Healthcare Information Network

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1 Healthcare Information Network P.O. Box 147 Liverpool, NY Tel: Webinar: ICD-10-CM Coding Update The attached handout was prepared by: Ms. Carmilla Kelli Marsh, RHIA, RAC-CT Consultant Elida, OH HIN maintains a commitment to recruit the highest caliber faculty, utilize the most effective teaching techniques, and present programs on the most current and important issues impacting providers today. HIN s policy regarding your continuing education is as follows: 1) You must complete the entire webinar session to receive continuing education credit. Your login and exit time is verified on Attendance Report generated by the webinar provider. 2) Each attendee must complete an Evaluation and CE Request form, located on the last page of this handout. This form MUST be submitted to HIN within 7 days via fax, or mail. 3) Upon receipt of your Evaluation and CE Request form, HIN will prepare Certificate(s) of Completion and mail to your designated webinar contact for distribution at your facility. Failure to comply with the above jeopardizes your ability to receive continuing education for this program. Lost or misplaced certificates can be replaced for a $10.00 fee, as long as attendance can be verified. (Verification includes steps number 1-2 above). Disclosures: There is no conflict of interest declared by planners & faculty/presenters/authors/content reviewers of this program. No commercial support was received for this educational activity. Successful completion of this program requires that you attend the entire event. View seminar information online, update your profile, link to directions, and register online at: Specializing in Long Term Care Education! HINinfo@HINseminars.com Marsh 2016

2 ICD-10-CM Coding Update OCTOBER 20, 2016 Presentor Carmilla Kelli Marsh, RHIA, RAC-CT 1

3 October 1, 2016 ICD-10-CM coding accuracy needs attention in key areas: V00-Y99 External causes of morbidity R00-R99 Symptoms, signs and abnormal findings S00-T88 Injury, poisoning and other external Q00-Q99 Congenital malformations D50-D89 Diseases of the blood and blood forming organs 3 FY 2017 ICD-10-CM Code Updates What do the code updates include? New, revised, and deleted codes and descriptions Index revisions-not all related to new codes Tabular revisions: Includes notes Excludes notes Use additional code notes The Official ICD-10-CM Guidelines for Coding and Reporting 4 2

4 EXCLUDES 1 NOTES Excludes Notes Excludes 1: Means NOT CODED HERE. Code being excluded is never used with the other code. The two conditions cannot occur together Example: R53.1 Weakness Asthenia NOS Excludes 1: Age related weakness (R54) Muscle weakness (M62.8-) Senile asthenia (R54) 5 EXCLUDES 2 NOTES Excludes Notes Excludes 2: Means NOT INCLUDED HERE. Excluded condition is not part of the condition represented by the code. If resident has both conditions, both can be coded Example R94.7 Abnormal results of other endocrine function studies Excludes 2: abnormal glucose (R73.0-) 6 3

5 EXCLUDES 1/2 NOTES Throughout all 21 chapters, many excludes 1 notes have been deleted and reassigned as excludes 2 notes 7 Chapter 1: Infectious and Parasitic Diseases (A00-B99) Zika Virus A92.5 has been added It includes Zika Virus Fever, Zika Virus Infection and Zika Virus, NOS Chronic Viral Hepatitis, B18.1-B18.9, includes Carriers of Viral Hepatitis. Code Z22.5 has been deleted and reclassified to this code category 8 4

6 Chapter 2: Neoplasms (C00-D49) New Codes C49.A0-C49.A9 for Gastrointestinal Stromal Tumors D47.Z2 for Castleman Disease D D49.59 for Neoplasm of Unspecified Behavior of Kidney Instructional Note Changes C61 Malignant Neoplasm of prostate C78 Secondary Malignant Neoplasm of Respiratory and Digestive Organs D16.4 Benign Neoplasm of Bones of Skull and Face 9 Chapter 3: Diseases of Blood and Blood forming organs (D50-D89) Neutropenia and Pancytopenia D61. Other Aplastic anemias and other bone marrow failure syndrome Excludes 1: neutropenia (D70.-) D61.81 Pancytopenia Excludes 1 changed to an Excludes 2 note Excludes 2: pancytopenia (due to) (with) myelodysplastic syndromes (D46.-) 10 5

7 Chapter 3: Diseases of Blood and Blood forming organs (D50-D89) New Codes D78.31-D78.34 Postprocedural hematoma/seroma of spleen following a procedure D89.40-D89.49 Mast cell activation syndrome and related disorders 11 Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) AHA Coding Clinic, 1 st Quarter 2016 According to the ICD-10-CM Official Guidelines for Coding and Reporting I.A.15 the term with means associated with or due to when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. Interpretation is intended to be used for coding Diabetes with associated manifestations and/or conditions. The classification assumes a cause-and-effect relationship between Diabetes and certain diseases 12 6

8 Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) Osteomyelitis in Diabetes Code Exx.69- Other specified complication is assigned for Osteomyelitis in Diabetes The Diabetes main term in the index includes with osteomyelitis (E11.69) Osteomyelitis has a new subterm In diabetes mellitus-see E08-E13 with Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) Diabetes With conditions: However, if the physician documentation specifies diabetes mellitus is not the underlying cause of the other condition, the condition should not be coded as a diabetic complication. When the coder is unable to determine whether a condition is related to diabetes mellitus, or the ICD- 10-CM classification does not provide coding instruction, it is appropriate to query the physician for clarification so that the appropriate codes may be reported. 14 7

9 Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) Laterality All of the Diabetes Mellitus codes with eye complications have been expanded to allow for the capture of laterality Right Left Bilateral E08.33 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy requires a 7 th character to be assigned to designate laterality of the disease: 1=right eye 2=left eye 3=bilateral 9=unspecified eye 15 Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) Combination Codes New combo codes were created to capture traction retinal detachment other types in Diabetic eye conditions. See category E08 in the tabular for specific details of the changes and additions. 16 8

10 Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) New Excludes 1 note E16.0-E16.2 Excludes 1: diabetes with hypoglycemia (E08.649, E10.649, E11.649, E13.649) New Use Additional Code (UAC) note at E08, E09, E11, E13 Use additional code to identify control using: Insulin (Z79.4) Oral antidiabetic drugs (Z79.84) Oral hypoglycemic drugs (Z79.84) 17 Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) Latent Autoimmune Diabetes of Adults (LADA) Latent autoimmune diabetes in adults (LADA) is a relatively new term for a type of diabetes. Although LADA more closely resembles type 1 diabetes, it can often be misdiagnosed as type 2 diabetes by health care providers who don t specialize in diabetes care. Providers have been taught that most people who develop type 1 are typically younger than age 30. Latent, Pre-diabetes mellitus R73.09 has been revised to: R

11 Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) E78.0 Hypercholesterolemia Expanded Unique codes for both Pure and Familial hypercholesterolemia E78.00 Pure hypercholesterolemia, unspecified E78.01 Familial hypercholesterolemia 19 Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) Currently hematoma is indexed under hemorrhage E E Description revised to remove hematoma and only include hemorrhage E E Postprocedural hematoma of an endocrine system organ or structure following an endocrine system procedure or following other procedure E E Postprocedural seroma of an endocrine system organ or structure following an endocrine system procedure or following other procedure 20 10

12 Chapter 4: Endocrine, Nutritional & Metabolic Diseases (E00-E89) Change Coma, hyperglycemic (diabetic) see Diabetes, coma Revised to: Coma, hyperglycemia (diabetic) see Diabetes, by type, with hyperosmolarity, with coma 21 Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Addition of inclusion term with dementia (F01-F02) Major neurocognitive disorder in other diseases classified elsewhere Addition of more Code First notes F02 Dementia in diseases classified elsewhere Code first dementia with Parkinsonism (G31.83) Huntington s disease (G10) Prion disease (A81.9) Traumatic brain injury (S06.-) 22 11

13 Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Deletion of Excludes 1 note F02 Dementia in other diseases classified elsewhere Excludes 1: dementia with Parkinsonism (G31.83) 23 Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Expansion of F32.8 Other depressive episodes F32.8 is no longer a valid code F32.81 Premenstrual dysphoric disorder F32.89 Other specified depressive episodes 24 12

14 Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Expansion of F34.8 Other persistent mood (affective) disorders F34.81 Disruptive mood dysregulation disorder F34.89 Other specified persistent mood disorders Expansion of F42 Obsessive-compulsive disorders (new codes) F42.2 Mixed obsessional thoughts and acts F42.3 Hoarding disorder F42.4 Excoriation (skin-picking) disorder F42.8 Other obsessive-compulsive disorders F42.9 Obsessive-Compulsive disorder, unspecified 25 Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Addition of many inclusion terms throughout F10 Alcohol Related Disorders category Anxiety disorder Bipolar and related d/o Depressive d/o Major neurocognitive d/o, amnestic-confabulatory type Major neurocognitive d/o, non amnestic-confabulatory type Mild neurocognitive d/o Psychotic d/o Sexual dysfunction Sleep d/o 26 13

15 Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Disorder (of) see also disease Disorder includes several new index references, new main terms, subterm revisions and deleted terms. Some of the new index entries Alcohol use Amphetamine-type substance use Amphetamine (or other stimulant) use Anxiety new sub term illness F45.21 Autism spectrum F84.0 Binge eating F50.81 Caffeine use Cannabis use 27 Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Disorder, communication F80.8 has a new subterm index entry Social pragmatic F80.82 Disorder, conversion see Disorder dissociative revised to conversion (functional neurological sx disorder) With was added under conversion as a subterm along with the addition of these subterms: Abnormal movement F44.4 Anesthesia or sensory loss F44.6 Attacks or seizures F44.5 Mixed symptoms F44.7 Special sensory symptoms F44.6 Speech symptoms F44.4 Swallowing symptoms F44.4 Weakness or paralysis F

16 Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Methadone use F11.20 Revised to: methadone use see use, opiod Psychosis, psychotic see Disorder, mood Revised to manic-depressive see Disorder, bipolar Attention Deficit disorder F90.0 Revised to F98.8 Disorder, disruptive behavior F98.9 Revised to: Disorder, disruptive behavior F Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Tobacco (nicotine) New subterm of abuse see Tobacco, use Tobacco, withdrawal state see Dependence, drug, nicotine Revised to: withdrawal state (see also Dependence, drug, nicotine) F

17 Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99) Use (of), alcohol F10.99 Revised to: ICD-10-CM code Z72.89 Use (of), methadone F11.20 Revised to: methodone see Use, opioid 31 Chapter 6: Diseases of the Nervous System (G00-G99) Changes include: Expansion of codes for laterality Excludes 1 notes changed to Excludes 2 notes Addition of codes for postprocedural hematoma and seroma of a nervous system organ or structure following a procedure No significant changes in this chapter pertinent to LTC 32 16

18 Chapter 7: Diseases of the Eye and Adnexa (H00-H59) Addition of codes: Amblyopia suspect Postprocedural hematomas and seromas of eye/adnexa following a procedure Expansion of several codes to include addition of 7 th characters H34.81 and H34.83 level of severity of retinal vein occlusions H35.31 and H35.32 stage of disease for macular degeneration H40.11 state of primary open-angle glaucoma 33 Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95) Three new subcategories added: H90.A11-H90.A32 Conductive and sensorineural hearing loss with restricted hearing on the contralateral side H93.A1-H93.A9 Pulsatile tinnitus H95.51-H95.54 Postprocedural hematoma/seroma of ear and mastoid process following a procedure 34 17

19 Chapter 9: Diseases of the Circulatory System (I00-I99) Code I Revision of inclusion term Fluency disorder following nontraumatic intracerebral hemorrhage Stuttering following non-traumatic intracerebral hemorrhage Term Subarachnoid was changed to intracerebral 35 Chapter 9: Diseases of the Circulatory System (I00-I99) Code I69.- Expanded codes with 6 th character to include specific cognitive deficits following cerebral hemorrhage or infarction to identify: 0 Attention and concentration deficit 1 Memory deficit 2 Visuospatial deficit and spatial neglect 3 Psychomotor deficits 4 Frontal lobe and executive function deficit 5 Cognitive social or emotional deficit 8 Other symptoms and signs involving cognitive function 9 Unspecified symptoms and signs involving cognitive function 36 18

20 Chapter 9: Diseases of the Circulatory System (I00-I99) Code I69.- Expanded codes to include specific cognitive deficits Examples: Resident suffered a stroke with residual of memory loss Code I Resident suffered a non traumatic subarachoid hemorrhage leaving them with social deficits Code: I Chapter 10: Diseases of the Respiratory System (J00-J99) J47.0 Bronchiectasis with acute lower respiratory infection Use Additional code to identify the infection Example: Resident has bronchiectasis and pneumonia Codes: J47.0; J

21 Chapter 11: Diseases of the Digestive System (K00-K95) K52.2 Expansion K52.21 Food protein-induced enterocolitis syndrome K52.22 Food protein-induced enteropathy K52.29 Other allergic and dietetic gastroenteritis and colitis 39 Chapter 11: Diseases of the Digestive System (K00-K95) K52.3 New Code K52.3 Indeterminate colitis Colonic inflammatory bowel disease unclassified (IBDU) Excludes 1: unspecified colitis (K52.9) 40 20

22 Chapter 11: Diseases of the Digestive System (K00-K95) K58.- Expansion with new codes for Irritable Bowel Syndrome (IBS) K58.1 Irritable bowel syndrome with constipation K58.2 Mixed irritable bowel syndrome K58.8 Other irritable bowel syndrome 41 Chapter 11: Diseases of the Digestive System (K00-K95) K59.0 Constipation New Codes: K59.03 Drug induced constipation K59.04 Chronic idiopathic constipation Including: Functional constipation Index Changes: Drug induced constipation (K59.03) Previously directed the codes to see Table of Drugs and Chemicals Can now be found in the index under constipation, Druginduced 42 21

23 Chapter 11: Diseases of the Digestive System (K00-K95) Example: 79 year old male who is receiving Fentanyl to treat pain r/t primary prostate cancer which has metastasized to the bone; presents with c/o of constipation. Doctor determines that the opioid medication is the cause of constipation. Diagnosis: Drug induced constipation d/t Fentanyl was documented in medical record 43 Chapter 11: Diseases of the Digestive System (K00-K95) Question: How is the Drug Induced Constipation coded? Answer: K59.03 Drug induced constipation along with a code to identify the adverse affect of the Fentanyl (T40.4x5-) 7 th character will be needed with the adverse affect code 44 22

24 Chapter 11: Diseases of the Digestive System (K00-K95) K85 Acute pancreatitis Inclusion terms deleted from Tabular Includes: Abscess of pancreas Acute necrosis of pancreas Gangrene of pancreas Hemorrhagic pancreatitis Infective necrosis of pancreas Suppurative pancreatitis 45 Chapter 11: Diseases of the Digestive System (K00-K95) New Codes for Acute Pancreatitis now include with or without necrosis and/or infection -K85.00-K85.02 Idiopathic acute pancreatitis -K85.10-K85.12 Biliary acute pancreatitis -K85.20-K85.22 Alcohol induced ac. pancreatitis -K85.30-K85.32 Drug induced ac. pancreatitis -K85.80-K85.82 Other acute pancreatitis K85.90-K85.92 Acute pancreatitis, unspecified 46 23

25 Chapter 11: Diseases of the Digestive System (K00-K95) Changes to ICD-10-CM index entry for Acute Pancreatitis -Infection, infected, infective (opportunistic), pancreas (acute) K85.9 Revised to : see Pancreatitis, acute -Infection, infected, infective (opportunistic), pancreas, specified NEC K85.8 Revised to (see also Pancreatitis, acute) K Chapter 11: Diseases of the Digestive System (K00-K95) K90.0 Celiac disease Includes Celiac disease with steatorrhea Deleted inclusion of idiopathic steatorrhea Expansion of K90.4 K90.41 Non-celiac gluten sensitivity K90.49 Malabsorption due to intolerance, NEC 48 24

26 Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99) Addition of code L76.3 Postprocedural hematoma and seroma of skin and subcutaneous tissue following a procedure Addition of code L98.7 Excessive and redundant skin and subcutaneous tissue 49 Chapter 13: Diseases of the Musculoskeletal & Connective Tissue (M00-M99) New Code Category: M21.61 Bunion Currently index instructs: see Deformity, toe, Hallux valgus; no separate code assigned, it s included in the Hallux valgus code New Codes and Categories: M M Pain in joints of hand Includes specific codes for pain in joint of hand Currently Pain, joint, hand indexed to M

27 Chapter 13: Diseases of the Musculoskeletal & Connective Tissue (M00-M99) Expansion of M50 for specificity M Cervical disc disorder with myelopathy, midcervical region M Cervical disc disorder w/radiculopathy, midcervical region M Other cervical disc displacement, mid-cervical region M Other cervical disc degeneration, mid-cervical region M Other cervical disc disorders, mid-cervical region M Cervical disc disorder, unspecified, mid-cervical region 51 Chapter 13: Diseases of the Musculoskeletal & Connective Tissue (M00-M99) Addition of Code M84.7 Non-traumatic fracture, NEC to reflect type, laterality M Atypical femoral fracture M Incomplete atypical femoral fx, rt. Leg M left leg M unspecified leg M Complete transverse atypical femoral fx, right leg M left leg M unspecified leg M Complete oblique atypical femoral fx, right leg M left leg M unspecified leg 52 26

28 Chapter 13: Diseases of the Musculoskeletal & Connective Tissue (M00-M99) Addition of new category: M97.01-M97.9: periprosthetic fracture around prosthetic joint M97.0-Periprosthetic fx around internal prosthetic hip joint M97.1- knee joint M97.2- ankle joint M97.3- shoulder joint M97.4- elbow joint M97.8- other joint M97.9- unspecified joint Previously classified as a complication of the joint prosthesis and assigned to T84 codes 53 Chapter 13: Diseases of the Musculoskeletal & Connective Tissue (M00-M99) Alphabetic Index Changes: Fx, pathologic, due to, osteoporosis M80.80 changed to M80.00 Fx, pathological new subterm of compression Fx, pathological, compression (not due to trauma) see also collapse, vertebra M Iritis, gouty M10.9 Revised to: (see also Gout by type) M10.9 [H22] 54 27

29 Chapter 13: Diseases of the Musculoskeletal & Connective Tissue (M00-M99) Alphabetic Index Changes: Neuritis (rheumatoid) gouty M10.00 [G63] Revised to: Neuritis (see also Gout, by type) M10.0 [G63] Nonunion new subterm: joint following fusion or arthrodesis M96.0 Synovitis now has a default code of M65.9 Synovitis, gouty see Gout, idiopathic Revised to: Synovitis, gouty see Gout M Chapter 14: Diseases of the Genitourinary System (N00-N99) Addition of New Code N13.0 Hydronephrosis with ureteropelvic junction obstruction Expansion of N39.49 Other specified urinary incontinence N Coital incontinence N Postural (urinary) incontinence 56 28

30 Chapter 14: Diseases of the Genitourinary System (N00-N99) Expansion of N42.3 Dysplasia of prostate N42.30 Unspecified dysplasia of prostate N42.31 Prostatic intraepithelial neoplasia N42.32 Atypical small acinar proliferation of prostate N42.39 Other dysplasia of prostate 57 Chapter 14: Diseases of the Genitourinary System (N00-N99) Expansion of N61.-Inflammatory disorders of breast N61.0 Mastitis without ascess N61.1 Abscess of the breast and nipple Special Note: Expansion of multiple categories regarding female genital tract ranging from N83- N99 which are not common to Long Term Care

31 Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00-Q99) Expansion of Q25 Congenital malformations of great arteries Q25.2 Atresia of aorta Q25.4 Other congenital malformations of aorta Expansion of Q52.12 Longitudinal vaginal septum Expansion of Q66.2 Congenital metatarsus Addition of code Q82.6 Congenital sacral dimple Addition of code Q87.82 Arterial tortuosity syndrome 59 Chapter 18: Symptoms, Signs and Abnormal Clinical & Lab Findings (R00-R99) Addition of code R73.03 Prediabetes Prediabetes will no longer be found under R73.09 Expansion of R82.7 Abnormal findings on microbiological exam of urine R82.71 Bacteriuria (N39.0 previously) R82.79 Other abnormal findings on microbiological examinations of urine Expansion of R97.2 Elevated prostate specific antigen (PSA) R97.20 Elevated prostate specific antigen (PSA) R92.21 Rising PSA following tx for malignant neoplasm of prostate 60 30

32 Chapter 19: Injury, Poisoning & Certain Other Consequences of External Causes (S00-T88) New expanded revisions & additional codes for complications of more specified devices (T83.-, T85.- categories Types of Complications: mechanical, displacement, leakage, breakdown, infection and inflammation, erosion of graft, stenosis, exposure, fibrosis and pain. Types of Devices: indwelling urethral catheter, nephrostomy catheter, penile/testicular prosthesis, implanted electronic neurostimulator, generator, ventricular intracranial shunt, nervous system prosthetic devices 61 Chapter 19: Injury, Poisoning & Certain Other Consequences of External Causes (S00-T88) Alphabetic Index Changes: New subterm of compression under fracture, pathological Fracture, pathological, compression (not due to trauma) (see also collapse, vertebra) M48.5- Fracture, traumatic many new subterms related to laterality.be careful when coding 62 31

33 Chapter 20: External Causes of Morbidity (V00-Y99) There is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless a provider is subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, reporting of ICD-10-CM codes in Chapter 20 is not required. These codes are used rarely in long term care 63 Chapter 21: Factors Influencing Health Status & Contact with Health Services (Z00-Z99) Alphabetic Index Change Carrier of Viral Hepatitis Z22.50-Z22.59 codes moved to the B18.- codes of infectious disease New Code Z79.84 Long term use of oral hypoglycemic drugs Example: Resident is being treated for diabetes with Metformin. Code: E11.9; Z

34 ICD-10-CM Official Coding Guidelines FY 2017 Available from NCHS website (address on a later slide) Narrative changes appear in bold text Items that were moved within guidelines since the FY 2016 version are underlined Revisions in heading changes are in italics 65 ICD-10-CM Official Coding Guidelines FY 2017 I.A.12.a. (page 11) Excludes1 A type 1 Excludes note is a pure excludes note. It means NOT CODED HERE! An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together

35 ICD-10-CM Official Coding Guidelines FY 2017 I.A.13. (page 11-12) Etiology/manifestation convention ( code first, use additional code and in diseases classified elsewhere notes) Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first, if applicable, followed by the manifestation. Wherever such a combination exists, there is a use additional code note at the etiology code, and a code first note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. No changes in Paragraphs ICD-10-CM Official Coding Guidelines FY 2017 I.A.15. (page 12-13) With The word with should be interpreted to mean associated with or due to when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated. For conditions not specifically linked by these relational terms in the classification, provider documentation must link the conditions in order to code them as related. The word with in Alphabetic Index is sequenced immediately following the main term, not in alphabetical order

36 ICD-10-CM Official Coding Guidelines FY 2017 I.A.19. (page 13) Code assignment and Clinical Criteria The assignment of a diagnosis code is based on the provider s diagnostic statement that the condition exists. The provider s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis. 69 ICD-10-CM Official Coding Guidelines FY 2017 I.B.13 (page 17) Laterality When a patient has a bilateral condition and each side is treated during separate encounters, assign the "bilateral" code (as the condition still exists on both sides), including for the encounter to treat the first side. For the second encounter for treatment after one side has previously been treated and the condition no longer exists on that side, assign the appropriate unilateral code for the side where the condition still exists (e.g., cataract surgery performed on each eye in separate encounters). The bilateral code would not be assigned for the subsequent encounter, as the patient no longer has the condition in the previously-treated site. If the treatment on the first side did not completely resolve the condition, then the bilateral code would still be appropriate

37 ICD-10-CM Official Coding Guidelines FY 2017 I.B.14 (page 17) Documentation for BMI, Depth of Non-pressure ulcers, Pressure Ulcer Stages, Coma Scale, and NIH Stroke Scale For the Body Mass Index (BMI), depth of non-pressure chronic ulcers, pressure ulcer stage, coma scale, and NIH stroke scale (NIHSS) codes, code assignment may be based on medical record documentation from clinicians who are not the patient s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient s diagnosis), since this information is typically documented by other clinicians involved in the care of the patient (e.g., a dietitian often documents the BMI, a nurse often documents the pressure ulcer stages, and an emergency medical technician often documents the coma scale). However, the associated diagnosis (such as overweight, obesity, acute stroke, or pressure ulcer) must be documented by the patient s provider. If there is conflicting medical record documentation, either from the same clinician or different clinicians, the patient s attending provider should be queried for clarification. The BMI, coma scale, and NIHSS codes should only be reported as secondary diagnoses. 71 ICD-10-CM Official Coding Guidelines FY 2017 I.B.16 (page 17) Documentation of Complications of Care Code assignment is based on the provider s documentation of the relationship between the condition and the care or procedure, unless otherwise instructed by the classification

38 ICD-10-CM Official Coding Guidelines FY 2017 I.C.1.f (page 26-27) Zika virus infections 1) Code only confirmed cases Code only a confirmed diagnosis of Zika virus (A92.5, Zika virus disease) as documented by the provider. This is an exception to the hospital inpatient guideline Section II, H. In this context, confirmation does not require documentation of the type of test performed; the physician s diagnostic statement that the condition is confirmed is sufficient. This code should be assigned regardless of the stated mode of transmission. If the provider documents "suspected", "possible" or "probable" Zika, do not assign code A92.5. Assign a code(s) explaining the reason for encounter (such as fever, rash, or joint pain) or Z20.828, Contact with and (suspected) exposure to other viral communicable diseases. 73 ICD-10-CM Official Coding Guidelines FY 2017 I.C.4.a.3 (page 34) Diabetes mellitus and the use of insulin and oral hypoglycemics If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11, Type 2 diabetes mellitus, should be assigned. Code Z79.4, Long-term (current) use of insulin, or Z79.84, Long term (current) use of oral hypoglycemic drugs, should also be assigned to indicate that the patient uses insulin or hypoglycemic drugs. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient s blood sugar under control during an encounter

39 ICD-10-CM Official Coding Guidelines FY 2017 I.C.4.a.6.a (page 35) Secondary diabetes mellitus and the use of insulin or hypoglycemic drugs For patients who routinely use insulin or hypoglycemic drugs, code Z79.4, Long-term (current) use of insulin, or Z79.84, Long term (current) use of oral hypoglycemic drugs should also be assigned. Code Z79.4 should not be assigned if insulin is given temporarily to bring a patient s blood sugar under control during an encounter. 75 ICD-10-CM Official Coding Guidelines FY 2017 I.C.9.a. (page 42) Hypertension The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term with in the Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated. For hypertension and conditions not specifically linked by relational terms such as with, associated with or due to in the classification, provider documentation must link the conditions in order to code them as related

40 ICD-10-CM Official Coding Guidelines FY 2017 I.C.9.a.1 (page 42-43) Hypertension with Heart Disease Hypertension with heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease. Use an additional code from category I50, Heart failure, to identify the type of heart failure in those patients with heart failure. The same heart conditions (I50.-, I51.4-I51.9) with hypertension are coded separately if the provider has specifically documented a different cause. Sequence according to the circumstances of the admission/encounter. 77 ICD-10-CM Official Coding Guidelines FY 2017 I.C.9.a.2 (page 43) Hypertensive Chronic Kidney Disease Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present. CKD should not be coded as hypertensive if the physician has specifically documented a different cause. The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease. See Section I.C.14. Chronic kidney disease. If a patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required

41 ICD-10-CM Official Coding Guidelines FY 2017 I.C.9.a.3 (page 43-44) Hypertensive Heart and Chronic Kidney Disease Assign codes from combination category I13, Hypertensive heart and chronic kidney disease, when there is hypertension with both heart and kidney involvement. If heart failure is present, assign an additional code from category I50 to identify the type of heart failure. The appropriate code from category N18, Chronic kidney disease, should be used as a secondary code with a code from category I13 to identify the stage of chronic kidney disease. See Section I.C.14. Chronic kidney disease. The codes in category I13, Hypertensive heart and chronic kidney disease, are combination codes that include hypertension, heart disease and chronic kidney disease. The Includes note at I13 specifies that the conditions included at I11 and I12 are included together in I13. If a patient has hypertension, heart disease and chronic kidney disease, then a code from I13 should be used, not individual codes for hypertension, heart disease and chronic kidney disease, or codes from I11 or I12. For residents with both acute renal failure and chronic kidney disease an additional code for acute renal failure is required. 79 ICD-10-CM Official Coding Guidelines FY 2017 I.C.9.a.10 (page 44) Hypertensive Crisis Assign a code from category I16, Hypertensive crisis, for documented hypertensive urgency, hypertensive emergency or unspecified hypertensive crisis. Code also any identified hypertensive disease (I10-I15). The sequencing is based on the reason for the encounter

42 ICD-10-CM Official Coding Guidelines FY 2017 I.C.9.e.1 (page 46-47) ST elevation myocardial infarction (STEMI) and non ST elevation myocardial infarction (NSTEMI) For encounters occurring while the myocardial infarction is equal to, or less than, four weeks old, including transfers to another acute setting or a postacute setting, and the myocardial infarction meets the definition for other diagnoses (see Section III, Reporting Additional Diagnoses), codes from category I21 may continue to be reported. For encounters after the 4 week time frame and the patient is still receiving care related to the myocardial infarction, the appropriate aftercare code should be assigned, rather than a code from category I21. For old or healed myocardial infarctions not requiring further care, code I25.2, Old myocardial infarction, may be assigned. 81 ICD-10-CM Official Coding Guidelines FY 2017 I.C.12.a.5 (page 51) Patients admitted with pressure ulcers documented as healing Pressure ulcers described as healing should be assigned the appropriate pressure ulcer stage code based on the documentation in the medical record. If the documentation does not provide information about the stage of the healing pressure ulcer, assign the appropriate code for unspecified stage. If the documentation is unclear as to whether the patient has a current (new) pressure ulcer or if the patient is being treated for a healing pressure ulcer, query the provider. For ulcers that were present on admission but healed at the time of discharge, assign the code for the site and stage of the pressure ulcer at the time of admission

43 ICD-10-CM Official Coding Guidelines FY 2017 I.C.12.a.6 (page 51) Patient admitted with pressure ulcer evolving into another stage during the admission If a patient is admitted with a pressure ulcer at one stage and it progresses to a higher stage, two separate codes should be assigned: one code for the site and stage of the ulcer on admission and a second code for the same ulcer site and the highest stage reported during the stay. 83 ICD-10-CM Official Coding Guidelines FY 2017 I.C.13.c. (page 52) Coding of Pathologic Fractures 7th character A is for use as long as the patient is receiving active treatment for the fracture. While the patient may be seen by a new or different provider over the course of treatment for a pathological fracture, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time. 7th character D is to be used for encounters after the patient has completed active treatment. The other 7th characters, listed under each subcategory in the Tabular List, are to be used for subsequent encounters for routine care of fractures during the healing and recovery phase as well as treatment of problems associated with the healing, such as malunions, nonunions, and sequelae. Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes

44 ICD-10-CM Official Coding Guidelines FY 2017 I.C.15.h. (page 58) Long term use of insulin and oral hypoglycemics Code Z79.4, Long-term (current) use of insulin, or code Z79.84, Longterm (current) use of oral hypoglycemic drugs, should also be assigned if the diabetes mellitus is being treated with insulin or oral medications. If the patient is treated with both oral medications and insulin, only the code for insulin-controlled should be assigned. 85 ICD-10-CM Official Coding Guidelines FY 2017 I.C.18.e. (page 67-68) Coma scale The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition. The coma scale codes should be sequenced after the diagnosis code(s). These codes, one from each subcategory, are needed to complete the scale. The 7th character indicates when the scale was recorded. The 7th character should match for all three codes

45 ICD-10-CM Official Coding Guidelines FY 2017 I.C.18.i. (page 69) NIHSS Stroke Scale The NIH stroke scale (NIHSS) codes (R ) can be used in conjunction with acute stroke codes (I63) to identify the patient's neurological status and the severity of the stroke. The stroke scale codes should be sequenced after the acute stroke diagnosis code(s). At a minimum, report the initial score documented. If desired, a facility may choose to capture multiple stroke scale scores. See Section I.B.14. for information concerning the medical record documentation that may be used for assignment of the NIHSS codes. 87 ICD-10-CM Official Coding Guidelines FY 2017 I.C.19.a. (page 69-70) Application of 7th Characters in Chapter 19 7th character A, initial encounter is used for each encounter where the patient is receiving active treatment for the condition. 7th character D subsequent encounter is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Paragraphs 1, 2, 5 and 6 have no changes

46 ICD-10-CM Official Coding Guidelines FY 2017 I.C.19.c.1. (page 71) Initial vs. Subsequent Encounter for Fractures Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion. The open fracture designations in the assignment of the 7th character for fractures of the forearm, femur and lower leg, including ankle are based on the Gustilo open fracture classification. When the Gustilo classification type is not specified for an open fracture, the 7th character for open fracture type I or II should be assigned (B, E, H, M, Q). Paragraphs 2-5 and 7 have no changes. 89 ICD-10-CM Official Coding Guidelines FY 2017 I.C.19.e.5.b (page 75) Poisoning When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36-T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional self-harm, assault and undetermined. If the intent of the poisoning is unknown or unspecified, code the intent as accidental intent. The undetermined intent is only for use if the documentation in the record specifies that the intent cannot be determined. Use additional code(s) for all manifestations of poisonings. If there is also a diagnosis of abuse or dependence of the substance, the abuse or dependence is assigned as an additional code

47 ICD-10-CM Official Coding Guidelines FY 2017 I.C.19.f. (page 76-77) Adult and child abuse, neglect and other maltreatment For cases of confirmed abuse or neglect an external cause code from the assault section (X92-Y09) should be added to identify the cause of any physical injuries. A perpetrator code (Y07) should be added when the perpetrator of the abuse is known. For suspected cases of abuse or neglect, do not report external cause or perpetrator code. If a suspected case of abuse, neglect or mistreatment is ruled out during an encounter code Z04.71, Encounter for examination and observation following alleged physical adult abuse, ruled out, or code Z04.72, Encounter for examination and observation following alleged child physical abuse, ruled out, should be used, not a code from T76. Paragraphs 1, 2 and 4 have no changes. 91 ICD-10-CM Official Coding Guidelines FY 2017 I.C.21.c.6 (page 91-92) Observation There are three observation Z code categories. They are for use in very limited circumstances when a person is being observed for a suspected condition that is ruled out. The observation codes are not for use if an injury or illness or any signs or symptoms related to the suspected condition are present. In such cases the diagnosis/symptom code is used with the corresponding external cause code. The observation codes are to be used as principal diagnosis only. The only exception to this is when the principal diagnosis is required to be a code from category Z38, Liveborn infants according to place of birth and type of delivery. Then a code from category Z05, Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out, is sequenced after the Z38 code. Additional codes may be used in addition to the observation code, but only if they are unrelated to the suspected condition being observed. The observation Z code categories: Z03 Encounter for medical observation for suspected diseases and conditions ruled out Z04 Encounter for examination and observation for other reasons Except: Z04.9, Encounter for examination and observation for unspecified reason Z05 Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out 92 46

48 ICD-10-CM Official Coding Guidelines FY 2017 Section II (page 100) Selection of Principal Diagnosis Since that time the application of the UHDDS definitions has been expanded to include all non-outpatient settings (acute care, short term, long term care and psychiatric hospitals; home health agencies; rehab facilities; nursing homes, etc). The UHDDS definitions also apply to hospice services (all levels of care). Paragraphs 1, 2, 4 and 5 have no changes. 93 ICD-10-CM Official Coding Guidelines FY 2017 Section III (page 103) Reporting Additional Diagnoses Since that time the application of the UHDDS definitions has been expanded to include all non-outpatient settings (acute care, short term, long term care and psychiatric hospitals; home health agencies; rehab facilities; nursing homes, etc). The UHDDS definitions also apply to hospice services (all levels of care) Paragraphs 1, 2, and 4 have no changes

49 ICD-10-CM Official Coding Guidelines FY 2017 Section IV (page ) Diagnostic Coding and Reporting Guidelines for Outpatient Services These coding guidelines for outpatient diagnoses have been approved for use by hospitals/ providers in coding and reporting hospital-based outpatient services and provider-based office visits. Guidelines in Section I, Conventions, general coding guidelines and chapter-specific guidelines, should also be applied for outpatient services and office visits. Though the conventions and general guidelines apply to all settings, coding guidelines for outpatient and provider reporting of diagnoses will vary in a number of instances from those for inpatient diagnoses, recognizing that: The Uniform Hospital Discharge Data Set (UHDDS) definition of principal diagnosis does not apply to hospital-based outpatient services and provider-based office visits. Coding guidelines for inconclusive diagnoses (probable, suspected, rule out, etc.) were developed for inpatient reporting and do not apply to outpatients. Paragraphs 2 and 3 have no changes. 95 ICD-10-CM Official Coding Guidelines FY 2017 Section IV.P (page 108) Encounters for general medical examinations with abnormal findings The subcategories for encounters for general medical examinations, Z00.0-, provide codes for with and without abnormal findings. Should a general medical examination result in an abnormal finding, the code for general medical examination with abnormal finding should be assigned as the first-listed diagnosis. An examination with abnormal findings refers to a condition/diagnosis that is newly identified or a change in severity of a chronic condition (such as uncontrolled hypertension, or an acute exacerbation of chronic obstructive pulmonary disease) during a routine physical examination. A secondary code for the abnormal finding should also be coded

50 Key Points for Success Get new ICD-10-CM Code Books Educate coding staff regarding changes Educate other providers concerning changes that impact their specific area, for example therapy, physicians, etc. Download and review the FY2017 ICD-10-CM Guidelines Updates 9 7 AHA Coding Clinic (1/2) Official clearinghouse for coding guidelines and advice Created through MOU between AHA and NCHS in 1963 Designated by 4 cooperating parties AHA, AHIMA, CMS and NCHS Work with NCHS and CMS to maintain integrity of classification system Serve as a clearinghouse for issue related to use of ICD-9-CM and ICD-10-CM

51 AHA Coding Clinic (2/2) Develop educational materials and programs Annual subscription to coding clinic published quarterly: Member $ Non member $ AHA Central Office, 155 North Wacker Drive, Suite 400, Chicago, Il th Quarter 2015 issue of Coding Clinic for ICD-10-CM New Guidance Concerning Excludes 1 Notes Allows both conditions to be reported together even though they are in an excludes 1 note when appropriate Example, the Excludes1 note at code range R40-R46 states that symptoms and signs constituting part of a pattern of mental disorder (F01-F99) cannot be assigned with the R40-R46 codes If dizziness (R42) is not a component of the mental health condition (e.g., dizziness is unrelated to bipolar disorder), then separate codes may be assigned for both dizziness and the mental health condition

52 4th Quarter 2015 issue of Coding Clinic for ICD-10-CM New Guidance Concerning Excludes 1 Notes Allows both conditions to be reported together even though they are in an excludes 1 note when appropriate Example, the Excludes1 note at code range I60-I69 Cerebrovascular Disease has an Excludes1 note for traumatic intracranial hemorrhage (S06.-). Codes in I60-I69 should not be used for a diagnosis of traumatic intracranial hemorrhage. However, if the patient has both a current traumatic intracranial hemorrhage and sequela from a previous stroke, then it would be appropriate to assign both a code from S06- and I ICD-10-CM Resources and References 51

53 ICD-10-CM Official Guidelines for Coding and Reporting d10cm.htm 114 pages ICD-10 Resources Other organizations who offer ICD-10 Resources: AHIMA (American Health Information Management Association)

54 ICD-10-CM Documentation Tips AHIMA Website Library of Clinical Documentation Improvement ICD-10-CM documentation tips for healthcare industry Tips focus on language and/or wording needed for details and specificity for a given diagnosis, condition, disease, etc. 78 pages Medicare Learning Network Medicare Learning Network (MLN) educational materials for the Medicare FFS provider community Education/Medicare-Learning-Network- MLN/MLNProducts/Downloads/ MLNMattersArticlesIndex.pdf Click on I in the index and all the article listed for ICD-10-CM will appear Click on the number listed then save or print

55 CMS ICD-10 Website The CMS ICD-10 website provides the latest ICD-10 information and links to resources for providers to prepare for ICD-10 implementation 0/index.html Sign up for CMS ICD-10 Industry Updates 10_Industry_ _Updates.html CMS Sponsored Teleconferences The CMS Sponsored ICD-10 Teleconferences web page provides information on upcoming and previous CMS ICD-10 National Provider Calls, including registration, presentation materials, video slideshow presentations, written transcripts and audio recordings Sponsored-ICD-10-Teleconferences.html

56 109 ICD-10- CM Questions???? 55