ICD-10-CM: PRL Training Session 1 Practice Resources, LLC 20151

ICD-10-CM: PRL Training Session 1

Practice Resources, LLC 2015 1

Objectives

• Understanding how to utilize the ICD-10 book– Includes notes.– Excludes 1 & Excludes 2.– Code First explanations.– Code also– Additional characters required.– Place holders.


Where to start

• Look up term in alphabetic index • Pay attention to parenthetical terms & instructions• Do not code from alphabetic index- go to tabular

section to verify accuracy of code• Read all the instructional material associated with

that code• Consult guidelines


Includes Notes

• Appear directly under certain categories in the tabular list– Example code J36 Peritonsillar abscessINCLUDESINCLUDES abscess of tonsil

peritonsillar cellulitisquinsy


Inclusion Terms

– These are listed under certain codes. They may be considered synonyms with the code title or conditions that can be used for that code number.• They are similar to the ‘includes notes’- Example code G44.00: Cluster headache syndrome, unspecified

Ciliary neuralgiaCluster headache NOSHistamine cephalgiaLower half migraineMigrainous neuralgia

Note this code needs 6th digit


Excludes 1

• Translates to NOT CODED HERE• These are mutually exclusive codes that cannot be reported

together• Example- a congenital form of disease cannot be coded

with an acquired form of the same condition– M20 Acquired deformities of fingers and toes– EXCLUDES 1EXCLUDES 1

acquired absence of fingers and toes (Z89.-)congenital absence of fingers and toes (Q71.3-, Q72.3-)congenital deformities and malformations of fingers

and toes (Q66-, Q68-Q70, Q74-)


Excludes 2

• Translates to NOT INCLUDED HERE• These are not normally coded together. However patient may

have both conditions at the same time. – Example J03 Acute tonsillitis• EXCLUDES 2EXCLUDES 2

Chronic tonsillitis (J35.0)


Code First/Use additional codeThese will be in red and will provide instructions on sequencing. You may need to code another diagnosis first or use an additional code to help paint a better picture of the patient’s condition

Example- J44 Other chronic obstructive pulmonary disease

Code also type of asthma, if applicable (J45.-)Use additional code to identify:

exposure to environmental tobacco smoke (Z77.22)history of tobacco use (Z87.891)tobacco dependence (F17.-)tobacco use (Z72.0)


Example of Code First

• J17 Pneumonia in diseases classified elsewhereCode first underlying disease, such as:

Q fever (A78)rheumatic fever (I00)schistosomiasis (B65.0- B65.9)


Edit for Medent

- There will be edits in the new version of Medent to flag providers about the code first or additional code needed

- You also may see this edit when billing through the ebill if provider did not add in the additional code


Additional Characters

• The additional character symbol indicates that the code is required to have another digit to accurately code the symptom.

• Could have additional 4th, 5th, 6th or 7th digit you need to choose.– Example R11 Nausea and vomiting

• Requires 4th additional digit– R11.0 Nausea– R11.1 Vomiting

• Vomiting further requires 5th additional digit– R11.10 Vomiting unspecified– R11.11 Vomiting without nausea– R11.12 Projectile vomiting– R11.13 Vomiting of fecal matter– R11.14 Bilious vomiting


Place Holders

• Also called ‘dummy placeholders’• Character ‘X’ used in the 5th or 6th position of the

code to keep that 7th character in the correct position.– Example T59.91XA Toxic effect of unspecified gases,

fumes and vapors, accidental (unintentional) initial encounter• Box with symbol will be blue in ICD-10 book to show place holder

is needed


Extra tips

• Unspecified diagnosis will be in yellow• Other specified diagnosis will be in gray• For codes that designate laterality– Right will be the number 1– Left will be the number 2

• Example M76.511 Patellar tendinitis, right kneeM76.522 Patellar tendinitis, left knee


Additional symbols

• Age and Sex symbols– Newborn Age: 0 symbol NN– Pediatric Age: 0-17 symbol PP–Maternity Age: 12-55 symbol MM– Adult Age: 15-124 symbol AA–Male diagnosis only ♂♂– Female diagnosis only ♀♀

*For example go to code N41.2- Abscess of prostate


Guidelines• Located in the beginning of the ICD-10 book• Formatted into Sections and chapters

Indexes• Normal Index• Neoplasm Table• Table of Drugs and Chemicals• External Cause Index


Time to Code


Diabetes Mellitus Coding

• Five Categories • E08 Diabetes mellitus due to an underlying condition• E09 Drug or chemical induced diabetes mellitus• E10 Type 1 diabetes mellitus• E11 Type 2 diabetes mellitus• E13 Other specified diabetes mellitus

All categories above except E10 include a note to direct you to use additional code to identify any insulin use and directs you to code Z79.4

Z79.4 Long term (current) use of insulin


Example

A 37 year old female patient presents to office for follow up on her diabetes. No complaints, glucose levels have been well controlled. Provider does an expanded problem focused history and examination on patient. Tells patient to continue with same dosage of Lantus* and continue following diet with exercise. She should continue monitoring her levels and return in 3 months.

What diagnosis code(s) are needed for this?

*Clue for the non-family practice billers- Lantus is insulin


Asthma Coding

• Has expanded to include different types of severity needed to correctly code for ICD-10.– Mild Intermittent– Mild Persistent– Moderate Persistent– Severe Persistent• Will further break down to uncomplicated,

exacerbation or status asthmaticus


Asthma Table


ExampleA 19 year old non-smoking male presents to the office with complaints of worsening asthma. Pollen in the air has been worse the past few weeks which has triggered his asthma. He has had asthmatic episodes 2-3 times a week where he needed to use his inhaler. Admits to only minor limitations with activities, but has woke up a few times in the night by his symptoms in the past month. Inhaler does help with his episodes. Patient not having any difficulty at present time. Provider performs detailed exam and history. Provider refills script for Advair and tells patient to follow up in 3 months or sooner if symptom become more frequent.

What diagnosis code(s) would be correct for this?


Answers• Slide 17- E11.9 Type 2 diabetes without complications, Z79.4 Long term

(current) use of insulin• Slide 20- J45.31 Mild persistent asthmas with (acute) exacerbation


Documents

ICD-10-CM: PRL Training Session 1 Practice Resources, LLC 20151