1. ICD-10 Orientation In Post Acute Care (Part III)
Rhonda Anderson, RHIA
Anderson Health Information Systems, Inc.
ICD-10 Orientation in Post Acute Care 4hrs PART III

2. Location, Date, Time Northern California Southern California
Fairfield Post Acute Rehab
March 20, 2014
9:00am – 3:00pm
Southern California
Garden View Post Acute Rehab
April 9, 2014

3. Presenters Staci LePage, RHIT
Mobile:
Khaleelah Wagner, RHIA
Mobile:
ICD-10 Orientation in Post Acute Care 4hrs PART III

4. Chapter 6 – Diseases Of The Nervous System G00-G99
Alzheimer’s moved to this chapter (was in mental disorder category) G30.
Expanded to include early and late onset of Alzheimer’s
Requires a second code for Alzheimer’s dementia with or without behaviors
Paralytic syndromes now include laterality in addition to dominant and non-dominant
Paralytic syndromes such as hemiplegia, paraplegia, monoplegia…
Not any changes in coding Parkinson’s G20.
ICD-10 Orientation in Post Acute Care 4hrs PART III

5. Paralytic Syndrome Coding
If the affected side is documented, but not specified as dominant or nondominant:
For ambidextrous patients, the default should be dominant
Left side affected, the default is nondominant
Right side affected, the default is dominant
Example: Hemiplegia, unspecified, affecting right dominant side G81.91
*excludes hemiplegia d/t sequela of CVD

6. Seizures/Convulsions
Convulsions or seizures, NOS code to R56.-
Seizure disorder, code to G40.-
If “disorder” is not documented by provider, but resident is receiving medications for seizures, should query provider

7. Coding Pain Pain, not elsewhere classified - G89.
Used in conjunction with codes from other categories to provide more detail about acute or chronic pain, neoplasm pain, or post-procedural pain
Can be listed as principal diagnosis
When pain control or pain mgmt is reason for admit, the underlying cause and site of pain should be reported as additional dx, if known.
Code only as appropriate, not when resident has pain asso w/OA, fx, etc.
Code only when it adds needed information.
ICD-10 Orientation in Post Acute Care 4hrs PART III

8. More Pain Coding… Chronic pain syndrome G89.4 vs. Chronic pain G89.2
Provider must specifically document the condition
Need to know:
if Alzheimer’s; early or late onset + if associated dementia
if paralytic syndrome; laterality, dominant/non-dominant status

9. Chapter 7 – Diseases Of Eye And Adnexa H00-H59
Assigning glaucoma codes:
Assign as many codes from category H40, as needed, to identify the type of glaucoma, the affected eye, and the glaucoma stage.
Need to know:
which eye (right, left or bilateral)
type of glaucoma (open-angle, primary angle-closure, glaucoma 2nd to trauma, drugs, or other eye disorders)
Stage of glaucoma (mild, moderate, severe, indeterminate)

10. Chapter 8 – Diseases of the Ear and Mastoid Process H60-H95
Separate chapter in ICD-10-CM
Need to know if disease is in right, left or bilateral ears

11. Chapter 9 – Diseases Of The Circulatory System I00-I99
No more hypertension table in index (malignant, benign, unspecified are all the same code now)
Artery and vein diseases are broken down by laterality, in addition to the location
Combination Codes for Conditions and Common Symptoms or Manifestations

12. Chapter 9 – Diseases Of The Circulatory System I00-I99 -2
Example: I Arteriosclerotic heart disease of native coronary artery with unstable angina pectoris

13. Hypertension Coding I11 Hypertension with Heart Disease
Heart conditions classified to I50 or I51.4-I51.9 are also assigned to, a code from category I11 when a causal relationship is stated (due to hypertension) or implied (hypertensive)
Use an additional code to identify type of heart failure I50., if known
Need to know: with or without heart failure

14. More Hypertension Coding
I12 Hypertensive chronic kidney disease
Cause and effect relationship is presumed
Need add’l code to identify the stage of CKD
Need to know: CKD stage
I13 Hypertensive heart and CKD
Causal relationship for HTN and heart dx must be doc’d by provider
Need to know: stage and with or without heart failure

15. Sequelae of Cerebrovascular Diseases I69
I69.0 Nontraumatic subarachnoid hemorrhage
I69.1 Nontraumatic intracerebral hemorrhage
I69.2 Other nontraumatic intracranial hemorrhage
I69.3 Sequelae of cerebral infarction
I69.8 Sequelae of other cerebrovascular diseases

16. Sequelae of Cerebrovascular Diseases I69 -2
I69.9 Sequelae of unspecified cerebrovascular diseases

17. Sequelae of Cerebrovascular Diseases
Sequelae of cerebrovascular disease I69
Used to indicate conditions in I60-I67 as the cause of sequelae. The “sequelae” include conditions specified as such, or as residuals which may occur at any time after the onset of the causal condition
Need to know: type of CVD, what the residual condition is, if paralytic syndrome – right or left, dominant or non-dominant
if tPA/rtPA given within 24 hrs, code Z92.82
Terminology change from “late effects of” to sequelae
-types of CVD include: subarachnoid hemorrhage, intracerebral hemorrhage, intracranial hemorrhage, cerebral infarction, other CVD, unspecified CVD
-tPA would be given at the hospital – review hospital records for this
ICD-10 Orientation in Post Acute Care 4hrs PART III

18. Acute Myocardial Infarction (AMI)
Myocardial Infarctions now have subcategories for ST elevation/STEMI and non-ST elevation/NSTEMI
Time frame change from eight weeks old to four weeks (28 days) or less from onset
Separate code for a subsequent MI within four weeks (28 days) of a previous MI

19. Acute Myocardial Infarction
I21 For encounters occurring while the AMI is equal to, or less than, four weeks old, including transfers to another acute setting or a post-acute setting and pt requires continued care for the AMI
Sites include: left ant descending coronary artery, inferior wall of coronary artery, anterior wall, transmural Q wave
ICD-10 Orientation in Post Acute Care 4hrs PART III

20. Acute Myocardial Infarction -2
I22 Subsequent MI
When a pt who has suffered an MI, has a new MI within the 4 wk time frame of the initial MI, code I22 in conjunction with I21 code
Need to know for both I21 or I22 if STEMI or NSTEMI and site of MI
Sites include: left ant descending coronary artery, inferior wall of coronary artery, anterior wall, transmural Q wave
ICD-10 Orientation in Post Acute Care 4hrs PART III

21. Complications Following MI’s
I23 Certain current complications following STEMI and NSTEMI MI within 28 day period
a code from category I23 must be used in conjunction with a code from category I21 or category I22
Still use a different code for old MI (greater than 28 days after initial MI onset) I25.2

22. Atrial Fibrillation and Flutter I48
More specific than ICD-9:
I48.0 Paroxysmal atrial fibrillation
I48.1 Persistent atrial fibrillation
I48.2 Chronic atrial fibrillation
I48.3 Typical atrial flutter/type I
I48.4 Atypical atrial flutter/type II
I48.9- Unspecified atrial fibrillation/flutter
Need to know type

23. Congestive Heart Failure/CHF I50
Same organization as ICD-9
Need to know:
type of heart failure (left, systolic, diastolic, combined)
acute, chronic, acute on chronic

24. Chapter 10 – Diseases Of Respiratory System (J00-J99)
J44 Other Chronic Obstructive Pulmonary Disease (COPD)
Includes asthma with COPD
Organized differently than in ICD-9
J44.0 COPD with acute lower resp infection
J44.1 COPD with acute exacerbation
J44.9 COPD, unspecified
Acute exacerbation is a worsening or a decompensation of a chronic condition

25. Asthma J45 Asthma is now in subcategories of: J45.2 Mild intermittent
J45.3 Mild persistent
J45.4 Moderate persistent
J45.5 Severe persistent
J45.9 Unspecified
J Unspecified asthma with exacerbation
J Unspecified asthma with status asthmaticus
J Unspecified asthma, uncomplicated
J is the correct code for asthma, NOS - NOT J45.998
ICD-10 Orientation in Post Acute Care 4hrs PART III

26. Asthma J45 -2 Asthma is now in subcategories of: J45.99_ Other asthma
Need to know type and if complicated
J is the correct code for asthma, NOS - NOT J45.998
ICD-10 Orientation in Post Acute Care 4hrs PART III

27. Influenza J09 Influenza due to certain identified influenza viruses
J10 Influenza d/t other identified influenza virus
J11 Influenza d/t unidentified influenza virus
Need to know what the influenza is due to and if any manifestations
Only on confirmed cases
Seasonal influenza d/t other identified influenza virus code J10.-
All J09-J11 now include coding of associated manifestations – pneumonia, other resp conditions, GI manifestations, other manifestations – more specific with ICD-10
ICD-10 Orientation in Post Acute Care 4hrs PART III

28. Pneumonia J12 Viral pneumonia, not elsewhere classified
J13 Pneumonia d/t Streptococcus pneumoniae
J14 Pneumonia d/t H. influenzae
J15 Bacterial pneumonia, not elsewhere classified
J16 Pneumonia d/t other infectious organisms, not elsewhere classified

29. Pneumonia -2 J17 Pneumonia in disease classified elsewhere
J18 Pneumonia, unspecified organism
J69 Pneumonitis d/t solids and liquids
Need to know type of virus/bacteria

30. Respiratory Failure J96 J96.0 Acute respiratory failure
J96.1 Chronic respiratory failure
J96.2 Acute and chronic respiratory failure
J96.9 Respiratory failure, unspecified
Need to know: for all of above acute or chronic and if with hypoxia or hypercapnia
Hypoxia: a condition in which the body or a region of the body is deprived of adequate oxygen supply

31. Respiratory Failure J96 -2
Hypercapnia: a condition of abnormally elevated carbon dioxide (CO2) levels in the blood

32. Chapter 11- Diseases of the Digestive System K00-K95
Increase in sections from seven (in ICD-9) to ten (in ICD-10)
Expanded breakdown of all types of ulcers and colitis
Need to know for ulcers, type and with/without hemorrhage and/or perforation

33. Non-Infective Enteritis and Colitis K50-K52
K50 Crohn’s disease
K51 Ulcerative colitis
K52 Other and unspecified noninfective gastroenteritis and colitis

34. Non-Infective Enteritis and Colitis K50-K52 -2
Need to know if associated manifestation of:
Rectal bleeding
Intestinal obstruction
Fistula
Abscess
Other complication

35. Chapter 12 – Diseases Of Skin & Subcutaneous Tissue L00-L99
L89 codes for Pressure Ulcer are combination codes that identify the site as well as the stage of the ulcer and also have added laterality
Assignment of the pressure ulcer stage should be guided by clinical documentation of the stage
Assign code for the highest stage reported for that site

36. Chapter 12 – Diseases Of Skin & Subcutaneous Tissue L00-L99 -2
Need to know for pressure ulcer coding site (including laterality) and stage

37. Non-Pressure Chronic Ulcers of Lower Limbs L97
Expanded breakdown of this section to include level of severity:
Limited to breakdown of skin
With fat layer exposed
With necrosis of muscle
With necrosis of bone
With unspecified severity
Need to know for chronic ulcer coding, site, laterality, level of severity

38. Chapter 13 – Diseases Of Musculoskeletal (M00-M99)
Gout now in this section
Site and laterality needed
Represents the bone, joint or muscle involved
Where more than one bone, joint or muscle is involved, such as osteoarthritis, use the assigned “multiple sites” code; if not available, use multiple codes to indicate the sites
Bone vs. Joint – Certain conditions where the bone may be affected at the upper & lower end; site designation will be the bone, not the joint
Some sites listed in ICD-9 include upper arm, forearm, lower leg – in ICD-10, this section is just listed by joint (shoulder, elbow, wrist, hand, hip, knee, ankle/foot)
Most codes listed by joint site, but a few by bone (M21.7 unequal limb length of which limb bone), and muscle (M23.0 cystic meniscus of which part of the meniscus muscle)
M32 Lupus is listed by organ/system involvement
ICD-10 Orientation in Post Acute Care 4hrs PART III

39. Chapter 13 – Diseases Of Musculoskeletal (M00-M99) -2
Bone, joint or muscle conditions that are the result of a healed injury are coded to this chapter
Chronic or recurrent conditions are also coded to this chapter
Pathologic fractures are coded with 7th character of “D” for subsequent encounters after active treatment is completed, if routine healing is occurring

40. Osteoarthritis M15-M19 M15 Polyosteoarthritis *new for multiple sites
M16 Osteoarthritis of hip
M17 Osteoarthritis of knee
M18 Osteoarthritis of first carpometacarpal joint
M19 Other and unspecified osteoarthritis
In ICD-10, sites are the main sub-categories, followed by primary/secondary, laterality, and if there was an underlying condition identified as the cause
Excludes OA spine M47.
If site had joint replacement, only code Z96.6-
ICD-10 Orientation in Post Acute Care 4hrs PART III

41. Osteoarthritis M15-M19 -2
Need to know joint site, laterality and underlying condition, and whether primary or secondary osteoarthritis
In ICD-10, sites are the main sub-categories, followed by primary/secondary, laterality, and if there was an underlying condition identified as the cause
Excludes OA spine M47.
If site had joint replacement, only code Z96.6-
ICD-10 Orientation in Post Acute Care 4hrs PART III

42. Back Pain
Low back pain was under disorders of muscle, now is under category of M54 Dorsalgia
M54.0- Panniculitis of neck and back
M54.1- Radiculopathy
M54.2 Cervicalgia
M54.3- Sciatica
M54.4- Lumbago with sciatica
M54.5 Low back pain
M54.6 Pain in thoracic spine
Dorsalgia = back pain
M54.8 Other dorsalgia
M54.9 unspecified dorsalgia
ICD-10 Orientation in Post Acute Care 4hrs PART III

43. Osteoporosis
M80 Osteoporosis with current pathological fracture is used for any patient with known osteoporosis who has a fracture, even if patient had minor fall or trauma, if that fall would not usually break a normal bone
M81 Osteoporosis without current pathological fracture is used for patients who do not currently have a pathologic fracture d/t osteoporosis, even if they have had a fracture in the past

44. Osteoporosis -2
Need to know if current pathological fx, site and laterality

45. Chapter 14 – Diseases Of Genitourinary (N00-N99)
Still need stage of chronic kidney disease (CKD) – stages N18.1-N18.5
If both a stage of CKD and ESRD are documented, then assign code N18.6 only
Code first any associated disease:
Diabetic chronic kidney disease
Hypertensive chronic kidney disease
Need to know stage and any associated dx

46. Renal Disease N17 Acute kidney failure N18 Chronic kidney disease
N19 Unspecified kidney failure
N28.9 Disorder of kidney and ureter, unspecified
Includes Renal disease (acute), NOS
Includes Renal insufficiency (acute)
Need to know if condition is acute or chronic
In long term care, typically we are usually treating the chronic condition, not the acute (these are usually conditions that would require the pt to be hospitalized).
Need MD to document “chronic”, as appropriate.
-N18.9 includes chronic renal insufficiency
-N19 includes Uremia, NOS
ICD-10 Orientation in Post Acute Care 4hrs PART III