Transcript Introduction to ICD-10-CM parts 9 & 10 Disorder`s of the

Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Respiratory & Circulatory System
Diseases of the circulatory and respiratory systems include:
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Acute rheumatic fever (I00-I02)
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Chronic rheumatic heart disease (I105-I09)
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Hypertensive disease (I10-I15)
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Ischemic heart disease (I20-I25)
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Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)
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Other forms of heart disease (I30-I52)
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Cerebrovascular disease (I60-I69)
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Diseases of the arteries, arterioles, and capillaries (I70-I79)
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Diseases of the veins and lymphatic vessels and lymph nodes, not elsewhere
classified (I80-I89)
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Other and unspecified disorders of the circulatory system (I95-I99)
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Respiratory & Circulatory System
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Hypertension is probably the most common condition included in this
chapter. There are two broad categories of hypertension: primary
(essential) and secondary. Secondary hypertension has an identifiable
cause whereas primary hypertension has no known cause (idiopathic).
Hypertension heart conditions classified to I50.- or I51.4 – 151.9 are
assigned to a code from category I11 – Hypertensive heart disease
Hypertensive Chronic Kidney Disease -Assign codes from category
I12
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.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Respiratory & Circulatory System
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The codes in category I13 – Hypertensive heart and chronic kidney
disease, are combination codes that include hypertension, heart
disease, and chronic kidney disease.
For patients with both acute renal failure and chronic kidney disease,
an additional code for acute renal failure is required
Hypertensive Cerebrovascular Disease -For hypertensive
cerebrovascular disease, first assign the appropriate code from
category I60-I69, followed by the appropriate hypertension code.
Hypertensive Retinopathy - Subcategory H35.0 – Background
retinopathy and retinal vascular changes, should be used with code I10
– Essential (primary) hypertension, to include the systemic
hypertension. The sequencing is based on the reason for the encounter.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Respiratory & Circulatory System
You may assign an additional code from category I50.- to identify the type of
heart failure. More than one code from category I50.- may be assigned if the
patient has systolic or diastolic failure and congestive heart failure.
High blood pressure in the absence of a diagnosis of hypertension should be
coded R03.0 - Elevated blood pressure reading without diagnosis of
hypertension.
Category I50.- - Heart failure, includes associated pulmonary edema.
Hypertensive heart disease is classified as I11.-. Hypertensive heart disease
and renal failure are classified as I13.-.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Respiratory & Circulatory System
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The guidelines for assigning the correct I22 (subsequent) code are the
same as for the initial AMI. The documentation in the patient’s chart
should indicate what area of the heart muscle is affected.
For category I21 a fifth character id required. In addition, the
instructional note indicates to use an additional code to identify other
circumstances such as tobacco use, dependence, or body mass index
(BMI).
Subcategories I21.0 – I21.2 and code I21.3 are used for STEMI. Code
I21.4 is used for NSTEMI myocardial infarction and transmural MIs
Code I21.3 ST elevation (STEMI) myova5rdial infarction of
unspecified site, is the default for the unspecified term “acute
myocardial infarction.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Respiratory & Circulatory System
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The sequencing of the I22 and I21 codes depends on the
circumstances of the encounter. If a patient who is in the
hospital due to an AMI has a subsequent AMI while still in
the hospital, code I21 would be sequenced first as the
reason for admission, with code I22 sequenced as a
secondary code.
If a patient has a subsequent AMI after discharge for care
of an initial AMI, and the reason for admission is the
subsequent AMI, the I22 code should be sequenced first
followed y the I21.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Respiratory & Circulatory System
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The neurologic deficits caused by cerebrovascular disease may be
present from the onset or may arise at any time after the onset of
conditions classifiable to categories I60 – I67
Codes from category I69 may be assigned on a health care record
with codes from I60 – I67, is the patient has a current
cerebrovascular disease and deficits from an old cerebrovascular
disease.
Assign code Z86.73 – Personal history of transient Ischemic attack
(TIA), and cerebral infarction without residual deficits (and not a
code from category I69), as an additional code for history of
cerebrovascular disease when no neurologic deficits are present.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Respiratory & Circulatory System
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Acute upper respiratory infections (J00 – J06) includes: acute
rhinitis, acute nasopharyngitis (common cold), acute sinusitis, acute
pharyngitis, acute tonsillitis, acute laryngitis, acute upper respiratory
infection, and acute bronchitis.
Pneumonia can be complicated to code. Make sure to determine the
cause of the pneumonia before attempting to select the appropriate
code. Do not forget to code the infections organism (agent) when
coding diseases of the respiratory system.
When a patient has been exposed to SARS, but nothing in the
laboratory findings indicates the disease if present, use Z20.89
because there is not a classification specifically for SARS.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Respiratory & Circulatory System
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Chronic obstructive pulmonary disease includes: bronchitis,
emphysema, asthma, bronchiectasis, extrinsic allergic alevolitis and
chronic airway obstruction, not elsewhere classified.
A code from subcategory J96.0 – Acute respiratory failure, or
subcategory J96.2 – acute and chronic respiratory failure, may be
assigned as a principal diagnosis when it is the condition established
after study to be chiefly responsible for occasioning the admission to
the hospital
If a patient is treated for acute respiratory failure, a code from J96.0- is
reported as the first listed diagnosis. Respiratory failure may be listed
secondary if it is present on admission and not the first listed/principal
diagnosis.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Digestive System
Diseases of the digestive system (K00 – K94) Tabular List includes the
following:
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Diseases of the Oral Cavity and Salivary lands (K00-L14)
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Diseases of the Esophagus, Stomach, and duodenum (K20-K38)
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Diseases of the Appendix (K35-K38)
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Hernia (K40-K46)
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Noninfectious Enteritis and Colitis (K50-K52)
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Other Diseases of Intestines (K55-K63)
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Diseases of the Peritoneum and Retroperitoneum (K65-K68)
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Diseases of Liver (K70-K77)
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Disorders of Gallbladder, Biliary Tract, and Pancreas (K80-K87)
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Other Diseases of the Digestive System (K90-K94)
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Digestive System
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Diseases of the esophagus, stomach and duodenum (K20-K31) include
ulcers, inflammation, reflux, rupture, perforation and spasms.
There are many types and causes of gastritis; use caution when making
a selection. Gastritis and duodenitis are classified as K29.- and require
a fifth character when codes are assigned in this category to identify
“with or without bleeding.”
Combination coding is used to identify gangrene or obstruction.
Documentation indicating that the hernia is “strangulated” and/or
“incarcerated” is classified as an obstruction. Incision ventral hernia is
classified as recurrent.
Many of the codes require a fifth-digit based on whether he hernia is
unilateral or bilateral and whether it is recurrent or not specified as
recurrent.
Introduction to ICD-10-CM parts 9 & 10
Diseases of the Skin & Subcutaneous Tissue
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Infections of Skin and Subcutaneous Tissue (L00-L08)
Bullous Disorders (L10-L14)
Dermatitis and Eczema (L20-L30)
Papulosquamous Disorders (L40-L45)
Urticaria and Erythema (L49-L54)
Radiation-related Disorders of the Skin and Subcutaneous Tissue (L55
L59)
Disorders of Skin Appendages (L60-L75)
Intraoperative and Postprocedural Complications of Skin and
Subcutaneous Tissue (L76)
Other Disorders of the Skin and Subcutaneous Tissue (L80-L99
Introduction to ICD-10-CM parts 9 & 10
Diseases of the Skin & Subcutaneous Tissue
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Many codes in this category are identified by type of condition and anatomic
location on the body. In addition, if an infectious agent is present, the coder is
instructed to use an additional code from categories B95-B97 to identify the
infectious agent. Pay careful attention to Excludes 1 and Excludes 2 notes in
this category.
Codes from category L89, pressure ulcer are combination codes that identify
the site of the pressure ulcer as well as the stage of the ulcer
ICD-10-CM classifies pressure ulcer stages based on severity, which is
designated by stages 1 through 4, unspecified stage and unstageable.
Assign as many codes from category L89 as needed to identify all the pressure
ulcers the patient has, if applicable.
Introduction to ICD-10-CM parts 9 & 10
Diseases of the Skin & Subcutaneous Tissue
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Most of the codes within chapter 13 have site and laterality
designations. the site represents that bone, joint, or the muscle
involved. For some conditions where more than one bone, joint or
muscle is usually involved, such as osteoarthritis, there is a “multiple
sites” code available. For categories where no multiple site code is
provided and more than one bone, joint or muscle is involved, multiple
codes should be used to indicate the different sites involved.
Seventh character A is for use as long as the patient is receiving active
treatment for the fracture
Care for complications of surgical treatment for fracture repairs during
the healing or recovery phase should be coded with the appropriate
complication codes.
Introduction to ICD-10-CM parts 9 & 10
Diseases of the Skin & Subcutaneous Tissue
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Osteoporosis is a systemic condition, meaning that all bones of the
musculoskeletal system are affected. Therefore, site is not a
component of the codes under category M81-Osteoporosis without
current pathological fracture.
The site codes under category M80-Osteoporosis with current
pathological fracture, identify the site of the fracture, not the
osteoporosis.
When the documentation indicates a spontaneous fracture, code the
encounter as a pathological fracture.
When the sole purpose is treatment of the pathological or spontaneous
fracture, the pathologic fracture if the first listed diagnosis.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Genitourinary System
Chapter 10 in the Tabular List includes the following sections:
Glomerular Diseases (N00-N08)
Renal Tubulo-interstitial diseases (N10-N16)
Acute Kidney Failure and Chronic Kidney Disease (N17-N19)
Urolithiasis (N20-N23)
Other Disorders of Kidneys and Ureters (N25-N29)
Other Diseases of the Urinary System (N30-N39)
Diseases of Male Genital Organs (N40-N53)
Disorders of Breast (N60-N65)
Inflammatory disorders of Female Genital Tract (N80-N89)
Noninflammatory disorders of Female Genital Tract (N80-N89)
Intraoperative and Postprocedural Complications and Disorders of
Genitourinary system, Not elsewhere Classified (N99)
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Genitourinary System
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Diabetes mellitus includes combination codes to identify the type of
diabetes mellitus and any associated manifestations.
When a patient has diabetes with chronic kidney disease, there is a
combination code to identity the kidney disease and the type of
diabetes, which is not coded in the genitourinary chapter but using a
diabetes code
Because there is a relationship with other conditions such as
hypertension and diabetes mellitus, there are specific coding rules for
both conditions when kidney disease is present.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Genitourinary System
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The ICD-10-CM classifies CKD based on severity. The severity of
CKD is designated by stages 1 through 5.
Code N18.6, end stage renal disease (ESRD) is assigned when the
provider has documented ESRD.
If both a stage of CKD and ESRD are documented, assign code N18.6
only.
Patient who have undergone kidney transplant may still have some for
of CKD because the kidney transplant many not fully restore kidney
function. Therefore, the presence of CKD alone does not constitute a
transplant complication.
Assign the appropriate N18 code for the patient’s stage of CKD and
code Z94.0 – Kidney transplant status.
Introduction to ICD-10-CM parts 9 & 10
Disorder’s of the Genitourinary System
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Disorders of the Breast: Firboadenomas of the breast are not coded in
this section, but are coded in Chapter 2 of ICD-10-CM (Neoplasms).
This section includes benign mammary dysplasia, fibrocystic disease
and fibrous masses or cysts of a hormonally mediated proliferative
condition. Other diseases of the breast include inflammatory disease
(eg, abscess, mastitis, hypertrophy, atrophy, and galactocele.
This section also includes signs and symptoms in the breat that may
require further investigation, including mastodynia, lump or mass in
breast and nipple discharge.