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ICD-10-CM Chapter 11-14
ICD-10-CM Chapter 11-14 CRIHB John Hailes ASC-E/M, CCS, CCS-P, CPC, CPC-H, CIRCC, CPMA, CPCI, CEMC, CFPC, Certifiedjhmci.com @ICD-10-CM/PCS Trainer 1 Objectives • Identify areas in ICD-10-CM that include new terminology for clinical documentation • Understanding the coding guidelines that pertain to ICD10-CM Chapter 11-14 • Assign the correct ICD-10-CM codes for the case studies involving chapters 11-14 • Define areas in ICD-10-CM that enable improved data capture if more specific conditions are documented – – – – Acuity Disease type Site specifity Disease stage jhmci.com Documentation Matters “If it was not documented, it was not done” jhmci.com 3 Coding and 7th Character Extensions Alpha (Except U) M A XS X 0 X 2 Category 2 Numeric 3 - 7 Numeric or Alpha . Additional Characters X 6 X 5 Xx A X Etiology, anatomic site, severity Added code extensions (7th character) for obstetrics, injuries, and external causes of injury 3 – 7 Characters jhmci.com Digestive System Chapter 11 K00-K95 • • • • • • • • • K00-K14 Diseases of oral cavity and salivary glands K20-K31 Diseases of the esophagus, stomach and duodenum K35-K38 Diseases of appendix K40-K46 Hernia K50-K52 Non-infective enteritis and colitis K65-K68 Diseases of peritoneum and retroperitoneum K70-K77 Disease of liver K80-K87 Diseases of gallbladder, biliary tract and pancreas K90-K95 Other diseases of the digestive system jhmci.com 5 Format/General Documentation changes • • • • • • Combination codes with hemorrhage Acute vs Chronic Loss of teeth by Class I-IV Hernia by Site Unilateral vs. Bilateral Not specificed as recurrent vs. recurrent – Example: K57.21, Diverticulitis of large intestine with perforation and abscess with bleeding jhmci.com 6 Combination codes with hemorrhage Acute vs. Chronic K25 Gastric ulcer • • • • • • • K25.0 Acute gastric ulcer with hemorrhage K25.1 Acute gastric ulcer with perforation K25.2 Acute gastric ulcer with both hemorrhage and perforation K25.3 Acute gastric ulcer without hemorrhage or perforation K25.4 Chronic or unspecified gastric ulcer with hemorrhage K25.5 Chronic or unspecified gastric ulcer with perforation K25.6 Chronic or unspecified gastric ulcer with both hemorrhage and perforation • K25.7 Chronic gastric ulcer without hemorrhage or perforation • K25.9 Gastric ulcer, unspecified as acute jhmci.com 7 Class I Ideal or minimally compromised Classification System for the Edentulous Patient Class II Moderately compromised Diagnostic Criteria 1. 2. 3. Class III Substantially compromised Class IV Severely compromised 4. jhmci.com Bone height--mandibular Maxillomandibular relationship Residual ridge morphologymaxilla Muscle attachments 8 Loss of teeth by Class I-IV • • • • • • • • • K08.10 Complete loss of teeth, unspecified cause K08.101 …… class I K08.102 …… class II K08.103 …… class III K08.104 …… class IV K08.109 …… unspecified class K08.11 Complete loss of teeth due to trauma K08.111 …… class I K08.112 …… class II jhmci.com 9 Hernia K40 Inguinal hernia • • • • • • • • • • • K40.0 Bilateral inguinal hernia, with obstruction, without gangrene K40.00 …… not specified as recurrent K40.01 …… recurrent K40.1 Bilateral inguinal hernia, with gangrene K40.10 …… not specified as recurrent K40.11 …… recurrent K40.2 Bilateral inguinal hernia, without obstruction or gangrene K40.20 …… not specified as recurrent K40.21 …… recurrent K40.3 Unilateral inguinal hernia, with obstruction, without gangrene K40.30 …… not specified as recurrent jhmci.com 10 K11 Diseases of salivary glands Use Additional code to identify: – alcohol abuse and dependence (F10.-) – 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) • • • • • • • • • • K11.1 Hypertrophy of salivary gland K11.2 Sialoadenitis K11.20 …… unspecified K11.21 Acute sialoadenitis K11.22 Acute recurrent sialoadenitis K11.23 Chronic sialoadenitis K11.3 Abscess of salivary gland K11.4 Fistula of salivary gland K11.5 Sialolithiasis K11.6 Mucocele of salivary gland jhmci.com 11 K50 Crohn's disease [regional enteritis] Use Additional code to identify manifestations, such as: pyoderma gangrenosum (L88) • K50.0 Crohn's disease of small intestine – K50.00 …… without complications • K50.01 Crohn's disease of small intestine with complications – – – – – – K50.011 Crohn's disease of small intestine with rectal bleeding K50.012 Crohn's disease of small intestine with intestinal obstruction K50.013 Crohn's disease of small intestine with fistula K50.014 Crohn's disease of small intestine with abscess K50.018 Crohn's disease of small intestine with other complication K50.019 Crohn's disease of small intestine jhmci.com 12 K51.5 Left sided colitis • K51.50 …… without complications – K51.51 Left sided colitis with complications – K51.511 Left sided colitis with rectal bleeding – K51.512 Left sided colitis with intestinal obstruction – K51.513 Left sided colitis with fistula – K51.514 Left sided colitis with abscess – K51.518 Left sided colitis with other complication – K51.519 Left sided colitis with unspecified jhmci.com 13 K57 Diverticular disease of intestine • K57.0 Diverticulitis of small intestine with perforation and abscess – K57.00 …… without bleeding – K57.01 …… with bleeding • K57.1 Diverticular disease of small intestine without perforation or abscess – K57.10 Diverticulosis of small intestine without perforation or abscess without bleeding – K57.11 Diverticulosis of small intestine without perforation or abscess with bleeding – K57.12 Diverticulitis of small intestine without perforation or abscess without bleeding – K57.13 Diverticulitis of small intestine without perforation or abscess with bleeding jhmci.com 14 K73 Chronic hepatitis, NEC • K73.0 Chronic persistent hepatitis, not elsewhere classified • K73.1 Chronic lobular hepatitis, not elsewhere classified • K73.2 Chronic active hepatitis, not elsewhere classified • K73.8 Other chronic hepatitis, not elsewhere classified • K73.9 Chronic hepatitis, unspecified jhmci.com 15 Disorders of gallbladder, biliary tract and pancreas K80-K87 • • • • • • • K80 Cholelithiasis K81 Cholecystitis K82 Other diseases of gallbladder K83 Other diseases of biliary tract K85 Acute pancreatitis K86 Other diseases of pancreas K87 Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere jhmci.com 16 K80 Cholelithiasis • • • • • • • • • • • • • • • • • • • K80.0 Calculus of gallbladder with acute cholecystitis K80.00 …… without obstruction K80.01 …… with obstruction K80.10 Calculus of gallbladder with chronic cholecystitis without obstruction K80.11 Calculus of gallbladder with chronic cholecystitis with obstruction K80.12 Calculus of gallbladder with acute and chronic cholecystitis without obstruction K80.13 Calculus of gallbladder with acute and chronic cholecystitis with obstruction K80.18 …… without obstruction K80.19 …… with obstruction K80.20 …… without obstruction K80.21 …… with obstruction K80.30 …… unspecified, without obstruction K80.31 …… unspecified, with obstruction K80.32 Calculus of bile duct with acute cholangitis without obstruction K80.33 Calculus of bile duct with acute cholangitis with obstruction K80.34 Calculus of bile duct with chronic cholangitis without obstruction K80.35 Calculus of bile duct with chronic cholangitis with obstruction K80.36 Calculus of bile duct with acute and chronic cholangitis without obstruction K80.37 Calculus of bile duct with acute and chronic cholangitis with obstruction jhmci.com 17 Chapter-Specific Guidelines Chapter 11 • TRUE/FALSE • Chapter 11 Diseases of the Digestive System (K00-K94) contains many combination codes that require careful reading. jhmci.com 18 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Ventral incisional hernia, without obstruction or gangrene. • ICD-10-CM Code:____________________ jhmci.com 19 Chapter 6: Chapter-Specific Guidelines ICD-10-CM Chapters 11 • For hemorrhage to be reported there does not have to be active bleeding; however, there must be documentation in the medical record indicating active bleeding has occurred and the source of the bleeding must be identified. jhmci.com 20 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Crohn’s disease of the small and large bowel complicated by pyoderma gangrenosum. • ICD-10-CM Codes:____________________, ___________________ jhmci.com 21 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Obstructed intestinal hernia with gangrene. ICD-10-CM Code:____________________ jhmci.com 22 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Choledocholithiasis (calculus of the bile duct) with acute and chronic cholangitis. • ICD-10-CM Code:_____________________ jhmci.com 23 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Choledochoduodenal fistula. • ICD-10-CM Code:_____________________ jhmci.com 24 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Recurrent chronic pancreatitis • ICD-10-CM Code: ____________________ jhmci.com 25 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Chronic ulcerative proctitis with fistula. • ICD-10-CM Code:____________________ jhmci.com 26 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • 23. Acute pseudo-obstruction of the intestine. • ICD-10-CM Code: ____________________ jhmci.com 27 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • 22. Acute gastrectasis (distention of stomach). • ICD-10-CM Code: ____________________ jhmci.com 28 Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Celiac disease. • ICD-10-CM Code: ___________________ jhmci.com 29 Diseases of the Skin/Subcutaneous Tissue Chapter 12 National Cancer Institute 30 jhmci.com Diseases of the skin/subcutaneous tissue • • • • • • L00-L08 Infections of the skin and subcutaneous tissue L10-L14 Bullous disorders L20-L30 Dermatitis and eczema L40-L45 Papulosquamous disorders L49-L54 Urticaria and erythema L55-L59 Radiation-related disorders of the skin and subcutaneous tissue • L60-L75 Disorders of skin appendages • L76 Intraoperative and postprocedural complications of skin and subcutaneous tissue • L80-L99 Other disorders of the skin and subcutaneous tissue jhmci.com 31 Infections • L00 Staphylococcal scalded skin syndrome Use additional code before L00 directs coder to report the infection with B95-B97 Use Additional code to identify percentage of skin exfoliation (L49.-) jhmci.com 32 Pressure Ulcers Stage 1: erythema (redness) of skin Stage 2: partial loss of skin (epidermis or dermis) Stage 3: full thickness loss of skin (up to but not through fascia) Stage 4: full thickness loss (extensive destruction and necrosis) jhmci.com 33 Pressure ulcers elbow • • • • • • • • • • • • • • • • • • • L89.00 Pressure ulcer of unspecified elbow L89.000 …… unstageable L89.001 …… stage 1 L89.002 …… stage 2 L89.003 …… stage 3 L89.004 …… stage 4 L89.009 …… unspecified stage L89.01 Pressure ulcer of right elbow L89.010 …… unstageable L89.011 …… stage 1 L89.012 …… stage 2 L89.013 …… stage 3 L89.014 …… stage 4 L89.019 …… unspecified stage L89.02 Pressure ulcer of left elbow L89.020 …… unstageable L89.021 …… stage 1 L89.022 …… stage 2 L89.023 …… stage 3 Stage 0-4 jhmci.com 34 Coding Guidelines • Assign as many codes as necessary from Category L89 to identify multiple pressure ulcers, by anatomical site and stage. • Pressure ulcer of the sacrum, stage 2 and right lower backstage I. • L89.152 Pressure ulcer of the sacral region, stage 2, L89.131 Pressure ulcer of the right lower back, stage 1 jhmci.com 35 Coding Guidelines • Code any associated gangrene: I96 as first listed. • Unstageable pressure ulcers are ulcers which cannot be staged determined by the documentation. May be for deep tissue injury not due to trauma and ulcers covered by an Escher or covered with a graft of skin or muscle. • Unstageable are not synonymous with unspecified stage. • Assign the ulcer stage based on the clinical documentation and guidance in the alphabetical index list of terms and subterms and verification of code assignment in the tabular list. jhmci.com 36 Coding Guidelines • No code is assigned for a pressure ulcer described as “healed.” • Pressure ulcers described as “healing” should be reported with the appropriate code based upon the clinical documentation. When the documentation is unclear as to whether the ulcer is a healing pressure ulcer, query the provider. • Diagnosis: Healing pressure ulcer of the left heel, stage 2 L89.622 jhmci.com 37 Coding Guidelines • A pressure ulcer that evolves from one stage to another during the course of the hospitalization is reported only at the highest level of severity as supported by the documentation. jhmci.com 38 Non-Pressure Ulcers If one of the following conditions is documented with an ulcer, sequence the underlying associated condition first. – – – – – – – Atherosclerosis of the extremities I70.23- to I70.74Chronic venous hypertension I87.31-, I87.33Diabetic ulcers E08.621, E08.622, E09, E10, E11, E13--Gangrene I96 Postphlebetic syndrome I87.01-, I87.03Postthrombotic syndrome I87.01-, I87.03Varicose ulcer I83.0-, I83.2jhmci.com 39 Non-pressure ulcer L97-L98 • Site specific • Stage specific by definition – – – – – – – – – – – – L97 Non-pressure chronic ulcer of lower limb, not elsewhere classified L97.1 Non-pressure chronic ulcer of thigh L97.10 Non-pressure chronic ulcer of unspecified thigh L97.101 …… limited to breakdown of skin L97.102 …… with fat layer exposed L97.103 …… with necrosis of muscle L97.104 …… with necrosis of bone L97.109 …… with unspecified severity L97.11 Non-pressure chronic ulcer of right thigh L97.111 …… limited to breakdown of skin L97.112 …… with fat layer exposed L97.113 …… with necrosis of muscle jhmci.com 40 Psoriasis Further specificity in ICD-10-CM • • • • • • • • • • • • L40 Psoriasis L40.0 Psoriasis vulgaris L40.1 Generalized pustular psoriasis L40.2 Acrodermatitis continua L40.3 Pustulosis palmaris et plantaris L40.4 Guttate psoriasis L40.5 Arthropathic psoriasis L40.50 …… unspecified L40.51 Distal interphalangeal psoriatic arthropathy L40.52 Psoriatic arthritis mutilans L40.53 Psoriatic spondylitis L40.54 Psoriatic juvenile arthropathy jhmci.com 41 Dermatitis • L23-L25 classifies dermatitis due to plants, foods, drugs and medications. – – – – – – – – – – L23.0 Allergic contact dermatitis due to metals L23.1 Allergic contact dermatitis due to adhesives L23.2 Allergic contact dermatitis due to cosmetics L23.3 Allergic contact dermatitis due to drugs in contact with skin L23.4 Allergic contact dermatitis due to dyes L23.5 Allergic contact dermatitis due to other chemical products L23.6 Allergic contact dermatitis due to food in contact with the skin L23.7 Allergic contact dermatitis due to plants, except food L23.8 Allergic contact dermatitis due to other agents L23.81 Allergic contact dermatitis due to animal (cat) (dog) dander • L27 classified dermatitis due to drugs taken internally. jhmci.com 42 L27 Dermatitis due to substances taken internally • L27.0 Generalized skin eruption due to drugs and medicaments taken internally – Use Additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) • L27.1 Localized skin eruption due to drugs and medicaments taken internally – Use Additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) • L27.2 Dermatitis due to ingested food • L27.8 Dermatitis due to other substances taken internally • L27.9 Dermatitis due to unspecified substance jhmci.com 43 Dermatitis due to drug First: Determine if the condition is: • An adverse of a drug • Properly administered • A Poisioning due to the incorrect use of the drug T Code for poisoning is listed as first listed code followed by the adverse effect. jhmci.com 44 Chapter-Specific Guidelines Chapter 12 • TRUE/FALSE • A stage II pressure ulcer is considered a full thickness loss of skin. jhmci.com 45 Chapter-Specific Guidelines ICD-10-CM Chapters 12 • Dyskinesia of esophagus. • ICD-10-CM Code: ____________________ jhmci.com 46 Chapter-Specific Guidelines ICD-10-CM Chapters 12 • Boil on the face, due to Staphylococcus epidermidis. • ICD-10-CM Codes:_____________________, _____________________ jhmci.com 47 Chapter-Specific Guidelines ICD-10-CM Chapters 12 • Mucinosis of the skin. • ICD-10-CM Code: _____________________ jhmci.com 48 Chapter-Specific Guidelines ICD-10-CM Chapters 12 • Pressure ulcer of right elbow with partial thickness skin loss involving epidermis and dermis. • ICD-10-CM Code: ____________________ jhmci.com 49 Diseases of the Musculoskeletal System and Connective Tissue, Chapter 13 M00-M99 • • • • • • • • • • • • • • • • • • M00-M02 Infectious arthropathies M05-M14 Inflammatory polyarthropathies M15-M19 Osteoarthritis M20-M25 Other joint disorders M26-M27 Dentofacial anomalies [including malocclusion] and other disorders of jaw M30-M36 Systemic connective tissue disorders M40-M43 Deforming dorsopathies M45-M49 Spondylopathies M50-M54 Other dorsopathies M60-M63 Disorders of muscles M65-M67 Disorders of synovium and tendon M70-M79 Other soft tissue disorders M80-M85 Disorders of bone density and structure M86-M90 Other osteopathies M91-M94 Chondropathies M95-M95 Other disorders of the musculoskeletal system and connective tissue M96-M96 Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified M99-M99 Biomechanical lesions, not elsewhere classified jhmci.com 50 Diseases of the Musculoskeletal System and Connective Tissue, Chapter 13 M00-M99 • Most codes specify: – Site: Location on the body – Laterality: Right, left, unilateral, bilateral • Site & laterality guideline • Bone vs. joint guideline • Acute traumatic vs. chronic or recurrent musculoskeletal conditions • Osteoporosis guideline (with or without pathologic fracture) jhmci.com 51 M16 Osteoarthritis of hip • • • • • • • M16.0 Bilateral primary osteoarthritis of hip M16.1 Unilateral primary osteoarthritis of hip M16.10 Unilateral primary osteoarthritis, unspecified hip M16.11 Unilateral primary osteoarthritis, right hip M16.12 Unilateral primary osteoarthritis, left hip M16.2 Bilateral osteoarthritis resulting from hip dysplasia M16.3 Unilateral osteoarthritis resulting from hip dysplasia • M16.30 …… unspecified hip • M16.31 …… right hip • M16.32 …… left hip jhmci.com 52 Bone versus joint • For certain conditions, the bone may be affected at the upper or lower end, (e.g., avascular necrosis of bone, M87, Osteoporosis, M80, M81). • Though the portion of the bone affected may be at the joint, the site designation will be the bone, not the joint. jhmci.com 53 Acute traumatic versus chronic or recurrent musculoskeletal conditions 1. Many musculoskeletal conditions are a result of previous injury or trauma to a site, or are recurrent conditions. 2. Bone, joint or muscle conditions that are the result of a healed injury are usually found in chapter 13. 3. Recurrent bone, joint or muscle conditions are also usually found in chapter 13. 4. Any current, acute injury should be coded to the appropriate injury code from chapter 19. 5. Chronic or recurrent conditions should generally be coded with a code from chapter 13. jhmci.com 54 Pathological Fractures • Also known as (AKA): Spontaneous fracture • Fracture reported in addition to underlying condition responsible for fracture • Never assign a code for a traumatic fracture and pathological fracture of same bone • 7th character indicates treatment plans, such as A for initial jhmci.com 55 Coding Note:ICD-10-CM has three ICD-10 Pathological or Stress Fracture Extensions different categories for pathologic fractures – due to neoplastic disease, due to osteoporosis, and due to other specified disease. A • Initial encounter D • Subsequent – routine healing G • Subsequent – delayed healing K • Subsequent – nonunion P • Subsequent – malunion S • Sequela jhmci.com 56 Fracture – Episode of Care • 7th character A (initial encounter) – Should be used as long as the patient is receiving active treatment for the fracture – Surgical treatment – ER visits – Evaluation & treatment by new provider • 7th character D (subsequent routine healing) – – – – – Should be used for encounters after active treatment is completed Cast change/removal Removal of fixation device (internal or external) Medication adjustments Follow up visit or other aftercare jhmci.com 57 Coding Note:ICD-10-CM has three different categories for pathologic fractures – due to neoplastic disease, due to osteoporosis, and due to other specified disease. jhmci.com 58 Coding of Pathologic Fractures • 7th character A is for use as long as the patient is receiving active treatment for the fracture. • Examples of active treatment are: surgical treatment, emergency department encounter, evaluation and treatment by a new physician. • 7th character, D is to be used for encounters after the patient has completed active treatment. • The other 7th characters, listed under each subcategory in the Tabular List, are to be used for subsequent encounters for treatment of problems associated with the healing, such as malunions, nonunions, and sequelae. • Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes. jhmci.com 59 M84.411 Pathological fracture, right shoulder • M84.411A …… initial encounter for fracture • M84.411D …… subsequent encounter for fracture with routine healing • M84.411G …… subsequent encounter for fracture with delayed healing • M84.411K …… subsequent encounter for fracture with nonunion • M84.411P …… subsequent encounter for fracture with malunion • M84.411S …… sequela jhmci.com 60 M84.51 Pathological fracture in neoplastic disease, shoulder • M84.511 Pathological fracture in neoplastic disease, right shoulder • M84.511A …… initial encounter for fracture • M84.511D …… subsequent encounter for fracture with routine healing • M84.511G …… subsequent encounter for fracture with delayed healing • M84.511K …… subsequent encounter for fracture with nonunion • M84.511P …… subsequent encounter for fracture with malunion • M84.511S …… sequela jhmci.com 61 Osteoporosis • Osteoporosis is a systemic condition, meaning that all bones of the musculoskeletal system are affected. • Therefore, site is not a component of the codes under category M81, Osteoporosis without current pathological fracture. • The site codes under category M80, Osteoporosis with current pathological fracture, identify the site of the fracture, not the osteoporosis. jhmci.com 62 Osteoporosis • M80 Osteoporosis with current pathological Fx – Systemic condition that affects bones – Fracture sustained with trauma that would not usually cause a fx – Age-related • M81 Osteoporosis without current pathological Fx – Systemic condition that affects bones – Fracture sustained with trauma that would not usually cause a fracture jhmci.com 63 Osteoporosis without pathological fracture • Category M81, Osteoporosis without current pathological fracture, is for use for patients with osteoporosis who do not currently have a pathologic fracture due to the osteoporosis, even if they have had a fracture in the past. • • For patients with a history of osteoporosis fractures, status code Z87.310, Personal history of (healed) osteoporosis fracture, should follow the code from M81. jhmci.com 64 Osteoporosis • M80 Osteoporosis with current pathological Fx – Systemic condition that affects bones – Fracture sustained with trauma that would not usually cause a fx – Age-related • M81 Osteoporosis without current pathological Fx – Systemic condition that affects bones – Fracture sustained with trauma that would not usually cause a fracture jhmci.com 65 M80.0 Age-related osteoporosis with current pathological fracture • M80.00 Age-related osteoporosis with current pathological fracture, unspecified site • M80.00XA …… initial encounter for fracture • M80.00XD …… subsequent encounter for fracture with routine healing • M80.00XG …… subsequent encounter for fracture with delayed healing • M80.00XK …… subsequent encounter for fracture with nonunion • M80.00XP …… subsequent encounter for fracture with malunion • M80.00XS …… sequela jhmci.com 66 Infectious Arthropathies M00-M02 • • M00 Pyogenic Arthritis – M01 Direct Infection joint – – – – – • • Code First underlying disease, such as: leprosy [Hansen's disease] (A30.-) mycoses (B35-B49) O'nyong-nyong fever (A92.1) paratyphoid fever (A01.1-A01.4) M02 Postinfective and Reactive – – – – – • Use Additional code (B95.61-B95.8) to identify bacterial agent Code First underlying disease, such as: congenital syphilis [Clutton's joints] (A50.5) enteritis due to Yersinia enterocolitica (A04.6) infective endocarditis (I33.0) viral hepatitis (B15-B19) Direct infections – – – Invades synovial tissue Invades the joint Invasive organism has been identified Indirect infections – – Reactive: Microbial infection identified but not in joint Postinfective: Microbial antigen present, but not constant and no evidence of multiplication jhmci.com 67 ICD-10 Inflammatory polyarthropathies M05-M14 • M05 Rheumatoid arthritis with rheumatoid factor – – – – – Site Lung Heart Neuropathy RH Factor • M06 Other rheumatoid arthritis – Site – Juvenile jhmci.com 68 Chapter-Specific Guidelines Chapter 13 • TRUE/FALSE • Chapter 13 contains codes for bone, joint and muscle conditions that are recurrent or chronic conditions while Chapter 19 contains codes for current injuries. jhmci.com 69 Chapter 6: Chapter-Specific Guidelines Chapters 13 • With indirect infections (Category M02) of joints due to infectious or parasitic disease classified elsewhere, the coder is directed to “code first” the underlying disease. jhmci.com 70 Chapter-Specific Guidelines ICD-10-CM Chapters 13 • Staphylococcus aureus arthritis of the left ankle is an example of when the organism is reported first, followed by a code to report the pyogenic arthritis. jhmci.com 71 Chapter-Specific Guidelines ICD-10-CM Chapters 13 • A stress fracture is the same as a pathologic fracture. jhmci.com 72 Chapter-Specific Guidelines ICD-10-CM Chapters 13 • Many conditions reported in the musculoskeletal chapter are a result of previous injury or trauma to a site, or are recurrent conditions. jhmci.com 73 Chapter-Specific Guidelines ICD-10-CM Chapters 13 • Stress fracture of the right foot, subsequent encounter with delayed healing. • ICD-10-CM Code:____________________ jhmci.com 74 Chapter-Specific Guidelines ICD-10-CM Chapters 13 • Staphylococcal aureus arthritis of the left hip. • ICD-10-CM Codes:____________________, ___________________ jhmci.com 75 Chapter-Specific Guidelines ICD-10-CM Chapters 13 • Osteopathy of right lower leg following poliomyelitis. • ICD-10-CM Codes:____________________, ____________________ jhmci.com 76 Chapter-Specific Guidelines ICD-10-CM Chapters 13 • Pathologic fracture of right femur, subsequent encounter with malunion. • ICD-10-CM Code:____________________ jhmci.com 77 Chapter-Specific Guidelines ICD-10-CM Chapters 13 • 9. Initial encounter for a pathologic fracture left metatarsal due to age-related postmenopausal osteoporosis. This patient had a previous pathologic fracture of the hip due to osteoporosis. • ICD-10-CM Codes:____________________, ____________________ • ANS: M80.072A, Z87.310 jhmci.com 78 ICD-10-CM National Cancer Institute Alan Hoofring DISEASES OF THE GENITOURINARY SYSTEM 79 jhmci.com Chapter 14 – Genitourinary System • • • • • • • • • • • N00-N08 Glomerular diseases N10-N16 Renal tubulo-interstitial diseases N17-N19 Acute kidney failure and chronic kidney disease N20-N23 Urolithiasis N25-N29 Other disorders of kidney and ureter N30-N39 Other diseases of the urinary system N40-N53 Diseases of male genital organs N60-N65 Disorders of breast N70-N77 Inflammatory diseases of female pelvic organs N80-N98 Noninflammatory disorders of female genital tract N99-N99 Intraoperative and postprocedural complications and disorders of genitourinary system, not elsewhere classified jhmci.com 80 Additional Codes Required 81 N17 • Code also underlying condition N18 • Code first etiology N30 • Additional code infectious agent N31 • Additional code urinary incontinence N33 • Code first underlying disease N40.1 • Additional code for associated symptoms jhmci.com Stages of chronic kidney disease (CKD) • Chapter 14 coding guidelines – ICD-10-CM classifies CKD based on severity – The severity of CKD is designated by stages 1-5 • • • • • • • N18 Chronic kidney disease (CKD) N18.1 Chronic kidney disease, stage 1 N18.2 Chronic kidney disease, stage 2 (mild) N18.3 Chronic kidney disease, stage 3 (moderate) N18.4 Chronic kidney disease, stage 4 (severe) N18.5 Chronic kidney disease, stage 5 N18.6 End stage renal disease jhmci.com 82 Stages of chronic kidney disease (CKD) • If both a stage of CKD and ESRD are documented, assign code N18.6 only. jhmci.com 83 Chronic kidney disease and kidney transplant status • Patients who have undergone kidney transplant may still have some form of chronic kidney disease • The presence of CKD alone does not constitute a transplant complication. • Assign the appropriate N18 code for the patient’s stage of CKD and code Z94.0, Kidney transplant status. • If a transplant complication such as failure or rejection or other transplant complication is documented, code complication(s) of a kidney transplant jhmci.com 84 Chronic kidney disease with other conditions • Patients with CKD may also suffer from other serious conditions, most commonly diabetes mellitus and hypertension. – The sequencing of the CKD code in relationship to codes for other contributing conditions is based on the conventions in the Tabular List. – See I.C.9. Hypertensive chronic kidney disease. jhmci.com 85 Nephritic syndrome • A collection of signs (known as a syndrome) associated with disorders affecting the kidneys, more specifically glomerular disorders. • Characterized by having a thin glomerular basement membrane and small pores in the podocytes of the glomerulus, large enough to permit proteins (proteinuria) and red blood cells (hematuria) to pass into the urine. • By contrast, nephrotic syndrome is characterized by only proteins (proteinuria) moving into the urine. Nephritic syndrome, like nephrotic syndrome, may involve hypoalbuminemia due to protein albumin moving from the blood to the urine. jhmci.com 86 N00-N08 Glomerular diseases • Code Also any associated kidney failure (N17-N19). – Type 1 Excludes hypertensive chronic kidney disease (I12.-) • • • • • • • N00 Acute nephritic syndrome N01 Rapidly progressive nephritic syndrome N02 Recurrent and persistent hematuria N03 Chronic nephritic syndrome N04 Nephrotic syndrome N05 Unspecified nephritic syndrome N06 Isolated proteinuria with specified morphological lesion • N07 Hereditary nephropathy, not elsewhere classified • N08 Glomerular disorders in diseases classified elsewhere jhmci.com 87 N00 Acute nephritic syndrome • N00.0 Acute nephritic syndrome with minor glomerular abnormality • N00.1 Acute nephritic syndrome with focal and segmental glomerular lesions • N00.2 Acute nephritic syndrome with diffuse membranous glomerulonephritis • N00.3 Acute nephritic syndrome with diffuse mesangial proliferative glomerulonephritis • N00.4 Acute nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis • N00.5 Acute nephritic syndrome with diffuse mesangiocapillary glomerulonephritis • N00.6 Acute nephritic syndrome with dense deposit disease • N00.7 Acute nephritic syndrome with diffuse crescentic glomerulonephritis • N00.8 Acute nephritic syndrome with other morphologic changes • N00.9 Acute nephritic syndrome with unspecified morphologic changes jhmci.com 4 character constant 88 N08 Glomerular disorders in diseases classified elsewhere • Code First underlying disease, such as: – – – – – – – – – amyloidosis (E85.-) congenital syphilis (A50.5) cryoglobulinemia (D89.1) disseminated intravascular coagulation (D65) gout (M1A.-, M10.-) microscopic polyangiitis (M31.7) multiple myeloma (C90.0-) sepsis (A40.0-A41.9) sickle-cell disease (D57.0-D57.8) jhmci.com 89 Acute kidney failure • Code Also associated underlying condition – N17.0 Acute kidney failure with tubular necrosis – N17.1 Acute kidney failure with acute cortical necrosis – N17.2 Acute kidney failure with medullary necrosis – N17.8 Other acute kidney failure – N17.9 Acute kidney failure, unspecified jhmci.com 90 N18 Chronic kidney disease (CKD) Code First any associated: – diabetic chronic kidney disease (E08.22, E09.22, E10.22, E11.22, E13.22) – hypertensive chronic kidney disease (I12.-, I13.-) – Use Additional code to identify kidney transplant status, if applicable, (Z94.0) • • • • • • • N18.1 Chronic kidney disease, stage 1 N18.2 Chronic kidney disease, stage 2 (mild) N18.3 Chronic kidney disease, stage 3 (moderate) N18.4 Chronic kidney disease, stage 4 (severe) N18.5 Chronic kidney disease, stage 5 N18.6 End stage renal disease N18.9 Chronic kidney disease, unspecified jhmci.com 91 Cystitis Use Additional code to identify infectious agent (B95-B97) • N30.0 Acute cystitis – – – – – – – – – – N30.00 …… without hematuria N30.01 …… with hematuria N30.1 Interstitial cystitis (chronic) N30.10 …… without hematuria N30.11 …… with hematuria N30.2 Other chronic cystitis N30.20 …… without hematuria N30.21 …… with hematuria N30.3 Trigonitis N30.30 …… without hematuria jhmci.com 92 Neuromuscular dysfunction of bladder Use Additional code to identify any associated urinary incontinence (N39.3-N39.4-) • N31 Neuromuscular dysfunction of bladder, not elsewhere classified – N31.0 Uninhibited neuropathic bladder, not elsewhere classified – N31.1 Reflex neuropathic bladder, not elsewhere classified – N31.2 Flaccid neuropathic bladder, not elsewhere classified – N31.8 Other neuromuscular dysfunction of bladder – N31.9 Neuromuscular dysfunction of bladder, unspecified jhmci.com 93 Bladder disorders in diseases classified elsewhere N33 Code First underlying disease, such as: schistosomiasis (B65.0-B65.9) jhmci.com 94 N40 Enlarged prostate • • N40.0 Enlarged prostate without lower urinary tract symptoms N40.1 Enlarged prostate with lower urinary tract symptoms – – – – – – – – – – – • Use Additional code for associated symptoms, when specified: incomplete bladder emptying (R39.14) nocturia (R35.1) straining on urination (R39.16) urinary frequency (R35.0) urinary hesitancy (R39.11) urinary incontinence (N39.4-) urinary obstruction (N13.8) urinary retention (R33.8) urinary urgency (R39.15) weak urinary stream (R39.12) N40.2 Nodular prostate without lower urinary tract symptoms – Additional codes (LUTS) • N40.3 Nodular prostate with lower urinary jhmci.com 95 Questions jhmci.com 96
