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1 Welcome to Practice Management Institute s Webinar and Audio Conference Training. We hope that the information contained herein will give you valuable tips that you can use to improve your skills and performance on the job. Each year, more than 40,000 physicians and office staff are trained by Practice Management Institute. For 30 years, physicians have relied on PMI to provide up-to-date coding, reimbursement, compliance and office management training. Instructor-led classes are presented in 400 of the nation s leading hospitals, healthcare systems, colleges and medical societies. PMI provides a number of other training resources for your practice, including national conferences for medical office professionals, self-paced certification preparatory courses, online training, educational audio downloads, and practice reference materials. For more information, visit PMI s web site at Please be advised that all information in this program is provided for informational purposes only. While PMI makes all reasonable efforts to verify the credentials of instructors and the information provided, it is not intended to serve as legal advice. The opinions expressed are those of the individual presenter and do not necessarily reflect the viewpoint of Practice Management Institute. The information provided is general in nature. Depending on the particular facts at issue, it may or may not apply to your situation. Participants requiring specific guidance should contact their legal counsel. CPT is a registered trademark of the American Medical Association. Practice Management Institute 8242 Vicar San Antonio, Texas tel: fax: (210) info@pmimd.com

2 Welcome to PMI s Webinar Presentation Brought to you by: Practice Management Institute pmimd.com Meet the Presenter Jeffrey Restuccio CPC, CPC-H, MBA On the topic: ICD-10-CM GEMS Conversion Tour of the AAFP Top 100 Code List

3 Tour of a GEMS conversion of the Top 100 AAFP ICD 9 Codes Jeffrey Restuccio, CPC, CPC H, MBA Coding and Billing Consultant Memphis TN (901) jeff@ritecode.com Ritecode.com 1 The Most Common Family Practice Codes 100 ICD 9 Codes [List Included] Converts to 362 ICD 10 codes [List Included] Most providers have not been reporting ICD 9 codes specifically or accurately in the past. In other words, most of ICD 10 training is learning both guidelines and specificity already in ICD 9. Hypertension has less specificity (!) Some codes have laterality [right, left, unspecified] Some codes increase specificity. A lot of common/popular codes are missing from this list. Ritecode.com 2 1

4 ICD 10 Highlights Laterality: Document and report any right/left anatomy as follows: For H codes the right, left and bilateral eye conventions are:.**1 = right.**2 = left.**9 = unspecified [recommend not using] Sometimes unspecified is a 0 and not a 9. Laterality [right or left] codes are never a seventh digit. There is a bilateral [3] digit in the H codes for both eyes and ears..**3 = bilateral [means both ] EyeCodingForum.com 3 Occurrence codes All injury codes will now have the following occurrence codes and an X placeholder code. Foreign Body (FB) codes (Note: XA, XD and XS) Initial, Subsequent and Sequela: T15.01XA Foreign body in cornea, right eye, initial encounter T15.01XD Foreign body in cornea, right eye, subsequent encounter T15.01XS Foreign body in cornea, right eye, sequela Note: all above are for the right eye; fifth digit = 1. EyeCodingForum.com 4 2

5 Late Effects and Occurrence codes The term "Late Effect" is not found in ICD 10. They are now listed as Sequela, which are reported using the external cause code with the 7th character S for sequela (sequelae is plural). Like late effects, a sequela can occur at any time after the initial injury. The most common sequelae in ICD 10 would be from ischemia, fractures, burns, foreign bodies, or penetrating injuries. EyeCodingForum.com 5 The ICD 10 X Placeholder Code Occasionally one will find an X character in the middle of an ICD 10 code. Example: T15.01X* Foreign body in cornea, right eye In this case, the X in the sixth digit position serves as a placeholder. It allows future expansion or simply moves the extender code to the correct (seventh) character position. Without the placeholder, the resulting code would be invalid. Placeholder codes will also be in some ICD 10 glaucoma codes. Note: I will be using an * (asterisk) as a wild card character throughout this course. I will not be using an X as a wild card because it is now a valid character anywhere in the code. EyeCodingForum.com 6 3

6 AAFP Top 100 List Converted Ritecode.com 7 Notice expansion of codes. 7810Warts, viral, unspec. 7999Viral infection, unspec. 7999Viral infection, unspec. Critter codes B079 Viral wart, unspecified B9710 Unspecified enterovirus as the cause of diseases classified elsewhere B9789 Other viral agents as the cause of diseases classified elsewhere You will see this other and unspecified a lot. Ritecode.com 8 4

7 216.9: neoplasm, benign, skin, unspec. D229 Melanocytic nevi, unspecified D239 Other benign neoplasm of skin, unspecified Ritecode.com 9 Endocrine System Endocrine 27800Obesity, NOS E6609 Other obesity due to excess calories 27800Obesity, NOS E661 Drug induced obesity 27802Overweight E663 Overweight 27800Obesity, NOS E668 Other obesity 27800Obesity, NOS E669 Obesity, unspecified Glucose 2719intolerance E749 Disorder of carbohydrate metabolism, unspecified Hypercholeste 2720rolemia, pure E780 Pure hypercholesterolemia Ritecode.com 10 5

8 305.1: Nicotine dependence, unspec. F17200 F17201 F17210 F17211 F17220 F17221 F17290 F17291 Nicotine dependence, unspecified, uncomplicated Nicotine dependence, unspecified, in remission Nicotine dependence, cigarettes, uncomplicated Nicotine dependence, cigarettes, in remission Nicotine dependence, chewing tobacco, uncomplicated Nicotine dependence, chewing tobacco, in remission Nicotine dependence, other tobacco product, uncomplicated Nicotine dependence, other tobacco product, in remission Ritecode.com 11 Psychology Codes Depressive Major depressive disorder, single episode, 311 Psychology disorder, NOS F329 unspecified Anxiety state, 30000unspec. F419 Anxiety disorder, unspecified Insomnia, sleep 30740disorder, unspec. F519 Attention deficit, 31401w/ hyperactivity F900 Attention deficit, 31401w/ hyperactivity F901 Attention deficit, 31401w/ hyperactivity F902 Attention deficit, 31401w/ hyperactivity F908 Attention deficit, 31401w/ hyperactivity F909 Sleep disorder not due to a substance or known physiological condition, unspecified Attention deficit hyperactivity disorder, predominantly inattentive type Attention deficit hyperactivity disorder, predominantly hyperactive type Attention deficit hyperactivity disorder, combined type Attention deficit hyperactivity disorder, other type Attention deficit hyperactivity disorder, unspecified type Ritecode.com 12 6

9 Otitis externa, unspec Crosswalks to 20 ICD 10 codes; right ear only listed (laterality) Note 5 digit codes; 6 digit codes; Crosswalks to: H6001 H6011 H60311 H60321 Abscess of right external ear Cellulitis of right external ear Diffuse otitis externa, right ear [laterality] Hemorrhagic otitis externa, right ear [laterality] H60391 Other infective otitis externa, right ear [laterality] Ritecode.com : Otitis media, acute Crosswalks to: H66001 H66004 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear [laterality] Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear [laterality] Ritecode.com 14 7

10 428.0 Congestive heart failure, unspecified I50.9 Heart failure, unspecified There are more specific code choices: I50.1 Left ventricular failure I50.21 Acute systolic (congestive) heart failure I50.22 Chronic systolic (congestive) heart failure I50.23 Acute on chronic systolic (congestive) heart failure I50.30 Unspecified diastolic (congestive) heart failure I50.31 Acute diastolic (congestive) heart failure I50.32 Chronic diastolic (congestive) heart failure I50.33 Acute on chronic diastolic (congestive) heart failure These are not unique to ICD 10. AAFP Ritecode.com 15 Congestive heart failure, cont. I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure **Code first [sequencing guideline]: heart failure complicating abortion or ectopic or molar pregnancy (O00 O07, O08.8) heart failure following surgery (I97.13 ) heart failure due to hypertension (I11.0) heart failure due to hypertension with chronic kidney disease (I13 ) obstetric surgery and procedures (O75.4) rheumatic heart failure (I09.81) Ritecode.com 16 AAFP 8

11 434.91: Cerebral artery occlusion w/ infarction, unspec Crosswalks to: I63511 I63521 I63531 I63541 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery Ritecode.com : Cerebral artery occlusion w/ infarction, unspec AAFP: Crosswalks to these codes per GEMS: I6350 I63511 I63512 I63519 I63521 I63522 I63529 I63531 I63532 I63539 I63541 I63542 I63549 I6359 I638 I639 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery Other cerebral infarction Cerebral infarction, unspecified Ritecode.com 18 9

12 451.19: Phlebitis, deep, lower extrem., other All codes below have laterality [1=right, 2=left, 9=unspecified]: I80201 I80221 I80231 I80291 Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity Phlebitis and thrombophlebitis of right popliteal vein Phlebitis and thrombophlebitis of right tibial vein Phlebitis and thrombophlebitis of other deep vessels of right lower extremity Crosswalks to a total of 12 codes [4 X 3]. Ritecode.com 19 Codes 461.9: Sinusitis, acute, NOS J0190 J0191 Acute sinusitis, unspecified Acute recurrent sinusitis, unspecified Ritecode.com 20 10

13 Expands to: 466.0: Bronchitis, acute J200 J201 J202 J203 J204 J205 J206 J207 J208 J209 Acute bronchitis due to Mycoplasma pneumoniae Acute bronchitis due to Hemophilus influenzae Acute bronchitis due to streptococcus Acute bronchitis due to coxsackievirus Acute bronchitis due to parainfluenza virus Acute bronchitis due to respiratory syncytial virus Acute bronchitis due to rhinovirus Acute bronchitis due to echovirus Acute bronchitis due to other specified organisms Acute bronchitis, unspecified Ritecode.com 21 Strep throat Strep throat has two separate crosswalks. 462 Pharyngitis, acute J028 Acute pharyngitis due to other specified organisms 462 Pharyngitis, acute J029 Acute pharyngitis, unspecified 340 Strep throat J020 Streptococcal pharyngitis 340 Strep throat J0300 Acute streptococcal tonsillitis, unspecified 340 Strep throat J0301 Acute recurrent streptococcal tonsillitis Ritecode.com 22 11

14 Esophageal reflux K21.9 Gastro esophageal reflux disease without esophagitis K21.0 Gastro esophageal reflux disease with esophagitis Ritecode.com Constipation, unspecified K59.00 Constipation, unspecified ** There are more specific code choice selections available for constipation. These include: K59.01 Slow transit constipation K59.02 Outlet dysfunction constipation K59.09 Other constipation Ritecode.com 24 12

15 Crosswalks to: K640 K641 K642 K643 K : Hemorrhoids, NOS First degree hemorrhoids Second degree hemorrhoids Third degree hemorrhoids Fourth degree hemorrhoids Unspecified hemorrhoids ICD 9: External hemorrhoids with complication NEC X walks to: K64.4 Residual hemorrhoidal skin tags K64.5 Perianal venous thrombosis Ritecode.com : Diarrhea R19.7 Diarrhea, unspecified K59.1 Functional diarrhea **There are many combination codes in ICD 10 CM that include diarrhea as a manifestation Ritecode.com 26 13

16 Skin Disorders 682.9: Cellulitis/abscess, unspecified L0291 L0390 L0391 Cutaneous abscess, unspecified Cellulitis, unspecified Acute lymphangitis, unspecified Ritecode.com : Eczema, atopic dermatitis Expands to: L200 L2081 L2082 L2084 L2089 L209 Besnier's prurigo Atopic neurodermatitis Flexural eczema Intrinsic (allergic) eczema Other atopic dermatitis Atopic dermatitis, unspecified Ritecode.com 28 14

17 692.9: Contact dermatitis, NOS Expands to: L239 L249 L259 L300 L302 L308 L309 Allergic contact dermatitis, unspecified cause Irritant contact dermatitis, unspecified cause Unspecified contact dermatitis, unspecified cause Nummular dermatitis Cutaneous autosensitization Other specified dermatitis Dermatitis, unspecified Ritecode.com : Acne, other Expands to: L700 L701 L703 L704 L705 L708 L709 Acne vulgaris Acne conglobata Acne tropica Infantile acne Acne excoriee des jeunes filles Other acne Acne, unspecified Ritecode.com 30 15

18 Expands to: 706.2: Sebaceous cyst L720 L722 L723 L728 L729 Epidermal cyst Steatocystoma multiplex Sebaceous cyst Other follicular cysts of the skin and subcutaneous tissue Follicular cyst of the skin and subcutaneous tissue, unspecified Ritecode.com 31 Crosswalks to: 706.1: Acne, other L730 Acne keloid When skin is injured, fibrous tissue (called scar tissue) forms over the wound to repair and protect the injury. In some cases, scar tissue grows excessively, forming smooth, hard growths called keloids. Ritecode.com 32 16

19 724.4: Back pain w/ radiation, unspec. Note the Regions; Expands to two groups of codes : M5114 M5115 M5116 M5117 M5414 M5415 M5416 M5417 Intervertebral disc disorders with radiculopathy, thoracic region Intervertebral disc disorders with radiculopathy, thoracolumbar region Intervertebral disc disorders with radiculopathy, lumbar region Intervertebral disc disorders with radiculopathy, lumbosacral region Radiculopathy, thoracic region Radiculopathy, thoracolumbar region Radiculopathy, lumbar region Radiculopathy, lumbosacral region Ritecode.com : Vaginitis/vulvitis, unspec. Expands to: N760 N761 N762 N763 Acute vaginitis Subacute and chronic vaginitis Acute vulvitis Subacute and chronic vulvitis Ritecode.com 34 17

20 726.10: Rotator cuff/shoulder syndrome, unspec. Laterality; Crosswalks to 12 codes [right, left, unspecified]: M66211 M66811 M75101 M7551 Spontaneous rupture of extensor tendons, right shoulder Spontaneous rupture of other tendons, right shoulder Unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic Bursitis of right shoulder Ritecode.com : Fibromyalgia/myositis, unspec Crosswalks to unspecific codes as well as more specific codes; yes, they still exist. M6080 Other myositis, unspecified site M6088 Other myositis, other site M6089 Other myositis, multiple sites Ritecode.com 36 18

21 729.1: Fibromyalgia/myositis, unspec. More specific codes with laterality; M60811 Other myositis, right shoulder [left = 2; unspec = 9] M60821 M60831 M60841 M60851 M60861 M60871 Other myositis, right upper arm Other myositis, right forearm Other myositis, right hand Other myositis, right thigh Other myositis, right lower leg Other myositis, right ankle and foot Ritecode.com : Pain in limb Right=1, Left=2, unspecified=9; Crosswalks (right listed only): M79601 M79604 M79621 M79631 M79641 M79644 M79651 M79661 M79671 M79674 Pain in right arm [left = 2; unspecified=9] Pain in right leg Pain in right upper arm Pain in right forearm Pain in right hand Pain in right finger(s) Pain in right thigh Pain in right lower leg Pain in right foot Pain in right toe(s) Ritecode.com 38 19

22 780.79: Fatigue and malaise, other Expands to: R530 R531 R5381 R5383 Neoplastic (malignant) related fatigue Weakness Other malaise Other fatigue Ritecode.com 39 Well exams expand to two options Without abnormal findings (can be a zero or one) With abnormal findings ( can be a one or nine) V700 Z0000 Well adult exam w/o V700 Z0001 Well adult exam w/ V202 Z00121 Well child check w/o V202 Z00129 Well child check w/ V7231 Z01411 Gynecological exam w/o V7231 Z01419 Gynecological exam w/ Ritecode.com 40 20

23 V25.02: Contraception, other (diaphragm, etc.) Expands to: Z30013 Z30014 Z30018 Z30019 Encounter for initial prescription of injectable contraceptive Encounter for initial prescription of intrauterine contraceptive device Encounter for initial prescription of other contraceptives Encounter for initial prescription of contraceptives, unspecified Ritecode.com 41 V22.0: Prenatal care, normal, first pregnancy Converts to: Z3400 Z3401 Z3402 Z3403 Encounter for supervision of normal first pregnancy, unspecified trimester Encounter for supervision of normal first pregnancy, first trimester Encounter for supervision of normal first pregnancy, second trimester Encounter for supervision of normal first pregnancy, third trimester Ritecode.com 42 21

24 V22.1: Prenatal care, normal, other pregnancy Z3480 Z3481 Z3482 Z3483 Encounter for supervision of other normal pregnancy, unspecified trimester Encounter for supervision of other normal pregnancy, first trimester Encounter for supervision of other normal pregnancy, second trimester Encounter for supervision of other normal pregnancy, third trimester Ritecode.com 43 V22.1: Prenatal care, normal, other pregnancy Z3490 Z3491 Z3492 Z3493 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester Encounter for supervision of normal pregnancy, unspecified, first trimester Encounter for supervision of normal pregnancy, unspecified, second trimester Encounter for supervision of normal pregnancy, unspecified, third trimester Ritecode.com 44 22

25 More V Codes Postpartum Follow up Postpartum follow up, V242 routine Z392 Encounter for routine postpartum follow up Ritecode.com 45 Signs and Symptoms 7851 R002 Palpitations 7962 R030 Elevated blood pressure reading, without diagnosis of hypertension 7862 R05 Cough R0602 Shortness of breath R079 Chest pain, unspecified R100 Acute abdomen R109 Unspecified abdominal pain R112 Nausea with vomiting, unspecified Ritecode.com 46 23

26 Signs and Symptoms R197 Diarrhea, unspecified [more specific codes] 7821 R21 Rash and other nonspecific skin eruption 7881 R300 Dysuria 7881 R309 Painful micturition, unspecified R350 Frequency of micturition 7804 R42 Dizziness and giddiness R502 Drug induced fever R509 Fever, unspecified 7840 R51 Headache [better codes for HA] Ritecode.com 47 Migraine Headaches For migraines you need to know if the following are true (with) or not true (without): Do they have a visual aura or not? Are this headache intractable or not? Status migrainosus refers to any migraine that persists longer than 72 hours. These apply to migraine, cluster, post traumatic, and other types of headaches not just migraines. Ritecode.com 48 24

27 Migraine headaches (without aura) G43001 G43009 G43011 G43019 Migraine without aura, not intractable, with status migrainosus Migraine without aura, not intractable, without status migrainosus Migraine without aura, intractable, with status migrainosus Migraine without aura, intractable, without status migrainosus Ritecode.com 49 Migraine headache (with aura) G43101 G43109 G43111 G43119 Migraine with aura, not intractable, with status migrainosus Migraine with aura, not intractable, without status migrainosus Migraine with aura, intractable, with status migrainosus Migraine with aura, intractable, without status migrainosus Ritecode.com 50 25

28 Specific Fever Codes R50.2 Drug induced fever R50.81 Fever presenting with conditions classified elsewhere R50.82 Postprocedural fever R50.83 Postvaccination fever R50.84 Febrile nonhemolytic transfusion reaction R50.9 Fever, unspecified EyeCodingForum.com 51 More codes BPH/LUTS w/o obstruction N400 Enlarged prostate without lower urinary tract symptoms 6019 Prostatitis, NOS N419 Inflammatory disease of prostate, unspecified Ritecode.com 52 26

29 Fatigue Fatigue and malaise, Neoplastic (malignant) related ss other [780.79] R530 fatigue Fatigue and malaise, other R531 Weakness Fatigue and malaise, other R5381 Other malaise Fatigue and malaise, other R5383 Other fatigue Ritecode.com 53 Additional Codes Edema, Localized: Edema, localized, NOS R600 Localized edema Edema, localized, NOS R601 Generalized edema Edema, localized, NOS R609 Edema, unspecified Other Codes 78321Abnormal loss of weight 79501Abnormal Pap, ASC US R634 Abnormal weight loss R87610 Atypical squamous cells of undetermined significance on cytologic smear of cervix (ASC US) Ritecode.com 54 27

30 840.9: Sprain/strain: shoulder/arm, unspec. Right=1, Left=2, unspecified=9. Note.**1A below. Placeholder Occurrence: (A=initial; D=subsequent; S=sequelae) Unspecified sprain of right shoulder joint, initial S43401A encounter [Initial occurrence code only] Sprain of unspecified parts of right shoulder girdle, S4391XA initial encounter S46911A S8391XA S86911A Strain of unspecified muscle, fascia and tendon at shoulder and upper arm level, right arm, initial encounter Sprain of unspecified site of right knee, initial encounter Strain of unspecified muscle(s) and tendon(s) at lower leg level, right leg, initial encounter Ritecode.com 55 Initial Unspecified sprain codes S43401A S43402A S43409A Unspecified sprain of right shoulder joint, initial encounter Unspecified sprain of left shoulder joint, initial encounter Unspecified sprain of unspecified shoulder joint, initial encounter Subsequent: Add D Sequela: Add S Total of 9 codes for each type of sprain and then by arm, leg or joint. Ritecode.com 56 28

31 845.00: Sprain of ankle, unspecified site Add specificity in ICD 9 (8 specific options) Sprains and strains of ankle and foot: ankle: unspecified site [Avoid] Sprains and strains of ankle and foot: ankle: deltoid (ligament), ankle Sprains and strains of ankle and foot: ankle: calcaneofibular (ligament) Sprains and strains of ankle and foot: ankle: tibiofibular (ligament), distal Sprains and strains of ankle and foot: ankle: other Sprains and strains of ankle and foot: foot: unspecified site [Avoid] Sprains and strains of ankle and foot: foot: tarsometatarsal (joint) (ligament) Sprains and strains of ankle and foot: foot: metatarsophalangeal (joint) Sprains and strains of ankle and foot: foot: interphalangeal (joint), toe Sprains and strains of ankle and foot: foot: other Ritecode.com 57 Scope of the Task Each specific ICD 9 injury sprain code will then convert to 9 ICD 10 codes! There will be right, left, and unspecified and then initial, subsequent and sequela for each location. In July, August and September: Recommend practicing entering the codes often. Recommend doing numerous documentation audits. You must get buy in from management, doctors, and staff to document the additional specificity. Ritecode.com 58 29

32 V22.1: Prenatal care, normal, other pregnancy Converts to: Z3480 Z3481 Z3482 Z3483 Z3490 Z3491 Z3492 Z3493 Encounter for supervision of other normal pregnancy, unspecified trimester Encounter for supervision of other normal pregnancy, first trimester Encounter for supervision of other normal pregnancy, second trimester Encounter for supervision of other normal pregnancy, third trimester Encounter for supervision of normal pregnancy, unspecified, unspecified trimester Encounter for supervision of normal pregnancy, unspecified, first trimester Encounter for supervision of normal pregnancy, unspecified, second trimester Encounter for supervision of normal pregnancy, unspecified, third trimester Ritecode.com 59 V586.9: High risk medication, longterm use Converts to: Z793 Z79891 Z79899 Long term (current) use of hormonal contraceptives Long term (current) use of opiate analgesic Other long term (current) drug therapy Ritecode.com 60 30

33 V586.9: High risk medication, long term use Z793 Z79891 Z79899 Long term (current) use of hormonal contraceptives Long term (current) use of opiate analgesic Other long term (current) drug therapy Ritecode.com 61 End of AAFP Top 100 List Now we will discuss some additional guidelines plus codes not included in the list. Use the included lists and compare to your current list. Try coding from this list. How many codes are missing? Audit your documentation for specificity. Ritecode.com 62 31

34 Action Plan to Prepare for ICD Circle all unspecific ICD 9 codes in your current fee ticket/icd 9 cheat sheet/provider documentation. 2. You should generate a list every ICD 9 code you have report for the last 12 months from your PM system. You can use this list to create your new ICD 10 fee ticket or cheat sheet. 3. Decide how codes are selected. Are you are going to code from the manual, a cheat sheet or a look up program to select the new ICD 10 codes? 4. All fee tickets must be reworked. Recommendation is between three to six months before Oct Remember, for many, the the number of codes expand over 4X. Ritecode.com 63 Tidbits on ICD 10 Alpha characters are not case sensitive I and O are used but only as the 1st character U is not used saved for the International version Combination codes are now required for many conditions including diabetes, glaucoma, diabetic retinopathies, angina, and CAD. ICD 10 restructures reporting of obstetric diagnoses. In ICD 9 CM, the patient is classified by diagnosis in relation to the episode of care. In ICD 10 CM, the patient is classified by diagnosis in relation to the patient s trimester of pregnancy. Ritecode.com 64 32

35 What s the Same? Many of the guidelines are exactly the same between ICD 9 CM and ICD 10 CM Conventions Format of the Index and Tabular List Abbreviations and Punctuation NEC, NOS*, brackets and colons, etc Steps in assigning codes Includes notes General Coding Guidelines *Not Elsewhere Classifiable; Not Otherwise Specified. Ritecode.com 65 ICD 10 CM Code Detail Character Number (1 7) S 5 2. Fracture of the forearm S Fracture of the shaft of the radius S S Transverse fracture of the shaft of the radius Displaced transverse fracture of the shaft of the right radius S A Displaced transverse fracture of the shaft of the right radius, initial encounter for closed fracture Ritecode.com 66 33

36 Burns Versus Corrosions Burn codes are for thermal burns, except sunburns, that come from a heat source, such as fire or hot appliance. Also for burns resulting from electricity and radiation. Corrosions are burns due to chemicals. Encounters for treatment of late effects of burns or corrosions should be coded with a burn or corrosion code with the 7th character of S sequlae. An external cause code should be used with burns and corrosions to identify the source and intent of the burn, as well as the place where it occurred. Ritecode.com 67 Initial, Subsequent, and Sequela (1) 7th character A, initial encounter is used while the patient is receiving active treatment for the condition. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician. 7th character D subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following treatment of the injury or condition. Source: AHA ICD 10 Coding Guidelines Manual Ritecode.com 68 34

37 Initial, Subsequent, and Sequela (2) 7th character A, initial encounter is used while the patient is receiving active treatment for the condition. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician. 7th character D subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits. Source: AHA ICD 10 Coding Guidelines Manual Ritecode.com 69 Initial, Subsequent, or Sequela Encounter? By Guest Contributor In Coding Edge April 1, 2014 Take the patient s perspective when appending the seventh character in ICD 10 CM. By Debra Mitchell, MSPH, CPC H The statement evaluation and treatment by a new physician can be a source of confusion, but you will code correctly if you are able to answer the basic question, Has the patient previously received active treatment for this condition in any setting or by any provider? Ritecode.com 70 35

38 Initial, Subsequent Example For example: The patient is evaluated in the emergency room (ER) for a displaced transverse fracture of the left ulna that cannot be managed at this time. The ER applies immobilization and ice and instructs the patient to follow up with orthopedics in the morning. This would be reported using S52.222A Displaced transverse fracture of the left ulna, initial encounter for closed fracture. When the orthopedist rechecks the patient and reduces the fracture the next day, the patient is receiving initial active treatment for this fracture. That is, this is the first encounter at which the patient receives definitive care (the ER was able to apply comfort care only). Per ICD 10 guidelines, you would again report S52.222A for an initial encounter. Ritecode.com 71 HIPAA Non Covered Entities All Health Insurance Portability and Accountability Act (HIPAA) of 1996 covered entities MUST implement the new code sets with dates of service, or date of discharge for inpatients, that occur on or after October 1, Non covered entities do not and that includes: worker's compensation (WC), disability and auto insurers. Therefore, your PM system and your clinic must be able to switch to ICD 9 codes if WC in your state does not convert to the ICD 10 codes. The probability is high that most, if not all WC agencies will convert to ICD 10 in Be sure to contact your state agency. Ritecode.com 72 36

39 Common ICD 9 Errors Abdominal Pain: Code Always document the correct quadrant. Avoid code Asthma: Document Instrinsic (493.1 ) versus extrinsic (493.0 ) With w/o status asthmaticus With acute exacerbation Diabetes Document both Type (1 or 2) and controlled or uncontrolled Unspecified headaches: document tension versus migraine. Hypertension: malignant versus benign Ritecode.com Abdominal pain, unspecified site Converts to: R10.9 Unspecified abdominal pain but there are more specific code choices: R10.0 Acute abdomen R10.10 Upper abdominal pain, unspecified R10.11 Right upper quadrant pain R10.12 Left upper quadrant pain R10.13 Epigastric pain R10.2 Pelvic and perineal pain R10.30 Lower abdominal pain, unspecified R10.31 Right lower quadrant pain R10.32 Left lower quadrant pain R10.33 Periumbilical pain R10.84 Generalized abdominal pain Note: all the options above already exist in ICD 9. These are not new to ICD 10. Ritecode.com 74 37

40 Hypertension ICD 9/ICD 10 In ICD 9 you were taught to avoid unspecified Hypertension (401.9) Document as either benign (401.1) or malignant (401.0). There is a hypertension table in the ICD 9 Index. Document secondary hypertension and HTN due to another factor (i.e., Cushings disease). In ICD 10 the same code is used for benign and malignant. I10: Essential (primary) hypertension Includes: hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic) Ritecode.com 75 Common Codes Z23 Encounter for immunization **Code first any routine childhood examination G89.4 Chronic pain syndrome * Code also related psychological factors associated with pain (F54.42 ) Dizziness and giddiness R42 Dizziness and giddiness Lumbago M54.5 Low back pain Ritecode.com 76 38

41 477.9 Allergic rhinitis, cause unspecified J30.9 Allergic rhinitis, unspecified * There are more specific code choices: J30.0 Vasomotor rhinitis [New for ICD 10] J30.1 Allergic rhinitis due to pollen J30.2 Other seasonal allergic rhinitis J30.5 Allergic rhinitis due to food J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander J30.89 Other allergic rhinitis Vasomotor rhinitis has no specific cause for the inflammation, which includes, nonallergic rhinitis, idiopathic rhinitis, and rhinitisnonallergic. Ritecode.com Asthma, unspecified Asthma, unspecified J Unspecified asthma, uncomplicated **Use additional code to identify: exposure to environmental tobacco smoke (Z77.22) exposure to tobacco smoke in the perinatal period (P96.81) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17 ) tobacco use (Z72.0) Ritecode.com 78 39

42 Asthma, unspecified J Unspecified asthma, uncomplicated ** There are more specific code choice selections available in ICD 10 CM. These include: J45.20 Mild intermittent asthma, uncomplicated J45.21 Mild intermittent asthma with (acute) exacerbation J45.22 Mild intermittent asthma with status asthmaticus J45.30 Mild persistent asthma, uncomplicated J45.31 Mild persistent asthma with (acute) exacerbation J45.32 Mild persistent asthma with status asthmaticus Ritecode.com Asthma, unspecified J45.40 Moderate persistent asthma, uncomplicated J45.41 Moderate persistent asthma with (acute) exacerbation J45.42 Moderate persistent asthma with status asthmaticus J45.50 Severe persistent asthma, uncomplicated J45.51 Severe persistent asthma with (acute) exacerbation J45.52 Severe persistent asthma with status asthmaticus J Unspecified asthma with (acute) exacerbation J Unspecified asthma with status asthmaticus J Exercise induced bronchospasm J Cough variant asthma J Other asthma Ritecode.com 80 40

43 Extrinsic asthma, unspecified J Unspecified asthma with (acute) exacerbation J Unspecified asthma with status asthmaticus J Unspecified asthma, uncomplicated **Use additional code to identify: exposure to environmental tobacco smoke (Z77.22) exposure to tobacco smoke in the perinatal period (P96.81) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17 ) tobacco use (Z72.0) Ritecode.com Bronchitis, not specified as acute or chronic J40 Bronchitis, not specified as acute or chronic ** Use additional code to identify: Exposure to environmental tobacco smoke (Z77.22) Exposure to tobacco smoke in the perinatal period (P96.81) History of tobacco use (Z87.891) Occupational exposure to environmental tobacco smoke (Z57.31) Tobacco dependence (F17. ) Tobacco use (Z72.0) Ritecode.com 82 41

44 F41.9 Anxiety disorder, unspecified *There are more specific code choices: F41.1 Generalized anxiety disorder F41.8 Other specified anxiety disorders Ritecode.com Impacted cerumen H61.21 Impacted cerumen, right ear [laterality] H61.22 Impacted cerumen, left ear H61.23 Impacted cerumen, bilateral H61.20 Impacted cerumen, unspecified ear Ritecode.com 84 42

45 V, W, X, Y CODES Secondary code assignments. The external cause codes are no longer a supplementary classification. Chapter 20: There are 33 subchapters used to report: 1. The cause/activity resulting in an injury or specified health condition. 2. The intent (unintended/accidental/intentional; suicide or assault). 3. The place where the event occurred. 4. The patient s status at the time of the event (civilian, military, etc ). Ritecode.com 85 V, W, X, Y CODES An external cause code is assigned for each encounter during which an injury or condition is treated not just for the initial treatment. Many codes require an occurrence code: A: initial encounter D: subsequent encounter S: sequelae Ritecode.com 86 43

46 Ball Codes, struck by Initial Occurrence Listed Only (three occurrence options) W21.00XA Struck by hit or thrown ball, unspec. type, init encntr W21.01XA Struck by football, initial encounter W21.02XA Struck by soccer ball, initial encounter W21.03XA Struck by baseball, initial encounter W21.04XA Struck by golf ball, initial encounter W21.05XA Struck by basketball, initial encounter W21.06XA Struck by volleyball, initial encounter W21.07XA Struck by softball, initial encounter W21.81XA Striking against or struck by football helmet, initial encounter EyeCodingForum.com 87 Location And Reason For Injury There are no location or reason for injury codes in the AAFP top 100 list. Here are a few examples. These are easy and straightforward to look up. Ritecode.com 88 44

47 Y Activity Codes Y93.01 Activity, walking, marching and hiking Y93.02 Activity, running Y93.11 Activity, swimming Y93.44 Activity, trampolining Y93.55 Activity, bike riding Y93.62 Activity, American flag or touch football Ritecode.com 89 Injuries Injuries W Codes W540XXA W5501XA W5503XA W890XXA W891XXA Bitten by dog, init enctr Bitten by cat, init enctr Scratched by cat, init enctr Exposure to welding light (arc), init enctr Exposure to tanning bed, init enctr Ritecode.com 90 45

48 Y Location Codes While there are many more location codes, perhaps the five below would be a good first start. Y Unspecified place in single family (private) house as the place of occurrence of the external cause [home] Y Unspecified place in other non institutional residence as the place of occurrence of the external cause Y Unspecified school as the place of occurrence of the external cause Y92.63 Factory as the place of occurrence of the external cause Y Public park as the place of occurrence of the external cause Ritecode.com Chest pain, unspecified R07.9 Chest pain, unspecified ** There are more specific code choice selections available in ICD 10 CM. These include: R07.1 Chest pain on breathing R07.81 Pleurodynia R07.89 Other chest pain Ritecode.com 92 46

49 External Cause Codes Per AHIMA: Just as with ICD 9 CM, 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, External Causes of Morbidity, is not required. If a provider has not been reporting ICD 9 CM external cause codes, the provider will not be required to report ICD 10 CM codes in Chapter 20, unless a new state or payer based requirement regarding the reporting of these codes is instituted. Such a requirement would be independent of ICD 10 CM implementation. In the absence of a mandatory reporting requirement, providers are encouraged to voluntarily report external cause codes, as they provide valuable data for injury research and evaluation of injury prevention strategies. Ritecode.com 93 Family History Codes (Z83.**) Z65.2 Malingerer [person feigning illness [V65.2] Z82.1 Family history of blindness and visual loss Z82.49 Family history of ischemic heart disease and other diseases of the circulatory system Z83.3 Family history of diabetes mellitus Z83.49 Family history of other endocrine, nutritional and metabolic diseases Z Family history of glaucoma Z Family history of other specified eye disorder Z91.19 Patient's noncompliance with other medical treatment and regimen [V15.81] Ritecode.com 94 47

50 ICD 10 Screening Codes Report Z for current long term Plaquenil use for rheumatoid arthritis (LT use). Report Z09 for an exam following completed treatment with high risk medication NEC. Report M06.9 for rheumatoid arthritis, unspecified. Always report both; link to both, and if the carrier does not pay on the Z code, link to the M code first (or only link to the M code above). Once an adverse effect is found for Hydrochlorquine sulfate (Plaquenil), the ICD 10 code is: T37.2X5A. Includes...Adverse effect of antimalarials and drugs acting on other blood protozoa, init enctr. Note there are the encounter codes (XA, XD and XS) Initial, Subsequent and Sequela. Ritecode.com 95 Adverse Effect [5]: Plaquenil T37.2X1* T37.2X2* T37.2X3* T37.2X4* T37.2X5* T37.2X6* Poisoning by antimalarials and drugs acting on other blood protozoa, accidental (unintentional) Poisoning by antimalarials and drugs acting on other blood protozoa, intentional self harm (suicide attempt) Poisoning by antimalarials and drugs acting on other blood protozoa, assault Poisoning by antimalarials and drugs acting on other blood protozoa, undetermined Adverse effect of antimalarials and drugs acting on other blood protozoa (of a drug properly taken) Underdosing of antimalarials and drugs acting on other blood protozoa These are often called poisoning codes. Note the fourth digit. The Underdosing term and concept is new to ICD 10. * Represents the occurrence codes: A, D or S Ritecode.com 96 48

51 AAFP Top 100 List ICD 10 coding July 2015 Jeffrey Restuccio, CPC, CPC H, MBA Memphis TN (901) Ritecode.com 97 49

52 American Academy of Family Practice Physicians top 100 ICD-9 codes list Ritecode.com p. 1 1: 034.0: Strep throat 2: : Warts, viral, unspec. 3: : Viral infection, unspec. 4: 216.9: neoplasm, benign, skin, unspec. 5: 244.9: Hypothyroidism, unspec. 6: 271.9: Glucose intolerance 7: 272.0: Hypercholesterolemia, pure 8: 280.9: Anemia, iron deficiency, unspec. 9: 285.9: Anemia, other, unspec. 10: 305.1: Tobacco abuse 11: 311: Depressive disorder, NOS 12: 380.4: Cerumen impaction 13: 401.1: Hypertension, benign 14: 401.9: Hypertension, unspec. 15: 414.9: Chronic ischemic heart disease, unspec. 16: 428.0: Heart failure, congestive, unspec. 17: 455.6: Hemorrhoids, NOS 18: 461.9: Sinusitis, acute, NOS 19: 462: Pharyngitis, acute 20: 486: Pneumonia, unspec. 21: 496: COPD, NOS 22: 465.9: Upper respiratory infection, acute, NOS 23: 466.0: Bronchitis, acute 24: 477.9: Rhinitis, allergic, cause unspec. 25: 558.9: Gastroenteritis, noninfectious, unspec. 26: 595.0: Cystitis, acute 27: 599.0: Urinary tract infection, unspec./pyuria 28: 601.9: Prostatitis, NOS 29: 626.2: Menstruation, excessive/frequent 30: 627.9: Menopausal disorders, unspec. 31: 682.9: Cellulitis/abscess, unspec. 32: 691.8: Eczema, atopic dermatitis 33: 692.9: Contact dermatitis, NOS 34: 706.1: Acne, other 35: 706.2: Sebaceous cyst 36: 709.9: Other skin disease, unspec. 37: 723.9: Cervical disorder, NOS 38: 724.2: Pain, low back 39: 724.4: Back pain w/ radiation, unspec. 40: 729.1: Fibromyalgia/myositis, unspec. 41: 729.5: Pain in limb 42: 780.4: Dizziness/vertigo, NOS 43: 782.1: Rash, nonvesicular, unspec. 44: 782.3: Edema, localized, NOS 45: 784.0: Headache, unspec. 46: 785.1: Palpitations 47: 786.2: Cough 48: 788.1: Dysuria 49: 796.2: Elevated BP w/o hypertension 50: 840.9: Sprain/strain: shoulder/arm, unspec. 51: 844.9: Sprain/strain: knee/leg, unspec. 52: 847.0: Sprain/strain: neck, unspec. 53: 924.9: Contusion, unspec. 54: : Diabetes II, uncomplicated 55: : Diabetes I, uncomplicated 56: : Obesity, NOS 57: : Overweight 58: : Anxiety state, unspec. 59: : Insomnia, sleep disorder, unspec. 60: : Attention deficit, w/ hyperactivity 61: : Epilepsy, unspec., not intractable 62: : Migraine, unspec., not intractable 63: : Conjunctivitis, unspec. 64: : Otitis externa, unspec. 65: : Otitis media, acute 66: : Atrial fibrillation 67: : Cerebral artery occlusion w/ infarction, unspec. 68: : Phlebitis, deep, lower extrem., other 69: : Asthma, unspec. 70: : Gastroesophageal reflux, no esophagitis 71: : Constipation, unspec. 72: : BPH/LUTS w/o obstruction 73: : Vaginitis/vulvitis, unspec. 74: : Osteoarthrosis, unspec. 75: : Arthropathy, unspec. 76: : Pain, knee 77: : Rotator cuff/shoulder synd., unspec. 78: : Synovitis/tenosynovitis, unspec. 79: : Fever, unspec. 80: : Fatigue and malaise, other 81: : Abnormal loss of weight 82: : Shortness of breath 83: : Chest pain, unspec. 84: : Nausea w/ vomiting 85: : Diarrhea, NOS 86: : Urinary frequency 87: : Abdominal pain/colic, unspec. 88: : Abnormal Pap, glandular, NOS 89: : Abnormal Pap, ASC-US 90: : Sprain/strain: ankle, unspec. 91: V04.81: Immunization, influenza 92: V20.2: Well child check 93: V22.0: Prenatal care, normal, first pregnancy 94: V22.1: Prenatal care, normal, other pregnancy 95: V24.2: Postpartum follow-up, routine 96: V25.02: Contraception, other (diaphragm, etc.) 97: V25.40: Contraception surveillance, unspec. 98: V58.69: High-risk medication, long-term use 99: V70.0: Well adult exam 100: V72.31: Gynecological exam

53 AAFP top 100 ICD-9 codes GEMS crosswalk to 362 ICD-10 codes Ritecode.com 1 B9710 Unspecified enterovirus as the cause of diseases classified elsewhere 2 B9789 Other viral agents as the cause of diseases classified elsewhere 3 D229 Melanocytic nevi, unspecified 4 D239 Other benign neoplasm of skin, unspecified 5 D509 Iron deficiency anemia, unspecified 6 D649 Anemia, unspecified 7 E039 Hypothyroidism, unspecified 8 E749 Disorder of carbohydrate metabolism, unspecified 9 E780 Pure hypercholesterolemia 10 F17200 Nicotine dependence, unspecified, uncomplicated 11 F17201 Nicotine dependence, unspecified, in remission 12 F17210 Nicotine dependence, cigarettes, uncomplicated 13 F17211 Nicotine dependence, cigarettes, in remission 14 F17220 Nicotine dependence, chewing tobacco, uncomplicated 15 F17221 Nicotine dependence, chewing tobacco, in remission 16 F17290 Nicotine dependence, other tobacco product, uncomplicated 17 F17291 Nicotine dependence, other tobacco product, in remission 18 F329 Major depressive disorder, single episode, unspecified 19 F419 Anxiety disorder, unspecified 20 F519 Sleep disorder not due to a substance or known physiological condition, unspecified 21 F900 Attention-deficit hyperactivity disorder, predominantly inattentive type 22 F901 Attention-deficit hyperactivity disorder, predominantly hyperactive type 23 F902 Attention-deficit hyperactivity disorder, combined type 24 F908 Attention-deficit hyperactivity disorder, other type 25 F909 Attention-deficit hyperactivity disorder, unspecified type 26 G40901 Epilepsy, unspecified, not intractable, with status epilepticus 27 G40909 Epilepsy, unspecified, not intractable, without status epilepticus 28 G933 Postviral fatigue syndrome 29 H6000 Abscess of external ear, unspecified ear 30 H6001 Abscess of right external ear 31 H6002 Abscess of left external ear 32 H6003 Abscess of external ear, bilateral 33 H6010 Cellulitis of external ear, unspecified ear 34 H6011 Cellulitis of right external ear 35 H6012 Cellulitis of left external ear 36 H6013 Cellulitis of external ear, bilateral 37 H60311 Diffuse otitis externa, right ear 38 H60312 Diffuse otitis externa, left ear 39 H60313 Diffuse otitis externa, bilateral 40 H60319 Diffuse otitis externa, unspecified ear 41 H60321 Hemorrhagic otitis externa, right ear 42 H60322 Hemorrhagic otitis externa, left ear 43 H60323 Hemorrhagic otitis externa, bilateral 44 H60329 Hemorrhagic otitis externa, unspecified ear 45 H60391 Other infective otitis externa, right ear 46 H60392 Other infective otitis externa, left ear 47 H60393 Other infective otitis externa, bilateral 48 H60399 Other infective otitis externa, unspecified ear 49 H6120 Impacted cerumen, unspecified ear 50 H6121 Impacted cerumen, right ear 51 H6122 Impacted cerumen, left ear 52 H6123 Impacted cerumen, bilateral 53 H66001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear 54 H66002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear 55 H66003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral 56 H66004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear 57 H66005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear 58 H66006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral 59 H66007 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear 60 H66009 Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified ear 61 I259 Chronic ischemic heart disease, unspecified 62 I480 Paroxysmal atrial fibrillation 63 I482 Chronic atrial fibrillation 64 I4891 Unspecified atrial fibrillation 65 I5020 Unspecified systolic (congestive) heart failure 66 I5021 Acute systolic (congestive) heart failure 67 I5022 Chronic systolic (congestive) heart failure 68 I5023 Acute on chronic systolic (congestive) heart failure 69 I5030 Unspecified diastolic (congestive) heart failure 70 I5031 Acute diastolic (congestive) heart failure 71 I5032 Chronic diastolic (congestive) heart failure 72 I5033 Acute on chronic diastolic (congestive) heart failure 73 I5040 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure 74 I5041 Acute combined systolic (congestive) and diastolic (congestive) heart failure 75 I5042 Chronic combined systolic (congestive) and diastolic (congestive) heart failure 76 I5043 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure 77 I509 Heart failure, unspecified 78 I63511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery 79 I63512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery 80 I63519 Cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery 81 I63521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery 82 I63522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery Custom ICD-9 to ICD-10 conversion services p. 1