohol dependence. If alcohol use is documented without further specificity as to abuse or dependence, it is classified to subcategory F10.9, Alcohol use, unspecified. (1) 61 Drug Dependence and Abuse ICD-10-CM classifies drug dependence and abuse in the following categories according to the class of drug: F11 Opioid related disorders F12 Cannabis related disorders F13 Sedative, hypnotic or anxiolytic related disorders F14 Cocaine related disorders F15 Other stimulant related disorders F16 Hallucinogen related disorders F17 Nicotine dependence F18 Inhalant related disorders F19 Other psychoactive substance related disorders (1) 62 31

32 Heroin & Methadone Normal View 39 y/o yr. hx of frequent heroin use top down surface view top down surface view full symmetrical brain activity marked overall decreased brain activity 63 Drug Dependence and Abuse ICD-10-CM provides combination codes that include both the alcohol or substance abuse/dependence and any associated complications. For example: F Alcoholic withdrawal delirium due to alcohol dependence F Alcohol-induced anxiety disorder due to alcohol abuse F Heroin dependence with heroin-induced psychosis and delusions Category F19, Other psychoactive substance related disorders, may be used when the specific drug class is not specified. (1) 64 32

33 Psychoactive Substance Abuse In addition to the codes for psychoactive substance abuse and dependence, ICD-10-CM CM provides codes for psychoactive substance use: F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, F16.9-). (1) 65 Psychoactive Substance Use, Abuse, and Dependence Code Hierarchy When the provider documentation refers to use, abuse, and dependence of the same substance (e.g., alcohol, opioid, cannabis), only one code should be assigned to identify the pattern of use, based on the following hierarchy: If both use and abuse are documented, assign only the code for abuse. If both abuse and dependence are documented, assign only the code for dependence. If use, abuse, and dependence are all documented, assign only the code for dependence If both use and dependence are documented, assign only the code for dependence

34 Selection of Principal Diagnosis The designation of the principal diagnosis for patients with either substance abuse or substance dependence is determined by the circumstances of the admission, as defined in the following examples: 1. When a patient is admitted for detoxification or rehabilitation for both drug and alcohol abuse or dependence, and both are treated, either condition may be designated as the principal diagnosis. 2. When a patient with a diagnosis of substance abuse or dependence is admitted for treatment or evaluation of a physical complaint related to the substance use, follow the directions in the Alphabetic Index for conditions described as alcoholic or due to drugs; sequence the physical condition first, followed by the code for abuse or dependence. 3. When a patient with a diagnosis of alcohol or drug abuse or dependence is admitted because of an unrelated condition, follow the usual guidelines for selecting a principal diagnosis. 67 Substance Abuse Therapy Treatment for patients with a diagnosis of substance abuse or dependence consists of detoxification, rehabilitation, or both. The abuse or dependence is the principal diagnosis for a patient admitted for such programs. (1) 68 34

35 Introduction to Chapter 6: Diseases of the Nervous System (G00-G99) 69 Chapter 6: Chapter Overview (G00- G99) Nervous system diseases can be found in Chapter 6 of ICD-10-CM. CM Dual coding is often required for infectious diseases of the central nervous system. Pain can be coded by recording the site of the pain. Codes for pain, not elsewhere classified (G89), can be used for coding pain control or management If the cause is known but not treated during the encounter, code it as an additional diagnosis. (1) 70 35

36 Chapter 6: Terms to Know (G00-G99) Central nervous system: the brain and spinal cord Conductive hearing loss: hearing loss due to a problem with a part of the ear Peripheral nervous system: all elements of the nervous system except the brain and spinal cord Sensorineural hearing loss: is hearing loss due to a problem with the sensory part of the ear or the nerves associated with hearing 71 Chapter 6: Terms to Know (G00-G99) Epilepsy: Brain disorder characterized by electrical-like disturbances; may include occasional impairment or loss of consciousness, abnormal motor phenomena and psychic or sensory disturbances. (1) Migraine: Benign vascular headache of extreme pain; commonly associated with irritability, nausea, vomiting and often photophobia; premonitory visual hallucination of a crescent in the visual field (scotoma)

37 Chapter 6: Anatomy and Physiology Terms to Know (G00-G99) ICD 10 CM G00 G47; G80 G99 G50 G73 Nervous System Central nervous system (brain and spinal cord) Peripheral nervous system (all other neural elements in the rest of the body) 73 Chapter 6: Anatomy and Physiology Terms to Know (G00-G99) 74 37

38 The Central Nervous System 75 Lobes of the Brain 76 38

39 Parts of the Brain 77 Brain Hemispheric Specialization 78 39

40 Spinal Cord 79 Peripheral Nervous System 80 40

41 Peripheral Nervous System 81 The Human Nervous System Organ Sympathetic System Parasympathetic System Eye Tear glands Salivary glands Lungs Heart Gut Liver Bladder Dilates pupil No effect Inhibits saliva production Dilates bronchi Speeds up heart rate Inhibits peristalsis Stimulates glucose production Inhibits urination Constricts pupil Stimulates tear secretion Stimulates saliva production Constricts bronchi Slows down heart rate Stimulates peristalsis Stimulates bile production Stimulates urination 82 41

42 Plexus 83 Nerves Nerves of the shoulder 84 42

43 Nerve Cells (Neurons) 85 Three Types of Neurons Length of Fibers Location Function Sensory neuron Interneuron Motor Neuron Long dendrites and short axon Cell body and dendrite are outside of the spinal cord; the cell body is located in a dorsal root ganglion Conduct impulse to the spinal cord Short dendrites and short or long anxon Entirely within the spinal cord or CNS Interconnect the sensory neuron with appropriate motor neuron Short dendrites and long axons Dendrites and the cell body are located in the spinal cord; the axon is outside of the spinal cord Conduct impulse to an effector (muscle or gland 86 43

44 Neuron Cell Body, Axons and Dendrites There are several differences between axons and dendrites: Axons Dendrites Take information away from the cell body Smooth Surface Generally only 1 axon per cell No ribosomes Can have myelin Branch further from the cell body Bring information to the cell body Rough Surface (dendritic spines) Usually many dendrites per cell Have ribosomes No myelin insulation Branch near the cell body 87 The Reflex Arc The Reflex Arc: The three types of neurons are arranged in circuits and networks, the simplest of which is the reflex arc. Reflex e arc accan asobe also represented epese tedbyas simple peflow daga diagram: 88 44

45 Chapter 6: Introduction (G00-G99) Diseases of the nervous system are classified in Chapter 6 of ICD-10-CM. Eye and adnexa diseases can be found in Chapter 7 of ICD-10-CM, and diseases of the ear and mastoid process are found in Chapter 8. G00-G47, G80-G99 Central nervous system (brain and spinal cord) G50-G73 Peripheral nervous system (all other neural elements in the rest of the body) (1) 89 Chapter 6: Categories (G00-G99) Chapter 6 contains 11 code families with the first character of G, and they are: G00-G09 Inflammatory diseases of the central nervous system G10-G14 Systemic atrophies primarily affecting the central nervous system G20-G26 Extrapyramidal and movement disorders G30-G32 G32 Other degenerative diseases of the nervous system G35-G37 Demyelinating diseases of the central nervous system 90 45

46 Chapter 6: Categories (G00-G99) G40-G47 Episodic and paroxysmal disorders G50-G59 Nerve, nerve root and plexus disorders G60-G65 Polyneuropathies and other disorders of the peripheral nervous system G70-G73 Diseases of myoneural junction and muscle G80-G83 G83 Cerebral palsy and other paralytic syndromes G89-G99 Other disorders of the nervous system 91 Chapter 6: Category & Chapter Restructuring ICD-10-CM contains many changes to the classification of diseases of the nervous system and special senses. (1) ICD 9 CM Chapter 6. Disease of the Nervous System and Sense Organs ( ) ICD 10 CM Chapter 6: Diseases of the Nervous System (G00 G99) Chapter 7: Diseases of the Eye and Adnexa (H00 H59) Chapter 8. Diseases of the Ear and Mastoid Process (H60 H95) 92 46

47 Chapter 6: Category & Chapter Restructuring Throughout ICD-10-CM, certain disease categories have been restructured in such a way as to bring together related conditions into contiguous classifications. Toward the end of Chapter 6, new categories for intraoperative complications and post procedural disorders specific to the nervous system were created. In ICD-9-CM, these conditions were divided between two separate chapters. Complications that are specific to the nervous system are now classified together with diseases of the nervous system in ICD-10-CM as the illustration on the next slide demonstrates. 93 ICD 9 CM Reaction to spinal or lumbar puncture Nervous system complications from surgically implanted device 997.Nervous system complications Nervous system complication, unspecified Central nervous system complication Iatrogenic cerebrovascular infarction or hemorrhage Other nervous system complications ICD 10 CM G97 Intraoperative and post procedural complications and disorders of nervous system, not elsewhere classified G97.0 Cerebrospinal fluid leak from spinal puncture G97.1 Other reaction to spinal and lumbar puncture G97.2 Intracranial hypotension following ventricular shunting G97.3 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a procedure o G97.31 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure o G97.32 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating other procedure 94 G97.4 Continued 47

48 Chapter 6: Category Title Changes A number of category title revisions were made in Chapter 6. Titles were changed to better reflect categorical content. (1) ICD-9-CM 354 Mononeuritis of upper limb and mononeuritis mutiplex ICD-10-CM G56 Mononeuopathies of upper limb 95 Chapter 6: Organizational Adjustments After reviewing the different disease categories, the developers of ICD-10-CM restructured some of them to bring together those groups that are more closely related by underlying pathology. ICD-10-CM maintains separation of conditions primarily affecting the central nervous system from those affecting the peripheral nervous system; however, conditions representing symptoms (pain) and operative complications have been restructured toward the end of the chapter

49 Chapter 6: Organizational Adjustments ICD 9 CM ICD 10 CM Inflammatory Diseases of the Central Nervous System 327 Organic Sleep Disorders Hereditary and Degenerative Diseases of the Central Nervous System 338 Other Headache Syndromes Other Disorders of the Central Nervous System G00 G09 Inflammatory diseases of the central nervous system G10 G14 Systemic atrophies primarily affecting the central nervous system G20 G26 Extrapyramidal and movement disorders G30 G32 Other degenerative diseases of the central nervous system G35 G37 Demyelinating diseases of the central nervous system G40 G47 Episodic and paroxysmal disorders 97 Chapter 6: Organizational Adjustments ICD 9 CM ICD 10 CM Cerebrallipidosis lipidosis E75.0 GM2 gangliosidosis Amaurotic (familial) E75.00 GM2 gangliosidosis, idiocy unspecified Disease: E75.01 Sandhoff disease Batten E75.02 Tay Sachs disease Jansky E75.1 Other and unspecified Bielschowsky Kufs Spielmeyer Vogt Tay Sachs Gangliosidosis gangliosidosis E75.10 Unspecified gangliosidosis E75.11 Mucolipidosis IV E75.19 Other Gangliosidosis 98 49

50 ICD 9 CM Chapter 6: Organizational Adjustments ICD 10 CM Eosinophilic meningitis Meningitis G03.9 Eosinophilic B83.2 B83.2 Angiostrongyliasis due to Parastrongylus cantonensis Eosinophilic meningoencephalitis due to Parastrongylusm cantonensis The code for eosinophilic meningitis has been reassigned in ICD-10-CM and is now classified in Chapter 1, Certain Infectious and Parasitic Diseases as seen here. 99 Chapter 6: Organizational Adjustments ICD 10 CM G30 Alzheimer s disease INCLUDES Alzheimer s dementia senile and presenile forms Use additional code to identify: delirium, if applicable (F05) dementia with behavioral disturbance (F02.81) dementia without behavioral disturbance (F02.80) EXCLUDES 1 senile degeneration of brain NEC (G31.1) senile with behavioral disturbance (F02.81) senility NOS (R41.81) G30.0 Alzheimer s disease with early onset G30.1 Alzheimer s disease with late onset G30.8 Other Alzheimer s disease G30.9 Alzheimer s disease, unspecified

51 Chapter 6: Organizational Adjustments ICD 10 CM G43 Migraine G43.7 Chronic migraine without aura G43.A Cyclical vomiting G43.B Ophthalmoplegic migraine G43.C Periodic headache syndromes in child or adult G43.D Menstrual migraine G43.8 Other migraine G43.9 Migraine, unspecified 101 Chapter 6: Organizational Adjustments Although the subcategory of disease status in epilepsy (e.g., intractable, t not intractable, t with or without status migrainosus) remains similar to that of ICD-9-CM, the hierarchy within code categories has been restructured. For example, localization-related epilepsy (G40.0-G40.2) has been sequenced before generalized epilepsy (G40.3-G40.4) in ICD-10-CM. (1)

52 ICD 9 CM Chapter 6: Organizational Adjustments ICD 10 CM Basilar artery syndrome G45.0 Vertebro basilar artery syndrome Vertebral artery G45.0 Vertebro basilar artery syndrome syndrome Vertebrobasilar artery G45.0 Vertebro basilar artery syndrome syndrome Otherspecified transient G45.1 Carotid artery syndrome cerebral ischemias G45.2 Multiple and bilateral precerebral artery syndromes Amaurosis fugax G45.3 Amaurosis fugax Transient global amnesia G45.4 Transient global amnesia 103 ICD 9 CM Chapter 6: Organizational Adjustments ICD 10 CM Subclavian steal syndrome G45.8 Other transient cerebral ischemic attacks and related syndromes Other transient cerebral ischemias G45.8 Other transient cerebral ischemic attacks and related syndromes Unspecified transient cerebral G45.9 Transient cerebral ischemic attack, unspecified ischemias Other transient cerebral ischemias G46.0 Middle cerebral artery syndrome Other transient cerebral ischemias G45.1 Anterior cerebral artery syndrome G46.2 Posterior cerebral artery syndrome Other ill defined cerebrovascular G46.3 Brain stem stroke syndrome disease G46.4 Cerebellar stroke syndrome G46.5 Pure motor lacunar syndrome G46.6 Pure sensory lacunar syndrome G46.7 Other lacunar syndromes G46.8 Other vascular syndromes of brain in cerebrovascular diseases

53 Chapter 6: New Codes New codes for ICD-10-CM: G40.A Absence epileptic syndrome Expansion to 6th character G40.B Juvenile myoclonic epilepsy Expansion to 6th character G43.8- Menstrual migraine 5th character intractable, status migrainosus G70.8- Lambert-Eaton syndrome Expansion to 5th character 105 Coding Guidance: Chapter 6 Official Guidelines The ICD-10-CM official guidelines for Chapter 6 are similar il to those in ICD-9-CM. CM Although h the guidelines for reporting pain (category G89) have been reorganized, the concepts and sequencing rules remain the same. However, the addition of laterality to the reporting hemiparesis and monoplegia has resulted in some significant changes. (1)

54 Coding Guidance: Multiple Coding Similar to ICD-9-CM, certain codes within this chapter require either multiple l codes or specific sequencing in order to properly report the condition. However, due to the increased data granularity (specificity) of the ICD-10 system, manifestation code edits have been reduced in number. (1) 107 Coding Guidance: Multiple Coding In the following example, ICD-10-CM requires multiple l coding, whereas ICD-9-CM CM classified the condition to a single, specific classification code. (1) ICD 9 CM ICD 10 CM Meningitis in other fungal diseases G02 Meningitis in other infectious & parasitic diseases classified elsewhere Meningitis gtsdue to viruses G02 Meningitis gtsin other infectious & parasitic as NEC diseases classified elsewhere Meningitis due to G02 Meningitis in other infectious & parasitic trypanosomiasis diseases classified elsewhere Meningitis in sarcoidosis G02 Meningitis in other infectious & parasitic diseases classified elsewhere

55 Coding Guidance: Unspecified Codes Certain ICD-10-CM classifications differentiate specific conditions that were previously classified together. For example, 323.9, Unspecified causes of encephalitis, myelitis and encephalomyelitis, is equivalent to two possible codes in ICD-10-CM. For example: ICD-9-CM Unspecified causes of encephalitis, myelitis and encephalomyelitis ICD-10-CM G04.90 Encephalitis and encephalomyelitis, unspecified G04.91 Myelitis, unspecified 109 Coding Guidance: Drug-Induced Conditions Unique codes have been established throughout this chapter to differentiate t drug-induced d d nervous system disorders from those otherwise specified, including extrapyramidal and abnormal movement disorders: G24.02 Drug-induced acute dystonia G24.09 Other drug induced dystonia G25.1 Drug-induced tremor G25.4 Drug-induced chorea G25.61 Drug-induced tics

56 Coding Guidance: Drug-Induced Conditions ICD-9-CM (1) Neuroleptic malignant syndrome Use additional E code to identify drug EXCLUDES neuroleptic induced Parkinsonism (332.1) ICD-10-CM G21.0 Malignant neuroleptic syndrome Code first (T43.3-T43.5) to identify drug EXCLUDES 1 neuroleptic induced Parkinsonism (G21.11) Diagnosis: Initial encounter for neuroleptic malignant syndrome due to adverse effects in therapeutic use of haloperidol T43.4X5A Adverse effect of butyrophenone and thiothixene neuroleptics G21.0 Malignant neuroleptic syndrome 111 Coding Guidance: Epilepsy and Migraine Classifications for epilepsy, migraine and headache h are generally similar il between systems. However, ICD-10-CM includes expanded character extensions, which differentiate headache as intractable or not intractable, by type similar to existing classifications for epilepsy and migraine. (1)

57 113 Coding Guidance: Cluster Headache ICD-10-CM classifications for headache syndromes are similar to their ICD-9-CM counterparts, with the exception of a sixth-character severity indicator that differentiates between intractable versus non-intractable presentations. (1) ICD 9 CM ICD 10 CM Cluster headache syndrome, G Cluster headache syndrome, unspecified, intractable intractable G Cluster headache syndrome, unspecified not intractable Episodic cluster headache G Episodic cluster headache, intractable G Episodic cluster headache, not intractable Chronic cluster headache G Chronic cluster headache, intractable G Chronic cluster headache, not intractable

58 Inflammatory Diseases of the Central Nervous System Infectious diseases of the central nervous system are classified in several ways, and it is imperative that the coder carefully follow the directions provided by the Alphabetic Index and Tabular List. Dual coding is frequently required, with the code for the underlying condition sequenced first, followed by a manifestation code. (1) 115 Inflammatory Diseases of the Central Nervous System Bacterial meningitis due to certain organisms such as Pneumococcus, Streptococcus, t and Staphylococcus is classified in category G00, with a fourth character indicating the responsible organism. Codes G00.2-G00.8 also require an additional code to further specify the organism. (1)

59 Types of Meningitis Bacterial Meningitis Caused by bacteria, like Neisseria meningitidis and Streptococcus pneumoniae. It can be a lifethreatening infection that needs immediate medical attention. There are vaccines to prevent some kinds of bacterial meningitis. Viral Meningitis Caused by viruses, like enteroviruses and herpes simplex viruses. It s serious, but rarely fatal in people with normal immune systems. There are vaccines to prevent some kinds of viral meningitis. Fungal Meningitis Caused by fungi like Cryptococcus and Histoplasma. Usually acquired by inhaling fungal spores from the environment. People with certain medical conditions like diabetes, cancer, or HIV are at higher risk of fungal meningitis. *Multistate Outbreak of Fungal Meningitis and Other Infections Associated with Contaminated Steroid Medication Links: and Parasitic Meningitis Caused by parasites and less common in developed countries. Parasites, like Angiostrongylus cantonensis can contaminate food, water and soil Non-infectious Meningitis Not spread from person to person, but can be caused by cancers, systemic lupus erythematosus (lupus), certain drugs, head injury, and brain surgery. 117 Parkinson s Disease Parkinson s disease, also known as parkinsonism, is a chronic, progressive disorder d of the central nervous system characterized by a fine, slowly spreading involuntary tremor, postural instability, and muscle weakness and rigidity. Parkinson s disease is assigned to code G20 and includes primary parkinsonism. (1)

60 Alzheimer s Disease Alzheimer s disease is a process of progressive atrophy involving the degeneration of nerve cells. This degeneration leads to mental changes that range from subtle intellectual impairment to dementia with loss of cognitive functions and failure of memory. Alzheimer s disease is coded to category G30. (1) G30.9 Alzheimer s disease [without any mention of dementia] G F02.81 Dementia with behavioral disturbance due to late onset Alzheimer s disease 119 Epilepsy Epilepsy is a paroxysmal disorder of cerebral function characterized by recurrent seizures. Coders must not assume, however, that any diagnostic statement describing convulsions or seizures should be coded to epilepsy; as these conditions also occur in a number of other diseases, such as brain tumor, cerebrovascular accident, alcoholism, electrolyte imbalance, and febrile conditions. (1)

61 Epilepsy Cont When the diagnosis is stated only in terms of convulsion or seizure without any further identification of the cause, code R56.9, Unspecified convulsions, should be assigned. (1) Please note that the classification assigns seizure disorder and recurrent seizures to epilepsy G40.909, whereas the main term seizure(s) is indexed to R56.9 (2) 121 Headache and Migraine A diagnosis of headache without any further specificity is classified to Chapter 18 of ICD-10-CM CM and coded to R51, Headache. Migraines are classified to category G43, while specific headaches are classified to category G44, Other headache syndromes, in Chapter 6, Diseases of the Nervous System. (1)

62 Headache and Migraine Cont ICD-10-CM classifies migraines to category G43 as follows: G G Migraine without aura G G Migraine with aura Specific headaches are classified to Chapter 6 of ICD- 10-CM under Other headache syndromes (category G44) as follows: G G Cluster headaches and other trigeminal autonomic cephalgias G44.10-G44.11 G4411Vascular headache, h not elsewhere classified Headache following lumbar puncture is assigned to code G97.1, Other reaction to spinal or lumbar puncture. 123 Narcolepsy Narcolepsy is a chronic neurological disorder characterized by the inability to regulate sleep and wakefulness normally. (1) ICD-10-CM distinguishes between subcategory G (narcolepsy) and G (narcolepsy in conditions classified elsewhere). Fifth characters distinguish between narcolepsy with cataplexy (G47.411, G47.421) and without cataplexy (G47.419, G47.429)

63 Hemiplegia/Hemiparesis Hemiplegia is paralysis of one side of the body. It is classified to category G81, with a fifth character to indicate the side affected and whether the affected side is dominant or non-dominant. (1) Hemiplegia occurring in connection with a cerebrovascular accident (CVA) often clears quickly and is sometimes called a transient hemiplegia. (2) I G81.91 Cerebral thrombosis with hemiplegia i right dominant side I Hemiplegia of left dominant side due to previous CVA 125 Pain Pain may be coded by reporting the site of pain. These codes may be found in the symptom chapter (e.g., headache, R51) or in the appropriate body system chapter (e.g., pain in limb, M79.609). Codes from category G89, Pain, not elsewhere classified, may be used in conjunction with the site of pain codes if the category G89 code provides more detail about acute and chronic pain and neoplasm-related pain unless otherwise indicated as follows: (1)

64 Encounter/Admission for Pain Control Management Category G89 codes may be used as the principal diagnosis or first-listed code when pain control or pain management is the reason for the admission/encounter. These encounters are typically not for diagnostic workup or treatment of the underlying condition but for management of pain. In these situations, if the underlying cause of the pain is known, report it as an additional diagnosis. (1) 127 Encounter/Admission for Pain Control Management Cont If the admission is for control of pain related to, associated with, or due to a malignancy, code G89.3, Neoplasm related pain (acute)(chronic), should be assigned. (1) If the admission or encounter is for a procedure to treat the underlying condition, the underlying condition should be assigned as the principal or first-listed diagnosis. (2)

65 Encounter/Admission for Pain Control Management Cont Patients with chronic pain whose conservative therapies have failed may undergo insertion of neurostimulators for pain control. In such cases, the appropriate pain code is assigned as the principal or first-listed diagnosis. (1) If the encounter is for any other reason except pain control or pain management and a related definitive diagnosis for the pain has not been established (confirmed) by the provider, the code for the specific site of pain should be assigned first, followed by the appropriate code from category G89. (2) 129 Postoperative Pain Post-thoracotomy pain and other postoperative pain are classified to subcategories G89.1 and G89.2, depending on whether the pain is acute or chronic. (1) Postoperative pain may be reported as the principal or first-listed diagnosis when the reason for the encounter or admission is postoperative pain control/management. (2)

66 Autonomic Dysreflexia Autonomic dysreflexia is a syndrome characterized by an abrupt onset of excessively high blood pressure caused by an uncontrolled sympathetic nervous system discharge in persons with spinal cord injury, usually at or above the T6 level. (1) Code G90.4, Autonomic dysreflexia, is used to report this condition (2) 131 Hydrocephalus Normal pressure hydrocephalus (NPH) or secondary NPH can be caused by any condition in which the flow of cerebrospinal fluid (CSF) is blocked, such as subarachnoid hemorrhage, head trauma, cerebral infarction, infection, tumor, or complications of surgery. Assign code G91.0, Communicating hydrocephalus, for secondary NPH. (1)

67 Encephalopathy Encephalopathy is a general term used to describe any disorder d of cerebral function. (1) G93.1, Anoxic brain damage, not elsewhere classified G31.2 Degeneration of nervous system due to alcohol G93.41, Metabolic encephalopathy G92, Toxic encephalopathy F51.2, Wernicke s encephalopathy G93.40, Encephalopathy, unspecified 133 Disorders of the Peripheral Nervous System Disorders of the peripheral nervous system are classified to categories G50 through h G73 according to the condition and the nerves involved. Many codes in this section are manifestations of other diseases and are assigned as additional codes, with the underlying condition listed first

68 Critical Illness Polyneuropathy Critical illness polyneuropathy is commonly associated with complications of sepsis and multiple organ failure. It is considered to be secondary to systemic inflammatory response syndrome. (1) Assign code G62.81, Critical illness polyneuropathy, for this condition. 135 Critical Illness Myopathy Critical illness myopathy is also associated with sepsis. It is a cause of difficulty in weaning patients from mechanical ventilation and prolonged recovery after illness. It is also associated with neuromuscular blocking agents and corticosteroids (in asthma and organ transplant patients), and neuropathy. Code G72.81, Critical Illness myopathy, is used to report this condition

69 Audience Questions 137 The End

70 ICD-10-CM Resources and References 139 ICD-10-CM Resources & References ICD-10-CM Draft Official Guidelines for Coding and Reporting Release of ICD-10-CM Code Guidelines, Addenda, List of Codes, GEMS HHS Announces Intent to Delay ICD-10-CM/PCS Compliance Date Search for the February 16, 2012 press release

71 ICD-10-CM Resources & References 2012 ICD-10-CM is available at or hhs 2012 ICD-10-CM Index to Diseases and Injuries 2012 ICD-10-CM Tabular List of Diseases and Injuries Instructional Notations 2012 Official Guidelines for Coding and Reporting 2012 Table of Drugs and Chemicals 2012 Neoplasm Table 2012 Index to External Causes 2012 Mapping ICD-9-CM to ICD-10-CM and ICD-10-CM to ICD-9-CM 141 ICD-10-CM Resources & References General ICD-10 Information General Equivalence Mappings and User s Guides 0_ICD10PCS.asp _ICD_10_CM.asp