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ICD-10-CM CODING ROUNDTABLES Myocardial Infarctions, Hypertension, Pregnancy, Fractures, and Sepsis

ICD-10-CM CODING ROUNDTABLES€¦ · ICD-10-CM CODING ROUNDTABLES ... Coding Scenario #1 Answers ... with stage 1 through stage 4 chronic kidney disease, or

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ICD-10-CM CODING ROUNDTABLES

Myocardial Infarctions, Hypertension, Pregnancy,

Fractures, and Sepsis

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CODING ROUNDTABLE SPONSOR

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INTRODUCTION

ICD-10

• Implementation date: October 1, 2015

• ICD-10-CM - Diagnosis codes

• ICD-10-PCS - Procedural codes

ICD-10 Structure

ICD-10-CM

• Alphanumeric

• Up to 7 characters

• Place holder “X”

• Alphabetic Index and Tabular List

• 21 chapters

• No supplemental classifications

(V-codes & E-codes incorporated in I-10)

• Two types of excludes notes

K80.10 Cholelithiasis

with chronic

cholecystitis

ICD-10 Structure

ICD-10-PCS

• Alphanumeric

• 7 characters (no decimal point)

• Place holder “z”

• Alphabetic Index, Tables, & List of Codes

• 16 sections

• No “NOS” options

• Limited “NEC” options

• No eponyms

• No diagnostic information in codes

OFT44ZZ Cholecystectomy

Similarities to ICD-9

• Inclusion notes

• Code First

• Use additional code

• Code Also

• Abbreviations (NOS, NEC)

• Cross references

– See

– See also

– See condition

• Punctuation marks

• Relational terms (And = “and” or “or”)

ICD-10-CM Coding Conventions

Differences than ICD-9

Exclusion notes:

• Excludes 1

– Not coded here

– Two conditions

cannot occur together

• Excludes 2

– Not included here

– The condition excluded is not part of the condition represented by the code; however, if patient has both conditions at the same time, both codes can be used

Congenital hydrocephalus Q03 Excludes 1: acquired hydrocephalus G91.-

Crowding of fully erupted teeth M26.31

Excludes 2: impacted teeth K01.-

ICD-10-CM Coding Conventions

ICD-10-CM Coding Conventions

Differences than ICD-9

• Laterality added

• Episode of care for injuries

– Initial encounter

– Subsequent encounter

– Sequela

Bicyclist injured in a traffic accident collision with car and seen in the ER V13.4xxA

ICD-10-CM Coding Conventions

Differences than ICD-9

• Trimester distinction for pregnancy

– Eliminated episode of care fifth digits

• Some changes to time frames for codes

– AMI-from 8 weeks to 4 weeks

– Abortion vs. fetal death-22 weeks to 20 weeks

Guidelines & Mapping

Guidelines

• Developed by NCHS

• Released by cooperating parties: AHA, AHIMA, CMS, & NCHS

• Mirror ICD-9 to extent possible

• Instructions and conventions take precedence over guidelines

Mapping

• General Equivalence Mappings (GEMS)

• Link ICD-9-CM to ICD-10-CM

Myocardial Infarction Guidelines

• Nontransmural or subendocardial with specified site are coded as subendocardial

• NSTEMI evolves to STEMI-code as STEMI

• STEMI converts to NSTEMI-code as STEMI

• Z92.82- status post tPA administered at a different facility within last 24 hrs.

– Only codable by receiving facility, secondary diagnosis only, code first condition for which receiving the tPA and applies even if still receiving it when they arrive at facility

STEMI I21.0-I21.2 Unspecified site I21.3 Non-STEMI I21.4

Myocardial Infarction Guidelines

Subsequent AMI

• I22 category

– Used with I21 category when a new AMI is suffered within 4 weeks of the initial AMI

• Sequencing depends on circumstances of the encounter

Old MI

• I25.2

• Assigned for old or healed MIs not requiring further care after 4 weeks

CODING PRACTICE

Coding Scenario #1

• Assign a code(s) for:

– Inferior transmural AMI

ASSIGN CODES!

Coding Scenario #1 Answers

• Inferior transmural AMI

– I21.19: STEMI involving other coronary artery of inferior wall

Coding Scenario #2

Mr. Jones received in transfer from Lakewood Community Hospital on the first day of his AMI. He had an anterior STEMI with administration of tPA before his transfer. During week two while recovering at your facility, he suffers another MI, this one a NSTEMI.

ASSIGN CODES!

Coding Scenario #2 Answers

Mr. Jones received in transfer from Lakewood Community Hospital on the first day of his AMI. He had an anterior STEMI with administration of tPA before his transfer. During week two while recovering at your facility, he suffers another MI, this one a NSTEMI.

• I21.09: STEMI involving other coronary artery of anterior wall

• I22.2: Subsequent NSTEMI

• Z92.82: Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to the admission to current facility

Hypertension Guidelines

• No hypertension table in ICD-10-CM

• Hypertension = I10

• No distinction between malignant, essential, or unspecified

• Hypertension and heart disease

– Combination code if causal relationship stated:

• Hypertensive heart disease

• Heart disease due to hypertension

• Add code for type of heart failure if appropriate

– Code independently if no relationship stated

Coding Scenario #3

• Assign a code(s) for:

– Hypertensive chronic diastolic congestive heart failure

ASSIGN CODES!

Coding Scenario #3 Answers

• Hypertensive chronic diastolic congestive heart failure

– I11.0: Hypertensive heart disease with heart failure

– I50.32: Chronic diastolic (congestive) heart failure

Coding Scenario #4

• Assign a code(s) for:

– Cardiorenal disease without heart failure, stage IV

ASSIGN CODES!

Coding Scenario #4 Answers

• Cardiorenal disease without heart failure, stage IV

– I13.10: Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease

– N18.4: Chronic kidney disease, stage 4 (severe)

Coding Scenario #5

• Assign a code(s) for:

– Hypertension with acute on chronic systolic heart failure

ASSIGN CODES!

Coding Scenario #5 Answers

– Hypertension with acute on chronic systolic heart failure

• I10: Essential (primary) hypertension

• I50.23: Acute on chronic systolic (congestive) heart failure

Pregnancy & Delivery Guidelines

• Chapter 15 codes used only on maternal record

• Final character indicates trimester

– Based on trimester for current admission/encounter

• If condition developed prior to admission/encounter

• If pre-existing condition

– If episode of care spans more than one trimester, assign trimester character for trimester when complication developed-not trimester of discharge

Pregnancy & Delivery Guidelines

• Normal delivery

– O80

• Same definition as ICD-9-CM

• Requires Z37.0 as Outcome of delivery-single live birth

• Outcome of delivery

– Required on all maternal records when delivery occurs

– Z37 category

Coding Scenario #6

• Assign a code(s)for:

– A twenty-five year old female delivers liveborn twins at 39 weeks. Delivery was vaginal with episiotomy.

ASSIGN CODES!

Coding Scenario #6 Answers

• A twenty-five year old female delivers liveborn twins at 39 weeks. Delivery was vaginal with episiotomy.

– O30.003: Twin pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester

– Z37.2: Twins, both liveborn

– Z3A.39: Weeks of gestation of pregnancy, 39 weeks

Coding Scenario #7

• Assign a code(s)for:

– A 42 year old female who is 36 weeks pregnant is admitted to your facility with premature rupture of membranes. 30 hours after admission, she goes into labor and vaginally delivers a single-liveborn infant.

ASSIGN CODES!

Coding Scenario #7 Answers

• A 42 year old female who is 36 weeks pregnant is admitted to your facility with premature rupture of membranes. 30 hours after admission, she goes into labor and vaginally delivers a single-liveborn infant.

– O60.14X0: Preterm labor third trimester with preterm delivery third trimester

– O42.113: Preterm premature rupture of membranes, onset of labor more than 24 hours following rupture, third trimester

– O09.513: Supervision of elderly primigravida, third trimester

– Z37.0: Single live birth

– Z3A.37: Weeks of gestation of pregnancy, 37 weeks

Fracture Guidelines

• Open or closed

– No specification-code to closed

• Displaced or not displaced

– No specification-code to displaced

• Sequence in order of severity

• Code multiple fractures by each specific site when known-only use multiple code when sites are not specified

Fracture Guidelines

Traumatic fractures

• Use 7th character extension

• Initial encounter=active treatment

– Surgical treatment

– Emergency department encounter

– E&M by new physician

• Subsequent care=routine care during healing or recovery

– Cast change or removal

– Removal internal or external fixation device

– Medication adjustment

– Follow-up visits

• Complications of care=malunion or nonunion

Coding Scenario #8

• Assign a code(s)for:

– A 68 year old female tripped on a throw rug and fell into her dining table with immediate onset of pain in her upper arm. She was found on the floor of the dining room in her home, and was taken to the ER where an x-ray showed a 3-part surgical neck fracture of her left humerus.

ASSIGN CODES!

Coding Scenario #8 Answers

• A 68 year old female tripped on a throw rug and fell into her dining table with immediate onset of pain in her upper arm. She was found on the floor of the dining room in her home, and was taken to the ER where an x-ray showed a 3-part surgical neck fracture of her left humerus.

– S42.232A: 3-part fracture of surgical neck of left humerus; initial encounter for closed fracture

– W01.190A: Fall on same level from slipping, tripping and stumbling with subsequent striking against furniture; initial encounter

– Y93.01: Activity, walking, marching and hiking

– Y92.011: Dining room of single-family (private) house as the place of occurrence of the external cause

– Y99.9: Unspecified external cause status

Coding Scenario #9

• Assign a code(s)for:

– A five year old boy suffered a both bone fracture of his right arm after a fall from monkey bars at the playground. X-ray indicated a greenstick fracture of the radius and ulnar shafts.

ASSIGN CODES!

Coding Scenario #9 Answers

• A five year old boy suffered a both bone fracture of his right arm after a fall from monkey bars at the playground. X-ray indicated a greenstick fracture of the radius and ulnar shafts.

– S52.311A: Greenstick fracture of shaft of radius, right arm; initial encounter for closed fracture

– S52.211A: Greenstick fracture of shaft of right ulna; initial encounter for closed fracture

– W09.2xxA or W09.8xxA: Fall on or from jungle gym (.2) OR other playground equipment (.8)

– Y93.89: Activity, other specified

– Y92.838: Other recreation area as the place of occurrence of the external cause

– Y99.8: Other external cause status

Sepsis Guidelines

Urosepsis

• NOT same as sepsis

• No code listed for this term in Alphabetic Index

• Must query for clarification if this term is documented

Sepsis

• Code appropriate underlying systemic infection

• Unknown infection or cause-A41.9

• Negative or inconclusive blood tests do

not preclude the diagnosis of sepsis

A41.9-sepsis,

unspecified

Sepsis Guidelines

Severe sepsis

• Requires minimum of 2 codes

– First-code for underlying systemic infection

• Use A41.9 if causal organism is not documented

– Second-code from subcategory R65.2, Severe sepsis

• NEVER assign codes from subcategory R65.2 as the principal diagnosis

– Code also any associated acute organ dysfunction

Sepsis Guidelines

Septic Shock

• Requires minimum of 2 codes

– First-code for underlying systemic infection

– Second-code R65.21, Severe sepsis with septic shock

– Code also any associated acute organ dysfunction

• Septic shock indicates presence of severe sepsis.

– Must code R65.21 if septic shock is documented, even if severe sepsis is not.

Coding Scenario #10

• Assign a code(s)for:

– 79 year old male SNF patient has been diagnosed with Group B Strep sepsis.

ASSIGN CODES!

Coding Scenario #10 Answers

• 79 year old male SNF patient has been diagnosed with Group B Strep sepsis.

– A40.1: Sepsis due to streptococcus, Group B

• Assign a code(s)for:

– An elderly female was admitted to the ICU with unstable vitals, including tachycardia, tachypnea, and a fever of 103˚F, along with a high white count which the doctor diagnosed as severe sepsis with acute respiratory failure. Upon discharge the final diagnosis was E. coli sepsis with acute respiratory failure.

Coding Scenario #11

ASSIGN CODES!

Coding Scenario #11 Answers

• An elderly female was admitted to the ICU with unstable vitals, including tachycardia, tachypnea, and a fever of 103˚F, along with a high white count which the doctor diagnosed as severe sepsis with acute respiratory failure. Upon discharge the final diagnosis was E. coli sepsis with acute respiratory failure.

– A41.51: Sepsis due to Escherichia coli [E.coli]

– R65.20: Severe sepsis without septic shock

– J96.00: Acute respiratory failure, unspecified whether with hypoxia or hypercapnia

Coding Scenario #12

• Assign a code(s)for:

– Following breakfast at a local diner where the eggs were undercooked, an elderly female who lives alone developed nausea, diarrhea, and stomach cramps. This continued for two days and was accompanied by a fever. She collapsed after becoming weak, was found several hours later by a neighbor, and taken to a nearby hospital where she was diagnosed with septic shock and acute salmonella sepsis.

ASSIGN CODES!

Coding Scenario #12 Answers

• Following breakfast at a local diner where the eggs were undercooked, an elderly female who lives alone developed nausea, diarrhea, and stomach cramps. This continued for two days and was accompanied by a fever. She collapsed after becoming weak, was found several hours later by a neighbor, and taken to a nearby hospital where she was diagnosed with septic shock and acute salmonella sepsis.

– A02.1: Salmonella sepsis

– R65.21: Severe sepsis with septic shock