FY 2017 ICD-10-CM Code Updates Webinar I Presented by: Melanie Endicott, MBA/HCM, RHIA, CHDA, CDIP, CCS, CCS-P, FAHIMA AHIMA- Approved ICD-10-CM/PCS Trainer Senior Director, HIM Practice Excellence, AHIMA
FY 2017 ICD-10-CM Code Updates This webinar will cover: Chapter 1: Certain Infectious & Parasitic Diseases Chapter 2: Neoplasms Chapter 3: Diseases of the Blood & Blood-forming Organs & Certain Disorders Involving the Immune Mechanism Chapter 4: Endocrine, Nutritional, & Metabolic Diseases Chapter 5: Mental, Behavioral & Neurodevelopmental Disorders 2
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 3
Review of some basics EXCLUDES1 NOTES Excludes Notes Excludes1: 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 Excludes1: age-related weakness (R54) muscle weakness (M62.8-) senile asthenia (R54) 4
Review of some basics EXCLUDES2 NOTES Excludes2: Means NOT INCLUDED HERE Excluded condition is not part of the condition represented by the code If patient has both conditions, both can be coded Example: R94.7 Abnormal results of other endocrine function studies Excludes2: abnormal glucose (R73.0-) 5
Review of some basics Application of 7 th Character in Chapter 19 A D S Initial Encounter Used while patient is receiving active treatment for condition Subsequent Encounter Used for encounters after patient has received active treatment and is receiving routine care during healing or recovery phase Sequela Used for complications/conditions that arise as a direct result of a condition 6
Review of some basics Fracture Classification Some fracture categories designate the specific type of open fracture based on the Gustilo open fracture classification A fracture not indicated as displaced or nondisplaced should be coded to displaced A fracture not designated as open or closed should be coded to closed 7
Review of some basics Fracture 7 th Character A Initial closed D Subsequent routine K Subsequent nonunion B Initial open G Subsequent delayed P Subsequent malunion S Sequela 8
Review of some basics Fracture Aftercare Note: The aftercare Z codes should not be used for aftercare for traumatic fractures. For aftercare of a traumatic fracture, assign the acute fracture code with the appropriate 7 th character. 9
CHAPTER 1: Certain Infectious and Parasitic Diseases (A00-B99)
Chapter 1: Infectious & Parasitic Diseases Minor changes to this chapter in both the Alphabetical Index and Tabular List Category A41 Sepsis Sepsis NOS (A41.9) has been deleted from the Excludes1 note. Coders should refer to Coding Guidelines for the intent of Excludes1. 11
Chapter 1: Infectious & Parasitic Diseases 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 Z22.50-Z22.59 has been deleted and reclassified to this code category 12
Chapter 1: Infectious & Parasitic Diseases Index Change Hepatitis, acute, infectious B15.9 changed to B17.9 13
CHAPTER 2: Neoplasms (C00-D49)
Chapter 2: Neoplasms New Codes - C49.A0-C49.A9 for Gastrointestinal Stromal Tumors - D47.Z2 for Castleman Disease - D49.511-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 15
CHAPTER 3: Diseases of the Blood & Blood-forming Organs & Certain Disorders Involving the Immune Mechanism (D50-D89)
Chapter 3: Diseases of the Blood & Blood-forming organs Neutropenia and Pancytopenia D61. Other aplastic anemias and other bone marrow failure syndrome Excludes1 : neutropenia (D70.-) D61.81 Pancytopenia Excludes1 changed to an Excludes2 Note (see below for new note) 17
Chapter 3: Diseases of the Blood & Blood-forming organs Revised Codes: D78.21 D78.22 Postprocedural hemorrhage and hematoma of the spleen following a procedure on the spleen (D78.21) or other procedure (D78.22) **The titles of the above codes were revised to remove hematoma and apply only to hemorrhage; both now indexed separately New Codes: D78.31 Postprocedural hematoma of the spleen following a procedure on the spleen D78.32 Postprocedural hematoma of the spleen following other procedure 18
Chapter 3: Diseases of the Blood & Blood-forming organs New Code Category: D89.40 Mast cell activation, unspecified D89.41 Monoclonal mast cell activation syndrome D89.42 Idiopathic mast cell activation syndrome D89.43 Secondary mast cell activation D89.49 Other mast cell activation disorder 19
Chapter 3: Diseases of the Blood & Blood-forming organs Index changes: Osteomyelofibrosis D75.89 Revised to: D47.4 Anticoagulant, circulating (intrinsic) D68.318 New subterm for iatrogenic D68.32 20
CHAPTER 4: Endocrine, Nutritional, & Metabolic Diseases (E00-E89)
Chapter 4: Endocrine, Nutritional & Metabolic Diseases 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 22
Chapter 4: Endocrine, Nutritional & Metabolic Diseases 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.69 23
Chapter 4: Endocrine, Nutritional & Metabolic Diseases 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. 24
Chapter 4: Endocrine, Nutritional & Metabolic Diseases All of the Diabetes Mellitus codes with eye complications have been expanded to allow for the capture of laterality Right Left Bilateral 25
Chapter 4: Endocrine, Nutritional & Metabolic Diseases Diabetic eye conditions created to include traction retinal detachment other types with combination codes E083539 E083541 E083542 E083543 E083549 E083551 E083552 E083553 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral E083559 Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye E083591 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye E083592 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye E083593 Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral 26
Chapter 4: Endocrine, Nutritional & Metabolic Diseases E16.0 E16.2 new Excludes1 note Excludes1: 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) 27
Chapter 4: Endocrine, Nutritional & Metabolic Diseases 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 Revised to: R73.03 Reference: http://www.diabeticlivingonline.com/newly-diagnosed/getting-started/what-lada-latent-autoimmunediabetes-adults 28
Chapter 4: Endocrine, Nutritional & Metabolic Diseases E78.0 Hypercholesterolemia expanded Unique codes for both Pure and Familial hypercholesterolemia E78.00 Pure hypercholesterolemia, unspecified E78.01 Familial hypercholesterolemia 29
Chapter 4: Endocrine, Nutritional & Metabolic Diseases Currently Hematoma is indexed under hemorrhage E89.810-E89.811 Description revised to remove hematoma and only include hemorrhage E89.820-E89.821 Postprocedural hematoma of an endocrine system organ or structure following an endocrine system procedure or following other procedure E89.822-E89.823 Postprocedural seroma of an endocrine system organ or structure following an endocrine system procedure or following other procedure 30
Chapter 4: Endocrine, Nutritional & Metabolic Diseases Coma, hyperglycemic (diabetic) see Diabetes, coma Revised to: Coma, hyperglycemia (diabetic) see Diabetes, by type, with hyperosmolarity, with coma 31
CHAPTER 5 Mental, Behavioral,& Neurodevelopmental Disorders (F01-F99)
Chapter 5: Behavioral Health F02 Dementia in diseases classified elsewhere New Code first note Excludes1: dementia in Parkinsonism (G31.83) delete F10.22 Alcohol Dependence with intoxication & F10.23 Alcohol with withdrawal Excludes1 notes changed to Excludes2 notes 33
Chapter 5: Behavioral Health Premenstrual dysphoric disorder (PMDD) N94.3 Revised to: Premenstrual dysphoric disorder (PMDD) F32.81 (new code) Disruptive Mood dysregulation disorder F34.81 (disorder, disruptive, mood dysregulation) Expansion of F42 Obsessive-compulsive disorders (new codes) Mixed obsessional thoughts and acts Hoarding disorder Excoriation (skin-picking) disorder Other obsessive-compulsive disorders 34
Chapter 5: Behavioral Health Binge eating disorder now has a new code - F50.81 Previously this was classified under other eating disorders Transsexualism new code - F64.0 Previously was classified to F64.1 Gender identity disorder in adolescence & adulthood F64.1 title changed to Dual role transvestism New code F64.0 created 35
Chapter 5: Behavioral Health Main term Alcohol includes several new mental health disorders as subterms such as: Anxiety disorder: F10.980 Bipolar and related disorder: F10.94 Depressive disorder: F10.94 Major neurocognitive disorder, amnesticconfabulatory type: F10.96 36
Chapter 5: Behavioral Health Cocainism Revised from: Cocainism see Dependence, drug, cocaine to Cocainism see Disorder, cocaine, use Delirium, delirious (acute or subacute) (not alcohol- or drug induced) (with dementia) R41.0 Subterm due to (secondary to) has a new subterm index entry of: Other (or unknown) substance: F19.921 37
Chapter 5: Behavioral Health Dependence, PCP (phencyclidine) See also note changed to see note Revised from: Dependence, PCP (phencyclidine) (see also Abuse, drug, hallucinogen) F16.20 Revised to: Dependence, PCP (phencyclidine) (or related substance) see Dependence, drug, hallucinogen) The default code at the subterm of PCP or Phencyclidine (PCP) has been removed. See convention must be followed Disturbance, perpetual due to, phencyclidine F19.922 changed to F16.122 38
Chapter 5: Behavioral Health Depression (acute) (mental) F32.9 Added subterm of recurrent episode to the following subterms (all assigned F33.8): Atypical Climacteric Involutional Masked Menopause 39
Chapter 5: Behavioral Health 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 40
Chapter 5: Behavioral Health Disorder, communication F80.9; has a new subterm index entry Social pragmatic F80.82 Disorder, conversion see Disorder dissociative revised to conversion (functional neurological symptom disorder) With was added under conversion as a subterm along with the addition of these subterms under with : 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 F44.4 41
Chapter 5: Behavioral Health Intoxication has revised index entries that affect: Caffeine (acute) (without dependence) see Abuse, drug, stimulant, with intoxication F15.129 Revised to: caffeine F15.929 Cannabinoids (acute) (without dependence) see Abuse, drug, cannabis, with intoxication Revised to: cannabinoids (acute) (without dependence) see Use, cannabis, with intoxication Also two new subterms under cannabinoids, with, Abuse and dependence 42
Chapter 5: Behavioral Health Methadone use F11.20 Revised to: methadone use see Use, opioid 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 F91.9 Disorder, dysmorphic body F45.1 Revised to: Disorder, dysmorphic body F45.22 43
Chapter 5: Behavioral Health Menopause, menopausal(asymptomatic) (state), depression or melancholia, recurrent F33.9 Revised to: Menopause, depression or melancholia, recurrent F33.8 Personality (disorder), mixed F60.81 Revised to: mixed (nonspecific) F60.89 Disorder, psychological, associated with, uncertainty about gender identity F66 Revised to: uncertainty about gender identity F64.9 44
Chapter 5: Behavioral Health State (of), transient organic psychotic NEC, Hallucinatory type F06.30 Revised to: hallucinatory type F06.0 obsessional F42 Revised to: obsessional F42.8 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) F17.203 45
Chapter 5: Behavioral Health Use (of), alcohol F10.99 Revised to: ICD-10-CM code Z72.89 Use (of), methadone F11.20 Revised to: methadone see Use, opioid Withdrawal state several new subterms added Alcohol With perceptual disturbances F10.232 Without perceptual disturbances F10.239 Caffeine F15.93 Cannabis F12.288 46
Thank you for joining us for the FY 2017 ICD-10-CM Code Updates Webinar I!