ICD-10-CM Mappings. Linking ICD-9-CM to All Valid ICD-10-CM Alternatives

Transcription

1 Mappings Linking to All Valid Alternatives 2016

2 Contents Preface...iii Official Classification Systems...iii Introduction...v Infectious Parasitic Diseases...1 Neoplasms...27 Endocrine, Nutritional Metabolic, Immunity...53 Blood Blood-Fming Organs...69 Mental Disders...73 Nervous System Sense Organs...9 Diseases of the Circulaty System Diseases of the Respiraty System Diseases of the Digestive System Diseases of the Genitourinary System Complications of Pregnancy, Childbirth, the Puerperium Skin Subcutaneous Tissue Musculoskeletal System Connective Tissue Congenital Anomalies Conditions in the Perinatal Period Symptoms, Signs, Ill-Defined Conditions...37 Injury Poisoning V Codes E Codes...5 Appendix A. Combination Mappings Appendix B. Abbreviations Optum360, LLC i

3 Introduction Introduction Mappings There are four coding scenarios f this particular example: tuberculosis of the spine maps back to arthropathy associated with tuberculosis, inflammaty spondylopathy due to tuberculosis, other infections (tuberculosis) involving bone, curvature of the spine due to tuberculosis. Scenarios: Use of Operats: GEM scenarios are the combinations of codes that are required to satisfy the meaning of an code. The user must take special note of the operats found throughout the mapping guide. Whenever these operats appear, they are shaded in red as an alert that additional selection logic must be applied ORNITHOSIS WITH PNEUMONIA A70 J17 CHLAMYDIA PSITTACI INFECTIONS PNEUMONIA IN DISEASES CLASSIFIED ELSEWHERE The equivalent clinical concept of the code f nithosis with pneumonia requires both codes A70 J17 to be assigned. In the following example, the code specifies that the traumatic amputation is bilateral but does not specify whether it is partial complete. Because both pieces of infmation left right foot partial complete amputation are specified in separate codes in, the entry in the to GEM is a scenario entry. Because two codes are required to satisfy the equivalent meaning in the combination code, because the injury can be partial on one side complete on the other, both sides partial, both sides complete, there are four different scenarios from which to select based upon available documentation TRAUMATIC AMP FT BILATERAL WITHOUT MENTION COMP SHLDR & UPPER ARM SUP FB NO MAJ OPN WOUND INFECTED S9.911A COMPLETE TRAUMAT AMP RT FT LEVEL UNS INITIAL ENC S9.921A COMPLETE TRAUMAT AMP RT FT LEVEL UNS INITIAL ENC S9.922A PART TRAUMATIC AMP LT FT LEVEL UNS INITIAL ENC S9.912A COMPLETE TRAUMAT AMP LT FT LEVEL UNS INITIAL ENC S40.259A SUPERFICIAL FB UNS SHOULDER INITIAL ENC S40.59A SUPERFICIAL FB UNS UPPER ARM INITIAL ENC L0.9 OTH SPEC LOCAL INFECTIONS THE SKIN & SUBQ TISSUE Because the coding system combines superficial feign body codes f shoulder upper arm into a single code does not, the user must make a selection between the separate codes related to body site. Regardless of that choice, the secondary code (L0.9) indicating the infection must be assigned in addition to the primary code f the feign body. Brackets: Some codes appear in this manual with brackets as a space-saving convention. The character values in the brackets crespond to the valid values f the character position where the brackets appear. F example: Original Codes: M Rheumatoid myopathy with rheumatoid arthritis of right h M Rheumatoid myopathy with rheumatoid arthritis of left h M Rheumatoid myopathy with rheumatoid arthritis of unspecified h Bracketed Codes: M05.44[1,2,9] Rheumatoid myopathy with rheumatoid arthritis of h 6 th character meanings f codes as indicated 1 RIGHT 2 LEFT 9 UNSPECIFIED x 2015 Optum360, LLC

4 Mappings RHEUMATOID ARTHRITIS M05.40 M05.41[1,2,9] M05.42[1,2,9] M05.43[1,2,9] M05.44[1,2,9] M05.45[1,2,9] M05.46[1,2,9] M05.47[1,2,9] M05.49 M05.50 M05.51[1,2,9] M05.52[1,2,9] M05.53[1,2,9] M05.54[1,2,9] M05.55[1,2,9] M05.56[1,2,9] M05.57[1,2,9] M05.59 M05.70 Introduction RHEUMATOID MYOPATHY WITH RA, UNSPECIFIED SITE RHEUMATOID MYOPATHY WITH RA, SHOULDER RHEUMATOID MYOPATHY WITH RA,ELBOW RHEUMATOID MYOPATHY WITH RA,WRIST RHEUMATOID MYOPATHY WITH RA,HAND RHEUMATOID MYOPATHY WITH RA, HIP RHEUMATOID MYOPATHY WITH RA, KNEE RHEUMATOID MYOPATHY WITH RA, ANKLE AND FOOT RHEUMATOID MYOPATHY WITH RA, MULTIPLE SITES RHEUMATOID POLYNEUROPATHY W/ RA, UNSPECIFIED SITE RHEUMATOID POLYNEUROPATHY WITH RA, SHOULDER RHEUMATOID POLYNEUROPATHY WITH RA, ELBOW RHEUMATOID POLYNEUROPATHY WITH RA,WRIST RHEUMATOID POLYNEUROPATHY WITH RA, HAND RHEUMATOID POLYNEUROPATHY WITH RA, HIP RHEUMATOID POLYNEUROPATHY WITH RA, KNEE RHEUMATOID POLYNEUROPATHY W/RA,ANKLE & FOOT RHEUMATOID POLYNEUROPATHY WITH RA, MULTIPLE SITES RA W/RHEUMATOID FCT W/O ORGN OR SYS INVLV 6th Character meanings f codes as indicated 1 RIGHT 2 LEFT 9 UNSPECIFIED Introduction The sixth character 1, 2, 9 may be assigned to code M05.44 to represent laterality. Each page with bracketed codes has a key near the bottom of that table entry that provides the meanings f the characters within the brackets. Most bracketed characters involve those in either the sixth seventh character position. Bracketed characters, along with their cresponding key, appear in blue type. Continued Continued on next page : Users should be aware that some mapping tables contain many code alternatives. If all the infmation cannot be displayed on one page, the wds Continued on the next page in red type appear at the end of the table. The code is continued on the next page with a designation Continued in red type underneath the code in the table. F instance, code Malunion of fracture, does not contain site-specific infmation in, but the codes do. As a result, the codes that map to encompass me than 19 pages. No Diagnosis: There are codes f which does not have an equivalent code(s) no mapping can be made. These codes will have NO DIAGNOSIS in the column. E50. ACCIDENTAL POISN OTH SPEC ANALGES & ANTIPYRETICS NO DIAGNOSIS How to Use the Mappings: Linking to All Valid Alternatives It is recommended that the following steps be followed when using this manual: 1. Locate the code, keeping in mind that the book is ganized in numeric chapters, just as the code book is. Ensure that the code is valid contains the full number of digits required f that categy subcategy. The codes are always located in the left column of the manual. Remember this version of the mappings includes the code changes effective October 1, Review the codes that appear in the same row on the right side of the page that are considered alternatives to the source code. 3. Note whether any arrow symbol appears, designating that code as an equivalent match, meaning that the clinical concepts represented by each code are considered equal equivalent. 4. Note whether any flag symbol appears, indicating that there is a complex combination mapping relationship between the coding systems in the backward mapping of to. If a flag appears next to an code, proceed to step 5. If no flag appears proceed to step Optum360, LLC xi

5 Mappings OTHER SIGN AND SYMPTOM IN BREAST N64.51 Induration of breast N64.52 Nipple discharge N64.53 Retraction of nipple N64.59 Other signs symptoms in breast PTOSIS OF BREAST Ê N64.1 Ptosis of breast HYPOPLASIA OF BREAST Ê N64.2 Hypoplasia of breast CAPSULAR CONTRACTURE OF BREAST IMPLANT N64.9 Other specified disders of breast OTHER SPECIFIED DISORDERS OF BREAST N64.9 Other specified disders of breast UNSPECIFIED BREAST DISORDER Ê N64.9 Disder of breast, unspecified DEFORMITY OF RECONSTRUCTED BREAST Ê N65.0 Defmity of reconstructed breast DISPROPORTION OF RECONSTRUCTED BREAST Ê N65.1 Disproption of reconstructed breast ACUTE SALPINGITIS AND OOPHORITIS N70.01 Acute salpingitis N70.02 Acute oophitis N70.03 Acute salpingitis oophitis CHRONIC SALPINGITIS AND OOPHORITIS N70.11 Chronic salpingitis N70.12 Chronic oophitis N70.13 Chronic salpingitis oophitis SALPINGITIS&OOPHORITIS NOT ACUT SUBACUT/CHRN N70.91 Salpingitis, unspecified N70.92 Oophitis, unspecified N70.93 Salpingitis oophitis, unspecified ACUTE PARAMETRITIS AND PELVIC CELLULITIS Ê N73.0 Acute parametritis pelvic cellulitis CHRONIC/UNSPEC PARAMETRITIS&PELVIC CELLULITIS N73.1 Chronic parametritis pelvic cellulitis N73.2 Unspecified parametritis pelvic cellulitis ACUTE OR UNSPECIFIED PELVIC PERITONITIS FEMALE Ê N73.3 Female acute pelvic peritonitis PELVIC PERITONEAL ADHESIONS, FEMALE Ê N73.6 Female pelvic peritoneal adhesions (postinfective) OTHER CHRONIC PELVIC PERITONITIS FEMALE Ê N73.4 Female chronic pelvic peritonitis 614. OTH SPEC INFLAM DISEASE FE PELVIC ORGANS&TISSUES N73. Other specified female pelvic inflammaty diseases N74 Female pelvic inflam disders in diseases classd elswhr UNSPEC INFLAM DISEASE FE PELVIC ORGANS&TISSUES A56.11 Chlamydial female pelvic inflammaty disease N73.5 Female pelvic peritonitis, unspecified N73.9 Female pelvic inflammaty disease, unspecified ACUTE INFLAMMATORY DISEASE UTERUS EXCEPT CERVIX Ê N71.0 Acute inflammaty disease of uterus CHRONIC INFLAMMATORY DISEASE UTERUS EXCEPT CERV Ê N71.1 Chronic inflammaty disease of uterus UNSPECIFIED INFLAMMATORY DISEASE OF UTERUS Ê N71.9 Inflammaty disease of uterus, unspecified CERVICITIS AND ENDOCERVICITIS Ê N72 Inflammaty disease of cervix uteri UNSPECIFIED VAGINITIS AND VULVOVAGINITIS N76.0 Acute vaginitis N76.1 Subacute chronic vaginitis N76.2 Acute vulvitis N76.3 Subacute chronic vulvitis VAGINITIS&VULVOVAGINITIS DISEASES CLASS ELSW A56.02 Chlamydial vulvovaginitis N77.1 Vaginitis, vulvitis vulvovaginitis in dis classd elswhr CYST OF BARTHOLINS GLAND N75.0 Cyst of Bartholin's gl N75. Other diseases of Bartholin's gl ABSCESS OF BARTHOLINS GLAND Ê N75.1 Abscess of Bartholin's gl OTHER ABSCESS OF VULVA Ê N76.4 Abscess of vulva UNSPECIFIED ULCERATION OF VULVA Ê N76.6 Ulceration of vulva ULCERATION OF VULVA DISEASE CLASSIFIED ELSEWHERE Ê N77.0 Ulceration of vulva in diseases classified elsewhere MUCOSITIS ULCERATIVE OF CERVIX VAGINA AND VULVA Ê N76.1 Mucositis (ulcerative) of vagina vulva OTHER INFLAMMATORY DISEASE CERVIX VAGINA&VULVA N75.9 Disease of Bartholin's gl, unspecified N76.5 Ulceration of vagina N76.9 Other specified inflammation of vagina vulva UNSPEC INFLAMMATORY DISEASE CERVIX VAGINA&VULVA N73.9 Female pelvic inflammaty disease, unspecified ENDOMETRIOSIS OF UTERUS Ê N0.0 Endometriosis of uterus ENDOMETRIOSIS OF OVARY Ê N0.1 Endometriosis of ovary ENDOMETRIOSIS OF FALLOPIAN TUBE Ê N0.2 Endometriosis of fallopian tube ENDOMETRIOSIS OF PELVIC PERITONEUM Ê N0.3 Endometriosis of pelvic peritoneum ENDOMETRIOSIS OF RECTOVAGINAL SEPTUM AND VAGINA Ê N0.4 Endometriosis of rectovaginal septum vagina ENDOMETRIOSIS OF INTESTINE Ê N0.5 Endometriosis of intestine ENDOMETRIOSIS IN SCAR OF SKIN Ê N0.6 Endometriosis in cutaneous scar 617. ENDOMETRIOSIS OF OTHER SPECIFIED SITES Ê N0. Other endometriosis ENDOMETRIOSIS, SITE UNSPECIFIED Ê N0.9 Endometriosis, unspecified UNS PROLAPS VAG WALLS W/O MENTION UTERN PROLAPS N1.9 Female genital prolapse, unspecified CYSTOCELE WITHOUT MENTION UTERINE PROLAPSE MIDLN N1.10 Cystocele, unspecified N1.11 Cystocele, midline CYSTOCELE WITHOUT MENTION UTERINE PROLAPSE LAT Ê N1.12 Cystocele, lateral URETHROCELE WITHOUT MENTION OF UTERINE PROLAPSE Ê N1.0 Urethrocele RECTOCELE WITHOUT MENTION OF UTERINE PROLAPSE Ê N1.6 Rectocele PERINEOCELE WITHOUT MENTION OF UTERINE PROLAPSE Ê N1.1 Perineocele OTH PROLAPS VAG WALLS W/O MENTION UTERN PROLAPS N1.9 Other female genital prolapse 61.1 UTERINE PROLAPSE W/O MENTION VAG WALL PROLAPSE N1.2 Incomplete uterovaginal prolapse 61.2 UTEROVAGINAL PROLAPSE, INCOMPLETE N1.2 Incomplete uterovaginal prolapse Diseases of the Genitourinary System Optum360, LLC See Appendix A Ê Equivalent Mapping Scenario Scenario 199

6 Injury Poisoning Mappings OPEN FRACTURE OF SHAFT OF FIBULA WITH TIBIA S2.201B Unsp fx shaft of right tibia, init f opn fx type I/2 S2.401B Unsp fracture of shaft of r fibula, init f opn fx type I/2 S2.202B Unsp fx shaft of left tibia, init f opn fx type I/2 S2.402B Unsp fx shaft of left fibula, init f opn fx type I/ TORUS FRACTURE OF TIBIA ALONE S2.161A Tus fracture of upper end of right tibia, init f clos fx S2.162A Tus fracture of upper end of left tibia, init f clos fx S2.169A Tus fracture of upper end of unsp tibia, init f clos fx S2.311A Tus fracture of lower end of right tibia, init f clos fx S2.312A Tus fracture of lower end of left tibia, init f clos fx S2.319A Tus fracture of lower end of unsp tibia, init f clos fx TORUS FRACTURE OF FIBULA ALONE S2.11A Tus fracture of upper end of right fibula, init S2.12A Tus fracture of upper end of left fibula, init f clos fx S2.19A Tus fracture of upper end of unsp fibula, init f clos fx S2.21A Tus fracture of lower end of right fibula, init S2.22A Tus fracture of lower end of left fibula, init f clos fx S2.29A Tus fracture of lower end of unsp fibula, init f clos fx TORUS FRACTURE OF FIBULA WITH TIBIA S2.161A Tus fracture of upper end of right tibia, init f clos fx S2.11A S2.311A S2.21A S2.162A S2.12A S2.312A Tus fracture of upper end of right fibula, init Tus fracture of lower end of right tibia, init f clos fx Tus fracture of lower end of right fibula, init Tus fracture of upper end of left tibia, init f clos fx Tus fracture of upper end of left fibula, init f clos fx Tus fracture of lower end of left tibia, init f clos fx S2.22A Tus fracture of lower end of left fibula, init f clos fx 23.0 CLOSED FRACTURE OF UNSPECIFIED PART OF TIBIA S2.201A Unsp fracture of shaft of right tibia, init f clos fx S2.202A Unsp fracture of shaft of left tibia, init f clos fx S2.209A Unsp fracture of shaft of unsp tibia, init f clos fx 23.1 CLOSED FRACTURE OF UNSPECIFIED PART OF FIBULA S2.401A Unsp fracture of shaft of right fibula, init f clos fx S2.402A Unsp fracture of shaft of left fibula, init f clos fx S2.409A Unsp fracture of shaft of unsp fibula, init f clos fx 23.2 CLOSED FRACTURE UNSPECIFIED PART FIBULA W/TIBIA S2.201A Unsp fracture of shaft of right tibia, init f clos fx S2.401A S2.202A Unsp fracture of shaft of right fibula, init f clos fx Unsp fracture of shaft of left tibia, init f clos fx S2.402A Unsp fracture of shaft of left fibula, init f clos fx OPEN FRACTURE OF UNSPECIFIED PART OF TIBIA S2.201B Unsp fx shaft of right tibia, init f opn fx type I/2 S2.201C Unsp fx shaft of right tibia, init f opn fx type 3A/B/C S2.202B Unsp fx shaft of left tibia, init f opn fx type I/2 S2.202C Unsp fx shaft of left tibia, init f opn fx type 3A/B/C S2.209B Unsp fx shaft of unsp tibia, init f opn fx type I/2 S2.209C Unsp fx shaft of unsp tibia, init f opn fx type 3A/B/C OPEN FRACTURE OF UNSPECIFIED PART OF FIBULA S2.401B Unsp fracture of shaft of r fibula, init f opn fx type I/2 S2.401C Unsp fx shaft of r fibula, init f opn fx type 3A/B/C S2.402B Unsp fx shaft of left fibula, init f opn fx type I/2 S2.402C Unsp fx shaft of left fibula, init f opn fx type 3A/B/C S2.409B Unsp fx shaft of unsp fibula, init f opn fx type I/2 S2.409C Unsp fx shaft of unsp fibula, init f opn fx type 3A/B/C OPEN FRACTURE UNSPECIFIED PART FIBULA W/TIBIA S2.201B Unsp fx shaft of right tibia, init f opn fx type I/2 S2.401B Unsp fracture of shaft of r fibula, init f opn fx type I/2 S2.202B Unsp fx shaft of left tibia, init f opn fx type I/2 S2.402B Unsp fx shaft of left fibula, init f opn fx type I/ CLOSED FRACTURE OF MEDIAL MALLEOLUS S2.51XA Disp fx of medial malleolus of right tibia, init f clos fx S2.52XA Disp fx of medial malleolus of left tibia, init f clos fx S2.53XA Disp fx of medial malleolus of unsp tibia, init f clos fx S2.54XA Nondisp fx of medial malleolus of right tibia, init S2.55XA Nondisp fx of medial malleolus of left tibia, init S2.56XA Nondisp fx of medial malleolus of unsp tibia, init S2.71A Displaced pilon fracture of right tibia, init f clos fx S2.72A Displaced pilon fracture of left tibia, init f clos fx S2.73A Displaced pilon fracture of unsp tibia, init f clos fx S2.74A Nondisplaced pilon fracture of right tibia, init f clos fx S2.75A Nondisplaced pilon fracture of left tibia, init f clos fx S2.76A Nondisplaced pilon fracture of unsp tibia, init f clos fx 24.1 OPEN FRACTURE OF MEDIAL MALLEOLUS S2.51XB Disp fx of med malleolus of r tibia, init op fx 1/2 S2.51XC Disp fx of med malleolus of r tibia, init op fx 3A/B/C S2.52XB Disp fx of med malleolus of l tibia, init op fx 1/2 S2.52XC Disp fx of med malleolus of l tibia, init op fx 3A/B/C S2.53XB Disp fx of med malleolus of unsp tibia, init op fx 1/2 S2.53XC Disp fx of med malleolus of unsp tibia, init op fx 3A/B/C S2.54XB Nondisp fx of med malleolus of r tibia, init op fx 1/2 S2.54XC Nondisp fx of med malleolus of r tibia, init op fx 3A/B/C S2.55XB Nondisp fx of med malleolus of l tibia, init op fx 1/2 (Continued on next page) S2.55XC Nondisp fx of med malleolus of l tibia, init op fx 3A/B/C 460 [Brackets] indicate valid character values f each code. Character value meanings provided f each code grouping Optum360, LLC