of 43 /43
PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM © RMACI, 2015

PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

  • Upload
    others

  • View
    19

  • Download
    0

Embed Size (px)

Citation preview

Page 1: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

                                                

 

 

 

PREPARING FOR ICD-10-CM

PHASE 2

INTRODUCTION TO ICD-10-CM  

 

 

 

 

© RMACI, 2015 

 

Page 2: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

TABLE OF CONTENTS

Introduction to ICD-10-CM ........................................................... 1

ICD-10-CM—Is It Ever Going To Happen? .................................... 3

Why Are We Making This Change ................................................. 4

Myths About ICD-10 ..................................................................... 4

Comparing ICD-9-CM to ICD-10-CM ............................................. 7

What Does ICD-10-CM Look Like? .............................................. 12

Tips to Finding ICD-10-CM Codes ............................................... 15

ICD-10-CM Guidelines ................................................................ 18

ICD-10-CM Code Organization .................................................... 22

What’s Next? ............................................................................... 41

Page 3: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

1

INTRODUCTION TO ICD-10-CM Many who are participating in this ICD-10 training program may have vastly different views about medical billing and coding. Some may not be very familiar with coding and how it works, while others may deal with coding on a daily basis. There are those who may enjoy the coding process, while others may view it as necessary evil that has to be tolerated in order to facilitate the flow of revenue into the practice. Regardless of one’s view today, we are about to undergo a major change in coding in the United States. The usage of ICD-10, beginning on October 1, 2015, completely revises one of the two code sets used to report the health care provided to patients and to submit claims to third party payers, such as health insurers. The transition from ICD-9 to ICD-10 is providing a unique opportunity to upgrade and standardize everyone’s knowledge concerning coding and its influence on billing and revenue. Fundamentally, coding is telling the story of the encounter with the patient in the most accurate manner possible. Words are not used—rather, codes are the communication medium. When we discuss correct coding, it means that we are selecting codes based on:

The most accurate possible description of “what” was done and “why” it was done

What can be supported by the documentation in the medical record Consistency with and adherence coding rules and guidelines

“What” is described by the procedure code, which is reported by either a Current Procedural Terminology (CPT) code or a Healthcare Common Procedure Coding System (HCPCS) Level II code, which describes certain procedures and/or medical supplies. “Why” is described by the diagnosis code, which is reported using the International Classification of Disease (ICD). At present, we are using Revision 9 (ICD-9), but will make the transition to Revision 10 (ICD-10) on October 1, 2015. While the relationship between code selection and documentation will receive greater attention in Phase 3 of this training, it is important to note that documentation requirements are going to change after this transition occurs because ICD-10 codes are more specific than ICD-9 codes. Therefore, it will be necessary to engage in more targeted documentation so that enough information exists within the record to select the appropriate ICD-10 code.

Page 4: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

2

Page 5: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

3

ICD-10-CM—IS IT EVER GOING TO HAPPEN? The transition to ICD-10 has been bumpy, to say the least. ICD-6 was first adopted for worldwide usage in 1948. For approximately 25 years, regular updates were made, but it was not until 1979 that ICD-9 was formally adopted for usage for the purpose of reporting claims to the Medicare/Medicaid programs, and to commercial insurers shortly thereafter. ICD-10 was formally issued by the World Health Organization (WHO) in 1993 and, over the years, has been adopted for usage by every member nation within the WHO, except for the United States. The United States did not rush into the use of ICD-10 because, even though it had already been in use for more than 15 years, it was not until January 2009 that the Department of Health and Human Services (DHHS) announced an implementation date, which was to be October 1, 2013. Successful “behind-the-scenes” work took place in 2012, when the format for communication of electronic claims was transitioned from the 4010 format to the 5010 format. This transition was necessary in order to make the usage of ICD-10 possible. However, in 2012, HHS recognized that preparations for ICD-10 were lagging and that key players were not going to be ready in time. Therefore, they delayed the implementation by one year, setting a new effective date of October 1, 2014. Everyone was making active progress toward the 10/1/2014 effective date when, during the debate about the Sustainable Growth Rate (SGR) and the impending Medicare reimbursement reductions, Congress became involved in the ICD-10 implementation. Language was inserted in the legislation that prevented the implementation of ICD-10 until at least October 1, 2015. The current effective date for ICD-10 is October 1, 2015. There is no indication that there will be any change to this effective date. The Centers for Medicare and Medicaid Services (CMS), which have always been in favor of a timely implementation, is fully moving forward with preparations. Since Congress is now in the hands of a single party, there is not expected to be any political conflict over the issue. In addition, those in Congress who blocked the implementation in 2014 are now publicly stating that they are in favor of implementation in 2015. Therefore, we must aggressively move forward with plans and preparations for an October 1 “go live” for ICD-10. In order to properly prepare for the transition, the following actions should take place between now and October 1, 2015:

• Continue the introduction and education about ICD-10 • Coach offices in planning for operational changes • Demonstrate the benefits of transitioning to ICD-10

Page 6: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

4

• Continued enhanced audits to upgrade documentation for ICD-10 • Opportunities to test ICD-10 submissions from billing software to payers

WHY ARE WE MAKING THIS CHANGE? There are three fundamental reasons why we are making the transition from ICD-9 to ICD-10. They are:

1. ICD-9 is outdated and obsolete. It needs to be updated to reflect changes in health care and our understanding of disease processes.

2. There needs to be a greater degree of data collection, both for quality of care and public health needs. ICD-10 allows that to happen and gives the United States the opportunity to participate with the rest of the world in public health monitoring and tracking.

3. The current reimbursement models in place for the healthcare system in the United States are seriously broken, because they incentivize the wrong behaviors and reimburse at levels that have nothing to do with the quality of care delivered. ICD-10 will give the opportunity to modify payment models so that utilization patterns and outcomes are more easily measured and, ultimately, providers are recognized when they treat sicker patients or produce consistently better outcomes.

MYTHS ABOUT ICD-10

One of the factors that has promoted the delays in the implementation of ICD-10 and resistance to the change is a number of myths about the code set that have been spread throughout the health care community. Let’s take a few moments to recognize and address these myths. 1. There is a dramatically larger number of codes that will be

unmanageable. As is the case with most myths, there is a certain element of truth to the statement, followed by something that is not accurate. In this case, it is true that there is a dramatically large number of codes in the ICD-10 code set (approximately 140,000 codes), compared to the ICD-9 code set (approximately 17,000 codes). However, it is not true that the increase in codes is unmanageable. There are two different elements that need to be understood in order to appropriately respond to this myth:

a. The largest increase in the number of codes is in the ICD-10 Procedural Coding System (PCS) data set. ICD-10-PCS is used only by hospitals to report inpatient services and is directly comparable to the ICD-9 Volume 3 codes, which are not used at all by physicians or physician clinics. There are approximately 3,000

Page 7: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

5

ICD-9 Volume 3 codes, while there are approximately 72,000 ICD-10-PCS codes (an increase of ~2400%). There are approximately 13,000 ICD-9 Clinical Modification (CM) diagnosis codes, compared to approximately 68,000 ICD-10-CM diagnosis codes (an increase of ~500%). Therefore, the increase in diagnosis codes is not nearly as dramatic as the raw numbers would seem to indicate.

b. Most of the increase in the number of diagnosis codes is associated with increased specificity. The information needed to select the correct ICD-10 code is usually already in the medical record. For example,

For obstetrics, what trimester is the patient in? For primary care, what side (right or left) is the injury found? For gastroenterology/general surgery, is the condition acute or chronic?

Is it primary or secondary? For dermatology, what type of ulcer is it and where (specifically) is it

found?

2. I have to report laterality and encounter type for every service.

In ICD-10-CM, there are two significant changes that will be obvious to anyone who has used ICD-9-CM:

The reporting of laterality The reporting of encounter type

There was no functionality in ICD-9-CM to indicate what side of the body was being addressed during the encounter. In many cases, but not all, in ICD-10-CM there is the requirement to indicate whether the condition being treated is:

On the left side On the right side Bilateral Unspecified

Some specialties (e.g. ophthalmology and orthopedics) will be affected by the reporting of laterality in virtually every case. Others will be affected to a much lesser degree. The key point to understand is that this information should be in the medical record already. Second, when laterality is an option, “unspecified” should be avoided if at all possible because it seems to indicate a lack of attention to detail. Many payers may deny claims if an “unspecified” side is used when a reasonable person could/should know what side of the body is being treated. An extreme example of an inappropriate laterality code is as follows:

S49.90X- Unspecified injury of shoulder and upper arm, unspecified arm

Page 8: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

6

For many codes, certain conditions such as burns, injuries, sprains, strains, and breaks require a 7th character to indicate the type of encounter. The basic encounter types are:

A—Initial encounter D—Subsequent encounter S—Sequelae

For certain conditions (particularly fractures and breaks), there are approximately one dozen other options to report whether it is open or closed fracture, whether it is healing properly or not, etc. Again, this is information that should be present in the record and it does not apply in every circumstance and does not apply to every specialty. 3. ICD-10-CM is exceptionally complicated.

Just because something is specific or new does not mean that it is particularly complicated. Some research conducted in professional training schools are finding that those who are learning ICD-10 without any exposure to ICD-9 are demonstrating proficiency more quickly than those who are learning ICD-9. The reason is that ICD-10-CM is organized more logically and flows more naturally than ICD-9-CM. Another major benefit of the change to ICD-10-CM is that everyone will be receiving training on the new code set and will have the same baseline knowledge. After we are done with the ICD-10-CM training, everyone’s knowledge about diagnosis codes will be greater than it was before, while we were using ICD-9-CM. 4. ICD-10-CM will be a significant burden.

To be sure, the transition to ICD-10-CM will be a burden. For example, the fact that you are taking the time to experience this training is an investment of effort that you would not be doing if it were not for the change to ICD-10-CM. It will also be a burden in the sense that many of us may have key ICD-9-CM codes memorized—in some cases, nearly all the frequently used codes. It will take more time to look up the new codes that represent the diagnoses that we want to report. Also, there may be delayed payment from third party payers as they work their way through the adjustment to the new code set. However, in the long run, the benefits will outweigh the short-term burden that we will experience. The need for specificity will cause us to document in more detail, which will produce better medical records and help facilitate better patient care. In addition, ICD-10-CM may result in faster claim payment because payers will not need to request medical records to clarify the usage of “other specified” and “unspecified” diagnosis codes that were used with ICD-9-CM.

Page 9: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

7

COMPARING ICD-9-CM TO ICD-10-CM

The Table of Contents ICD-9-CM ICD-10-CM

INTRODUCTION

Official Guidelines for Coding and Reporting

YES YES

ALPHABETIC INDEX

Index to Diseases and Injuries YES YES

Table of Neoplasms NO (included in disease index)

YES

Table of Drugs and Chemicals YES YES

Index to External Causes of Injury

YES YES

TABULAR LIST OF DISEASES

Primary List (# of chapters) 17 21

Supplementary List (# of chapters)

2 0 (included in primary list)

Most discussions of the transition to ICD-10-CM focus on the differences between ICD-9 and ICD-10. However, there are a great number of similarities. This is evident simply by looking at the Table of Contents of each book. Both versions begin with an Introduction, which includes the Official Guidelines for Coding and Reporting. The items included in the Alphabetic Index are unchanged. The only modification is the separation of the Table of Neoplasms into a separate component. In ICD-9-CM, the Table of Neoplasms is a part of the Index to Diseases and Injuries (listed under “Neoplasm.” The Tabular List is not terribly different in its organization, other than the fact that the Supplementary List in ICD-9 (the “V” and “E” codes) have been incorporated into the primary list.

Page 10: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

8

When considering the differences between the two code sets, they can be characterized as follows:

ICD-10-CM codes are more specific. In order to properly select a code, the medical record must contain documentation with sufficient specificity to support the code.

Each chapter is separated into “blocks” of codes, divided into logical and reasonable subcategories. This will be addressed in much greater detail later in this training.

There are two additional chapters in ICD-10-CM—one for each of the sensory organs (eyes and ears). In ICD-9, the codes for these organs were included as part of the neurologic system.

As mentioned previously, ICD-10 is actually comprised of two code sets. They are:

ICD-10-CM-diagnostic coding ICD-10-PCS—procedural coding

ICD-10-CM codes describe the clinical picture of the patient with 3-7 character alphanumeric codes. These codes are generally organized by organ system, although a few chapters are organized by the patient’s condition/situation (e.g. viral/infectious disease, pregnancy, or congenital conditions). On the other hand, ICD-10-PCS describes procedures reported by hospitals. Every ICD-10-PCS code is a 7 character alphanumeric code, which details anatomic site, surgical approach, device used, and other code-specific information. The usage of Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS) Level II will remain completely unchanged by the transition with ICD.

Some other key changes that will be recognized in the transition are: The codes have been reclassified in some areas to reflect current medical

knowledge and to organize them more logically. Medical care and our understanding of disease processes are different today than they were in 1975 when ICD-9 was introduced. In addition, many of the codes in ICD-9 are organized in a way that doesn’t necessarily make sense, simply because there is no room to place them in the appropriate location.

Separate codes for intraoperative and postoperative complications have been created in some of the individual disease chapters. For example, postoperative complications of digestive system procedures are located in the digestive system chapter, while complications of a genitourinary system procedure are located in that chapter.

In the ICD-10-CM chapter used to report injuries, all of the codes are organized first by the site of the injury, then by the type of injury. In ICD-9-CM, there is a lack of consistency in the way that these codes are organized.

Page 11: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

9

In ICD-10-CM, there are more combination codes that allow reporting of conditions with their symptoms and/or manifestations. In ICD-9-CM, it would require multiple codes to accomplish the same reporting. There are also additional combination codes for poisonings and the external causes of the poisoning.

There is a new type of “exclusion” notes in ICD-10-CM, which will be discussed at length later in this training.

The following chart more clearly illustrates the differences between ICD-9-CM and ICD-10-CM: ICD-9 ICD-10

Number of characters 3–5 digits in length 3–7 characters in length

Number of codes Approximately 13,000 codes

Approximately 68,000 available codes

Types of characters First digit can be alpha (E or V) or numeric; digits 2–5 are numeric; most codes are all numeric

Character 1 is alpha; character 2 is numeric; characters 3–7 are alpha or numeric

Code capacity Limited space for adding new codes

Flexible for adding new codes

Specificity Lacks detail Very specific

Laterality designations (right vs. left)

Lacks laterality Has laterality

A “convention” is defined as “the way in which something is usually done, especially within a particular area or activity.” There are certainly “conventions” in diagnosis coding. You will be interested to know that the conventions in ICD-9-CM coding are remarkably similar to the conventions in ICD-10-CM coding. The following chart illustrates those similarities: Convention ICD-9-CM ICD-10-CM

Notes Further define terms, clarify information, or list choices for additional digits.

Further define terms, clarify information, or list choices for additional digits. With/without notes are the options for the final character of a set of codes.

Page 12: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

10

Convention  ICD-9-CM  ICD-10-CM 

Includes Notes that further define or provide examples and can apply to a chapter, section, or category.

Same as ICD-9-CM.

Not otherwise specified

Used when the information at hand does not permit a more specific code assignment.

Same as ICD-9-CM.

Excludes Notes that indicate terms that are to be coded elsewhere.

Same as ICD-9-CM.

Code first underlying disease

Used in categories not intended as the primary diagnosis.

Same as ICD-9-CM

Use additional code

Appears in categories in which further information must be added by using an additional code, to provide a more complete picture.

Same as ICD-9-CM.

Colon

Used after an incomplete term that needs one or more of the modifiers that follows to make it assignable to a category.

Same as ICD-9-CM.

Brackets

Enclose synonyms, alternate wording, or explanatory phrases. Vulvar intraepithelial neoplasia [VIN], grade 1

Same as ICD-9-CM.

Parentheses

Enclose supplementary words that may be present or absent, without affecting the code number to which it is assigned. N39.3 Stress incontinence (male) (female)

Same as ICD-9-CM.

Braces Enclose a series of terms, each of which is modified by the statement appearing at the right.

Not used in ICD-10-CM.

Page 13: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

11

Convention  ICD-9-CM  ICD-10-CM 

Excludes1 Not used in ICD-9-CM.

Indicates that the code excluded can never be used at the same time as the code to which the excludes list applies. For example, a congenital and acquired condition cannot coexist.

Excludes2 Not used in ICD-9-CM.

Indicates that the condition is not included as part of the code. If the patient has both conditions, a separate code must be used to report it.

As you can see, there are very few changes in the key conventions. The most significant is ensuring that we understand the distinction between the inclusion and exclusion notes. “Includes” is always listed under the 3 character category code that helps define the types of conditions that are included in that category. It may include synonyms or conditions that are associated with that category. In other cases, this may a term that exists in the alphabetic index, but does not appear in the actual code definition. For example, if you look up “ulcer, gastrointestinal” in the alphabetic index, it says, “see ulcer, gastrojejunal.” When you follow that instruction, it points to K28—Gastrojejunal ulcer. In the “includes” notes under K28, it lists “gastrointestinal ulcer.” This cross-reference helps identify codes more easily. “Excludes” notes in ICD-9-CM mean that the code(s) in the exclusion list absolutely cannot be used in conjunction with the codes found in the corresponding section. The Excludes1 convention in ICD-10-CM is exactly the same. If you use a code from the Excludes1 list on the same claim as a code from that category, the claim will be denied by the payer. However, Excludes2 (the new convention), means that the codes listed therein are not included as part of the category in which the list is found. A great example of all three conventions (Includes, Excludes1 and Excludes2) can be found in connection with the code for essential hypertension—I10.

Page 14: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

12

I10 Essential (primary) hypertension Includes high blood pressure

hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic)

Excludes 1 hypertensive disease complicating pregnancy, childbirth, and the puerperium (O10-O11, O13- O16)

Excludes 2 essential (primary) hypertension involving vessels of the brain (I60-I69)

essential (primary) hypertension involving vessels of eye (H35.0-)

To summarize, the code I10 is used to report any kind of high blood pressure that is characterized by the terms in the “includes” list. If the patient has hypertensive disease complicating pregnancy (the Excludes1 list), I10 can’t be used in any circumstance (because it is already included in the pregnancy hypertension codes). If the patient has essential hypertension involving vessels of the brain or eye (the Excludes2 list), simply reporting I10 is not adequate. In this case, you would report only the more specific codes, or you could report both codes, especially if the patient’s underlying hypertension is being treated during the present encounter.

WHAT DOES ICD-10-CM LOOK LIKE?

Thinking about 68,000 codes can be somewhat overwhelming. However, if we break it down into the individual organ system chapters, we will see that the number of codes is not nearly as daunting. ICD-10 

Chap.

 

Description

Code 

Range

Number of 

Codes

Equivalent ICD-9 

Codes

1 Certain Infectious and 

Parasitic Diseases

A00-B99 1056 001-139

2 Neoplasms C00-D49 1620 140-239

3 Disease of the Blood and 

Blood Forming Organs and 

Certain Disorders Involve 

the Immune Mechanism

D50-D89 238 280-289

Page 15: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

13

ICD-10 

Chap. 

  

Description 

Code 

Range 

Number of 

Codes 

Equivalent ICD-9 

Codes 

4 Endocrine, Nutritional, 

and Metabolic 

Diseases

E00-E89 675 240-279

5 Mental and Behavior 

Disorders

F01-F99 724 290-319

6 Disease of the 

Nervous Systems

G00-G99 591 320-389

7  Disease of the Eye and Adnexa 

H00-H59 2452 320-389

8  Diseases of Ear and Mastoid Process 

H60-H95 642 320-389

9  Disease of the Circulatory System 

I00-I99 1254 390-459

10  Diseases of the Respiratory System 

J00-J99 336 460-519

11  Diseases of the Digestive System 

K00-K95 706 520-579

12  Disease of the Skin and Subcutaneous Tissue 

L00-L99 769 680-709

13  Diseases of the Musculoskeletal System and Connective Tissue 

M00-M99 6339 710-739

14  Diseases of the Genitourinary System 

N00-N99 591 580-629

15  Pregnancy, Childbirth, and the Puerperium 

O00-O9A 2155 630-679

Page 16: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

14

ICD-10 Chap. 

  Description 

Code Range 

Number of Codes 

Equivalent ICD-9 Codes 

16  Certain Conditions Originating in the Perinatal Period 

P00-P96 417 760-779

17  Congenital Malformations, Deformations, and Chromosomal Abnormalities 

Q00-Q99 790 740-759

18  Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified 

R00-R99 639 780-799

19  Injury, Poisoning, and Certain Other Consequences of External Causes 

S00-T88 39869 800-999

20  External Causes of Morbidity 

V01-Y99 6812 E800-E999

21  Factors Influencing Health Status and Contact with Health Services 

Z00-Z99 1178 V01-V91

After examining this list, you will notice some of the following facts:

More than half of all ICD-10-CM codes are found in Chapter 19. The reason for the large number of codes is the fact that almost all codes in this section require both laterality and encounter type, which dramatically increases the total number of codes.

Another 6800 codes are found in Chapter 20, which are the equivalent of “E” codes in ICD-9-CM. If you don’t frequently use “E” codes in ICD-9-CM, you probably won’t use them frequently in ICD-10-CM.

Page 17: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

15

Approximately 6300 codes are in the musculoskeletal system (Chapter 13). The large number there is the result of frequently laterality and reporting of encounter types.

The relatively large number of codes in Chapter 7 and Chapter 15 are attributable to the issue of laterality for the eyes (left, right, bilateral, unspecified) and for trimester of pregnancy, respectively.

The bottom line is that the number of codes that are unique to your specialty or that you would use with any frequency are not that significant and are certainly manageable. The raw number of codes you will be using will certainly increase, but it will not be too difficult for you to use.

TIPS TO FINDING ICD-10-CM CODES One problem with the ICD-9-CM code set is that it is primarily numeric, which makes it difficult to easily remember the location of certain codes, unless you memorize them. The fact that ICD-10-CM is alphanumeric gives us the opportunity to use mnemonic (aid in memory) devices associated with the first letter of each code. This means that if you know the general nature of the diagnosis, you will know exactly what chapter to check. The chart on the next page illustrates some mnemonic devices that will help you to know where to begin your search for codes. Here’s the thinking behind each of the mnemonic tools: Chapter 1 If someone has an infectious or parasitic disease, I think we would all

agree that it is “A Bad Thing.” All of the codes for infectious and parasitic diseases begin with either “A” or “B”.

Chapter 2 The codes in the chapter for neoplasms begin with the letters “C” or “D”. While not all neoplasms are Cancerous, it is a good tool to remember the codes. Ironically, all of the codes for malignant neoplasms (traditionally defined as “cancer”) do begin with the letter “C”. In-situ cancers and non-malignant neoplasms all begin with the letter “D”.

Chapter 3 Because this chapter involves diseases of the blood and blood forming organs, the terms “Dripping” or “Dracula” can be used to remind us that these codes all begin with the letter “D”.

Chapter 4 The codes in the chapter for endocrine, nutritional and metabolic diseases all begin with the letter “E” (E for Endocrine).

Chapter 5 Mental and behavioral health providers frequently discuss the patient’s Feelings. Since all of the codes related to mental and behavioral disorders begin with the letter “F”, this is a good tool to guide us to this chapter.

Page 18: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

16

 

ICD-10 

Chap.

 

Description

 

 

Code Range

 

Mnemonic 

Device

Equivalent 

ICD-9 

Codes

1 Certain Infectious and Parasitic Diseases A00-B99 A Bad Thing 001-139

2 Neoplasms C00-D49 Cancer 140-239

3 Disease of the Blood and Blood Forming 

Organs and Certain Disorders Involve the 

Immune Mechanism

D50-D89 Dripping or 

Dracula

280-289

4 Endocrine, Nutritional, and Metabolic 

Diseases

E00-E89 Endocrine 240-279

5 Mental and Behavior Disorders F01-F99 Feelings 290-319

6 Disease of the Nervous Systems G00-G99 Groggy or Gehrig 320-389

7  Disease of the Eye and Adnexa  H00-H59  Head  320-389 

8  Diseases of Ear and Mastoid Process  H60-H95  Head  320-389 

9  Disease of the Circulatory System  I00-I99  Ischemic or 

Infarction 

390-459 

10  Diseases of the Respiratory System  J00-J99  Junk in the Lungs  460-519 

11  Diseases of the Digestive System  K00-K95  Kick in the Gut  520-579 

12  Disease of the Skin and Subcutaneous 

Tissue 

L00-L99  Layers  680-709 

13  Diseases of the Musculoskeletal System 

and Connective Tissue 

M00-M99  Musculoskeletal  710-739 

14  Diseases of the Genitourinary System  N00-N99  Nephrology or 

Not Pregnant 

580-629 

15  Pregnancy, Childbirth, and the Puerperium O00-O9A  Obstetrics  630-679 

16  Certain Conditions Originating in the 

Perinatal Period 

P00-P96  Perinatal  760-779 

17  Congenital Malformations, Deformations, 

and Chromosomal Abnormalities 

Q00-Q99  Questions  740-759 

18  Symptoms, Signs, and Abnormal Clinical 

and Laboratory Findings, Not Elsewhere 

Classified 

R00-R99  Rule Out  780-799 

19  Injury, Poisoning, and Certain Other 

Consequences of External Causes 

S00-T88  Sprains, Strains, 

and Trauma 

800-999 

20  External Causes of Morbidity  V01-Y99  Why, Why  E800-E999

21  Factors Influencing Health Status and 

Contact with Health Services 

Z00-Z99  Zebras  V01-V91 

Page 19: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

17

Chapter 6 If someone is “Groggy” or if they have been diagnosed with Lou Gehrig’s Disease, they may have a disease of the nervous system. All codes in this chapter begin with the letter “G”. In ICD-9-CM, these codes are found in the series 320-389, along with the codes for the sensory organs (chapters 7 & 8 in ICD-10-CM).

Chapter 7 Diseases of the eye and adnexa are found in this chapter and all codes begin with the letter “H”. The mnemonic device in this case is “H” for “Head,” where the eyes are found.

Chapter 8 “Head” is also the mnemonic device for the chapter for the diseases of the ear and mastoid process, since they are found in the head. The eye and adnexa are found in the first half of this chapter, while the ear and mastoid processes are found in the last half. An easy way to remember this is that the “eyes” are located in front of the “ears” in the head.

Chapter 9 The diseases of the circulatory system are found in this chapter, which all begin with the letter “I”. A tool to remember this is to use the terms “Ischemic” (shortage of blood flow) or “Infarction” (loss of blood flow resulting in death of tissue).

Chapter 10 The diseases of the respiratory system are found in this chapter, in which all of the codes begin with “J”. If a patient presents with a complaint of “Junk in their lungs,” they likely have a disease of the respiratory system.

Chapter 11 Many digestive diseases cause the patient to feel that they have been “Kicked in the gut.” Codes related to diseases of the digestive system all begin with the letter “K”.

Chapter 12 The codes for diseases of the skin and subcutaneous tissues all begin with the letter “L”. This is good for mnemonic device since the skin is constructed in Layers.

Chapter 13 Diseases of the musculoskeletal system have codes that all begin with the letter “M”, which corresponds with the memory tool, “Musculoskeletal.”

Chapter 14 This chapter has codes for diseases of genitourinary system, which encompasses both the urinary system and the male and female genital systems. Since all of these codes begin with the letter “N”, this can be remember by the terms “Nephrology” (diseases of the kidney) or “Not pregnant” (if the patient being seen has genital system complaints and they are not pregnant).

Chapter 15 Patients who are pregnant are considered to be “Obstetric” patients. For any condition related to pregnancy, childbirth, and the puerperium (postpartum period), the codes begin with “O”.

Chapter 16 Conditions originating in the Perinatal period all begin with the letter “P”. Chapter 17 When the patient has a congenital malformation, deformation, and/or a

chromosomal abnormality, a code beginning with the letter “Q” is used to report it. Often, when someone is born with one of these conditions, the parents have many Questions, such as “Why did it occur?” or “What could have been done to prevent it?”

Page 20: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

18

Chapter 18 In diagnostic coding, services are not to be coded as “rule out….” When the provider doesn’t yet have a definitive diagnosis, they should use codes for signs and symptoms related to the condition, which all begin with “R” and are found in the chapter for symptoms, signs, and abnormal clinical findings. In other words, these codes are used while you are Ruling out other conditions.

Chapter 19 The chapter for injury, poisoning and certain other consequences of external causes have codes that begin with the letters “S” and “T”. When a patient presents with a Sprain, Strain, or Trauma, the code for their condition will likely be found in this chapter.

Chapter 20 External causes of morbidity are reported with codes that begin with “W”, “V”, “X”, and “Y.” In most cases, these codes explain “how” and “Why” an illness or injury occurred.

Chapter 21 Factors influencing health status and contact with health services are reported with codes beginning with the letter “Z”. The term Zebras is used to remember this chapter because there are so few words that begin with “Z”.

ICD-10-CM GUIDELINES The official guidelines for ICD-10-CM have been created by the “Cooperating Parties for ICD-10-CM.” The organizations involved in this process are the:

American Hospital Association (AHA) American Health Information Management Association (AHIMA) Centers for Medicare and Medicaid Services (CMS) National Center for Health Statistics (NCHS)

These guidelines complement the fundamental conventions and instructions in ICD-10-CM and, under the HIPAA regulations, adherence to them is required. Every ICD-10-CM book has these guidelines printed prior to the alphabetic index. There are five sections to the official guidelines, but only Section I and Section IV are relevant to physician practices. The other sections apply only to diagnosis code selection for inpatient facilities. For the purpose of this training, we will only be discussing Section I: Conventions, General Guidelines, and Chapter Specific Guidelines. The Alphabetic Index is a tool to assist the user find codes, by listing terms and their corresponding codes in alphabetic order. The Tabular List is not a numeric list, but a “chronological” list of the codes sorted by:

Chapter Code Blocks Categories (3 character sections)

Page 21: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

19

Subcategories (4-5 characters, when necessary) Codes (the actual codes reported, ranging from 3-7 characters in length

The guidelines specifically state that it is necessary to use both the alphabetic index and tabular list in order to select the correct code. This is necessary because the index does not always provide the full code. In some cases, a dash “-“ exists after codes listed in the alphabetic index, which indicates that additional character(s) are required. However, there are other cases in which additional characters are required, even when a dash is not present with the code in the alphabetic index. The alphabetic index never lists codes that are specific to laterality or type of encounter. Therefore, if you select codes only from the alphabetic index, you may select an incomplete code or an altogether incorrect code. The first character of all ICD-10-CM codes is always an alphabetic number and the second character is always a number. The third character is typically a number, although it can be a letter. The fourth through the seventh characters can be either letters or numbers, although distinct patterns can be found in the way that the codes are organized. The codes are organized as follows:

Code Format: XXX.XXX X XXX= Category XXX= Etiology, anatomic site, severity X= Extension

Many codes require that there be a seventh character that indicates the type of encounter, the fetus number, or some other extension. However, not every code has six characters to which to add a seventh character. When that occurs, a placeholder character (X) is added in order to create a valid code. For example:

Initial encounter to treat a burn of the second degree of the lower back: T21.24XA

T21: Burn and corrosion of trunk 24: Burn of second degree of lower back X: Placeholder A: Initial encounter

In ICD-10-CM, as well as ICD-9-CM, there are codes for “other” or “other specified” conditions, as well as codes for “unspecified” conditions. “Other” or “other specified” codes should be used when the provider has a definitive diagnosis, but there simply is not a code available to describe that condition. The “unspecified” code should be used

Page 22: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

20

only when the provider cannot assign a more precise diagnosis. An example of this pattern can be found in the codes for the Cardiovascular System:

I20.0 Unstable angina I20.1 Angina pectoris with documented spasm I20.8 Other forms of angina pectoris I20.9 Angina pectoris, unspecified

There are occasions in which it is necessary to use more than one code to accurately report a condition. In these cases, the guidelines will instruct the user to “use additional code” or “report underlying condition first. It may not always necessarily be required in order to receive payment, but it is a best practice to be as complete as possible in reporting services. Examples of these instructions include:

N72 Inflammatory disease of the cervix uteri Use additional code (B95-B97) to identify infectious agent

R50.81 Fever presenting with conditions classified elsewhere Code first underlying condition such as with:

Leukemia (C91-C95) Neutropenia (D70.-) Sickle-cell disease (D57.-)

Degree of Certainty In the coding guidelines, users are encouraged to code to the highest degree of certainty possible. If a definitive diagnosis can’t be assigned, it is perfectly legitimate to report signs or symptoms as the reason for the encounter. Codes can be assigned based on the provider’s clinical knowledge (e.g. a laboratory report is not necessary to indicate a urinary tract infection if the provider clinically believes that one exists). However, it would be quite acceptable to report the signs or symptoms that lead the provider to believe that a urinary tract infection is present. Acute/Chronic Another element of ICD-10-CM that is used more than it was in ICD-9-CM is the classification of conditions as “acute” or “chronic.” It will be important for documentation to clearly indicate how the patient’s condition is classified. The classification is made by the clinical judgment of the provider. The difference between the two categories is primarily related to the time involved in the condition. An “acute” condition is one that usually has a rapid onset and can be rapidly progressive, is of short duration, and usually needs urgent care. On the other hand, a “chronic” condition is one that has an indefinite duration or is relatively stable.

Page 23: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

21

The precise definition of “acute” can vary by the condition. For example, an acute myocardial infarction (heart attack) may last one week, while an acute sore throat may last only 1-2 days. If a patient has a chronic condition that becomes acute, codes for both conditions are reported, with the acute condition being reported first. For example:

J03.90 Acute tonsillitis, unspecified J35.01 Chronic tonsillitis

Laterality As mentioned previously, some codes indicate whether the condition involves the right side, the left side, is bilateral, or is unspecified. The only time when an unspecified code related to laterality should be used is if the site is not identified in the medical record. This is completely suboptimal and, if the record does not indicate, the provider should be queried as to the location of the condition. The most common chapter in which bilateral conditions can exist are diseases of the eye or adnexa. For example:

H10.42 Simple chronic conjunctivitis H10.421 Simple chronic conjunctivitis, right eye H10.422 Simple chronic conjunctivitis, left eye H10.423 Simple chronic conjunctivitis, bilateral H10.424 Simple chronic conjunctivitis, unspecified eye

When “bilateral” is not an option, but the condition is present bilaterally, codes for both sides are used.

N60.0 Solitary cyst of breast N60.01 Solitary cyst of right breast N60.02 Solitary cyst of left breast N60.09 Solitary cyst of unspecified breast

Combination Codes Combination codes are used when there is/are:

• Two diagnoses • Diagnosis with an associated secondary process (manifestation) • Diagnosis with associated complication

An example of a combination code is E10.321—Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema. This single code encompasses the primary condition (diabetes) and two associated processes or

Page 24: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

22

complications. It would not be proper to use additional diagnoses related to this condition because this code accurately and adequately reports the condition. Complications of Care Because ICD-10-CM has specific sections related to complications of care, it is essential that the medical record is clear when a condition is the result of a complication vs. when a condition happens to be subsequent to another condition. Just because “B” happens after “A,” it does not automatically mean that “B” is a complication of “A.” Intraoperative, postprocedural, and postoperative complications are typically found in the disease chapter specific to the condition. Other more general complications are found in Chapter 19—Injury, Poisoning and Certain Other Consequences of External Causes.

ICD-10-CM CODE ORGANIZATION It is not the purpose of this phase of the training to discuss specific codes or to begin to practice appropriate code selection. However, we will take some time at this stage to dig a little bit into the organization of the specific chapters and where certain codes are found. At some point, all providers will use codes from nearly every section. Clearly, different specialties will use codes in certain chapters with greater frequency than others and, in some cases, the majority will be from a single chapter (e.g. Ophthalmology and Chapter 7). However, in order to use the codes appropriately, everyone needs to be aware of the fundamental structure of ICD-10-CM. Chapter 1—Infectious and Parasitic Diseases (A00-B99) Code Block 

 Description 

Code Block 

 Description 

A00-A09  Intestinal infectious diseases  B10  Other human herpes viruses 

A15-A19  Tuberculosis  B15-B19  Viral hepatitis 

A20-A28  Certain zoonotic bacterial diseases 

B20  Human immunodeficiency virus [HIV] disease 

A30-A49  Other bacterial diseases  B25-B34  Other viral diseases 

A50-A64  Infections with a predominantly sexual mode of transmission 

B35-B49  Mycoses 

A65-A69  Other spirochetal diseases  B50-B64  Protozoal diseases 

Page 25: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

23

Code Block 

 Description 

Code Block 

Description 

A70-A74  Other diseases caused by chlamydiae 

B65-B83  Helminthiases 

A75-A79  Rickettsioses  B85-B89  Pediculosis, acariasis and other infestations 

A80-A89  Viral infections of the central nervous system 

B90-B94  Sequelae of infectious and parasitic diseases 

A90-A99  Arthropod-borne viral fevers and viral hemorrhagic fevers 

B95-B97  Bacterial, viral and other infectious agents 

B00-B09  Viral infections characterized by skin and mucous membrane lesions 

B99  Other infectious diseases 

Chapter 1 has more blocks of codes than any other single chapter, because it influences every organ system and every specialty. While Infectious Disease specialists will spend the majority of their time in this chapter, the following blocks will be used by providers across a range of specialties: A00-A09 Intestinal infectious diseases, such as bacterial infections (A04), food

poisoning (A05), and gastroenteritis (A08). A50-A64 Infections with a predominantly sexual mode of transmission, such as

gonococcal infections (A54), chlamydia (A55-A56), trichomonas (A59), herpes (A60), and genital warts (A63).

B00-B09 Viral infections influencing the skin and mucous membranes, such as herpes (B00, B02), chicken pox (varicella) (B01), measles (B05), rubella (B06) and viral warts (B07).

B15-B19 Viral hepatitis (both acute and chronic) B20 HIV (active, confirmed cases) B95-B97 Various types of bacterial and viral infections, including streptococcus,

staphylococcus, E. coli, influenza, H. pylori, retrovirus, etc.

Page 26: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

24

Chapter 2—Neoplasms (C00-D49) Code Block 

 Description 

Code Block 

 Description 

C00-C14  Malignant neoplasms of lip, oral cavity and pharynx 

C73-C75  Malignant neoplasms of thyroid and other endocrine glands 

C15-C26  Malignant neoplasms of digestive organs 

C7A  Malignant neuroendocrine tumors 

C30-C39  Malignant neoplasms of respiratory and intrathoracic organs 

C7B  Secondary neuroendocrine tumors 

C40-C41  Malignant neoplasms of bone and articular cartilage 

C76-C80  Malignant neoplasms of ill-defined, other secondary and unspecified sites 

C43-C44  Malignant neoplasms of skin  C81-C96  Malignant neoplasms of lymphoid, hematopoietic and related tissue 

C45-C49  Malignant neoplasms of mesothelial and soft tissue 

D00-D09  In situ neoplasms 

C50   Malignant neoplasms of breast 

D10-D36  Benign neoplasms, except benign neuroendocrine tumors 

C51-C58  Malignant neoplasms of female genital organs 

D3A  Benign neuroendocrine tumors 

C60-C63  Malignant neoplasms of male genital organs 

D37-D48  Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes 

C64-C68  Malignant neoplasms of urinary tract 

D49  Neoplasms of unspecified behavior 

C69-C72  Malignant neoplasms of eye, brain and other parts of central nervous system 

   

 

Every specialty will use this chapter, with a focus on the organ system(s) that they treat. The codes for all malignant neoplasms begin with “C”. In situ neoplasms, which are malignant, but non-invasive, are found in the D00-D09 block, sorted by organ system. Non-malignant neoplasms are in the block for D10-D36, including uterine fibroids (D25).

Page 27: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

25

Chapter 3—Disorders of Blood/Blood Forming Organs (D50-D89) Code Block

 Description

Code Block

 Description

D50-D53 Nutritional anemias D70-D77 Other disorders of blood and blood-forming organs

D55-D59 Hemolytic anemias D78 Intraoperative and postprocedural complications of spleen

D60-D64 Aplastic and other anemias and other bone marrow failure syndromes

D80-D89 Certain disorders involving the immune mechanism

D65-D69 Coagulation defects, purpura and other hemorrhagic conditions

Chapter 3 will primarily be the domain of hematologists, but nutritional anemias, such as iron deficiencies due to blood loss, Vitamin B12 deficiencies, etc. are found in the block for D50-D53. Chapter 4—Endocrine, Nutritional, and Metabolic Diseases (E00-E89) Code Block 

 Description 

Code Block 

 Description 

E00-E07  Disorders of thyroid gland  E40-E46  Malnutrition 

E08-E13  Diabetes mellitus  E50-E64  Other nutritional deficiencies 

E15-E16  Other disorders of glucose regulation and pancreatic internal secretion 

E65-E68  Overweight, obesity and other hyperalimentation 

E20-E35  Disorders of other endocrine glands 

E70-E88  Metabolic disorders 

E36  Intraoperative complications of endocrine system 

E89  Postprocedural endocrine and metabolic complications and disorders, not elsewhere classified 

 

Endocrinologists will clearly spending a great deal of time working in this chapter, but a broad variety of other providers will use codes from this chapter. Some of the more commonly used blocks of codes will be:

Page 28: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

26

E00-E07 Thyroid disorders, including hypothyroidism, hyperthyroidism, thyroiditis, and goiters.

E08-E13 Diabetes—The distinction is made between diabetes caused by other conditions (E08), drug or chemical induced diabetes (E09), Type 1 diabetes (E10), Type 2 diabetes (E11), and “other specified” diabetes (E13). There is no distinction between “controlled” or “uncontrolled” in ICD-10-CM, as there is in ICD-9-CM. If the patient’s condition is “uncontrolled,” that is considered a complication and it is reported with the appropriate code

E20-E35 The endocrine gland disorders include pituitary gland disorders (E22-E23), ovarian dysfunction (E28), testicular dysfunction (E29), and other glandular disorders.

E65-E68 All types of obesity (from overweight to morbid obesity) are reporting using a code from the E66 series.

Chapter 5—Mental and Behavioral Disorders (F01-F99) Code Block 

 Description 

Code Block  

 Description 

F01-F09  Mental disorders due to known physiological conditions 

F60-F69  Disorders of adult personality and behavior 

F10-F19  Mental and behavioral disorders due to psychoactive substance use 

F70-F79  Mental retardation 

F20-F29  Schizophrenia, schizotypal and delusional, and other non-mood psychotic disorders 

F80-F89  Pervasive and specific developmental disorders 

F30-F39  Mood [affective] disorders  F90-F98  Behavioral and emotional disorders with onset usually occurring in childhood and adolescence 

F40-F48  Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders 

F99  Unspecified mental disorder 

F50-F59  Behavioral syndromes associated with physiological disturbances and physical factors 

   

Page 29: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

27

Mental health professionals will obviously use this code set with great frequency, but there are other occasions in which other providers will use these codes. F10-F19 These codes are used to report any sort of substance use or abuse,

including alcohol (F10), tobacco (F17), and other illicit (legal and illegal) drugs and substances.

F30-F39 Many conditions in this block are serious (e.g. manic episodes, bipolar disorders), but it also includes the full range of depressive disorders (F32-F33), from mild to severe.

F40-F48 This block contains codes for all sorts of anxiety disorders, ranging from phobias, to panic disorders, generalized disorders, and severe dissociative disorders.

F90-F98 Conditions such as ADHD (F90), conduct disorders (F91), as well as other conditions typically associated with or initiated in childhood are found in this block of codes. The instructions for this block are clear that these codes can be used regardless of the age of the patient.

Chapter 6—Diseases of the Nervous System (G00-G99) Code Block 

 Description 

Code Block 

 Description 

G00-G09  Inflammatory diseases of the central nervous system 

G50-G59  Nerve, nerve root and plexus disorders 

G10-G14  Systemic atrophies primarily affecting the central nervous system 

G60-G64  Polyneuropathies and other disorders of the peripheral nervous system 

G20-G26  Extrapyramidal and movement disorders 

G70-G73  Diseases of myoneural junction and muscle 

G30-G32  Other degenerative diseases of the nervous system 

G80-G83  Cerebral palsy and other paralytic syndromes 

G35-G37  Demyelinating diseases of the central nervous system 

G89-G99  Other disorders of the nervous system 

G40-G47  Episodic and paroxysmal disorders 

   

Chapter 6 will primarily be the domain of neurologists and gerontologists, as the condition are generally related to the brain and central nervous system. Some of these conditions, which might be seen in the context of other specialties include:

Page 30: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

28

Meningitis (G00-G03) Huntington’s disease (G10) Lou Gehrig’s disease (G12) Parkinson’s disease (G20) Alzheimer’s disease (G30)

Multiple sclerosis (G35) Epilepsy (G40) Migraines (G43) Sleep disorders (G47)

Chapter 7—Diseases of the Eye and Adnexa (H00-H59) Code Block

 Description

Code Block

 Description

H00-H05 Disorders of eyelid, lacrimal system and orbit

H43-H44 Disorders of vitreous body and globe

H10-H11 Disorders of conjunctiva H46-H47 Disorders of optic nerve and visual pathways

H15-H22 Disorders of sclera, cornea, iris and ciliary body

H49-H52 Disorders of ocular muscles, binocular movement, accommodation and refraction

H25-H28 Disorders of lens H53-H54 Visual disturbances and blindness

H30-H36 Disorders of choroid and retina

H55-H57 Other disorders of eye and adnexa

H40-H42 Glaucoma H59 Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified

This chapter will almost be the exclusive home of optometrists and ophthalmologists. Common eye infections treated by other specialists will be found in the H10-H11 block. Chapter 8—Diseases of the Ear and Mastoid Process (H60-H95) Code Block

 Description

Code Block

 Description

H60-H62 Disease of external ear H90-H94 Other disorders of ear

H65-H75 Diseases of middle ear and mastoid

H95 Intraoperative and postprocedural complications and disorders of ear and mastoid process, not elsewhere classified

H80-H83 Diseases of inner ear

Page 31: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

29

While otolaryngologists (ENT) will use this chapter frequently, it will also be used by others to report various ear infections. The most common type is otitis media, which is found in the block for H65-H75. Chapter 9—Diseases of the Circulatory System (I00-I99) Code Block 

Description  Code Block 

Description 

I00-I02  Acute rheumatic fever  I30-I52  Other forms of heart disease 

I05-I09  Chronic rheumatic heart diseases 

I60-I69  Cerebrovascular diseases 

I10-I15  Hypertensive diseases  I70-I79  Diseases of arteries, arterioles and capillaries 

I20-I25  Ischemic heart diseases  I80-I89  Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified 

I26-I28  Pulmonary heart disease and diseases of pulmonary circulation 

I95-I99  Other and unspecified disorders of the circulatory system 

Cardiologists and cardiovascular surgeons will use this chapter extensively. Other providers will be using the blocks for hypertensive diseases (I10-I15), arteriosclerosis/atherosclerosis (I70-I79), and phlebitis and deep vein thrombosis (I80-I89). Chapter 10—Diseases of the Respiratory System (J00-J99) Code Block 

 Description 

Code Block 

 Description 

J00-J06  Acute upper respiratory infections 

J80-J84  Other respiratory diseases principally affecting the interstitium 

J09-J18  Influenza and pneumonia  J85-J86  Suppurative and necrotic conditions of the lower respiratory tract 

J20-J22  Other acute lower respiratory infections 

J90-J94  Other diseases of the pleura 

Page 32: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

30

Code Block 

 Description 

Code Block 

 Description 

J30-J39  Other diseases of upper respiratory tract 

J95  Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified 

J40-J47  Chronic lower respiratory diseases 

J96-J99  Other diseases of the respiratory system 

J60-J70  Lung diseases due to external agents 

   

This chapter will largely be the domain of otolaryngologists and pulmonologists, but will be used frequently by primary care physicians when reporting upper respiratory infections (J00-J06) and flu/pneumonia (J09-J18). Chapter 11—Diseases of the Digestive System (K00-K95) Code Block 

 Description 

Code Block 

 Description 

K00-K14  Diseases of oral cavity and salivary glands 

K55-K63  Other diseases of intestines 

K20-K31  Diseases of esophagus, stomach and duodenum 

K65-K68  Diseases of peritoneum and retroperitoneum 

K35-K38  Diseases of appendix  K70-K77  Diseases of liver 

K40-K46  Hernia  K80-K87  Disorders of gallbladder, biliary tract and pancreas 

K50-K52  Noninfective enteritis and colitis 

K90-K95  Other diseases of the digestive system 

Chapter 11 will be used extensively by general surgeons, gastroenterologists, and colo-rectal surgeons. The codes are grouped logically, beginning at the mouth (the start of the digestive tract) and continuing throughout the tract, with special blocks for key ancillary organs, such as the appendix, liver, gallbladder, pancreas, etc.

Page 33: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

31

Chapter 12—Diseases of the Skin and Subcutaneous Tissue (L00-L99) Code Block 

 Description 

Code Block 

 Description 

L00-L08  Infections of the skin and subcutaneous tissue 

L55-L59  Radiation-related disorders of the skin and subcutaneous tissue 

L10-L14  Bullous disorders  L60-L75  Disorders of skin appendages 

L20-L30  Dermatitis and eczema  L76  Intraoperative and postprocedural complications of skin and subcutaneous tissue 

L40-L45  Papulosquamous disorders  L80-L99  Other disorders of the skin and subcutaneous tissue 

L49-L54  Urticaria and erythema     

Dermatologists will spend much of their time working in this chapter, although other specialists will use this chapter as well. Common skin disorders, such as dermatitis and eczema are found in block L20-L30. The block containing codes L60-L75 is used to report conditions such as nail disorders, alopecia, acne, and sweat gland disorders. Chapter 13—Diseases of the Musculoskeltal System and Connective Tissue (M00-M99) Code Block 

 Description 

Code Block 

 Description 

M00-M02  Infectious arthropathies  M60-M63  Disorders of muscles 

M05-M14  Inflammatory polyarthropathies 

M65-M67  Disorders of synovium and tendon 

M15-M19  Osteoarthritis  M70-M79  Other soft tissue disorders 

M20-M25  Other joint disorders  M80-M85  Disorders of bone density and structure 

M26-M27  Dentofacial anomalies [including malocclusion] and other disorders of jaw 

M86-M90  Other osteopathies 

M30-M36  Systemic connective tissue disorders 

M91-M94  Chondropathies 

Page 34: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

32

Code Block 

 Description 

Code Block 

 Description 

M40-M43  Deforming dorsopathies  M95  Other disorders of the musculoskeletal system and connective tissue 

M45-M49  Spondylopathies  M96  Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified 

M50-M54  Other dorsopathies  M99  Biomechanical lesions, not elsewhere classified 

Diseases of the musculoskeletal system and connective tissue (typically considered the domain of orthopedic surgeons, physical therapists, etc.) will be used widely within other specialties—particularly internal medicine and gerontology. The most commonly used blocks will be M15-M19—Osteoarthritis and M80-M85—Disorders of bone density and structure. This section has a significant number of codes because nearly every code requires laterality (right or left) and the codes related to fractures (M80-M85) require a seventh character to indicate the encounter type (initial, subsequent, progress of fracture healing, etc.) It is important to note that the only fractures that appear in this chapter are pathological in nature—occurring absent a trauma. The reporting of traumatic breaks and fractures use codes from Chapter 19. Chapter 14—Diseases of the Genitourinary System (N00-N99) Code Block 

 Description 

Code Block 

 Description 

N00-N08  Glomerular diseases  N40-N51  Diseases of male genital organs 

N10-N16  Renal tubulo-interstitial diseases 

N60-N65  Disorders of breast 

N17-N19  Acute kidney failure and chronic kidney disease 

N70-N77  Inflammatory diseases of female pelvic organs 

N20-N23  Urolithiasis  N80-N98  Noninflammatory disorders of female genital tract 

Page 35: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

33

Code Block 

 Description 

Code Block 

 Description 

N25-N29  Other disorders of kidney and ureter 

N99  Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified 

N30-N39  Other diseases of the urinary system 

   

This chapter will be used with regularity by nephrologists, urologists, gynecologists, and general surgeons (for breast issues). The most commonly used blocks are as follows: N17-N19 Acute kidney failure and chronic kidney disease, with separate codes for

each of the stages of chronic kidney disease. N30-N39 Conditions of the urinary system that are not related to the kidney or

ureters, such as cystitis (N30), urethritis and urethral stricture (N34-N35), urinary tract infection (N39.0), and stress and urge incontinence (N39.3 and N39.4-).

N40-N51 Male genital conditions, such as prostate issues (N40-N42), testicular issues (N43-N45), and male infertility (N46).

N60-N65 Disorders of the breast, including cysts and fibrocystic breast disease (N60), as well as other non-obstetric disorders related to the breast, such as lumps (N63), nipple discharge (N64.52), and problems with reconstructed breasts (N65).

N70-N77 This block incorporates any infection/inflammation of the female pelvis, including oophoritis, salpingitis, PID, Bartholin’s gland issues, vaginitis, and vulvitis. One major change is a greater emphasis on the distinction between acute and chronic conditions.

N80-N98 This blocks is used to report any female pelvic disorder that is not inflammatory in nature, such as endometriosis, pelvic weakening, ovarian cysts and torsions, dysplasias, female infertility, recurrent pregnancy loss, menopausal issues, and abnormal bleeding and dysmenorrhea.

Page 36: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

34

Chapter 15—Pregnancy, Childbirth, and the Puerperium (O00-O99) Code Block 

 Description 

Code Block 

 Description 

O00-O08  Pregnancy with abortive outcome 

O60-O77  Complications of labor and delivery 

O09  Supervision of high risk pregnancy 

O80-O82  Encounter for delivery 

O10-O16  Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium 

O85-O92  Complications predominantly related to the puerperium 

O20-O29  Other maternal disorders predominantly related to pregnancy 

O94-O9A  Other obstetric conditions, not elsewhere classified 

O30-O48  Maternal care related to the fetus and amniotic cavity and possible delivery problems 

   

The codes for obstetric services are organized in a highly logical fashion, based on the stage of pregnancy or the type of complication. These codes are only used on the maternal record—never on the newborn’s record. When a patient is being supervised for routine antepartum visits, but they are high risk, the primary diagnosis code will always be a code from the O09 block. There is no “episode of care” reporting in ICD-10-CM. The number of codes in this section is significantly higher than in the corresponding section of ICD-9-CM, because additional codes are required to designate the trimester in which the service is taking place. Chapter 16—Certain Conditions Originating in the Perinatal Period (P00-P96) Code Block 

 Description 

Code Block 

 Description 

P00-P04  Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery  

P50-P61  Hemorrhagic and hematological disorders of newborn 

Page 37: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

35

Code Block 

 Description 

Code Block 

 Description 

P05-P08  Disorders related to length of gestation and fetal growth 

P70-P74  Transitory endocrine and metabolic disorders specific to newborn 

P09  Abnormal findings on neonatal screening 

P76-P78  Digestive system disorders of newborn 

P10-P15  Birth trauma  P80-P83  Conditions involving the integument and temperature regulation of newborn 

P19-P29  Respiratory and cardiovascular disorders specific to the perinatal period 

P84  Other problems with newborn 

P35-P39  Infections specific to the perinatal period 

P90-P96  Other disorders originating in the perinatal period 

The codes in this chapter will never be used on the maternal record, but will be assigned to the newborn’s record. These codes can be used throughout the life of the newborn, regardless of their age, if the condition is still affecting them later in life. Typically, these codes will be used by pediatricians and neonatologists. If the newborn was delivered prematurely and/or had a low birth weight, codes from the P05-P08 block would be used. If there is a birth trauma, it is reported with codes from the block P10-P15. Chapter 17—Congential Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99) Code Block 

 Description 

Code Block 

 Description 

Q00-Q07  Congenital malformations of the nervous system 

Q50-Q56  Congenital malformations of genital organs 

Q10-Q18  Congenital malformations of eye, ear, face and neck 

Q60-Q64  Congenital malformations of the urinary system  

Page 38: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

36

Code Block 

 Description 

Code Block 

 Description 

Q20-Q28  Congenital malformations of the circulatory system 

Q65-Q79  Congenital malformations and deformations of the musculoskeletal system 

Q30-Q34  Congenital malformations of the respiratory system 

Q80-Q89  Other congenital malformations 

Q35-Q37  Cleft lip and cleft palate  Q90-Q99  Chromosomal abnormalities, not elsewhere classified 

Q38-Q45  Other congenital malformations of the digestive system 

   

Codes from this chapter are not reported on the maternal or fetal record, even if the abnormality is identified before birth. They should be reported on the newborn record if the condition has been identified, and used as long as the condition exists or influences the patient’s medical care. Chapter 18—Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) Code Block 

 Description 

Code Block 

 Description 

R00-R09  Symptoms and signs involving the circulatory and respiratory systems 

R50-R69  General symptoms and signs 

R10-R19  Symptoms and signs involving the digestive system and abdomen 

R70-R79  Abnormal findings on examination of blood, without diagnosis 

R20-R23  Symptoms and signs involving the skin and subcutaneous tissue 

R80-R82  Abnormal findings on examination of urine, without diagnosis 

R25-R29  Symptoms and signs involving the nervous and musculoskeletal systems 

R83-R89  Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis 

Page 39: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

37

Code Block 

 Description 

Code Block 

 Description 

R30-R39  Symptoms and signs involving the urinary system 

R90-R94  Abnormal findings on diagnostic imaging and in function studies, without diagnosis 

R40-R46  Symptoms and signs involving cognition, perception, emotional state and behavior 

R97  Abnormal tumor markers 

R47-R49  Symptoms and signs involving speech and voice 

R99  Ill-defined and unknown cause of mortality 

The signs, symptoms, and abnormal findings reported using the codes in this chapter are designed to report circumstances in which a definitive diagnosis has not yet been determined. The codes are largely organized by organ system or the type of abnormal finding that is recorded. Some blocks that require special attention include: R10-R19 For the first time, there is a code that is explicitly for the purpose of

reporting pelvic/perineal pain (R10.2). In ICD-9-CM, a more generalized “unspecified” code was used. In addition, this code block allows the differentiation between abdominal pain and abdominal tenderness.

R83-R89 These codes are used to report abnormal findings on specimens that are not blood or urine. The most common use for this block of codes will be the reporting of abnormal pap smears (R86-R87).

R90-R94 This code block is used to report abnormalities on diagnostic imaging (e.g. x-rays, ultrasounds, mammograms, etc.) and function studies (e.g. EEG, EKG, kidney function, liver function, etc.) prior to a time of a formal diagnosis. These codes simply indicate that an abnormality is noted that prompted further investigation.

Chapter 19—Injury, Poisoning and Certain Other Consequences of External Causes (S00-T98) Code Block 

 Description 

Code Block 

 Description 

S00-S09  Injuries to the head  T07  Unspecified multiple injuries 

S10-S19  Injuries to the neck  T14  Injury of unspecified body region 

Page 40: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

38

Code Block 

 Description 

Code Block 

 Description 

S20-S29  Injuries to the thorax  T15-T19  Effects of foreign body entering through natural orifice 

S30-S39  Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals 

T20-T32  Burns and corrosions 

S40-S49  Injuries to the shoulder and upper arm 

T33-T34  Frostbite 

S50-S59  Injuries to the elbow and forearm 

T36-T50  Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances 

S60-S69  Injuries to the wrist and hand  T51-T65  Toxic effects of substances chiefly nonmedicinal as to source 

S70-S79  Injuries to the hip and thigh  T66-T78  Other and unspecified effects of external causes 

S80-S89  Injuries to the knee and lower leg 

T79  Certain early complications of trauma 

S90-S99  Injuries to the ankle and foot  T80-T88  Complications of surgical and medical care, not elsewhere classified 

The usage of this chapter will depend in large part on the frequency with which a given specialist treats injuries and other traumas. This will definitely be used heavily by providers in Emergency Departments and trauma surgeons. This chapter is, by far, the largest in the book because it requires laterality and type of encounter for virtually every code. The specific block that will be used by nearly every specialty at some point will be T80-T88—Complications of surgical and medical care, not elsewhere classified. As mentioned previously, nearly every chapter has its own set of intraoperative and postoperative complication codes. The codes from T80-T88 are used when the codes in those sections are not adequate to describe the situation. Some examples of codes found in this block include:

Complications with transfusions/infusions Foreign bodies left following surgeries

Page 41: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

39

Mechanical complications of devices, such as heart valve prostheses, or graft leakage

Medical device displacement, such as catheters, IUDs, prostheses, pelvic mesh, artificial joints

Transplant complications Other complications of medical care

Chapter 20—External Causes of Morbidity (V01-Y99) Code Block 

 Description 

Code Block 

 Description 

V00-X58  Accidents  Y62-Y69  Misadventures to patients during surgical and medical care 

X71-X83  Intentional self-harm  Y70-Y82  Medical devices associated with adverse incidents in diagnostic and therapeutic use 

X92-Y08  Assault  Y83-Y84  Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure 

Y21-Y33  Event of undetermined intent  Y90-Y99  Supplementary factors related to causes of morbidity classified elsewhere 

Y35-Y38  Legal intervention, operations of war, military operations, and terrorism 

   

This chapter has many additional blocks that are subcategories of the first block—all of them related to an accident of some type. This chapter will typically only be used by those specialties that treat accidents, trauma, or conditions that have external causes. These codes, in effect, explain how the injury or trauma reported from Chapter 19 actually occurred.

Page 42: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

40

Chapter 21—Factors Influencing Health Status and Contact with Health Services (Z00-Z99) Code Block 

 Description 

Code Block 

 Description 

Z00-Z13  Persons encountering health services for examination and investigation 

Z55-Z65  Persons with potential health hazards related to socioeconomic and psychosocial circumstances 

Z14-Z15  Genetic carrier and genetic susceptibility to disease 

Z66  Do not resuscitate [DNR] status 

Z16  Infection with drug resistant microorganisms 

Z67  Blood type 

Z17  Estrogen receptor status  Z68  Body mass index (BMI) 

Z20-Z28  Persons with potential health hazards related to communicable diseases 

Z69-Z76  Persons encountering health services in other circumstances 

Z30-Z39  Persons encountering health services in circumstances related to reproduction 

Z77-Z99  Persons with potential health hazards related to family and personal history and certain conditions influencing health status 

Z40-Z53  Persons encountering health services for specific procedures and health care 

   

The codes from Chapter 21 are used to report the reason for an encounter when the patient doesn’t have a particular illness or injury present at that moment. Every specialty will use some of these codes at some point. The key blocks are as follows: Z00-Z13 The codes in this block are used to report general examinations, pediatric

examinations, gynecological examinations, administrative exams, postoperative follow-up exams (Z08-Z09), and encounters for all types of screening (Z11-Z13).

Z30-Z39 The codes in this section are used to report management of contraception and procreative management (including infertility diagnosis and treatment) (Z30-Z31), pregnancy tests (Z32), supervision of normal pregnancy (Z34), antenatal screening (Z36), outcome of delivery (Z37), postpartum care (Z39), and the number of weeks gestation (Z3A).

Z68 Body mass index (BMI) codes are to be used in conjunction with the overweight and obesity codes from Chapter 4, to indicate the patient’s precise BMI.

Page 43: PREPARING FOR ICD-10-CM PHASE 2 INTRODUCTION TO ICD-10-CM

 

 

41

Z77-Z99 The block of codes for personal history and family history of certain conditions is significantly larger in ICD-10-CM than they were in ICD-9-CM. The purpose of these codes is to indicate that the patient no longer has the condition, but there is a possibility that the condition may return. This, in itself, may justify more careful surveillance than the typical patient.

WHAT’S NEXT? The next phase of the training will be specialty-specific and code-specific, with real-world practice cases involved as part of the education. In the meantime, here are the recommended steps to take that will help you become familiar with the codes that will be used regularly in your practice…. 1. Obtain access to the code set

a. A hard copy of the book b. An electronic version (available within this training)

2. Create a crosswalk between ICD-9-CM and ICD-10-CM for the codes commonly used in your practice

3. Identify online resources to help you increase familiarity 4. Identify the current uses of ICD-9-CM in your office

a. What needs to be adjusted? b. What changes need to be made in your documentation?