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ICD-10-CM Chapter 11-14CRIHB

John Hailes

ASC-E/M, CCS, CCS-P, CPC, CPC-H, CIRCC, CPMA, CPC-I, CEMC, CFPC, Certified @ICD-10-CM/PCS Trainer

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Objectives

• Identify areas in ICD-10-CM that include new terminology for clinical documentation

• Understanding the coding guidelines that pertain to ICD-10-CM Chapter 11-14

• Assign the correct ICD-10-CM codes for the case studies involving chapters 11-14

• Define areas in ICD-10-CM that enable improved data capture if more specific conditions are documented – Acuity– Disease type– Site specifity– Disease stage

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Documentation Matters

“If it was not documented, it was not done”

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X X X X

Category

.Etiology, anatomic

site, severity

Added code extensions (7th character) for obstetrics, injuries, and external causes of injury

Coding and 7th Character Extensions

X X XAMS 0 2 6. 5 x A

Additional Characters

Alpha (Except U)

2 Numeric3 - 7 Numeric or Alpha

3 – 7 Characters

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DISEASES OF THE RESPIRATORY SYSTEMCHAPTER 10

ICD-10-CMNational Cancer Institute

5

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Diseases of the Respiratory System

• J00-J06 Acute upper respiratory infections• J09-J18 Influenza and pneumonia• J20-J22 Other acute lower respiratory infections• J30-J39 Other diseases of upper respiratory tract• J40-J47 Chronic lower respiratory diseases• J60-J70 Lung diseases due to external agents• J80-J84 Other respiratory diseases principally affecting the interstitium• J85-J86 Suppurative and necrotic conditions of the lower respiratory tract• J90-J94 Other diseases of the pleura• J95-J95 Intraoperative and postprocedural complications and disorders of

respiratory system, not elsewhere classified• J96-J99 Other diseases of the respiratory system

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Respiratory System

• ICD-9-CM to ICD-10-CM Model• Acute Anatomic site of infection • Other Severity • Pneumonia Cause • Chronic Acute, other, then chronic

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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)• Infectious agent (B95-B97)• Occupational exposure to environmental tobacco

smoke (Z57.31)• Tobacco dependence (F17.-)• Tobacco use (Z72.0)

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Diseases of the Respiratory System

• Chapter 10 category range = J00-J99• Combination codes = condition and organism

– J02.0 Streptococcal pharyngitis

• Other codes require separate reporting of organism– Acute sinusitis J01-– Use Additional code (B95-B97) to identify infectious

agent.

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• New terminology for asthma

• Respiratory condition in more than 1 site (not specifically indexed) classified to lower anatomic site

• Additional code notes

Chapter 10

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Asthma

ICD-9• 493.XX

– 4th Digit• Extrinsic• Intrinsic• Chronic Obstructive• Other

– 5th Digit• Exacerbation or status

asthmatics

ICD-10• J45.XXX

• Extrinsic• Intrinsic• Chronic Obstructive• Other

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J45 Asthma

• J45.2 Mild intermittent asthma• J45.20 …… uncomplicated• J45.21 …… with (acute) exacerbation• J45.22 …… with status asthmaticus• J45.3 Mild persistent asthma• J45.30 …… uncomplicated• J45.31 …… with (acute) exacerbation• J45.32 …… with status asthmaticus• J45.4 Moderate persistent asthma• J45.40 …… uncomplicated• J45.41 …… with (acute) exacerbation• J45.42 …… with status asthmaticus• J45.5 Severe persistent asthma

5th Character mano-num system

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Upper Respiratory Infections• J00 Acute nasopharyngitis [common cold] • J01 Acute sinusitis • J02 Acute pharyngitis • J03 Acute tonsillitis • J04 Acute laryngitis and tracheitis • J05 Acute obstructive laryngitis [croup] and epiglottitis • J06 Acute upper respiratory infections of multiple and

unspecified sites

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Upper Respiratory Tract

• Acute sinusitis by site• Acute recurrent sinusitis by site.

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J01 Acute sinusitis

• J01.0 Acute maxillary sinusitis• J01.00 …… unspecified• J01.01 Acute recurrent maxillary sinusitis• J01.1 Acute frontal sinusitis• J01.10 …… unspecified• J01.11 Acute recurrent frontal sinusitis• J01.2 Acute ethmoidal sinusitis• J01.20 …… unspecified• J01.21 Acute recurrent ethmoidal sinusitis• J01.3 Acute sphenoidal sinusitis• J01.30 …… unspecified

•Anatomical Site•Acute•Recurrent

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465.9 Acute upper respiratory infection

• J06 Acute upper respiratory infections of multiple and unspecified sites

• J06.0 Acute laryngopharyngitis• J06.9 Acute upper respiratory infection,

unspecified

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462 Acute Pharyngitis

• J02.0 Streptococcal pharyngitis• J02.8 Acute pharyngitis due to other specified

organisms• J02.9 Acute pharyngitis, unspecified

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Instructional note

When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to

J40-J47 Chronic lower respiratory diseases

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J40-J47 Chronic lower respiratory diseases

• J41 Simple and mucopurulent chronic bronchitis

• J42 Unspecified chronic bronchitis• J43 Emphysema• J44 Other chronic obstructive pulmonary

disease• J45 Asthma• J47 Bronchiectasis

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Allergic rhinitis

• Excludes 1: Allergic rhinitis with asthma (bronchial) – Code to the Asthma code. J45.909

• J30 Vasomotor and allergic rhinitis– J30.0 Vasomotor rhinitis– J30.1 Allergic rhinitis due to pollen– J30.2 Other seasonal allergic rhinitis– J30.5 Allergic rhinitis due to food Cause and Effect

– J30.8 Other allergic rhinitis– J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander– J30.89 Other allergic rhinitis– J30.9 Allergic rhinitis, unspecified

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Influenza

• Influenza may be coded alone or in combination with other codes.

Code only confirmed cases: – Exception to Guideline II, H. (Uncertain Diagnoses)

• J09 – Due to certain identified influenza viruses

• J10 – Due to other identified influenza viruses

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COPD

ICD-9-CM - 491.2x or 493.2x

– Asthma with COPD – Chronic asthmatic (obstructive) asthma – Chronic bronchitis with airway

obstruction – Chronic bronchitis with emphysema – Chronic obstructive asthma – Chronic obstructive bronchitis – Chronic obstructive tracheobronchitis

ICD-10-CM J44

– J44 Other chronic obstructive pulmonary disease

– J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection

– J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation

– J44.9 Chronic obstructive pulmonary disease

J44 Includes    •asthma with chronic obstructive pulmonary disease •chronic asthmatic (obstructive) bronchitis •chronic bronchitis with airways obstruction •chronic bronchitis with emphysema •chronic emphysematous bronchitis •chronic obstructive asthma •chronic obstructive bronchitis •chronic obstructive tracheobronchitis

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Pneumonia

• Coded as a combination with the responsible organism

• Coded as a dual classification

• J13 and J14 = code first influenza (J09, J10, J11) is applicable

• J13 Pneumonia due to Streptococcus pneumoniae

• J14 Pneumonia due to Hemophilus influenzae

• J15 Bacterial pneumonia, not elsewhere classified

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Acute Respiratory Failure Coding Guideline 10.b.1

• Acute respiratory failure as the principal diagnosis • J96.0 May be assigned as the principal diagnosis

when • it is the condition established after study to be

chiefly responsible for the admission to the hospital. • The selection of the code is supported by the • Alphabetical and Tabular list. • Chapter specific guidelines take precedence. • Obstetrics, poisonings, HIV and newborn

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Acute Respiratory Failure Coding Guideline 10.b.2

• Acute respiratory failure as a secondary diagnosis

• Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or is present on admission, but does not meet the definition of the principal diagnosis.

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Acute Respiratory Failure Coding Guideline 10.b.3

• Sequencing of acute respiratory failure and another acute condition.

• When the patient is admitted with respiratory failure and another condition such as myocardial infarction, CVA or aspiration pneumonia, the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or non-respiratory condition. Principle diagnosis will be dependent on the circumstances of the admission. admission. If two conditions are equally responsible and there are no chapter specific guidelines, the guideline for two or more diagnosisthat equally meet the definition of principal diagnosis may be applied.

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J96 Respiratory failure

• J96.0 Acute respiratory failure• J96.00 …… unspecified whether with hypoxia or hypercapnia• J96.01 …… with hypoxia• J96.02 …… with hypercapnia• J96.1 Chronic respiratory failure• J96.10 …… unspecified whether with hypoxia or hypercapnia• J96.11 …… with hypoxia• J96.12 …… with hypercapnia• J96.2 Acute and chronic respiratory failure• J96.20 …… unspecified whether with hypoxia or hypercapnia• J96.21 …… with hypoxia

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Questions