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NJPR
CURRENT TOPICS IN ICD-10
Presented by:
Diane Stoner, RHIT, CCS
Senior Health Information Consultant, NJPR
AHIMA-APPROVED ICD-10 TRAINER
1
NJPR Disclaimer
The ICD-10 codes presented by NJPR are based on the 2013 Complete Official Draft Code Set of ICD-10-CM and ICD-10-PCS. Updates, corrections and revisions will be issued for the ICD-10 code set prior to and after implementation, therefore some of the codes presented may become invalid. The most current ICD-10 books, updates and revisions regularly issued by The Centers for Medicare and Medicaid Services (CMS) are the official source for code look up and assignment and should be referenced prior for coding instruction.
NJPR and its instructors assume no responsibility for the use of these codes outside of its intended use and disclaim any liability that may result from the use of this information for coding and billing purposes.
2
ICD-10-PCS Code Changes
– Four codes added under new technology application, valid
October 1, 2013 – Three new codes added and three
codes deleted, to correct body part value for temporary occlusion of abdominal aorta
3
ICD-10-PCS Code Changes Four codes added under new technology application
Valid October 1, 2013
08H005Z Insertion of Epiretinal Visual Prosthesis into Right Eye, Open Approach
08H105Z Insertion of Epiretinal Visual Prosthesis into Left Eye, Open Approach
30280B1 Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate into Vein, Open Approach
30283B1 Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate into Vein, Percutaneous Approach
4
ICD-10-PCS Code Changes
Three new codes added, to correct body part value for temporary occlusion of abdominal aorta
- New: 04V00DJ* Restriction of Abdominal Aorta with Intraluminal Device, Temporary, Open Approach
- New: 04V03DJ* Restriction of Abdominal Aorta with Intraluminal Device, Temporary, Percutaneous Approach
- New: 04V04DJ* Restriction of Abdominal Aorta with Intraluminal Device, Temporary, Percutaneous Endoscopic Approach
5
ICD-10-PCS Code Changes
*Appendix G – Character meanings for the Heart and Great Vessels
Root Operation V - Restriction
Qualifier - character 7
J - temporary
6
ICD-10-PCS Code Changes
Three codes deleted, to correct body part value for temporary occlusion of abdominal aorta
- Deleted: 02VW0DJ* Restriction of Thoracic Aorta with Intraluminal Device, Temporary, Open Approach
- Deleted: 02VW3DJ* Restriction of Thoracic Aorta with Intraluminal Device, Temporary, Percutaneous Approach
- Deleted: 02VW4DJ* Restriction of Thoracic Aorta with Intraluminal
Device, Temporary, Percutaneous Endoscopic Approach
7
New ICD-10-PCS codes for FY 2014
08H[0,1]05Z - Insertion of Epiretinal Visual Prosthesis into Right Eye, into Left Eye, Open Approach (2 codes)
8
New ICD-9-CM codes for FY 2014
14.81 Implantation of epiretinal visual prosthesis
14.82 Removal of epiretinal visual prosthesis
14.83 Revision of epiretinal visual prosthesis
9
RETINAL IMPLANTS AND WHO NEEDS THEM
Retinal implants restore vision in patients that are blind due to photoreceptor loss from retinitis pigmentosa.
Retinitis pigmentosa is a rare, inherited, blinding disease in which light sensitive photoreceptor cells of the eye slowly and progressively degenerate and die. However the retinal neurons, e.g. bipolar cells or ganglion cells, are retained and still work.
10
HEALTHY EYES
In a healthy eye, the photoreceptors (rods and cones) in the retina convert light into tiny electrochemical impulses that are sent through the optic nerve and into the brain, where they are decoded into images. If the photoreceptors no longer function correctly - due to conditions such as retinitis pigmentosa - the first step in this process is disrupted, and the visual system cannot transform light into images.
11
How does the Epiretinal Visual Prosthesis System work?
The Argus® II System • epiretinal implant that is fully implanted in and around the eye
• miniature video camera housed in the patient’s glasses captures a scene
• video is sent to a small patient-worn computer (i.e., the video processing unit – VPU
• processes and transformed into instructions that are sent back to the glasses
• real time video signals are wirelessly transmitted to the implant
12
How does the Epiretinal Visual Prosthesis System work?
• signals are then sent to the electrode array, which emits small pulses of electricity
• pulses are intended to bypass the damaged photoreceptors and stimulate the retina’s remaining cells which are secured at the level of ganglion cells
• overlying neurons signals are transmitted to a retinal stimulator that is secured at the level of ganglion cells
• transmits the visual information along the optic nerve to the brain
• process is intended to create the perception of patterns of light which patients can learn to interpret as visual patterns
13
GEM CROSSWALKNew 2014 entry
Example: 08H[0,1]05Z – Insertion of Epiretinal Visual
Prosthesis into Right Eye, Open Approach (2 codes)
To/from 14.81 – Implantation of Epiretinal Visual Prosthesis
14
New ICD-10-PCS codes for FY 2014
30280B1 Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate into Vein, Open Approach
30283B1 Transfusion of Nonautologous 4-Factor Prothrombin Complex Concentrate into Vein, Percutaneous Approach
15
New ICD-9-CM codes for FY 2014
00.96 - Infusion of 4-Factor Prothrombin Complex Concentrate
16
What is Infusion of 4-Factor Prothrombin Complex Concentrate?
Administration of prothrombin complex concentrate (PCC) is used for the immediate reversal of the anticoagulant effect of vitamin K antagonists, for example in case of intracranial hemorrhage or life-threatening bleeding.
There are two types of PCCs containing four (vitamin K-dependent) factors II, VII, IX
and X. containing mainly factors II, IX, and X.
17
What is Infusion of 4-Factor Prothrombin Complex Concentrate?
Voils and Baird performed a systematic review on the efficacy of these agents in clinical studies, specifically comparing the 3-factor and 4-factor concentrates.
The conclusion was that 4-factor PCCs result in a more reliable correction of the INR compared to 3-factor concentrates.
Kcentra™ 4F-PCC is FDA-approved for rapid Warfarin reversal in patients experiencing an acute major bleed.
18
GEM CROSSWALKNew 2014 entry
Example: 3028[0,3]B1 – Transfusion of Nonautologous
4-Factor Prothrombin Complex Concentrate in Vein, Percutaneous Approach (2 codes)
To/From 00.96 Infusion 4-Factor Prothrombin Complex Concentrate
19
New ICD-10-PCS codes for FY 2014
• 04V00DJ*, restriction of abdominal aorta with intraluminal device, temporary, open approach
• 04V03DJ*, restriction of abdominal aorta with intraluminal device, temporary, percutaneous approach
• 04V04DJ*, restriction of abdominal aorta with intraluminal device, temporary, percutaneous endoscopic approach
To/from 39.77 Temporary (partial) therapeutic endovascular occlusion of vessel
20
Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments
• Ninety-nine percent (99%) of the cases showed no change in MS-DRG when coded in ICD-10-CM/PCS.
• Of the 1% of the cases with MS-DRG shifts. • 45% of those shifted to higher weight MS-DRGs• 55% shifted to lower weight MS-DRGs. • Payment increases and decreases due to a change in DRG assignment are
estimated to essentially net out. • MS-DRG shifts due to re-coding in ICD-10 are caused by unavoidable
differences between the two classification systems.
21
Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Payments
2014 GEM reimbursement update available Oct 2013
22
INDEX ISSUES
AND
CLINICAL DOCUMENTATION
OPPORTUNITIES
23
AKIAcute Kidney Injury
(Nontraumatic)
No ICD-10 CM index listing for
acute nontraumatic kidney injury
24
ICD-10-CM Index
Injury
Kidney S37.00-
Specified S37.09-
25
No ICD-10 CM Index listing for…
Injury
Renal
Kidney – see condition
Renal – see condition
Acute – see condition26
S37.0 Injury of Kidney
Excludes 2 note: acute kidney injury (nontraumatic) (N17.9)
N17.9 Acute kidney failure, unspecified
Acute kidney injury (nontraumatic)
Excludes 2 note: traumatic kidney injury (S37.0-)
27
FRACTURE GUIDELINES and CDI ORTHO OPPORTUNITIES
A fracture not indicated as open or closed should be coded to closed.
A fracture not indicated whether displaced or not displaced should be coded to displaced.
28
ICD-10-CM Traumatic Fracture 7th character
A - initial encounter for closed fracture
B - initial encounter for open fracture
D - subsequent encounter for fracture with routine healing
G - subsequent encounter for fracture with delayed healing
K - subsequent encounter for fracture with nonunion
P - subsequent encounter for fracture with malunion
S - sequela
29
ICD-10-CM Traumatic Fracture 7th character
INITIAL ENCOUNTER
The patient is receiving active treatment for the fracture
Examples of active treatment • surgical treatment• emergency department encounter• evaluation and treatment by a new physician• patient who delayed seeking treatment for the
fracture or nonunion.
30
ICD-10-CM Traumatic Fracture 7th character
SUBSEQUENT CARE
• Encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase
Examples of fracture aftercare
• cast change or removal• removal of external or internal fixation device• medication adjustment• follow-up visits following fracture treatment.
31
ICD-10-CM Traumatic Fracture 7th character
SEQUELAE
• Complication or the condition as a result of the injury
Example – Scar
– Sequelae is sequenced first.– Injury code is sequenced as a secondary
diagnosis with the 7th character “S”.32
GUSTILO OPEN FRACTURE CLASSIFICATION
Classifies open fractures into three major categories (Type 1, Type II, Type III) depending on the mechanism of the injury, soft tissue damage and degree of skeletal involvement
33
GUSTILO OPEN FRACTURE CLASSIFICATION
• Type I – usually a simple fracture with wound less than 1 cm and minimal soft tissue injury
• Type II – usually a simple fracture with wound
greater than 1 cm and moderate soft tissue injury
• Type III – fractures that involve extensive damage
to the soft tissues including muscle, skin and neurovascular structures
34
GUSTILO OPEN FRACTURE CLASSIFICATION
• Subtype IIIA – open fracture with adequate soft tissue coverage despite fracture severity
• Subtype IIIB – open fracture with extensive soft
tissue loss
• Subtype IIIC – open fracture which involves major
arterial injury requiring repair for limb salvage
35
ICD-10-CM Traumatic Fracture 7th character
S52 Fracture of forearm
List of appropriate 7th character is to be added to all codes from category S52 [unless otherwise indicated].
• A initial encounter for closed fracture• B initial encounter for open fracture type I or II initial
encounter for open fracture NOS• C initial encounter for open fracture type IIIA, IIIB, or
IIIC
36
ICD-10-CM Traumatic Fracture 7th character
S52 Fracture of forearm
List of appropriate 7th character is to be added to all codes from category S52 [unless otherwise indicated].
• D subsequent encounter for closed fracture with routine healing
• E subsequent encounter for open fracture type I or II with
routine healing• F subsequent encounter for open fracture type IIIA,
IIIB, or IIIC with routine healing
37
ICD-10-CM Traumatic Fracture 7th character
S52 Fracture of forearm
List of appropriate 7th character is to be added to all codes from category S52 [unless otherwise indicated].
• G subsequent encounter for closed fracture with delayed healing
• H subsequent encounter for open fracture type I or II with delayed healing
• J subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
• S sequela
38
ICD-10-CM Traumatic Fracture 7th character
NONUNION
Care of complications of fractures with nonunion are coded with the 7th character
• K- subsequent encounter for closed fracture with nonunion
• M - subsequent encounter for open fracture Type 1 or II with nonunion
• N - subsequent encounter for open fracture type IIIA, IIIB, IIIC with nonunion
39
ICD-10-CM Traumatic Fracture 7th character
MALUNION
Care of complications of fractures with malunion are coded with the 7th character
• P - subsequent encounter for closed fracture with malunion
• Q - subsequent encounter for open fracture Type 1 or Type 2 with malunion
• R - subsequent encounter for open fracture Type IIIA, IIIB, IIIC with malunion
40
ICD-10-CM Fractures
A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.
41
ICD-10-CM Traumatic Fractures
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 7th character.
42
CDI for ORTHO CASES
Fx - open
- closed
- displaced
- nondisplaced
episode of care - initial
- subsequent
- sequela
Gustilo open fracture classification choices
Is fracture related to or due to osteoporosis - yes
- no43
SMOKING
ICD-9 305.1 or V15.82
ICD-10-CM smoker – see dependence drug, nicotine
Dependence drug, nicotine F17.200
with disorder F17.209
remission F17.201
specified disorder NEC F17.208
withdrawal F17.203
44
SMOKING
ICD-10-CM
Same code choices for chewing tobacco, cigarettes, and other nicotine specified products
Dependence, drug, nicotine, withdrawal is a CC.
F17.2- codes
Excludes 1
History of tobacco dependence Z87.891
45
Alcohol use, abuse and dependence in ICD-10-CM
USE
Use (of )
alcohol F10.99
with sleep disorder F10.982
harmful — see Abuse, alcohol
F10.99 is a CC because the code description reads“Alcohol use, unspecified with unspecified alcohol induced
disorder”
46
Alcohol use, abuse and dependence in ICD-10-CM
ABUSE alcohol (non-dependent) F10.10
with
anxiety disorder F10.180intoxication F10.129
with delirium F10.121uncomplicated F10.120
mood disorder F10.14other specified disorder F10.188
psychosis F10.159delusions F10.150
hallucinations F10.151sexual dysfunction F10.181sleep disorder F10.182
unspecified disorder F10.19
47
Alcohol use, abuse and dependence in ICD-10-CM
DEPENDENCEalcohol (ethyl) (methyl) (without remission) F10.20
with
amnestic disorder, persisting F10.26
anxiety disorder F10.280dementia, persisting F10.27intoxication F10.229
with delirium F10.221uncomplicated F10.220
mood disorder F10.24psychotic disorder F10.259
with
delusions F10.250
hallucinations F10.25148
Alcohol use, abuse and dependence in ICD-10-CM
DEPENDENCEalcohol (ethyl) (methyl) (without remission) F10.20
with
remission F10.21
sexual dysfunction F10.281sleep disorder F10.282
specified disorder NEC F10.288withdrawal F10.239
withdelirium F10.231perceptual disturbance F10.232uncomplicated F10.230
49
ICD-10-CM Coding Guidelines
Similarities
Changes
And
Major Changes
50
ICD-10-CM Coding Guidelines
Fracture 7th characters
Mental Health diagnosis with manifestations
51
ICD-10-CM Coding Guidelines
HIV GUIDELINES• Code ONLY confirmed cases as in ICD-9, this is an
exception to the basic coding guidelines• Code B20 – old 042• If a patient admitted for an HIV-related condition, use
the HIV code followed by additional diagnosis codes for all reported HIV-related conditions
• If a patient with HIV disease admitted for an unrelated illness, code condition first followed by the HIV code
• Code Z21 for asymptomatic HIV status
52
ICD-10-CM Coding Guidelines
• Code only confirmed cases of influenza due to certain identified influenza viruses, and due to other identifiable influenza virus. This is an exception to the hospital inpatient guidelines.
• If documentation states “suspected”, “possible”, “probable” avian influenza or novel influenza or other identifiable influenza, a code from Category J11 (Influenza due to unidentified influenza virus) should be assigned.
53
ICD-10-CM Coding Guidelines
Chronic kidney disease and hypertension
• ICD-10-CM presumes a causal relationship between HTN and CKD.
• Secondary code to identify the stage of kidney disease.
• If a patient has acute renal failure, an additional code for the acute renal failure is required.
54
ICD-10-CM Coding Guidelines
Hypertensive heart diseases is coded when a causal relationship is stated (due to hypertension) or implied (hypertensive).
An additional code is needed to identify the type of heart failure for patients with heart failure.
55
ICD-10-CM Sepsis Coding Guidelines
• Sequencing of sepsis codes is dependent on circumstances of admission
• Assign A41.9 if type of infection or causal organism is not further specified (ICD-9 = 038.9)
• Urosepsis is not recognized as a disease in ICD-10
56
ICD-10-CM Sepsis Coding Guidelines
• A minimum of 2 codes is required for the coding of Sepsis with Associated Organ Dysfunction– One code for underlying infection– One code from subcategory (severe sepsis)
• Severe Sepsis is implied when septic shock is documented.
• Additional codes for the associated acute organ dysfunctions are also required
57
ICD-10-CM Neoplasm Coding Guidelines
The neoplasm table in the alphabetic index should be referenced first. However, if the histological term is documented, that term should be referenced first rather than going immediately to the neoplasm table, in order to determine which column in the neoplasm is appropriate.
Carcinoid (tumor) – see Tumor, carcinoid
Tumor, carcinoid has both benign and malignant codes
58
ICD-10-CM Coding Guidelines
STAGES OF CHRONIC KIDNEY DISEASE (CKD)• The ICD-10-CM classifies CKD based on severity. The severity of CKD
is designated by stages 1-5. • Stages of CKD
– Stage 1 – N18.1– Stage 2 – N18.2 (mild)– Stage 3 – N18.3 (moderate)– Stage 4 – N18.4 (severe)– Stage 5 – N18.5
Note: Code CKD, Stage 5 requiring chronic dialysis to N18.6 (ESRD)
59
ICD-10-CM Coding Guidelines
ANEMIA ASSOCIATED WITH MALIGNANCY
When admission/encounter is for management of an anemia associated with the malignancy, and the treatment is only for anemia, the appropriate code for the malignancy is sequenced as the principal or first-listed diagnosis followed by the code for Anemia in neoplastic disease.
60
ICD-10-CM Coding Guidelines
CODE ASSIGNMENTS FOR ENCOUNTERS SOLELY FOR THE ADMINISTRATION OF CHEMOTHERAPY, IMMUNOTHERAPY AND RADIATION THERAPY
• Z51.0 – Encounter for antineoplastic radiation therapy• Z51.11 – Encounter for antineoplastic chemotherapy• Z51.12 – Encounter for antineoplastic immunotherapy
61
ICD-10-CM Coding Guidelines
DIABETES GUIDELINES
No more controlled vs. uncontrolled
• combination codes that include the type of DM, the body system affected and the complications affecting that body system
• should be sequenced based on the reason for a particular encounter. Assign as many codes as needed to identify all of the associated conditions that the patient has
.62
ICD-10-CM Coding Guidelines
NERVOUS SYSTEM GUIDELINESDOMINANT/NONDOMINANT SIDE of HEMIPLEGIA
Default codes should be dominant if the right side is affected. If the left side is affected, the default is non-dominant.
63
ICD-10-CM Coding Guidelines
LATERALITY
right
left
BILATERALITY
When the condition is bilateral, it is correct to assign a code for the left and right sides when there is no bilateral code available.
64
ICD-10-CM Coding Guidelines
Some of the Ear diagnosis codes ask us to -
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)• Occupational exposure to environmental tobacco smoke
(Z57.31)• Tobacco dependence (F17.-)• Tobacco use (Z72.0)
65
ICD-10-CM Coding Guidelines
ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris.
The subcategories for these codes include coronary artery disease of the native coronary arteries, coronary artery bypass graft(s) and arteries of transplanted heart with angina.
66
ICD-10-CM Coding Guidelines
A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris, unless the documentation indicates the angina is due to something other than the atherosclerosis.
67
ICD-10-CM Coding Guidelines
Acute and subsequent myocardial infarctions -
ICD-9 Acute MI timeframe is 8 weeks ICD 10 Acute MI timeframe is 4 weeks
ICD-10 Initial MI code I21ICD-10 Subsequent MI code I22
Use a code from category I21 for the initial MI for that admission and any other subsequent admissions
that occur in the next 4 weeks
Any additional MIs that occurs during that 4 weeks timeframe from the initial MI is considered a subsequent MI and uses a code from the I22 category
68
ICD-10-CM Coding Guidelines
The sequencing of the I22 and I21 codes depends on the circumstances of the encounter. Should a patient who is in the hospital due to an AMI have 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. Should a patient have 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 by the I21. An I21 code must accompany the I22 code to identify the site of the initial AMI, and to indicate that the patient is still within the 4 week time frame of healing from the initial AMI
69
ICD-10-CM Coding Guidelines
Code I25.2 is used for an “old” or healed MI not requiring further care.
70
ICD-10-CM Coding Guidelines
ICD-10-CM provides combination codes for complications commonly associated with Crohn’s disease. These combination codes can be found under category K50 (Crohn’s Disease).
71
ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES
FINAL CHARACTER FOR TRIMESTER
The majority of codes in Chapter 15 have a final character indicating the trimester of pregnancy. The time frames for the trimesters are as follows:
• 1st trimester – less than 14 weeks, 0 days• 2nd trimester – 14 weeks, 0 days to less than 28 weeks, 0
days• 3rd trimester – 28 weeks, 0 days until delivery
72
ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES
If trimester is not a component of a code, it is because the condition always occurs in a specific trimester, or the concept of trimester of pregnancy is not applicable. Certain codes have characters for only certain trimesters because the condition does not occur in all trimesters, but it may occur in more than just one.
73
ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES
Assignment of the final character for trimester should be based on the trimester for the current admission/encounter.
This applies to the assignment of trimester for pre-existing conditions as well as those that develop during or are due to the pregnancy.
74
ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES
Whenever delivery occurs during the current admission, and there is “in childbirth” option for the obstetric complication being coded, the “in childbirth” code should be assigned.
75
ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES
UNSPECIFIED TRIMESTER
Each category that includes codes for trimester has a code for “unspecified trimester”. The “unspecified trimester” code should rarely be used, such as when the documentation in the record is insufficient to determine the trimester and it is not possible to obtain clarification.
76
ICD-10 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM GUIDELINES
• NEW• Assign a code from category Z3A (weeks of
gestation) on the maternal record to provide additional information about the pregnancy.
• SAME• Assign a code from category Z37 (Outcome of
Delivery) on all maternal records where a delivery has occurred.
77
ICD-10-CM Coding Guidelines
Chapter 19 includes codes for traumatic fractures, burns, complications of care (pain from devices, transplant complications other than kidney) as well as adverse effects, poisonings, underdosing and toxic effects.
78
ICD-10-CM Coding Guidelines
Codes from category T36-T65 (Adverse Effects, Poisonings, Underdosing and Toxic Effects) are combination codes that include the substances related to the adverse effect, the poisoning, underdosing and toxic effect as well as the external cause of the poisoning, underdosing and toxic effect.
79
ICD-10-CM Coding Guidelines
Most categories in chapter 19 have seventh character classifications that are required for each applicable code. Most categories in this chapter have three extensions (with the exception of fractures): A, initial encounter, D, subsequent encounter and S, sequela.
80
ICD-10-CM Coding Guidelines
The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, assign the acute care injury code with the seventh character “D” (subsequent encounter).
81
ICD-10-CM Coding Guidelines
ADVERSE EFFECT
The drug has been correctly prescribed and properly administered.
Assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug
The code for the drug should have a 5th or 6th character “5” (for example T36.0X5 Adverse effect of penicillins) .
82
ICD-10-CM Coding Guidelines
POISONING
Poisoning is the improper use of a medication including overdose, wrong substance given or taken in error, wrong route of administration.
Poisoning codes have an associated intent: accidental, intentional self-harm, assault and undetermined. Use additional code(s) for all manifestations of poisonings.
83
ICD-10-CM Coding Guidelines
UNDERDOSING
Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction.
84
ICD-10-CM Coding Guidelines
Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.
85
ICD-10-CM Coding Guidelines
PRESSURE ULCERS
Codes for pressure ulcers are combination codes that identify the site of the pressure ulcer as well as the stage of the ulcer.
86
ICD-10-CM Coding Guidelines
• Code based on severity using stages 1-4, unspecified and unstageable
• Unstageable = Cannot be clinically determined – not the same as unspecified
• Healed: Do not code pressure ulcers documented as healed on admission
• Healing: Code to stage documented in record• Evolution of stage throughout admission: code the highest stage
reported for that site
87
ICD-10-CM Coding Guidelines
PRESSURE ULCERS
The pressure ulcer category has specific coding instructions for gangrene -
. “Code first any associated gangrene”
88
REFERENCES• www.cms.hhs.gov/ICD9ProviderDiagnosticCodes• www.cms.gov/mmrr/Downloads/MMRR2011_001_02_A02.pdf • Ingenix OPTUM 2013 ICD-10-CM, The complete official draft code set• TruCode 2013, 2Q• http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/Downloads/March5-ICD9-
CM.pdf. • Prevention magazine, September 2013 issue, Answers Dr,Sanjay Gupta/The Neurosurgeon • Published: Dec 2012 - Marcel Levi• Systematic review: 3-factor versus 4-factor prothrombin complex concentrate for warfarin reversal:
does it matter? • Voils SA, Baird B, Thromb Res 2012;130:833-840• Wikipedia.com • A Fully Implantable Epiretinal Vision Prosthesis for Retinitis Pigmentosa Patients
Thomas Schanze, Uwe Thomas, EpiRet GmbH, Winchester Straße 8 D-35394 Gießen• Blind patients implanted with this prosthesis can perform spatial and motion tasks.
BY CONNI BERGMANN KOURY, EDITOR-IN-CHIEF • 2-sight.eu/en/product-en
89