ICD-9-CM to ICD-10-CM Prep Presented by: Khaleelah Wagner, RHIA Staci LePage, RHIT ICD-9 to ICD-10 Prep 01-13-15

Objectives Participants will: Correctly assign diagnoses to ICD-9-CM codes Correctly identify primary/secondary diagnoses Identify correct sequence of diagnoses for coding assignment Identify documentation needed for ICD-10-CM coding We have also included some anatomy and physiology information on some of the slides ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

ICD-9 and ICD-10 History The 9th revision was published in 1977. The U.S. National Center for Health Statistics (NCHS) and CMS are responsible for maintaining ICD-9-CM. The World Health Organization (WHO) adopted ICD-10 (International Classification of Diseases, Tenth Revision) in 1990 and it came into use in 1994 by other countries. The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) was developed under the oversight of National Center for Health Statistics in 1997 and has undergone several modifications since then. Page 2 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

2014 ICD-9-CM and ICD-10-CM Availability http://www.cdc.gov/nchs/icd/icd9cm.htm http://www.cdc.gov/nchs/icd/icd10cm.htm or http://www.cms.hhs.gov/ICD10 2014 ICD-10-CM Index to Diseases and Injuries 2014 ICD-10-CM Tabular List of Diseases and Injuries Instructional Notations 2014 Official Guidelines for Coding and Reporting 2014 Table of Drugs and Chemicals 2014 Neoplasm Table 2014 Mapping ICD-9-CM to ICD-10-CM and ICD-10-CM to ICD-9-CM” ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

ICD-9-CM and ICD-10-CM Coding Guidelines The guidelines are approved by four organizations: American Hospital Association (AHA) American Health Information Management Association (AHIMA) Centers for Medicare and Medicaid Services (CMS), and National Center for Health Statistics (NCHS) Review the official guidelines. The Public Health Service and CMS jointly publish the official ICD-9 Guidelines for Coding and reporting. You can download this information at www.cdc.gov/nchs/icd9.htm. ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding to Support Need for Medicare The principal diagnosis and top 8 secondary diagnoses are entered onto the UB-04. Accurate reporting of ICD-9 CM codes effect: Medicare billing Quality measures Data collected Overall accuracy of MDS/RUG categories The main benefit of correct coding is validation of service delivered and reduced compliance risk. The industry is using more checks and balances to reject claims and review for fraud and abuse. Inaccurate codes will lead to rejection of claims and services. ICD-9 to ICD-10 Prep 01-13-15

Coding Conventions and Guidelines In this section, we are going to discuss basics on how to use your coding book as well as discussing some of the basic ICD-10 coding changes: -1st remember to review the clinical documentation and identify all of the residents dx’s, conditions or symptoms -then, look up the term that describes the residents dx/condition/symptom in the alpha index -finally, look up the selected code in the tabular list to make a definitive code selection -and remember, in many cases, proper coding requires more than one code I will show you why it is imperative that your coding book is utilized for obtaining correct ICD-9 codes – and no, Googling or only using your computer coding library are NOT sufficient! For ease of recognizing ICD-9 vs ICD-10 codes, the ICD-10 codes have been put into italicized brackets ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding from ICD-9-CM to ICD-10-CM Three to five characters Three to seven characters First digit is numeric but can be alpha (E or V) First character always alpha 2–5 are numeric All letters used except U Always at least three digits Character 2 always numeric: 3–7 can be alpha or numeric Decimal placed after the first three characters (or with E codes, placed after the first four characters) Alpha characters are not case-sensitive Decimal placed after the first three characters ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Alphabetic Index -2 Main terms in boldface font are listed in alphabetic order. Then, indented beneath the main term, any applicable subterm or essential modifier will be shown in alphabetical order. The indented subterm is always read in combination with the main term. Pneumonia 486 [J18.9] aspiration 507.0 [J69.0] due to food 507.0 [J69.0] For those of you who have perused an ICD-10 coding book, you will notice that each subcategory indentation has a vertical line, making it easier when looking up terms and subterms ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Alphabetic Index -3 Nonessential modifiers appear in parentheses ( ) and do not affect the code number assigned. The “-” at end of an index entry indicates that additional characters are required (ICD-10) Amblyopia (congenital) (ex anopsia) (partial) (suppression) 368.00 [H53.00-] deprivation 368.02 [H53.01-] ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Alphabetic Index -4 Manifestation codes are included in the alphabetic index by including a second code, shown in brackets [ ] directly after the underlying or etiology code which should always be reported first. Chorioretinitis – see also inflammation chorioretinal Tuberculosis 017.3 [363.13] [A18.53] Page 9 - 10 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Tabular List Most but not all categories are subdivided into four or five character subcategories, e.g. (496 [J44.9] COPD or 401.9 [I10] – Hypertension) The fourth character when placed after the decimal point of: 8 - (.8) is used to indicate “other specified”, and 9 - (.9) is usually reserved for “unspecified” 365.89 Other specified glaucoma 365.9 Unspecified glaucoma K52.89 Other specified noninfective gastroenteritis and colitis K52.9 Noninfective gastroenteritis and colitis, unspecified ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Tabular List -4 (NEC) – “not elsewhere classified” (NOS) – “not otherwise specified” Both NEC and NOS have their own codes Five and six character codes provider greater specificity or more information about the condition Codes must be assigned to the highest number of characters available or to the highest level of specificity, or bills will be rejected Page 12 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Convention Abbreviations Not Elsewhere Classified “NEC” – A residual category, subdivision, or subclassification that provides a location for “other” types of specified conditions that have not been classified anywhere else in the code set. These residual codes may also contain the term “NEC” as part of their descriptor. 276.9 Electrolyte and fluid disorders, not elsewhere classified E87.8 Other Disorder of electrolyte and fluid balance, not elsewhere classified Page 19 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Beginning of the chapter – 780-799 or R00-R99 Tabular List Notes Pertinent coding information is located at the beginning of chapters or any subdivisions that follow and apply to all the categories within it. Beginning of the chapter – 780-799 or R00-R99 Beginning of a subchapter – 235-238 or D37-D48 Page 13 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Convention Abbreviations -2 Not Otherwise Specified “NOS” - for use when the documentation of the condition identified by the provider is insufficient to assign a more specific code. 294.20 Unspecified dementia without behavioral disturbance or Dementia, NOS F03.90 Unspecified dementia without behavioral disturbance – Dementia, NOS Page 19 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Conventions Punctuation ( ) Parentheses – supplemental words that may or may not be present. [ ] - Brackets – synonyms, alternative wordings or explanatory phrases. 401.9 Hypertension (essential) (primary) I10 – Essential (primary) hypertension Page 19 & 20 of the Instructor & Student Training Guide 814.02 Fracture of lunate [semilunar] S62.12 Fracture of lunate [semilunar] ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Conventions Punctuation -2 Colon ( : ) – used after an incomplete term which needs one or more of the modifiers following the colon. Used in both “includes” and “excludes” notes in which the words that precede the colon are not considered complete terms and therefore must be appended by one of the modifiers indented under the statement. 359.6 Symptomatic inflammatory myopathy in diseases classified elsewhere Code first underlying disease, as: malignant neoplasm (140.0-208.9) rheumatoid arthritis (714.0) Page 20 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Conventions Punctuation -3 Dashes ( - ) in the Alphabetic Index, dashes at the end of a code indicates an incomplete code *ICD-10 only In the Tabular List, a dash preceded by a decimal point (.-) indicates an incomplete code *ICD-10 only Fracture, pathological ankle M84.47- carpus M84.44- J43 Emphysema Excludes 1: emphysematous (obstructive) bronchitis (J44.-) Page 20 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Convention Instructional Notes Includes notes – used to clarify the condition included within a particular chapter, section, category, subcategory or code. They are not exhaustive and may include diagnoses not listed in the inclusion note. The word “includes” is not preceded by the list of terms at the code level. 531 Gastric ulcer Includes: ulcer, stomach K25 Gastric ulcer Includes: stomach ulcer (peptic) Page 21 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Convention Instructional Notes -2 Excludes – terms excluded from the code are to be coded elsewhere *ICD-9 Excludes 1 – not coded here. Used when two codes cannot occur together *ICD-10 355.9 Mononeuritis of unspecified site Excludes: Causalgia, upper/lower limb (355.71/354.4) G59 Mononeuropathy in disease classified elsewhere Excludes 1: Diabetic mononeuropathy (E09 – E14 with .41) Page 21 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Convention Instructional Notes -3 Excludes 2 – not included here. Used when the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time *ICD-10 only J01 Acute Sinusitis Excludes 1 – Sinusitis NOS (J32.9) Excludes 2 – Chronic Sinusitis (J32.0 – J32.8) Page 21 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Conventions Code First & Use Additional Code Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. The underlying condition is sequenced first followed by the manifestation. The “use additional code” note appears at the etiology and a “code first” note at the manifestation code. The next slide has a few examples ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Convention Instructional Notes -3 331.0 Alzheimer’s disease Use additional code to identify… 294 Persistent mental disorders due to conditions classified elsewhere Code first underlying condition G30 Alzheimer’s disease Use additional code to identify: dementia with behavioral disturbance (F02.81) dementia without behavioral disturbance (F02.80) F02 Dementia in other diseases classified elsewhere Code first the underlying physiological condition, such as: Alzheimer’s (G30.-) Page 21 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Conventions Cross Reference Notes Cross reference notes are used in the Alphabetic Index to advise the coding professional to look elsewhere before assigning a code. There are three terms used: see, see also, see condition Hemorrhage, cranial – see Hemorrhage, intracranial Labyrinthitis (circumscribed) (destructive) (diffuse) (inner ear) (latent) (purulent) (suppurative) – see also subcategory H83.0 Hematoma (traumatic) (skin surface intact) (see also Contusion) Page 22 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Conventions Relational Terms And – should be interpreted to mean “and/or” when it appears in the code title within the Tabular List. 451 Phlebitis and thrombophlebitis I80 Phlebitis and thrombophlebitis 453 Other venous embolism and thrombosis I82 Other venous embolism and thrombosis Page 23 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Conventions Relational Terms -2 With – should be interpreted to mean “associated with” or “due to” when it appears in the code title, the Alphabetical Index, or an instructional note in the Tabular List. The term “with” in the Alphabetical Index is sequenced immediately following the main term, not in alphabetical order. Asthma, asthmatic with chronic obstructive pulmonary disease 493.2/J44.9 493.2 Chronic obstructive asthma J44 Other chronic obstructive pulmonary disease Includes asthma with COPD Page 23 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Signs and Symptoms Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider Chapter 16 of ICD-9-CM contains many, but not all codes for symptoms Chapter R00 – R99, for ICD-10-CM, Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified contains many, but not all codes for symptoms Not in the instructor manual ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Integral Part of a Disease Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification. Examples: Altered Mental Status due to UTI -599.0/N39.0 COPD with Shortness of Breath -496/J44.9 Not in the instructor manual ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Not an Integral Part of Disease -2 Signs and symptoms that may not be associated routinely with a disease process should be coded when present. Resident has a culture that returned difficile. The resident has diarrhea with additional symptoms of malaise, low-grade fever and frequent diarrhea. The resident was started on Flagyl. The resident is weak, dehydrated, and needs IV fluids. Infection, Clostridium, difficile, food borne (disease) 008.45/A04.7 Dehydration 276.51/E86.0 Not in the instructor manual ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Multiple Coding In addition to the etiology/manifestation convention that requires two codes, there are other single conditions that also require more than one code. See “Use additional code” notes in the Tabular List at the code level. These are sequenced secondary to the condition code. ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Multiple Coding -2 “Code first” notes are under certain codes that are not specifically manifestation codes but may be due to an underlying cause. When there is a “code first” note and an underlying condition is present, the underlying condition is sequenced first. “Code if applicable, any causal condition” notes indicate that this code may be assigned as a principal diagnosis when the causal condition is unknown or not applicable. If the causal condition is known, then the code for that condition should be sequenced as the principal diagnosis or first-listed diagnosis. Example on next slide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Multiple Coding Example Multiple codes may be needed for sequela conditions. See Guideline #10. E. coli urinary tract infection Infection, Urinary (tract) 599.0/N39.0 Use additional code to identify infectious organism/agent Infection, bacterial, Escherichia coli [E. coli] (see also Escherichia coli) 041.04/B96.20 Not in the instructor manual “Use additional code” is part of the tabular, not alpha index ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Acute and Chronic Conditions If the same condition is described as both acute (subacute) and chronic and separate subentries exist in the Alphabetic Index at the same indention level, code both and sequence the acute (subacute) code first Acute and chronic bronchitis Bronchitis, acute or subacute (with bronchospasm or obstruction) 466.0/J20.9 Bronchitis, chronic 491.9/J42 Not in the instructor manual ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Combination Code A combination code is a single code used to classify: Two diagnoses, or A diagnosis with an associated secondary manifestation Type 2 diabetes with other specified complication 250.80/E11.69 Use additional code to identify complication A diagnosis with an associated complication Acute Bronchitis with COPD 491.22/J44.0 Two dx = 491.22 Dx w/asso manifestation = 250.80 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Combination Code -2 Assign only the combination code that fully identifies the diagnostic conditions involved or when directed by the Alphabetical Index Multiple coding should not be used when the classification provides a combination code that clearly identifies all the elements documented in the diagnosis When a combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code Not in the instructor manual ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Late Effects/Sequela “A residual effect (condition produced) after the acute phase of an illness or injury has terminated.” There is no time limit for the late effect or sequela code The residual may be apparent early or years later Generally requires two codes: The condition or nature of the late effect/sequela – first 438.5/I69.16 Other paralytic syndrome following intracerebral hemorrhage The late effect/sequela code – second 344.00/G82.5- Quadriplegia Not in the instructor manual ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Sequela Exceptions to above guideline. In instances where the code for the late effect/sequela is followed by a manifestation code identified in the Tabular List and title, or the late effect/sequela code has been to include the manifestation. Example: 438/I69 Late Effects/Sequela of Cerebrovascular Disease The code for the acute phase of an illness or injury that led to the late effect/sequela is never used with a code for the late effect. Example is CVD w/late effect of hemiplegia = 438.20 includes both the late effect and the manifestation code ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Reporting Same Dx More than Once Each unique code may be reported only once for an encounter This applies to bilateral conditions when there are no distinct codes for laterality or two different conditions classified to the same ICD-9-CM or ICD-10-CM diagnosis code IE pressure ulcers – if a resident has x2 on the buttock, would only code x1 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Laterality *ICD-10 only Laterality Guidelines For bilateral sites, the final character of the codes indicates laterality. An unspecified site code is also provided should the side not be identified in the medical record. If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side Might need MD clarification if a bilateral code is needed ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Documentation of BMI and Pressure Ulcer Stages Body Mass Index (BMI) and pressure ulcer stage codes may be based on the medical record documentation from clinicians who are not the patient’s provider, such as a dietician for BMI or licensed nurse for pressure ulcer staging. Associated conditions (overweight, obesity, or pressure ulcer) must be documented by the patient’s provider. If there is conflicting medical record documentation, either from the same clinician or different clinicians, the patient’s attending provider should be queried for clarification. Not in the instructor manual ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Coding Guidelines Syndromes Follow the Alphabetical Index for guidance when coding syndromes If there is no guidance in the Alphabetical Index assign codes for the documented manifestations of the syndrome Look for the syndrome by its name in the alphabetical index first and then if not there, under syndrome Not in the instructor manual ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Guidelines Complications “Code assignment is based on the provider's documentation of the relationship between the condition and the care or procedure.” The guideline extends to any complications of care, regardless of the chapter the code is located in. Note: not all conditions that occur during or following medical care or surgery are classified as complications. Page 24 of the Instructor & Student Training Guide Will not always be able to look under “complications” in alpha index ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding Guidelines Complications -2 There must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a complication. If the complication is not clearly documented, query the provider for clarification. Page 24 of the Instructor & Student Training Guide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Principal Diagnosis Uniform Hospital Discharge Data Set/UHDDS Definition: “The condition established after study to be chiefly responsible for occasioning the admission of the resident to the facility” Two or more diagnoses equally meet the definition for principal diagnosis Uncertain diagnoses – probable, suspected, possible…are NOT coded ICD-9 to ICD-10 Prep 01-13-15

Other Additional or Secondary Diagnoses UHDDS defines other diagnoses as “all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or the length of stay. Diagnoses that relate to an earlier episode which have no bearing on the current stay are to be excluded” For purposes of the UB04, secondary diagnoses include the 2nd listed code thru the 9th listed code ICD-9 to ICD-10 Prep 01-13-15

Infectious and Parasitic Diseases We organized this presentation by chapters that are consistent with the chapters in your coding book This presentation is reflective of the top 100 diagnoses’ that are most commonly used in your facilities ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

HIV Infections Code Only Confirmed Cases Code only confirmed cases of HIV “Confirmation” does not require documentation of positive serology, the provider’s diagnostic statement that the patient is HIV positive is sufficient Asymptomatic HIV is to be applied when the patient without documentation of symptoms is listed as being “HIV Positive”. Do not use this code if the terms AIDS is used or if the patient is treated for any HIV-related illness. If resident is admitted for an HIV-related condition, principal diagnosis should be 042 followed by add’l codes for all reported HIV-related conditions *higher Medicare payment ICD-9 to ICD-10 Prep 01-13-15

Infectious Agents Certain infections are classified in chapters other than Chapter 1 and no organism is identified as part of the infection code An additional code from Chapter 1 should be used to identify the organism: 041/B95 Streptococcus, Staphylococcus, and Enterococcus 041.8/B96, Other bacterial agents 079/B97 Viral agents ICD-9 to ICD-10 Prep 01-13-15

Infectious Agents -2 An instructional note will be found at the infection code advising that an additional organism code is required Use an additional code to identify infectious agent ICD-9 to ICD-10 Prep 01-13-15

Examples UTI with hematuria due to E.coli 599.0, 599.70 UTI, hematuria, or N30.91, Cystitis unspecified with hematuria 041.4 Escherichia coli, or B96.2, Escherichia coli [E. coli] as the cause of diseases classified elsewhere Pneumonia due to streptococcus group B with sepsis 482.32, or J15.3, Pneumonia due to streptococcus, group B 995.91, or A41.9 Sepsis, unspecified organism Septicemia NOS ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Infections Resistant to Antibiotics Identify all infections documented as antibiotic resistant Assign code V09.9-/Z16 Infection with drug-resistant microorganisms following the infection code This category is intended for use as an additional code for infectious conditions to indicate the presence of drug-resistance of the infectious organism, VRE, etc ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Septicemia, SIRS, Sepsis, Severe Sepsis, and Septic Shock Septicemia and sepsis are often used interchangeably, but they are NOT considered synonymous terms. Septicemia refers to a systemic disease associated with the presence of toxins in the blood Systemic inflammatory response syndrome/SIRS refers to the systemic response to infection with symptoms of fever, tachycardia, tachypnea and leukocytosis Sepsis refers to SIRS d/t infection Severe sepsis refers to sepsis with associated acute organ dysfunction Septic shock refers to circulatory failure associated w/severe sepsis ICD-9 to ICD-10 Prep 01-13-15

Coding of SIRS, Sepsis and Severe Sepsis for ICD-9-CM Requires a minimum of 2 codes: A code for the underlying cause (such as infection; if unspecified septicemia, code 038.9) *sequence first And a code from subcategory 995.9- *sequence second Severe sepsis requires an additional code for the associated acute organ dysfunction Either the term sepsis or SIRS must be documented to assign a code from subcategory 995.9- ICD-10 has different guidelines each for sepsis, severe sepsis and SIRS ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

meaning urinary tract infection 599.0 Urosepsis – code to condition Urosepsis Guidelines Urosepsis cannot be coded in ICD-10-CM. Guideline states: “The term urosepsis is a nonspecific term. It is not to be considered synonymous with sepsis. It has no default code in the Alphabetic Index. Should a provider use this term, he/she must be queried for clarification.” ICD-9-CM Alpha Index Urosepsis 599.0 meaning sepsis 995.91 meaning urinary tract infection 599.0 ICD-10-CM Alpha Index Urosepsis – code to condition ICD-9 to ICD-10 Prep 01-13-15

Sepsis documentation to look for… Or query MD for… Streptococcal sepsis 995.91, 041.00 [A40.9] Sepsis d/t Staphylococcus aureus 995.91, 041.11 [A41.01] Sepsis d/t other Gram-negative organisms 995.91, 041.85 [A41.5] Severe sepsis 995.92 [R65.20] Sepsis d/t MRSA 995.91, 041.12 [A41.02] Sepsis d/t MSSA 995.91, 041.11 [A41.01] d/t joint prosthesis (complication) 996.66, V43.6- [T84.5-] d/t indwelling catheter (complication) 996.64 [T83.51] Other organism?? Remember, code 1st underlying infection… ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Severe Sepsis Coding Example ICD-9-CM Severe sepsis due to hemophilus influenza with septic shock and acute renal failure 038.41 (Hemophilus influenza septicemia) 995.92 (Severe sepsis) 785.52 (Septic shock) 584.9 (Acute renal failure) ICD-10-CM A41.3 (Hemophilus influenza sepsis) R65.21 (Severe sepsis with septic shock) N17.9 (Acute renal failure) ICD-9 to ICD-10 Prep 01-13-15

Coding Note: In ICD-9-CM, when coding an infection due to an indwelling urinary catheter, the coding professional is instructed to use an additional code to identify the infection (besides coding the complication 996.31). Additionally, if the infectious agent is also known, this should be assigned as an additional diagnosis. ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Methicillin Resistant Staphylococcus Aureus (MRSA) Conditions Selection and sequencing of MRSA codes (a) Combination codes for MRSA infection – when an infection due to MRSA has a combination code that includes the causal organism (e.g. sepsis, pneumonia) assign the appropriate combination code for the condition Do not code 041.12/B95.62 MRSA infection as the cause of diseases elsewhere or V09.0/Z16.11 Resistance to penicillin as additional codes (b) Other codes for MRSA infection – when there is a current infection and that infection does not have a combination code that includes the causal organism, assign the appropriate code to identify the condition along with code 041.12/B95.62 Do not use V09.0/Z16.11 Resistance to penicillin a. B95.62 is not needed because the combination code already includes the type of infection AND the MRSA organism. ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Methicillin Resistant Staphylococcus Aureus (MRSA) Conditions -2 Other codes for MRSA infection c) Methicillin susceptible Staphylococcus aureus (MSSA) and MRSA colonization- means that MSSA or MSRA is present on or in the body without necessarily causing illness Assign code V02.54/Z22.322 Carrier or suspected carrier of MRSA, or V02.53/Z22.321 Carrier or suspected carrier of MSSA MRSA colonization status is fairly common on documentation from your acute hospital since they might be testing everyone for this upon admission to the hospital ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Neoplasms ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

General Neoplasm Guidelines The Neoplasm Table in the Alphabetic Index should be referenced first. However, if the histological term is documented, that term should be referenced first, rather than going immediately to the Neoplasm Table, in order to determine which column in the Neoplasm Table is appropriate. Example: Epidermoid, in situ, Bowen’s type see Neoplasm, skin, in situ ICD-9 to ICD-10 Prep 01-13-15

Neoplasm Table Explain each column in following slides… ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Neoplasm Table -2 Malignant – Primary Original site of cancer 2 primary sites may be coded, if indicated Alphabetic Instructions will indicate if malignant Primary site unknown or unspecified Use 199.1/C80.1, Malignant (primary) neoplasm, unspecified ICD-9 to ICD-10 Prep 01-13-15

Neoplasm Table -3 Malignant – Secondary The site where the cancer spreads to (metastasizes) Primary cancer that spreads to a secondary site may be stated as: Primary site with metastasis to secondary site Secondary site with metastasis from primary site Secondary site due to metastatic primary site If secondary site unknown - use 199.1/C79.9, secondary malignant neoplasm of unspecified site ICD-9 to ICD-10 Prep 01-13-15

Neoplasm Table -4 Ca in situ Benign Atypical malignancy; encapsulated – has not spread Physician must indicate “in situ” or index will instruct you to code this type Benign Not malignant Does not metastasize ICD-9 to ICD-10 Prep 01-13-15

Neoplasm Table -5 Uncertain Unspecified Behavior Alphabetic index will instruct to use this type if appropriate – See neoplasm, by site, uncertain behavior Not used if it is the coder that is uncertain of the behavior Unspecified Behavior Not specified as malignant or benign Index instructions will direct here as appropriate – See neoplasm, by site, unspecified behavior ICD-9 to ICD-10 Prep 01-13-15

Current vs. History of Neoplasm is coded as a current condition if being actively treated Diagnosed but no treatment administered Has been removed surgically but treatment is still being administered (for example, chemotherapy/radiation) Neoplasm is coded as a “history of” if Site has ben surgically removed and/or treatment has been completed AND There is no mention of recurrence Use V10/Z85 category to indicate a personal history of neoplasm Usually I find that facilities code the cancer as current, when upon further review of the chart, the tumor was removed or treated years ago…in which case hx of should be coded ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Anemia Defined A condition in which your blood has a reduced number of circulating red blood cells usually defined as an abnormally low hemoglobin or hematocrit level. Caused by: Disease (malignancy, kidney failure, immunity) Blood loss Decreased blood formation or destruction of cells Nutritional Deficiency Drug induced types on next slide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Anemia -2 Specified type General = unspecified Acquired hemolytic *caused by high rates of red blood cell destruction Chronic blood loss *such as chronic posthemorrhagic anemia Iron *fewer red blood cells made or red blood cells that are too small Nutritional *such as simple chronic anemia In chronic diseases *such as neoplastic disease, CKD, hypothyroidism Common codes on next slide ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Anemia, Due to 280.0/D50.0 – Iron deficiency secondary to blood loss (chronic blood loss) 280.9/D50.9 – Iron deficiency Anemia 281.1/D51.0 – Vitamin B12 deficiency anemia 281.4/D53.0 – Protein deficiency anemia 285.1/D62 – Acute blood loss 285.21/D63.1 – Anemia in chronic kidney disease 285.22/D63.8 – Anemia in neoplastic disease 285.3/D64.81 – Anemia due to antineoplastic chemotherapy ICD-9 to ICD-10 Prep 01-13-15

ENDOCRINE, NUTRITIONAL AND METABOLIC DISEASES

Diabetes Combination Codes Documentation needs to include type of diabetes Type I Type II Secondary Other specified Is there a body system affected: Kidney Ophthalmic Neurological Circulatory Other specified (diabetic ulcer, etc.) Discuss how to look up…diabetes, type, complication -need two codes if complication: one for DM indicating affected body system 250.4- DM w/renal manifestations one to id specific manifestation 585.- CKD ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Diabetes Combination Codes -2 What is the specific complication affecting the system(s)? Note one new categories of diabetes. Discuss how to look up…diabetes, type, complication ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

What’s the difference? DIABETES TYPE I DIABETES TYPE II Differences on next slide… ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Diabetes Types Age Not Sole Factor Determining Type Diabetes, Type I Cause: Absent or insufficient insulin production 10% of diabetics Usually juvenile onset Does not respond to oral anti-glycemic agents Always requires insulin Diabetes, Type II Cause: Improper utilization of insulin 90% adult onset (age 40>, but being seen more in younger population) Responds to oral anti-glycemic agents May require insulin American Diabetes Asso lobbied yrs ago and had “insulin dependent” vs “non-insulin dep” terminology changed The terms “juvenile” and “adult onset” have also changed to just type I and type II as there are now many cases of juveniles with type II DM ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Secondary Diabetes – ICD-9 Code 249.- Due to another underlying condition Cystic Fibrosis Malignant Neoplasm of Pancreas Pancreatectomy Drug or chemical induced Adverse effect of drug Poisoning *Follow coding directions at the beginning of each category! 249 category in ICD-9 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Diabetes Type Not Documented? Default = Type II Diabetes DEFAULT Or physician query… ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Q: Do I always use an additional code for long term use of insulin when ordered? A: No ICD-9 to ICD-10 Prep 01-13-15

Diabetes and Long Term Use of Insulin – V58.67/Z79.4 Type I: Do NOT code long term use of insulin Type II: Code long term use of insulin Secondary to underlying condition: Code use of insulin Drug/Chemical induced: Code use of insulin ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Obesity Obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat, and/or body water. Both terms mean that a person's weight is greater than what's considered healthy for his or her height. Type of obesity Morbid/severe 278.01/E66.01 Due to excess calories E66.09 Drug-induced obesity E66.1 Vs. Overweight (code for this too) 278.02/E66.3 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Gout Gout is a kind of arthritis. It can cause an attack of sudden burning pain, stiffness, and swelling in a joint, usually a big toe. Types: acute, chronic or secondary *ICD-10 only Idiopathic M1A.0- Lead-induced gout 984.-/M10.1- Drug-induced gout M10.2- Due to renal impairment 274.1-/M10.3- Other secondary gout M10.4- Specify joint site/laterality *ICD-10 only (shoulder, elbow, wrist, hand, hip, knee, ankle/ft) For secondary gout *code 1st associated condition Many new codes/categories for ICD10 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Dehydration The excessive loss of body water with an accompanying disruption of metabolic processes Note: make sure this is a current condition that is being actively treated upon admission to your facility, otherwise do NOT code ICD-9 to ICD-10 Prep 01-13-15

Hypothyroidism Often called underactive thyroid, it is a common endocrine disorder in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as tiredness, poor ability to tolerate cold, and weight gain Acquired 244/E03.9 or congenital 243/E03.1? Due to: Iodine deficiency 244.2/E01.8 Post-irradiation therapy 244.1/E89.0 Post-surgery 244.0/E89.0 Other specified 244.8/E03.8 ICD-9 to ICD-10 Prep 01-13-15

Hypercholesterolemia Hypercholesterolemia is the presence of high levels of cholesterol in the blood. It is a form of “hyperlipidemia" (elevated levels of lipids in the blood) and "hyperlipoproteinemia" (elevated levels of lipoproteins in the blood) 272.0/E78.0 Does documentation show: With hyperglyceridemia 272.1/E78.2 (an elevated concentration of glycerides in the blood), or With dietary counseling (use additional code) Z71.3 *ICD-10 only ICD-9 to ICD-10 Prep 01-13-15

Hyperlipidemia Abnormally elevated levels of any or all lipids and/or lipoproteins in the blood. It is the most common form of dyslipidemia (which includes any abnormal lipid levels). Specified type: Combined (also known as "Multiple-type hyperlipoproteinemia” ) 272.2/E78.2 Familial combined hyperlipidemia 272.0/E78.4 Group A (272.0/E78.0), B (272.1/E78.1), C (272.2/E78.2) or D (272.3/E78.3) Mixed 272.2/E78.2 Other specified type 272.4/E78.5 Lipoprotein deficiency 272.5/E78.0 ICD-9 to ICD-10 Prep 01-13-15

Mental and Behavioral Disorders ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Dementia Specific type Vascular/multi-infarct *a result of infarction of the brain due to vascular disease, including hypertensive cerebrovascular disease. Code 1st underlying condition (CVD, etc.) 290.40/F01.5- In diseases classified elsewhere code 1st underlying condition (Alzheimer’s, Parkinson’s, etc.) 294.1-/F02.8- Senile *separate code in ICD-9, but dementia unspecified in ICD-10 290.0/F03.9- Delirium superimposed on dementia/Sundowning 293.-/F05. Unspecified 294.2-/F03.9- Vascular dementia currently coded as uncomplicated 290.40, w/delirium 290.41, w/delusions 290.42, or w/depressed mood 290.43 -ICD10 will only be coded as with or without behavioral disturbance ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Dementia -2 With or without behavioral disturbance Aggressive, combative, violent behavior Old code 294.8 *should NOT be using anymore, invalid for coding dementia, NOS Additional code for wandering Z91.83 *ICD-10 only If psychotherapeutic drugs given, check guidelines Ongoing goal of Nat’l Partnership to Improve Dementia Care is for 25% reduction of antipsychotic meds by the end of 2015 -this group includes CMS, AHCA, AMDA, and several other partners… -initial focus on reducing use of antipsychotic meds, larger mission is to enhance the use of non-pharmacologic approaches and person-centered dementia care practices. CMS will continue to monitor the reduction of antipsychotics… ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Episodic Mood Disorders/Bipolar Disorder Episodic Mood Disorders/Bipolar Disorder *also known as Manic-depressive Illness ICD-10-CM changes: Bipolar, F31, and Major depression, F32-33, have separate categories Bipolar disorder, severe *with or without psychotic features Major depression, severe *with or without psychotic features New ability to code “with psychotic features” if severe Bipolar or Major Depression is documented ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

ICD-9 Single or Recurrent (296) Episodic Mood Disorders/Bipolar Disorder *also known as Manic-Depressive Illness -2 Specify type/subcategory If psychotherapeutic drugs given, check guidelines ICD-9 Single or Recurrent (296) Manic Depressed Mixed Other ICD-10 (F31) Hypomanic In remission ICD-9 to ICD-10 Prep 01-13-15

Major Depression Has its own category in ICD-10 – F32-33 In ICD-10, Depression, NEC (coded as 311 in ICD-9) is coded to Major depressive disorder, single episode, unspecified F32.9 Specify type: Major depressive disorder, single episode 296.2-/F32.- Major depressive disorder, recurrent 296.3-/F33.- Major depressive disorder, recurrent, in remission 296.3-/F33.4- Specify intensity: mild, moderate or severe (5th digit) If severe: with or without psychotic features If psychotherapeutic drugs given, check guidelines ICD-9 to ICD-10 Prep 01-13-15

Schizophrenia Specify type Paranoid 295.3-/F20.0 Disorganized 295.1-/F20.1 Catatonic 295.2-/F20.2 Undifferentiated *atypical 295.9-/F20.3 Residual 295.6-/F20.5 Schizophreniform disorder 295.4-/F20.81 Schizotypal disorder *types like borderline, latent, etc. 295.5-/F21. Schizoaffective disorder *types include bipolar or depressive 295.7-/F25.- Other 295.8-/F20.89 In ICD-10, 5th digit of chronic, in remission, etc. is gone If psychotherapeutic drugs given, check guidelines ICD-10 has 4th digit categories for different types of schizoaffective disorder ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Psychosis If d/t a known mental disorder, code to that condition Delusional disorder *includes paranoia, paranoid state 297.1/F22 Mood disorder w/psychotic symptoms 296.-/F39 Brief psychotic disorder *includes paranoid reaction 298.8/F23 Shared psychotic disorder *includes induced paranoid disorder 297.3/F24 Unspecified mental disorder d/t known physiological condition *includes OBS, NOS; mental disorder NOS , *code 1st underlying physiological condition 306.-/F06.- Unspecified psychosis NOT d/t known physiological condition *includes Psychosis, NOS 298.9/F29 ICD-9 to ICD-10 Prep 01-13-15

Psychosis -2 If d/t a known mental disorder, code to that condition (cont.) Other psychotic disorder NOT d/t known physiological condition *includes chronic hallucinatory psychosis F28 Mental disorder, NOS *includes mental illness, NOS 300.9/F99 If psychotherapeutic drugs given, check guidelines ICD-9 to ICD-10 Prep 01-13-15

Anxiety Specify type Panic disorder *includes panic attack, panic state 300.01/F41.0 Generalized anxiety disorder *includes anxiety reaction, anxiety state 300.02/F41.1 Other mixed anxiety disorders *suffer from both anxiety and depressive symptoms F41.3 Other specified anxiety disorders *includes anxiety depression 300.09/F41.8 If psychotherapeutic drugs given, check guidelines ICD-9 to ICD-10 Prep 01-13-15

Diseases of the Nervous System ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Hemiplegia 342.-/G81.- These codes are only to be used when the paralytic syndrome is specified w/o further specification, or is stated to be old but unspecified cause This category is also for use in multiple coding to identify the specific type of hemiplegia resulting from any cause *flaccid, spastic or other ICD-9 to ICD-10 Prep 01-13-15

Hemiplegia -2 Should the affected side be documented, but not specified as dominant or non-dominant, and the classification system does not indicate a default, code selection is as follows: For ambidextrous (using both sides equally) patient, the default should be dominant If the left side is affected, the default is non dominant If the right side is affected, the default is dominant *5th digit ICD-9 to ICD-10 Prep 01-13-15

Dementia with Parkinson’s Disease vs. Parkinsonism Parkinson's disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells *code 332.0/G20, with dementia add 294.1-/F02.- Parkinsonism shares symptoms found in Parkinson’s disease, from which it is named; but Parkinsonism is a symptom complex, and differs from Parkinson’s disease which is a progressive neurodegenerative illness *code 331.82/G31.83 *same as Lewy body dementia Parkinsonism is not synonymous with Parkinson’s disease. Parkinsonism dementia (G31.83) and dementia due to Parkinson’s disease (G20) describe different conditions. Refer to Excludes 1 note under F02 for dementia with Parkinsonism (G31.83). ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Alzheimer’s Disease 331.0/G30.- *the most common form of dementia Identify type *ICD-10 only Alzheimer’s disease with early onset G30.0 Alzheimer’s disease with late onset G30.1 Other Alzheimer’s disease G30.8 Alzheimer’s disease, unspecified G30.9 Use additional code to identify: Dementia w/behavioral disturbance 294.11/F02.81 Dementia w/o behavioral disturbance 294.10/F02.80 Delirium , if applicable 293.0/F05 *ICD-10 requires the use of both the Alzheimer and dementia codes ICD-9 to ICD-10 Prep 01-13-15

Seizure Disorder vs. Convulsions Epilepsy/seizure disorder is a spectrum of brain disorders ranging from severe, life-threatening and disabling, to ones that are much more benign Convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body If seizures repeatedly continue after the underlying problem is treated, the condition is called epilepsy (resident is usually on a routine med for seizures) ICD-9 to ICD-10 Prep 01-13-15

Epilepsy, Recurrent Seizures and Migraines The following terms are equivalent to intractable: pharmacoresistent (pharmacologically resistant), treatment resistant, refractory (medically), and poorly controlled. ICD-9 to ICD-10 Prep 01-13-15

Coding of Epilepsy Identify if epilepsy, seizure disorder, or convulsion, NOS 345.- vs. 780.39 (G40.909 vs. R56.9) Specify type Intractable (poorly controlled) Not intractable With status epilepticus (a life-threatening condition in which the brain is in a state of persistent seizure) *ICD-10 expanded category Without status epilepticus *ICD-10 expanded category Intractable/not intractable is a 5th digit subclassification in ICD-9 Status epilepticus in ICD-9 is listed as a grand mal seizure, in ICD-10 need to know for every epilepsy code ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Neuropathy 355.9/G62.9 vs. Peripheral Neuropathy 356.9/G62.9 Specify type Polyneuropathy in diseases classified elsewhere 357.-/G63 ICD-9 In diabetes 250.6- + 357.2 In malignant disease CA code + 357.3 ICD-10 In diabetes, type 2 E11.42 With neoplasm code CA + G63 ICD-9 to ICD-10 Prep 01-13-15

Diseases of the Eye and adnexa ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Combination Codes & Laterality ICD-9-CM Diabetic Retinopathy with Macular Degeneration needs three codes: 250.50, 362.01, 362.50 Cystic Macular Degeneration 362.54 ICD-10-CM (combination codes) Diabetic Retinopathy with Macular Degeneration uses a combination code: E08.351 Laterality: Macular cyst, hole, right eye H35.341 ICD-9 to ICD-10 Prep 01-13-15

ICD-10 Glaucoma Coding Changes Identify the type of glaucoma, the affected eye, and the glaucoma stage. A 7th character is to be assigned to designate the stage of glaucoma: mild, moderate, severe, indeterminate, or unspecified ICD-9 to ICD-10 Prep 01-13-15

Coding Note for Glaucoma Use additional external cause code, if applicable, to identify the cause of the eye condition Glaucoma types: Borderline glaucoma 365.0-/H40.0- Open-angle glaucoma 365.1-/H40.1- Primary angle-closure glaucoma 365.2-/H40.2 Corticosteroid-induced glaucoma 365.3- Glaucoma asso w/congenital anomalies, dystrophies, and systemic syndromes 365.4-/H42 *includes glaucoma d/t diabetes 250.50, 365.44 Glaucoma associated with disorders of the lens 365.5- Glaucoma associated with other ocular disorders 365.6-/H40.5- Other specified forms of glaucoma 365.8-/H40.8- *ICD-10 – new categories: H40.3- Glaucoma secondary to eye trauma H40.4- Glaucoma secondary to eye inflammation H40.6- Glaucoma secondary to drugs *Where do you get this information from? Ask your eye doctors to clarify ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Cataract Terms 366.-/H25-26 ICD-10 CM uses the terms “age-related” cataract and “senile cataract” interchangeably. There are also terms for “age-related”, “infantile & juvenile cataract”, “traumatic cataract”, “complicated cataract”, “drug-induced cataract”, and “secondary cataract”. Within the age-related/senile category there are cortical, subcapsular, incipient, nuclear, and morgagnian cataracts. *Similar terminology to ICD-9 ICD-9 to ICD-10 Prep 01-13-15

Blindness and Low Vision Coding Notes Visual impairment refers to a functional limitation of the eye. Visual disability indicates a limitation of the abilities of the individual. For international reporting, WHO, defines blindness as profound impairment. This definition can apply to blindness of one eye or both eyes. For determination of benefits in the USA, the definition of legal blindness as severe impairment is often used. This definition applies to blindness of the individual only. 369.-/H54.- ICD-9 to ICD-10 Prep 01-13-15

ICD-10 Terms for Blindness In the case of blindness, the code H54 has a note: Code first any associated underlying cause of blindness. Blindness codes include laterality. Example: H54.52, which is low vision left eye, normal vision right eye. ICD-9 to ICD-10 Prep 01-13-15

Diseases of the Circulatory System ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Cardiac dysrhythmias 427.0/I47.1 Paroxysmal supraventricular tachycardia 427.1/I47.2 Paroxysmal ventricular tachycardia 427.2/I47.9 Paroxysmal tachycardia, unspecified 427.3-/I48.- Atrial fibrillation and flutter *ICD-10 Includes a code for chronic a-fib 427.4-/I49.0- Ventricular fibrillation and flutter 427.5/I46.9 Cardiac arrest 427.6-/I49.- Premature beats 427.8-/I49.- Other specified cardiac dysrhythmias Sick sinus syndrome ICD-9 to ICD-10 Prep 01-13-15

Heart Failure 428.0/I50.9 Congestive heart failure, unspecified 428.1/I50.1 Left heart failure 428.2-/I50.2- Systolic heart failure ** 428.3-/I50.3- Diastolic heart failure ** 428.4-/I50.4- Combined systolic and diastolic heart failure ** Code, if applicable, heart failure d/t HTN 1st *if supporting MD documentation **also need to know if acute, chronic or acute on chronic ICD-9 to ICD-10 Prep 01-13-15

Acute Myocardial Infarction (AMI) Myocardial infarction or acute myocardial infarction (AMI) is the medical term for an event commonly known as a heart attack. It happens when blood stops flowing properly to part of the heart and the heart muscles are injured due to not receiving enough oxygen. ICD-9 to ICD-10 Prep 01-13-15

Acute Myocardial Infarction (AMI) -2 Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to a buildup of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden and serious ICD-9 to ICD-10 Prep 01-13-15

Acute MI – 410.-/I21.- ICD-10 Coding: ICD-9 Coding: ST elevation (STEMI) or non-ST elevation (NSTEMI)? Occurred 8 weeks or less for acute MI/410.- 5th digit needed for acute MI/410.-- 2 = Subsequent episode of care *appropriate code for SNF, if treated 1st at hospital If MI > 8 wks old, code 412. ICD-10 Coding: I21 – Initial AMIs I22 – Subsequent AMIs Occurred 4 weeks/28 days or less for acute MI ICD-9 coding of acute MI/410.— -5th digit choices: 0 = episode of care unspecified 1 = initial episode of care 2 = subsequent episode of care ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Atherosclerotic Coronary Artery Disease and Angina Atherosclerosis (hardening of the arteries) can slowly narrow and harden the arteries throughout the body when atherosclerosis affects the arteries of the heart, it’s referred to as coronary artery disease Coronary artery disease is the No. 1 killer of Americans. Most of these deaths are from heart attacks, caused by sudden blood clots in the heart’s arteries. ICD-9 to ICD-10 Prep 01-13-15

Atherosclerotic Coronary Artery Disease and Angina Atherosclerosis is a blood clot causing an acute coronary syndrome. Two things can happen: Unstable angina - the clot doesn't totally block the blood vessel and then dissolves without causing a heart attack Myocardial infarction (heart attack) - the coronary artery is blocked by the clot the heart muscle, starved for nutrients and oxygen, dies ICD-9 to ICD-10 Prep 01-13-15

Coding Coronary Artery Disease/CAD Should be coding to 414.00/I25.10, unless MD specifies otherwise Differentiate between coding of coronary arteries 414/I25.- or of the extremities 440/I70.-- ICD-9 to ICD-10 Prep 01-13-15

ICD-10 Coding of Arteriosclerosis of the Heart I25 4th digit Vessel: Native, bypass graft, autologous vein bypass graft, non- autologous biological bypass graft, non-biological bypass graft 5th digit Symptom: claudication, rest pain, ulcer and with gangrene. 6th digit Extremities: right, left, bilateral, other, unspecified Site of leg: thigh, calf, ankle, heel, mid-foot, foot, other. *ICD-10 will also have a combination code for CAD with angina I25.11 ICD-9 to ICD-10 Prep 01-13-15

Cerebrovascular System ICD-9 to ICD-10 Prep 01-13-15

CVA Versus TIA CVA Brain infarction or hemorrhage usually associated with permanent or temporary neurologic deficits; includes transient focal neurological deficits lasting longer than 24 hours Persistent neurological deficit >24 hours Positive image study (MRI/CT) TIA A brief period of focal neurologic deficit lasting less than 24 hours (usually less than one hour) due to temporarily blocked blood flow to a specific area of the brain Symptoms resolve in 24 hours (usually < 1 hour) No infarction or hemorrhage Negative MRI/CT ICD-9 to ICD-10 Prep 01-13-15

Coding Late Effects of Cerebrovascular Disease 438.-/I69.- Once cerebrovascular disease/CVD has been treated at the hospital, just the late effects/sequelae are being treated, if any. Category 438/I69.- is used to indicate conditions/residuals that have occurred any time after the onset of CVD. Use a separate code for each residual effect. Should NOT be using codes from 430-437/I60-I67 if the late effects are being treated. If no residual/late effects should code V12.54/Z86.73 CVD includes all types of cerebrovascular disease, including all cerebral hemorrhages, occlusions and any other cerebrovascular disease In post acute care you are treating the late effects of the cerebrovascular disease, code appropriate 438.- code/s, not codes from 430-437 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Hypertension Hypertension, also referred to as high blood pressure, it is a condition in which the arteries have persistently elevated blood pressure. Every time the human heart beats, it pumps blood to the whole body through the arteries. ICD-9 to ICD-10 Prep 01-13-15

ICD-10 Hypertension Coding Changes Type of hypertension (benign, malignant, unspecified) is not used as an axis for the ICD-10-CM hypertension codes, there is only one code for essential hypertension (I10) ICD-9 to ICD-10 Prep 01-13-15

Types of Hypertension 401/I10 Essential hypertension 402/I11 Hypertensive heart disease *MD must document causal relationship 403/I12 Hypertensive chronic kidney disease *implied relationship if both diagnoses documented, also need to code CKD to indicate the stage 585.- 404/I13 Hypertensive heart and chronic kidney disease *if resident has all three diagnoses/AKA cardiorenal – MD must still indicate heart dx and hypertension have causal relationship 405/I15 Secondary hypertension *is high blood pressure that's caused by another medical condition ICD-9 to ICD-10 Prep 01-13-15

Peripheral Vascular Disease 443.81/I73.9 Peripheral angiopathy in diseases classified elsewhere *code 1st underlying disease 443.9/I73.9 Peripheral/arterial/vascular disease *ICD-10 will have a combo code for DM w/PVD *Excludes atherosclerosis of the extremities ICD-9 to ICD-10 Prep 01-13-15

Venous Embolism and Thrombosis 453.40/I82.40- DVT, NOS coded to acute venous embolism and thrombosis of deep vessels of the lower extremity 453.41/I82.4Y- (acute), I82.5Y- (chronic) DVT of proximal lower extremity 453.42/I82.4Z- (acute), I82.5Z- (chronic) DVT of distal lower extremity 453.5-/I82.50- Chronic DVT *also code V58.61/Z70.01 for long term use of anticoagulants *if vein specified, make sure you have the correct code *make sure treatment is currently being given and is NOT for prophylactic measures (Coumadin tx) *if no current treatment given, code V12.51/Z86.718 for hx of DVT ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Diseases of the Respiratory System National Cancer Institute ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Asthma Terminology for ICD-10 Terminology used to describe asthma has been updated to reflect the current clinical classification of asthma The following terms have been added to describe asthma: Mild intermittent, and Three degrees of persistent mild, moderate, severe ICD-9 to ICD-10 Prep 01-13-15

Asthma Symptoms – Coding for ICD-10 Stage 1: mild / J45.2- thru J45.3- Possible chronic cough and sputum production Stage 2: moderate / J45.4- Shortness of breath on exertion Stage 3: Severe / J45.5- Shortness of breath Fatigue Multiple exacerbations Reduced exercise tolerance Stage IV: Very severe / J45.5- Respiratory failure Elevation of jugular venous pressure Pitting ankle edema. GOLD = Global Initiative for Obstructive Lung dx Worldallergy.org ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Current ICD-9 Coding for Asthma 493.0- Extrinsic asthma *or allergic asthma, is characterized by symptoms that are triggered by an allergic reaction 493.1- Intrinsic asthma *a nonseasonal, nonallergic form of asthma, which usually first occurs later in life than allergic asthma and tends to be chronic and persistent rather than episodic 493.2- Chronic obstructive asthma *includes asthma w/COPD and chronic asthmatic bronchitis 5th digit for: Status asthmaticus, and Acute exacerbation ICD-9 to ICD-10 Prep 01-13-15

Pneumonia Remember, if you know the organism code it! Default code = 486/J18.9 Pneumonia, unspecified organism 480-/J12.9 Viral pneumonia 481/J13 Pneumococcal pneumonia (includes lobar) 482-/J15.9 Other bacterial pneumonia 483-/J15.8 Pneumonia d/t other specified organism 484-/* Pneumonia in infectious disease classified elsewhere 485/J18.0 Bronchopneumonia, organism unspecified 507.0/J69.0 Aspiration pneumonia d/t inhalation food/vomitus *in ICD-10 no general code for “PNA in dx classified elsewhere” code to specific dx w/PNA ICD-9 to ICD-10 Prep 01-13-15

COPD – 496/J44.9 This code is not to be used with any code from categories 491.- 493. (bronchitis, emphysema, asthma) *ICD-9 only COPD w/emphysema 492.8/J44.9 COPD w/bronchitis: Acute 491.22/J44.0 Chronic 491.20/J42 COPD w/acute exacerbation 491.21/J44.1 ICD-9 to ICD-10 Prep 01-13-15

Other Diseases of the Lung – 518.8-/J98.4 Acute respiratory failure 518.81/J96.0- -can develop quickly and may require emergency treatment and is usually treated in an intensive care unit Acute respiratory insufficiency 518.82/R06.89 -condition in which the lungs cannot take in sufficient oxygen or expel sufficient carbon dioxide to meet the needs of the cells of the body Chronic respiratory failure 518.83/J96.1 -develops more slowly and lasts longer. Chronic respiratory failure can be treated at home or at a long-term care center Acute and chronic respiratory failure 518.84/J96.2 -pt exhibits severe pulmonary impairment as a baseline characteristic which may require hospitalization and mechanical ventilation In ICD-10, no code for ACUTE respiratory insufficiency – resp insuff is coded to signs/symptoms code for abnormal breathing ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Diseases of the Digestive System National Cancer Institute ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Esophageal Reflux Disease 530.81/K21.9 Esophageal reflux/GERD Includes acid reflux Excludes reflux esophagitis 530.11/K21.0 Excludes hemorrhage d/t esophageal varices 456/I85.01 Reflux esophagitis 530.11/K21.0 ICD-9 to ICD-10 Prep 01-13-15

Constipation 564.0-/K59.00 Constipation Slow transit 564.01/K59.01 -there is a prolonged delay in the transit of stool through the colon Outlet dysfunction 564.02/K59.02 -difficulty or inability to expel the stool Other 564.09/K59.09 -atonic, neurogenic, spastic Irritable bowel syndrome 564.1/K58.- -sometimes alternating bouts of constipation and diarrhea *ICD-10 includes 5th digit with or without diarrhea ICD-9 to ICD-10 Prep 01-13-15

Gastrointestinal Hemorrhage Hematemesis 578.0/K92.0 -vomiting of blood *ICD-10 with ulcer, code by site under ulcer w/hemorrhage, K27.4 Blood in stool 578.1/K92.1 -melena Hemorrhage of GI tract, unspecified 578.9/K92.2 Excludes: that with mention of: diverticulitis of lg and sm intestine 562.13/K57.9-, diverticulosis of lg and sm intestine 562.12/K57.9-, Gastritis 535.--/K29.71 and duodenitis 535.--/K29.81, and stomach ulcers 531.4/K25.4 If type of stomach ulcer specified, ie duodenal, peptic, or gastrojejunal – code to that site ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Diseases of the Skin and Subcutaneous Tissue National Cancer Institute ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Cellulitis and Abscess Face 682.0/L03.211 Neck 682.1/L03.221 Trunk 682.2/L03.319 Upper arm/forearm 682.3/L03.11- *code laterality Hand, except fingers and thumb 682.4/L03.11- Buttock 682.5/L03.317 Leg, except foot 682.6/L03.11- *code laterality Foot, except toes 682.7/L03.11- *code laterality Other specified sites 682.8/L03.818 Unspecified site 682.9/L03.90 Use additional code to identify organism ICD-10 with MORE specific sites (axilla, abd wall, back, chest wall, groin, etc) AND laterality ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Chronic Ulcer of Skin Pressure ulcer 707.0-/L89.--- (elbow, upper back, lower back, hip, buttock, ankle, heel, other) *ICD-10 5th digit = site w/laterality, 6th digit = stage Ulcer of lower limb, except pressure ulcer 707.1-/L98.4-- (lower limb, thigh, calf, ankle, heel and midfoot, other part of ft) *code any causal condition first Pressure ulcer stages (I-IV, unstageable) 707.2-/L89.--- *must use this code after coding 707.0- in ICD-9 should NOT be using an “unspecified site” code 707.9 Causal conditions can include: atherosclerosis of extremities, chronic venous HTN, DM ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

VISUAL GUIDE TO SOME FREQUENTLY SEEN SKIN PROBLEMS NCHS Coding Guidelines page 48 - 49 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

A pressure ulcer results when there is localized damage ro the skin and underlying tissue as a result of compression between a bony prominence and an external surface. Damage is caused by the force of pressure, shear, and friction acting individually or in combination with each other. Stage I: Skin is intact with an area of nonblanching erythema. This is usually over a bony prominence. Pressure Ulcer Stage I ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Pressure Ulcer Stage II Stage II: Partial thickness skin loss with loss of epidermis and some of the dermis. It appears as a shallow ulcer with a red-pink color. No slough or necrotic tissue is present in the base. It may also appear as an enclosed or open serum-filled blister. Pressure Ulcer Stage II ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Pressure Ulcer Stage III Stage III: Full-thickness loss of skin with the epidermis and dermis gone and damage to or necrosis of subcutaneous tissues. Damage extends down to but not through the underlying fascia. Subcutaneous fat may be visible, but muscle, tendon, or bone is not seen. Tunneling or undermining may be present. Pressure Ulcer Stage III ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Pressure Ulcer Stage IV Stage IV: Full-thickness loss of skin with extensive destruction, tissue necrosis. And damage to bone, muscle or other supporting structures that are exposed. Pressure Ulcer Stage IV ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Suspected Deep Tissue Injury Suspected Deep Tissue Injury: Area of localized, discolored intact skin that is purple or maroon-red in color. It may also appear as a blood filled blister resulting from damage to underlying soft tissue. Preceding skin changes may include skin that is painful, firm, boggy or that has a different temperature compared to the surrounding skin. Suspected Deep Tissue Injury ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Unstageable Pressure Ulcer Unstageable Pressure Ulcer: Full-tissue thickness loss in which the base of the ulcer is covered by slough or an eschar and, therefore, the true depth of the damage cannot be estimated until these are removed. Unstageable Pressure Ulcer ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Diabetic foot ulcers occur as a result of various factors, such as mechanical changes in conformation of the bony architecture of the foot, peripheral neuropathy, and atherosclerotic peripheral arterial disease, all of which occur with higher frequency and intensity in the diabetic population. Nonenzymatic glycosylation predisposes ligaments to stiffness. Neuropathy causes loss of protective sensation and loss of coordination of muscle groups in the foot and leg, both of which increase mechanical stresses during ambulation. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. Diabetes is the leading cause of nontraumatic lower extremity amputations in the United States, with approximately 5% of diabetics developing foot ulcers each year and 1% requiring amputations. Physical examination of the extremity having a diabetic ulcer can be divided into examination of the ulcer and the general condition of the extremity, assessment of the possibility of vascular insufficiency, and assessment for the possibility of peripheral neuropathy. A vascular surgeon and/or podiatric surgeon should evaluate all patients with diabetic foot ulcers so as to determine the need for debridement, revisional surgery on bony architecture, vascular reconstruction, or soft tissue coverage. Diabetic Ulcer ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Vascular Ulcers Vascular Ulcers: A skin ulcer is a type of wound that develops on the skin. A venous skin ulcer is a shallow wound that occurs when the leg veins don't return blood back toward the heart the way they should. This is called venous insufficiency. See a picture of abnormal blood flow caused by venous insufficiency. These ulcers usually form on the sides of the lower leg, above the ankle and below the calf. Venous skin ulcers are slow to heal and often come back if you don't take steps to prevent them. ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Cellulitis is a common bacterial skin infection Cellulitis is a common bacterial skin infection. Cellulitis may first appear as a red, swollen area that feels hot and tender to the touch. The redness and swelling often spread rapidly. Cellulitis is usually painful. In most cases, the skin on the lower legs is affected, although the infection can occur anywhere on the body or face. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burns, insect bites, surgical wounds, intravenous drug injection sites or sites of intravenous catheter insertion. Cellulitis ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Diseases of the Musculoskeletal System and Connective Tissue ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Arthropathy vs. Arthritis vs. Osteoarthritis Arthropathy = disease of the joints Arthritis = inflammation of the joints Osteoarthritis = degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth Arthritis is a form of Arthropathy In ICD-9, Arthritis is coded 716.- and Osteoarthritis is coded 715.- In ICD-10, Arthritis and Osteoarthritis will have the same unspecified code M19.90 ICD-9 to ICD-10 Prep 01-13-15

Osteoarthritis/OA/DJD Osteoarthritis, generalized 715.0-/M15.9 Osteoarthritis, localized, primary 715.1-/M19.91 Osteoarthritis, localized, secondary 715.2-/M19.93 Osteoarthritis, localized, not specified whether primary or secondary 715.3-/M19.90 Osteoarthritis involving, or with mention of more than one site/polyosteoarthritis 715.8-/M15.- Osteoarthritis, unspecified whether generalized or localized 715.9-/M19.90 ICD-10 codes listed are for unspecified sites ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

5th digits for Osteoarthritis 0 – site unspecified 1 – shoulder region 2 – upper arm *use for elbow 3 – forearm *use for wrist 4 – hand 5 – pelvic region and thigh *use for hip 6 – lower leg *use for knee 7 – ankle and foot 8 – other specified sites 9 – multiple sites *ICD-10 will only list joint sites and will also need laterality ICD-9 to ICD-10 Prep 01-13-15

Other Derangement of Joint Loose body in joint 718.1-/M24.0-- *Loose bodies are fragments of bone and/or cartilage that freely float in the joint space Recurrent dislocation of joint 718.3-/injury code depends on site for ICD-10 Contracture of joint 718.4-/M24.5-- *a permanent shortening of a joint Ankylosis of joint 718.5-/M24.6-- *stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint, which may be the result of injury or disease Other joint derangement, NEC 718.8-/M24.8-- *instability of joint ICD-10 – will also need laterality for these codes ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Osteoporosis Osteoporosis, unspecified 733.00/M81.0 Senile osteoporosis 733.01/M81.0 *a geriatric syndrome with a particular pathophysiology Disuse osteoporosis 733.03/M81.8 *bone loss that results from not enough stress or pressure on the bones. Bones become brittle and weak, causing them to fracture easily. In ICD-10, will code osteoporosis with or without current pathologic fracture Use additional code to identify personal hx of pathologic fracture V13.51/Z87.311 ICD-9 to ICD-10 Prep 01-13-15

Pathologic Fracture Terms Spontaneous fracture Occurs in seemingly normal bones with no apparent blunt-force trauma Fragility fracture Sustained with trauma no more than a fall from a standing height or less occurring under circumstances that would not cause a fracture in a normal healthy bone ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Pathologic Fracture Sites Pathologic fracture of humerus V54.21/M84.42- Pathologic fracture of distal radius/ulna V54.22/M84.43- Pathologic fracture of vertebrae V54.27/M84.48 Pathologic fracture of neck of femur V54.23/M84.45- Includes aftercare for healing pathologic fracture Includes chronic fracture, spontaneous fracture Excludes aftercare following joint replacement V54.81 Excludes stress fracture, traumatic fracture *ICD-10 6th digit = laterality ICD-9 to ICD-10 Prep 01-13-15

Other and Unspecified Disorders of Joint/Gait disorders Difficulty in walking 719.7/R26.2 -in ICD-10, Excludes falling R29.6 Unsteadiness on feet R26.81 Abnormality of gait/ataxic/gait disturbance/paralytic/spastic/staggering gait 781.2/R26.9 -in ICD-10, separate code for ataxic gait R26.0, paralytic gait R26.1 ICD-9 to ICD-10 Prep 01-13-15

Other Disorders of the Back/Dorsalgia Pain in thoracic spine 724.1/M54.6 Lumbago/low back pain 724.2/M54.5 Sciatica 724.3/M54.4- *neuralgia or neuritis of sciatic nerve Backache/back pain 724.5/M54.9 Category name change in ICD-10 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Disorder of Muscle, Ligament, and Fascia/Other Disorders of Muscle Muscle weakness (generalized) 728.87/M62.81 *different than generalized weakness/malaise and fatigue 780.79/R53.1 Muscular wasting and disuse atrophy 728.2/M62.5- *in ICD-10, extra digits for site and laterality Other specific muscle disorders 728.3/M62.89 In ICD-10, category for disorders of muscle in diseases classified elsewhere M63 *includes dx such as: neoplasm ICD-9 to ICD-10 Prep 01-13-15

Diseases of the Genitourinary System National Cancer Institute Alan Hoofring ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Acute and Chronic Kidney Failure Acute kidney failure 584/N17 - develops rapidly over a few hours or a few days, can be fatal and requires intensive treatment. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care. Chronic kidney disease/CKD 585/N18 4th digit for stage ESRD is 585.6/N18.6 *code first any associated condition: diabetic chronic kidney disease 250.4-/E08-E13 hypertensive chronic kidney disease 403-404/I12-I13 Renal failure, unspecified 586/N19 Acute kidney failure is the rapid  loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your body. In this case, rapid means less than 2 days. There are many possible causes of kidney damage. They include: Acute tubular necrosis (ATN) Autoimmune kidney disease Blood clot from cholesterol (cholesterol emboli) Decreased blood flow due to very low blood pressure, which can result from: Burns Dehydration Hemorrhage Injury Septic shock Serious illness Surgery Disorders that cause clotting within the kidney's blood vessels Infections that directly injure the kidney, such as: Acute pyelonephritis Septicemia Urinary tract blockage *usually, you have to stay overnight in the hospital for treatment. ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Stages of Chronic Kidney Disease/CKD CKD, Stage 1 585.2/N18.2 CKD, Stage 2 (mild) 585.3/N18.3 CKD, Stage 3 (moderate) 585.4/N18.4 CKD, Stage 4 (severe) 585.5/N18.5 CKD, Stage 5 585.6/N18.6 End Stage Renal Disease (CKD requiring chronic dialysis) ICD 10 classifies CKD based on severity. The severity of CKD is designated by stages 1 – 5, and ESRD. N18.6 or ESRD is coded when the provider has documented end-stage renal disease (ESRD) If both the stage of the CKD and ESRD are documented assign code N18.6. If the patient is on renal dialysis the appropriate code is N18.6 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Urinary Tract Infection 599.0/N39.0 is the code for site not specified, if site is known this would be an incorrect code: -bladder – see cystitis 595.-/N30.- -kidney – see infection, kidney 590.-/N15.9 -urethra – see urethritis 597.-/N34.- Use additional code to identify organism, if known B95-B97 = bacterial or viral infectious agent ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Hyperplasia/Enlarged Prostate Benign prostatic hyperplasia/BPH is the same as enlarged prostate 600.0-/N40.0-N40.1 Subcategories for enlarged and nodular: Enlarged prostate without lower urinary tract symptoms/LUTS 600.00/N40.0 -incomplete bladder emptying, nocturia, straining on urination, urinary freq, urinary hesitancy, urinary incont, urinary obstruction, urinary retention, urinary urgency weak urinary stream Enlarged prostate with LUTS 600.01/N40.1 Nodular prostate without LUTS 600.10/N40.2 -nodular = a "bump" that can be felt in the prostate Nodular prostate with LUTS 600.11/N40.3 BPH, NOS = N40.0 LUTS = lower urinary tract symptoms *if symptoms, note to use additional code for associated symptoms, if specified -incomplete bladder emptying, nocturia, straining on urination, urinary freq, urinary hesitancy, urinary incont, urinary obstruction, urinary retention, urinary urgency weak urinary stream ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Symptoms, Signs and Abnormal Clinical and Laboratory Findings ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Codes Used For ICD-9 to ICD-10 Prep 01-13-15 a No more specific diagnosis can be made even after all facts have been investigated b Signs or symptoms existing at time of initial encounter - transient and causes not determined c Provisional diagnosis in patient failing to return d Referred elsewhere before diagnosis made e More precise diagnosis not available f Certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right ICD-9 to ICD-10 Prep 01-13-15

Signs and symptoms associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the code book. Examples: SOB in COPD Edema in CHF Fever in strep throat Urinary urgency in UTI In LTC, often symptoms are used as therapy treatment diagnoses. Code as long as therapy is treating. ICD-9 to ICD-10 Prep 01-13-15

Superficial injuries, such as abrasions or contusions are not coded when associated with more severe injuries of the same site. ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Coding from Lab/X-Ray Reports Attending physician must document the significance of any abnormal finding Can use lab/x-ray reports to further define documented diagnoses, but not to code a new diagnosis when the provider has not documented ICD-9 to ICD-10 Prep 01-13-15

Common Signs and Symptoms Syncope and collapse/fainting 780.2/R55 Other malaise and fatigue/gen. weakness 780.79/R53.1 Debility 799.3/R53.81 *weak and feeble Generalized pain, pain NOS 780.96/R52 *site? Altered mental status 780.97/R41.82 *on ER report Other general symptoms 780.99/R68.89 *?? Adult failure to thrive 783.7/R62.7 *a descriptive, non- specific term that encompasses "not doing well" Edema, unspecified 782.3/R60.9 *is the s/s code approx. or should we be coding the dx that caused it? Is s/s code giving more specific pertinent info about the pt? ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Common Signs and Symptoms -2 Shortness of breath 786.05/R06.02 Cough 786.2/R05 Nausea with vomiting 787.01/R11.2 *different code for nausea w/o vomiting 787.02/R11.0 *is the s/s code approx. or should we be coding the dx that caused it? Is s/s code giving more specific pertinent info about the pt? ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Insomnia/Sleep Disorders Sleep disturbance, unspecified 780.50/G47.9 Insomnia with sleep apnea, unspecified 780.51/G47.3- *ICD-10 only code the sleep apnea Insomnia, unspecified 780.52/G47.00 Unspecified sleep apnea 780.57/G47.30 Insomnia d/t medical condition classified elsewhere 327.01/G47.01 *code first underlying condition ICD-9 to ICD-10 Prep 01-13-15

Common Therapy Treatment Diagnoses Abnormality of gait 781.2/R26.9 *excludes ataxic gait, difficulty walking Lack of coordination/muscular incoordination 781.3/R27.- Abnormal posture 781.92/R29.3 Aphasia 784.3/R47.01 *if following CVA, code 438.11/I69.- Symbolic dysfunction 784.60/R48.- *may experience a lack of ability to initiate and/or terminate a conversation, as well as difficulty with other forms of communication Dysphagia 787.2-/R13.1- *identify phase of dysphagia after eval *if d/t CVA, code first 438.82/I69.- Cognitive communication deficit 799.52/*no like code in ICD-10 *a characteristic that acts as a barrier to the cognition process ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Factors Influencing Health Status & Contact with Health Services ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

V Codes/Z Codes There are numerous categories for V Codes (Z codes in ICD-10) We will define the categories most frequently seen in post-acute care We will explore examples of the common codes from frequently used categories in LTC. We will practice coding conditions found in this chapter. ICD-9 to ICD-10 Prep 01-13-15

V Codes Represent reasons for encounters: When person who may or may not be sick encounters health services for some specific purpose, i.e. to receive limited care or service for current condition, donate an organ or tissue, receive prophylactic vaccination, discuss problem When some circumstance or problem is present which influences person’s health status but is not a current illness or injury ICD-9 to ICD-10 Prep 01-13-15

V Codes Represent Reasons for Encounters Identify significant past health histories Identify services provided following an acute care episode Identify services related to the provision of aftercare Identify delivery of specific healthcare services: screening, tests & vaccinations Identify presence of problem influencing health status but which is not a current illness (history of) ICD-9 to ICD-10 Prep 01-13-15

Use of V Codes in any Healthcare Setting V codes are for use in any healthcare setting V codes may be used as either first-listed or secondary diagnosis, depending on the circumstances of the encounter Certain V codes may only be used as first-listed or principal diagnosis *See the Official Coding Guidelines for a list of these codes I.C.21.c.16. (ICD-10) Z codes are NOT procedure codes, but indicate when aftercare is being given for a procedure recently done ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

V01/Z20 Contact / Exposure These codes are for patients who do not show any signs or symptoms of a disease but are suspected to have been exposed to it by close personal contact or are in an area where a disease is epidemic. This category also indicates contact with and suspected exposures hazardous to health *may be used as a first-listed or secondary code ICD-9 to ICD-10 Prep 01-13-15

V03 – V06/Z23 Inoculations and Vaccinations Codes are for encounters for inoculations and vaccinations It indicates that a patient is being seen to receive a prophylactic inoculation against a disease There is only one code for inoculations, and if coded, need an additional procedure code to identify the vaccine We don’t usually code these, but you could ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Status Codes Status codes indicate that a patient is either a carrier of a disease or has the residual of a past disease or condition Includes presence of prosthetic or mechanical devices resulting from past treatment A status code is informative, because the status may affect the course of treatment or its outcome A status code is distinct from a history code (history code indicates that patient no longer has the condition) ICD-9 to ICD-10 Prep 01-13-15

Resistance to Antimicrobial Drugs V09/Z16 NOTE: The codes in this category are provided for use as additional codes to identify the resistance and non responsiveness of a condition to antimicrobial drugs. Exclude 1: Code first the infection: MRSA infection (038.12/A49.02) MSSA infection (038.11/A49.01) MRSA pneumonia (482.42/J15.212) ICD-9 to ICD-10 Prep 01-13-15

Carrier of Infectious Disease V02/Z22 Carrier of Infectious Disease Colonization status Suspected carrier Example: V02.54/Z22.322 Carrier or (suspected) carrier of Methicillin resistant Staphylococcus aureus MRSA colonization *Carrier = person that harbors the specific organisms of a disease without manifest symptoms and is capable of transmitting the infection Carrier = person that harbors the specific organisms of a disease without manifest symptoms and is capable of transmitting the infection ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Long Term (current) Drug Therapy V58.6-/Z79 Codes from this category indicate a patient’s continued use of a prescribed drug for the long term treatment of a condition or for prophylactic use. Not used for patients with addictions to drugs Used for patients receiving a medication for an extended period of time There is no definition of “Extended period of time” However, codes in this category are not used for short term conditions. Example: LT current use of antibiotics would not be used to treat the normal course of an infection ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Long Term (current) Drug Therapy Includes: Long term (current) drug use for prophylactic purposes Exclude 1: Code also any therapeutic drug level monitoring (V58.83/Z51.81) V58.61/Z79.01 Long term (current) use of anticoagulants V58.66/Z79.82 Long term (current) use of aspirin V58.62/Z79.2 Long term (current) use of antibiotics V58.67/Z79.4 Long term (current) use of insulin Check the new drugs included and those that have been moved to this section from other sections of the ICD-9 code book. NSAIDS = non-steroidal anti-inflammatories (for pain and inflammation) Note that long term steroid use has a separate code for inhaled steroids, (those commonly used for COPD) and systemic steroids (Prednisone) LT use of insulin is NOT coded if type I DM Bisphosphonates are used to tx Osteoporosis ICD-9 to ICD-10 Prep 01-13-15 192 ICD-9 to ICD-10 Prep 01-13-15

Amputations Determine cause of amputation, traumatic vs acquired Traumatic = due to an incident An amputation not identified as partial or complete should be coded to complete for traumatic amputations Use the appropriate 7th character in ICD-10: “D” subsequent encounter “S” sequela/late effect If acquired amputation, go to Absence, by site, acquired - -V49.6-V49.7/Z89 Currently we do not code traumatic amputations, since they were treated elsewhere, only code amputee status V49 or Z89 code Need emergency room doc to determine amputation status, if traumatic ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Acquired Absence of Limb Acquired Absence of Organ Examples: V49.75/Z89.5- Amputation status below knee V49.76/Z89.6- Amputation status above knee V45.71/Z90.1- Acquired absence breast and nipple V45.73/Z90.5 Acquired absence of kidney Code after tx is completed and no residual effects/sequela ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Artificial Opening Status Transplanted Organ Status Examples: V44.1/Z93.1 Gastrostomy status V44.3/Z93.3 Colostomy status V44.0/Z93.0 Tracheostomy status V42.0/Z94.0 Kidney transplant status V42.5/Z94.7 Corneal transplant status Note that there are added cystostomy status codes at Z93.5 given medical – surgical advances. Z93 codes, only use if NO tx for these sites is being given, otherwise Z43 codes should be used to capture mgmt of these sites (cleansing, etc) ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Organ Or Tissue Replaced By Other Means Examples: V43.1/Z96.1 Presence of intraocular lens (s/p cataract removal surgery) V43.64/Z96.64 Presence of artificial hip joint (s/p joint replacement) V43.21/Z95.811 Presence of heart assist device (cardiac shunt, etc.) ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Other Postprocedural Status Examples: V45.61/Z98.4- Cataract extraction status V45.87/Z98.85 Transplant organ removal status V45.11/Z99.2 Dependence on renal dialysis V45.12/Z91.15 Noncompliance with renal dialysis V45.01/Z95.0 Cardiac pacemaker status ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

History (of) Two types, family and personal A history codes indicate that a patient no longer has the condition, and is no longer receiving any treatment, but has the potential for recurrence, and therefore may require continued monitoring History codes are acceptable on any medical record, as the history of an illness is important information that may alter the type of treatment ordered There is limited value to code family history in SNFs due to the age of the patients Don’t get family hx instead of personal hx – look at the tabular to confirm code! Family hx Z80-Z84 Personal hx Z85-Z87 ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

History (of), Personal V10.3/Z85.3 Personal history breast cancer V12.04/Z86.14 Personal history MRSA infection V12.51/Z86.718 Personal hx of venous thrombosis or embolism V13.51/Z87.311 Personal hx pathological fx V15.51/Z87.81 Personal hx traumatic fracture (healed) V15.88/Z91.81 Personal history of falling *at risk for falling Hx UTI Z87.440 Hx corrected cleft hlip/palate Z87.730 Hx traumatic brain injury Z87.820 - no residuals ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Personal History of Medical Treatment V87.41/Z92.21 Personal history of antineoplastic chemotherapy V87.43/Z92.23 Personal history of estrogen therapy V87.44/Z92.240 Personal history of inhaled steroid therapy V87.45/Z92.241 Personal history of systemic steroid therapy V15.3/Z92.3 Personal history of irradiation Women were encouraged to do estrogen therapy for menopausal symptoms; However, now women are being discouraged from taking estrogen therapy as it has become controversial. ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Aftercare Aftercare visit codes cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare V code should not be used if treatment is directed at a current, acute disease or injury. Aftercare codes are generally first listed to explain the specific reason for the encounter. This Z code category will be the most used in post acute care ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Aftercare + Status Codes Status V codes may be used with aftercare V codes to indicate the nature of the aftercare or to indicate the surgery for which the aftercare is being performed Example: V58.73/Z48.812 Encounter for surgical aftercare following surgery on the circulatory system V45.81/Z95.1 Aortocoronary bypass status – “CABG” status ICD-9 to ICD-10 Prep 01-13-15

Aftercare Categories V55/Z43 Attention to artificial openings V54 Orthopedic aftercare *code to condition in ICD-10 V57 Care involving the use of rehabilitation procedures *code that may only be principal/first-listed dx *only use one code in this category (if > one therapy, code multiple therapy V57.89) *not coded in ICD-10 V58/Z48 Aftercare following surgery ICD-9 to ICD-10 Prep 01-13-15

Attention to Artificial Openings Encounter for Other Aftercare V55.0/Z43.0 Attention to tracheostomy V55.3/Z43.3 Attention to colostomy *includes toileting/cleansing of sites V58.31/Z48.01 Attention to surgical dressings V58.32/Z48.02 Attention to sutures Good code to use to show that facility is taking care of an artificial opening site Z45.018 terminology changed from ICD-9 – now includes mgmt of device – facility is managing device ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Orthopedic Aftercare V54.13 Aftercare for healing traumatic fracture of hip V54.81 Aftercare following joint replacement *Use additional code to identify the joint (V43.-) V54.82 Aftercare following explanation of joint prosthesis V54.09 Other aftercare involving internal fixation device V54.89 Other orthopedic aftercare *code to condition in ICD-10 There are separate codes to identify the aftercare for this procedure on the shoulder, hip and knee joints Note the Excludes 1 for acquired absence of joint following prior explanation of the particular joint prosthesis and joint prosthesis explanation status. Z47.81 is a new code ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Acute Fractures vs. Aftercare – ICD-9 Coding Traumatic fractures are coded using the acute fracture codes (800-829) while the patient is receiving active treatment for the fracture. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician. Fractures are coded using the aftercare codes (V54) for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. ICD-9 to ICD-10 Prep 01-13-15

Fracture Coding for ICD-10 Code fracture (no aftercare codes) Obtain documentation indicating specific fracture type and site Use 7th character: D = subsequent encounter for fracture with routine healing G = subsequent encounter for fracture with delayed healing K = subsequent encounter for fracture with nonunion P = subsequent encounter for fracture with malunion S = sequel/late effect *do not use “A” unless fracture was NOT treated elsewhere, this is for the initial encounter ICD-9 to ICD-10 Prep 01-13-15

Aftercare Following Surgery for Neoplasm V58.42/Z48.3 Aftercare following surgery for Neoplasm *Use additional code to identify the neoplasm If an organ was removed, in total or partial, use a code for acquired absence of the organ V42/Z90 This code overrides the codes in category Z48.81- Encounter for surgical aftercare following surgery on a specific body system, when a tumor is removed ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Aftercare following Surgery on Specified Body Systems V58.7-/Z48.81- NOTE: These codes identify the body system requiring aftercare. They are for use in conjunction with other aftercare codes to fully explain the aftercare encounter. The condition treated should also be coded if still present. Excludes Aftercare following organ transplant V58.44/Z48.2- Excludes Aftercare following surgery for neoplasm V58.42/Z48.3 Note that a few of the systems have been divided in two from codes in ICD-9. The digestive system was all inclusive in ICD-9. In ICD-10 we have separate codes for surgery on the teeth and oral cavity and one for the remaining parts of the digestive system. ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Aftercare Following Surgery to Specified Body Systems V58.71/Z48.810 Sense organs *conditions classifiable to 360-379, 380-389 V58.73/Z48.812 Circulatory system *conditions classifiable to 390-459 V58.75/Z48.81- Teeth, oral cavity and digestive system *conditions classifiable to 520-579 V58.78 Musculoskeletal system *conditions classifiable to 710-739 *code to condition in ICD-10 *Should not need to use V58.49 Other specified aftercare following surgery **get those operative reports! ICD-9 to ICD-10 Prep 01-13-15

Encounter for Miscellaneous Care V66.7/Z51.5 Encounter for palliative care V66.2/Z51.89 Convalescence following chemotherapy ICD-9 to ICD-10 Prep 01-13-15

Procedure for Updating Codes At Quarterly Care Conference, look at facesheet and physician orders Resolve any diagnoses that are NOT current Make sure that you have MD documentation to support ALL current diagnoses in the record. Start querying MD’s for any additional documentation needed for ICD-10 (laterality, etc.) ICD-9 to ICD-10 Prep 01-13-15 ICD-9 to ICD-10 Prep 01-13-15

Tips for Correct Coding Use code book! Always count the number of digits and compare with the number of digits required *use tabular listing in code book Avoid unspecified codes *Remember: payers may reject payment based on missing digits ICD-9 to ICD-10 Prep 01-13-15

Any questions?? Thanks for coming!