1. ICD-10 Ready or Not here it comes!
Coding & Clinical Documentation Class
Presented by: Kathryn Melton- SIP and John Hailes- SMF
September 23, 2015

2. Countdown to ICD-10 Implementation

3. Sutter Independent Physicians ICD-10
8 days to go!!!
Compliance date: October 1, 2015
The Nation switches from ICD-9 to ICD-10 coding for medical diagnosis and inpatient hospital procedures
No grace period for Medicare, SIP or any other organization

4. Sutter Independent Physicians ICD-10
Claim Submissions
A valid ICD-10 code will be required on all claims for diagnosis reporting with dates of service, or dates of discharge for inpatients, that occur on or after 10/1/2015
ICD-10 codes will be rejected if submitted prior to 10/1/2015
SIP processing systems are not able to accept the new codes prior to the compliance date.
No combo diagnosis coding
Mixed reporting of both ICD-9 and ICD-10 codes will be rejected.

5. Sutter Independent Physicians ICD-10
Importance of Documentation
Will require greater detail for medical conditions
Acuity, Disease Type, Laterality (Left, Right, Bilateral), Disease Stage
Documentation must support the assignment of codes
No assumption with coding
“If it is not documented, it did not happen”
Compliance
Good documentation practice protects you from penalties and audit reviews
RAF- Risk Adjustment Factor
CMS reimburses Medicare Advantage plans based on patients health status
RAF data is pulled from diagnosis on claims and medical records documentation

6. Sutter Independent Physicians ICD-10
Resources & Provider Support
CMS Road to 10-
Training videos, common ICD-10 codes by specialty
Clinical documentation tips
Clinical scenarios
Noridian JE Part B- ICD-10 Web-based workshop September 24, 2015 and October 22,

7. Sutter Independent Physicians ICD-10
ICD-10 Update on RAF
CMS list of ICD-10-CM diagnosis codes for the CMS-Hierarchical Condition Category (HCC) risk adjustment model:

8. Sutter Independent Physicians ICD-10
Optum 2015 WebEx Training
These classes are FREE to Providers, Coders, Billers and Office Staff
California Training Sessions
Intro to ICD-10-CM and Coding for Risk Adjustment -1.5 Hours
ICD-10-CM training will include emphasis on clinical documentation improvement and compares coding in ICD-9-CM and ICD-10-CM for chronic conditions such as Diabetes Mellitus (DM), Chronic Kidney Disease (CKD), Hypertensive Diseases (CKD and Heart Failure [HF]), and Peripheral Arterial Disease (PAD).
National Training Sessions
Specialty Presentations-1 hour
Content will include both ICD-9-CM and ICD-10-CM coding and documenting for Medicare Advantage. Specialties covered:
Pulmonary Diseases
Peripheral Vascular Diseases
Diabetes
Space is limited! To register contact Kathryn at

9. Sutter Independent Physicians ICD-10
Training
American Academy of Professional Coders (AAPC)-
ICD-10 Training for Physicians, Coders and office staff
ICD-9 to ICD-10 Crosswalks (by Specialty)
Contemporary Forums-
in association with AAPC
Live ICD-10-CM 2 day Boot Camp training sessions

11. ICD-10 Documentation Tips
Sutter Health
ICD-10 Documentation Tips
Clinical Documentation Improvement

12. Keys to ICD-10 Clinical Documentation

13. Documentation Tips

14. Documentation Tips

15. Documentation Tips

16. Documentation Tips

17. Documentation Tips

18. Documentation Tips

19. Documentation Tips

20. Procedure Documentation Tips

21. Procedure Documentation Tips

22. Sutter Health ICD-10 Resources
HealthStream:
Pre-Test provides option to test out of further training if proficient in ICD-10 documentation concepts
Specialty-specific modules and videos assigned based on your designated specialty
Available both inside and outside of the Sutter Network
Logging in from outside of Sutter? You can VPN into the Physician Education Site at
You have already been assigned HealthStream courses based on your specialty. To access your HealthStream courses use your network login. (Your password will be your last name, all lowercase.) To access HealthStream from outside the network, click here:

23. Documentation Drives ICD-10
John Hailes
ASC-E/M, CCS, CCS-P, CPC, CPC-H, CIRCC, CPMA, CPC-I, CEMC, CFPC, Trainer

24. Objectives
Identify areas in ICD-10-CM that include new terminology for clinical documentation
Define areas in ICD-10-CM that enable improved data capture if more specific conditions are documented
Acuity
Disease type
Site specifity
Disease stage
Show providers examples of the type of terminology needed to show. stage, status, exacerbation, relapse and other qualifiers for conditions that can vary widely in their acuity and severity
Track x – xxx day –

25. Top Clinical Documentation Issues for ICD‐10‐CM
Expanded anatomy specificity requirements in high volume diseases
Extensive code categories that combine the underlying cause with manifestations or complications for many common acute and chronic diseases
Increased numbers of codes that identify both the infective cause or agent and the specific state of the infectious disease diagnosis
Track x – xxx day –

26. Documentation Matters
“If it was not documented, it was not done”

27. Documentation Matters
Impact of clinical
documentation
Patient
Quality of care provided
Continuity of care
Non-payment by Insurance
Physician
Demonstrates accountability
Performance Management
Reduced or denied payment
Relative Value Unit (RVU)
Hierarchy Coding Category (HCC)
Facility
Coding and Billing
Supporting documentation for treatment and services rendered
Appropriate reimbursement
DRG

28. ICD-10 Code Build Anatomical location Laterality Severity
Which anatomical structure
Proximal, distal, medial, lateral, central, peripheral, superior, inferior, anterior, posterior…
Laterality
Right side or left side
Severity
Mild, moderate or severe
Environmental factors
Smoking

29. ICD-10 Code Build (cont.) Time parameters
Intermittent/Paroxysmal
Recurring
Acute or chronic
Post-op, post delivery
Comorbidities or complications
Diabetes with neuropathic joint
Intracranial injury
Manifestations
Paralysis
Loss of consciousness
Healing level
Routing healing, delayed healing, non-union, malunion…

30. Historical Clinician Education
 Findings and symptoms  
Fever
Hypoglycemia/hyperglycemia
Wheezing
External causes
Motor vehicles, injury locations
Assault, accidental, work related, intentional self harm
Type of encounter
Initial encounter, subsequent encounter, encounter for condition sequela, routine evaluation

31. ICD- 9 VS. ICD-10

32. Coding and 7th Character Extensions
2 Numeric
3 - 7 Numeric or Alpha
Additional Characters
Alpha
(Except U) . . X M S A X 2 X 6 X X 5 X x A X
Category
Etiology, anatomic
site, severity
Added code extensions (7th character) for obstetrics, injuries, and external causes of injury
3 – 7 Characters

33. ICD-10 Big Picture
50% of all ICD-10 codes are related to the musculoskeletal system
36% of all ICD-10 codes distinguish right from left
25% of all ICD-10 codes are related to fractures
25% of the code increase is related to specification of encounter
1st trimester, 2nd trimester, 3rd Trimester

34. ICD- 10 Overview

35. Encounter Form

36. One More Example ICD-10-CM ICD-9-CM Sprained Ankle Sprained Ankle
45 Codes
Which part of the ankle was injured?
Right or Left?
First-time Injury?
Sprained Ankle
5 Codes 36

37. Non-Coronary Artery Arteriosclerosis
ICD-9
ICD-10
440.XX
Renal
Extremities
Native/Graft
Other Specified site(s)
I70.XXX
More specific Sites
Concept of laterality
Right
Left
Bilateral
Intermittent claudication
Rest pain
Ulceration
Gangrene

38. 707.13 Ulcer of ankle, except pressure ulcer
ICD-10-CM Codes
L Non-pressure chronic ulcer of unspecified ankle with unspecified severity
** There are more specific code choice selections available in ICD-10-CM. These include:
L Non-pressure chronic ulcer of unspecified ankle limited to breakdown of skin
L Non-pressure chronic ulcer of unspecified ankle with fat layer exposed
L Non-pressure chronic ulcer of unspecified ankle with necrosis of muscle
L Non-pressure chronic ulcer of unspecified ankle with necrosis of bone
L Non-pressure chronic uler of unspecified ankle with unspecified severity
L Non-pressure chronic ulcer of right ankle limited to breakdown of skin
** Code first any associated underlying condition:
Atherosclerosis of the lower extremities (I70.23-, I70.24-, I70.33-, I70.34-, I70.43-, I70.44-, I70.53-, I70.54-, I70.63-, I70.64-, I70.73-, I70.74-)
Chronic venous hypertension (I87.31-, I87.33-)
Diabetic ulcers (E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622, E13.621, E13.622)
Postphlebetic syndrome (I87.01-, I87.03-)
Postthrombotic syndrome (I87.01-, I87.03-)
Varicose ulcer (I83.0-, I83.2-)
Code first any associated gangrene (I96)

39. Diseases of the Circulatory System
ICD-10-CM
Gray’s Anatomy 1918
Diseases of the Circulatory System

40. Type of hypertension not used as an axis
ICD-9-CM guidelines indicate that an MI is acute for 8 weeks, whereas ICD-10-CM guidelines state “4 weeks.”
Type of hypertension not used as an axis
Acute MI codes changed from 8 weeks to 4 weeks or less
Gray’s Anatomy 1918

41. 401.9 Hypertension (essential), unspecified
ICD-10-CM Codes
I10 Essential (primary) hypertension
*Instructional note in ICD-10-CM indicates to use additional code to identify:
exposure to environmental tobacco smoke (Z77.22)
history of tobacco use (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17-)
tobacco use (Z72.0)

42. Hypertension Essential (primary) hypertension I10
Type 1 Excludes hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)
Type 2 Excludes essential (primary) hypertension involving vessels of brain (I60-I69)
essential (primary) hypertension involving vessels of eye (H35.0-)

43. I11 Hypertensive heart disease
I11.0 Hypertensive heart disease with heart failure
I11.9 Hypertensive heart disease without heart failure
Use Additional code to identify type of heart failure (I50)

44. I50 Heart failure
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive)
I50.9 Heart failure, unspecified

45. O10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium
O10.0 Pre-existing essential hypertension complicating pregnancy, childbirth and the puerperium
O10.01 Pre-existing essential hypertension complicating pregnancy,
O …… first trimester
O …… second trimester
O …… third trimester
O …… unspecified trimester
O10.02 Pre-existing essential hypertension complicating childbirth
O10.03 Pre-existing essential hypertension complicating the puerperium
O10.1 Pre-existing hypertensive heart disease complicating pregnancy, childbirth and the puerperium
O10.11 Pre-existing hypertensive heart disease complicating pregnancy
O …… first trimester
O …… second trimester
O …… third trimester
O …… unspecified trimester

46. O10.219 …… unspecified trimester
O10.2 Pre-existing hypertensive chronic kidney disease complicating pregnancy, childbirth and the puerperium
O10.21 Pre-existing hypertensive chronic kidney disease complicating pregnancy
O …… first trimester
O …… second trimester
O …… third trimester
O …… unspecified trimester

47. 427.31 Atrial fibrillation ICD-10-CM Codes
I48.0 Paroxysmal atrial fibrillation
I48.1 Persistent atrial fibrillation
I48.2 Chronic atrial fibrillation
I48.91 Unspecified atrial fibrillation

48. 427.0 Paroxysmal Supraventricular Tachycardia
ICD-10-CM Codes
I47.1 Supraventricular tachycardia
*Instructional note in ICD-10-CM indicates to code first tachycardia complicating:
abortion or ectopic or molar pregnancy (O00-O07, O08.8)
obstetric surgery and procedures (O75.4)

49. 427.89 Cardiac Dysrhythmias, other specified
ICD-10-CM Codes
I49.8 Other specified cardiac arrhythmias
*Instructional note in ICD-10-CM indicates to code first cardiac arrhythmia complicating:
abortion or ectopic or molar pregnancy (O00-O07, O08.8)
obstetric surgery and procedures (O75.4)

50. 427.81 Sinoatrial Node Dysfunction
ICD-10-CM Codes
I49.5 Sick sinus syndrome
*Instructional note in ICD-10-CM indicates to code first cardiac arrhythmia complicating:
abortion or ectopic or molar pregnancy (O00-O07, O08.8)
obstetric surgery and procedures (O75.4)

51. 414.01 Coronary athersclerosis of native coronary artery
ICD-10-CM Codes I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris **Assign code from I25.110–I when angina pectoris is present *Instructional note in ICD-10-CM indicates to use additional code, if applicable, to identify coronary atherosclerosis due to lipid rich plaque (I25.83) Use additional code to identify: chronic total occlusion of coronary artery (I25.82) exposure to environmental tobacco smoke (Z77.22) history of tobacco use (Z87.891) occupational exposure to environmental tobacco smoke (Z57.31) tobacco dependence (F17-) tobacco use (Z72.0)

52. AV Block 426.0 Atrioventricular block, complete
I44.2 Atrioventricular block, complete
Atrioventricular block, first degree
I44.0 Atrioventricular block, first degree

53. 424.1 Aortic valve disorders
ICD-10-CM Codes
I35.9 Nonrheumatic aortic valve disorder, unspecified
I35.0 Nonrheumatic aortic (valve) stenosis
I35.1 Nonrheumatic aortic (valve) insufficiency
I35.2 Nonrheumatic aortic (valve) stenosis with insuffisiciency
I35.8 Other nonrheumatic aortic valve disorders

54. 786.50 Chest pain, unspecified
ICD-10-CMCodes
R07.9 Chest pain, unspecified
**There are more specific code choice selections available in ICD-10-CM. These include:
R07.89 Other chest pain
R07.2 Precordial pain
R07.1 Chest pain on breathing
R07.81 Pleurodynia

55. Chapter 9 I21 Initial AMIs I22 Subsequent AMIs
I23 Complication following STEMI and NSTEMI MI (within 28 day period)

56. 410.40 Myocardial infarction, acute, of other inferior wall, episode of care unspecified
ICD-10-CM Codes
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
*Instructional note in ICD-10-CM indicates to use additional code to identify:
exposure to environmental tobacco smoke (Z77.22)
history of tobacco use (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
status post administration of TPA in a different facility within the last 24 hours prior to admission to current facility (Z92.82)
tobacco dependence (F17-) tobacco use (Z72.0)

57. Category I22
Chapter 9
A code from category I22 must be used in conjunction with a code from category I21.
Category I22 is never used alone.
The sequencing of the I22 and I21 codes depends on the circumstances of the encounter.

58. Endocrine, Nutritional and Metabolic Diseases
ICD-10-CM
Endocrine, Nutritional and Metabolic Diseases

59. ICD-10 versus ICD-9

60. Chapter 4 ICD-10 Diabetes Mellitus Combination codes
No longer classified as controlled or uncontrolled
Inadequately, out of control or poorly controlled coded by type with hyperglycemia
Chapter 4 ICD-10

61. Chapter 4 Diabetes mellitus ICD-10 Combination codes
No longer classified as controlled or uncontrolled
Inadequately, out of control or poorly controlled coded by type with hyperglycemia
Chapter 4

62. ICD-10 DM FORMAT
Diabetes mellitus codes (DM) in ICD-10-CM are combination codes that include the
(1) type of DM
(2) the body system affected
(3) the complication affecting that body system

63. ICD-10 DM Category
E08 Diabetes mellitus due to underlying condition E09 Drug or chemical induced diabetes mellitus E10 Type 1 diabetes mellitus E11 Type 2 diabetes mellitus E13 Other specified diabetes mellitus

64. DM Add-ON
Identify any insulin use (Z79.4) Poisoning due to drug or toxin, if applicable (T36-T65) Adverse effect, if applicable, to identify drug (T36-T50)

65. E08 Diabetes mellitus due to underlying condition
Code First the underlying condition, such as:
Congenital rubella (P35.0)
Cushing's syndrome (E24.-)
Cystic fibrosis (E84.-)
Malignant neoplasm (C00-C96)
Malnutrition (E40-E46)
Pancreatitis and other diseases of the pancreas (K85-K86.-)

66. E09 Drug or Chemical induced diabetes mellitus
Code first (T36-T65) to identify drug or chemical
Use additional code to identify any insulin use (Z79.4)

67. E10 Type 1 diabetes mellitus
Type 1 Excludes
diabetes mellitus due to underlying condition (E08.-)
drug or chemical induced diabetes mellitus (E09.-)
gestational diabetes (O24.4-)
hyperglycemia NOS (R73.9)
neonatal diabetes mellitus (P70.2)
postpancreatectomy diabetes mellitus (E13.-)
postprocedural diabetes mellitus (E13.-)
secondary diabetes mellitus NEC (E13.-)
type 2 diabetes mellitus (E11.-)

68. E11 Type 2 diabetes mellitus
Use additional code to identify any insulin use (Z79.4)
Type 1 Excludes
diabetes mellitus due to underlying condition (E08.-)
drug or chemical induced diabetes mellitus (E09.-)
gestational diabetes (O24.4-)
neonatal diabetes mellitus (P70.2)
postpancreatectomy diabetes mellitus (E13.-)
postprocedural diabetes mellitus (E13.-)
secondary diabetes mellitus NEC (E13.-)
type 1 diabetes mellitus (E10.-)

69. E13 Other specified diabetes mellitus (specified type with)
Use additional code to identify any insulin use (Z79.4)
Type 1 Excludes
diabetes (mellitus) due to autoimmune process (E10.-)
diabetes (mellitus) due to immune mediated pancreatic islet beta-cell destruction (E10.-)
diabetes mellitus due to underlying condition (E08.-)
drug or chemical induced diabetes mellitus (E09.-)
gestational diabetes (O24.4-)
neonatal diabetes mellitus (P70.2)
type 2 diabetes mellitus (E11.-)
Includes
diabetes mellitus due to genetic defects of beta-cell function
diabetes mellitus due to genetic defects in insulin action
postpancreatectomy diabetes mellitus
postprocedural diabetes mellitus
secondary diabetes mellitus NEC

70. DM 4th Digit 0 = Hyperosmolarity 1 = Ketacidosis 2 = Nephropathy
usually complication of type 2 diabetes that involves extremely high blood sugar (glucose) levels without the presence of ketones. Ketones are byproducts of fat breakdown
1 = Ketacidosis
metabolic state associated with high concentrations of ketone bodies, formed by the breakdown of fatty acids and the deamination of amino acids (usually type 1)
2 = Nephropathy
3 = Opthalmic
4= Neurological
5 = Circulatory
6 = Other

71. 2 = Nephropathy
E08.2 Diabetes mellitus due to underlying condition with kidney complications
E08.21Diabetes mellitus due to underlying condition with diabetic nephropathy
E08.22Diabetes mellitus due to underlying condition with diabetic chronic kidney disease
E08.29Diabetes mellitus due to underlying condition with other diabetic kidney complication

72. 3 = Opthalmic
E08.31Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy
E08.311…… with macular edema
E08.319…… without macular edema
E08.32Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy
E08.321…… with macular edema
E08.329…… without macular edema
E08.33Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy
E08.331…… with macular edema
E08.339…… without macular edema

73. 3 = Opthalmic
E08.34Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy
E08.341…… with macular edema
E08.349…… without macular edema
E08.35Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy
E08.351…… with macular edema
E08.359…… without macular edema
E08.36Diabetes mellitus due to underlying condition with diabetic cataract
E08.39Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication

74. 4= Neurological
E08.4 Diabetes mellitus due to underlying condition with neurological complications
E08.40Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified
E08.41Diabetes mellitus due to underlying condition with diabetic mononeuropathy
E08.42Diabetes mellitus due to underlying condition with diabetic polyneuropathy
E08.43Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy
E08.44Diabetes mellitus due to underlying condition with diabetic amyotrophy
E08.49Diabetes mellitus due to underlying condition with other diabetic neurological complication

75. 5 = Circulatory
E08.5 Diabetes mellitus due to underlying condition with circulatory complications
E08.51 Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene
E08.52Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
E08.59Diabetes mellitus due to underlying condition with other circulatory complications

76. 6 = Other
E08.6 Diabetes mellitus due to underlying condition with other specified complications
E08.61Diabetes mellitus due to underlying condition with diabetic arthropathy
E08.610Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy
E08.618Diabetes mellitus due to underlying condition with other diabetic arthropathy
E08.62Diabetes mellitus due to underlying condition with skin complications
E08.620Diabetes mellitus due to underlying condition with diabetic dermatitis
E08.621Diabetes mellitus due to underlying condition with foot ulcer
E08.622Diabetes mellitus due to underlying condition with other skin ulcer
E08.628Diabetes mellitus due to underlying condition with other skin complications

77. Examples of compliant documentation
Diabetic nephrosis, type 1
Secondary diabetes mellitus due to pancreatic malignancy, snowflake cataract
Type 1 diabetes with ketoacidosis
Diabetes mellitus, type 2 with hyperosmolar, nonketotic coma
CKD stage IV due to type 1 diabetes
Impotence due to diabetic peripheral neuropathy
Neonatal hypoglycemia
Hyperglycemic Type 1 diabetes mellitus with peripheral vascular disease and gangrene of the right foot

78. Pregnancy, Childbirth and the Puerperium
ICD-10-CM
Pregnancy, Childbirth and the Puerperium

79. Chapter 15
Trimester axis of classification rather than episode of care
Not all conditions include codes for all three trimesters or is N/A
Counted from first day of last menstrual period
Trimesters
1st
Less than 14 weeks 0 days
2nd
14 weeks 0 days to less than 28 weeks 0 days
3rd
28 weeks 0 days until delivery

80. Chapter 15 Definitions Abortion vs. fetal death
20 weeks instead of 22
Early vs. late vomiting
Preterm labor
37 completed weeks of gestation

81. 0 – not applicable or unspecified
7th Character
Chapter 15
0 – not applicable or unspecified
1 – fetus 1
2 – fetus 2
3- fetus 3
4 – fetus 4
5 – fetus 5
9 – other fetus

82. Coding Note: The note at the beginning of Chapter 15 specifies the use of an additional code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy. This is found in the alphabetic Index under Pregnancy, weeks of gestation.

83. V72.31 Routine Gynecological Exam
ICD-10-CM Codes
Z01.411
Encounter for gynecological examination (general) (routine) with abnormal findings
* Use additional code to identify abnormal findings
Z01.419
Encounter for gynecological examination (general) (routine) without abnormal findings
Instructional note under codes should be as follows:
**Use additional code:
for screening for human papillomavirus, if applicable (Z11.51)
for screening vaginal pap smear, if applicable (Z12.72)
to identify acquired absence of uterus, if applicable (Z90.71-)

84. 626.2 Excessive Menstruation
ICD-10-CM Codes
N92.0 Excessive and frequent menstruation with regular cycle
N92.1 Excessive and frequent menstruation with irregular cycle
N92.2 Excessive menstruation at puberty
N92.4 Excessive bleeding in the premenopausal period

85. 632 Missed Abortion ICD-10-CM Codes O02.1 Missed abortion
** Use additional code from category O08 to identify any associated complication
** An additional code from category Z3A is needed to specify the weeks of gestation of the pregnancy.

86. 616.10 Vaginitis and Vulvovaginitis, unspecified
ICD-10-CM Codes
N76.0 Acute vaginitis
**Use additional code (B95-B97), to identify infectious agent There are other codes from this subcategory to describe vaginitis:
N76.1 Subacute and chronic vaginitis
N76.2 Acute vulvitis
N76.3 Subacute and chronic vulvitis
N76.89 Other specified inflammation of vagina and vulva

87. 626.4 Irregular menstrual cycle
ICD-10-CM Codes
N92.5 Other specified irregular menstruation
N92.6 Irregular menstruation, unspecified
* There are more specific code choice selections available in ICD-10-CM. These include:
N92.0 Excessive and frequent menstruation with regular cycle
N92.1 Excessive and frequent menstruation with irregular cycle
N92.2 Excessive menstruation at puberty
N92.4 Excessive bleeding in the premenopausal period

88. Pediatrics Top 5 Diagnosis
V Routine infant or child health check
465.9 Acute upper respiratory infection
382.9 Unspecified otitis media
462 Acute pharyngitis
Asthma, unspecified type

89. V20.2 Routine infant or child health check
Z00.0 Encounter for general adult medical examination
Z00.00 …… without abnormal findings
Z00.01 …… with abnormal findings
Z00.1 Encounter for newborn, infant and child health examinations
Z00.11 Newborn health examination
Z Health examination for newborn under 8 days old
Z Health examination for newborn 8 to 28 days old
Z00.12 Encounter for routine child health examination
Z …… with abnormal findings
Z …… without abnormal findings
Z00.2 Encounter for examination for period of rapid growth in childhood
Z00.3 Encounter for examination for adolescent development state
Z00.5 Encounter for examination of potential donor of organ and tissue
Z00.6 Encounter for examination for normal comparison and control in clinical research program
Z00.7 Encounter for examination for period of delayed growth in childhood
Z00.70 …… without abnormal findings
Z00.71 …… with abnormal findings

90. Otitis Media H65 Nonsuppurative otitis media
H66 Suppurative and unspecified otitis media
H67 Otitis media in diseases classified elsewhere

91. 382.9 Unspecified Otitis Media
H66.0 Acute suppurative otitis media
H66.00 Acute suppurative otitis media without spontaneous rupture of ear drum
H …… right ear
H …… left ear
H …… bilateral
H …… recurrent, right ear
H …… recurrent, left ear
H …… recurrent, bilateral
H …… recurrent, unspecified ear
H …… unspecified ear

92. Upper Respiratory Infections
J00 Acute nasopharyngitis [common cold]
J01 Acute sinusitis
J02 Acute pharyngitis
J03 Acute tonsillitis
J04 Acute laryngitis and tracheitis
J05 Acute obstructive laryngitis [croup] and epiglottitis
J06 Acute upper respiratory infections of multiple and unspecified sites

93. 462 Acute Pharyngitis J02.0 Streptococcal pharyngitis
J02.8 Acute pharyngitis due to other specified organisms
J02.9 Acute pharyngitis, unspecified

94. 465.9 Acute upper respiratory infection
J06 Acute upper respiratory infections of multiple and unspecified sites
J06.0 Acute laryngopharyngitis
J06.9 Acute upper respiratory infection, unspecified

95. 462 Acute Pharyngitis J02.0 Streptococcal pharyngitis
J02.8 Acute pharyngitis due to other specified organisms
J02.9 Acute pharyngitis, unspecified

96. Asthma ICD-9 ICD-10 493.XX J45.XXX 4th Digit 5th Digit Extrinsic
Intrinsic
Chronic Obstructive
Other
5th Digit
Exacerbation or status asthmatics
J45.XXX
Extrinsic
Intrinsic
Chronic Obstructive
Other

97. 493.90 Asthma, unspecified type
J45 Asthma
J45.2 Mild intermittent asthma
J45.20 …… uncomplicated
J45.21 …… with (acute) exacerbation
J45.22 …… with status asthmaticus
J45.3 Mild persistent asthma
J45.30 …… uncomplicated
J45.31 …… with (acute) exacerbation
J45.32 …… with status asthmaticus
J45.4 Moderate persistent asthma
J45.40 …… uncomplicated
J45.41 …… with (acute) exacerbation
J45.42 …… with status asthmaticus
J45.5 Severe persistent asthma
J45.50 …… uncomplicated
J45.51 …… with (acute) exacerbation
J45.52 …… with status asthmaticus

98. 496 Chronic airway obstruction, not elsewhere classified
ICD-10-CM Codes
J44.9 Chronic obstructive pulmonary disease, unspecified
** There are more specific code choice selections available in ICD-10-CM. These include:
J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
** Code also type of asthma, if applicable (J45.-)
** Use additional code to identify:
Exposure to environmental tobacco smoke (Z77.22)
History of tobacco use (Z87.891)

99. Shortness of breath
Shortness of breath R06.02 Shortness of breath

100. 786.09 Other dyspnea and respiratory abnormalities
ICD-10-CM Codes
R06.83 Snoring
R06.3 Periodic breathing
R06.4 Hyperventilation
R06.00 Dyspnea, unspecified
R06.89 Other abnormalities of breathing

101. 466.0 Acute bronchitis ICD-10-CM Codes
J20.9 Acute bronchitis, unspecified
** There are more specific code choice selections available in ICD-10-CM. These include:
J20.0 Acute bronchitis due to Mycoplasma pneumoniae
J20.1 Acute bronchitis due to Hemophilus influenzae
J20.2 Acute bronchitis due to streptococcus
J20.3 Acute bronchitis due to coxsackievirus
J20.4 Acute bronchitis due to parainfluenza virus
J20.5 Acute bronchitis due to respiratory syncytial virus
J20.6 Acute bronchitis due to rhinovirus
J20.7 Acute bronchitis due to echovirus
J20.8 Acute bronchitis due to other specified organisms

102. ICD-10-CM
Neoplasms

103. What’s new in ICD-10-CM for Coding Neoplasms?
Laterality
Greater specificity (anatomical site)
Greater Clarity (Acuity)

104. Examples - Laterality
C34.31 – Malignant neoplasm RIGHT main bronchus or lung
C34.32 – Malignant neoplasm LEFT main bronchus or lung
C4A. 71 – Merkel cell carcinoma of the RIGHT lower limb, including hip
C4A.72 - Merkel cell carcinoma of the LEFT lower limb, including hip

105. Examples - Greater specificity in terms of anatomical sites:
C Malignant neoplasm of external upper lip
Malignant neoplasm of lipstick area of upper lip
Malignant neoplasm of upper lip NOS
Malignant neoplasm of vermilion border of upper lip
C Malignant neoplasm of middle ear
Malignant neoplasm of antrum tympanicum
Malignant neoplasm of auditory tube
Malignant neoplasm of eustachian tube
Malignant neoplasm of inner ear
Malignant neoplasm of mastoid air cells
Malignant neoplasm of tympanic cavity

106. Some 1 to 1 Conversions C61 Malignant neoplasm of prostate
Replaces 185 Malignant neoplasm of prostate
D07.5 Carcinoma in situ of prostate
233.4 Carcinoma in situ of prostate  

107. Other Skin L57.0 Actinic keratosis
L Inflamed seborrheic keratosis OR L82.1 other seborrheic keratosis
L Sebaceous cyst
ICD Actinic keratosis ICD SK ICD Sebaceous Cyst

108. N63 Unspecified lump in breast
Breast Lump/Mass
ICD-9 code
NOW
N63 Unspecified lump in breast

109. Breast Cancer ICD-10
Malignant neoplasm breast 54 choices for male/female breast
Documentation must include: Laterality
Location
Estrogen receptor status (when necessary)

110. Breast Neoplasms

111. +Estrogen receptor status (Z17)
Code 1st malignant neoplasm of breast (C50.-)
Z17.0 Estrogen receptor positive status [ER+]
Z17.1 Estrogen receptor negative status [ER-]

112. ICD-10 Ophthalmic Codes

113. ICD-10 Ophthalmic Codes

114. ICD-10 Cataract

115. ICD-9-CM vs. ICD-10-CM Codes
ICD-9-CM for aqueous misdirection (malignant glaucoma)
ICD-10-CM H40.83 for aqueous misdirection (malignant glaucoma)
H Aqueous misdirection, right eye
H Aqueous misdirection, left eye
H Aqueous misdirection, bilateral eyes
H Aqueous misdirection, unspecified eye .
115

116. Primary Care Most Common Codes ICD-9 to ICD-10

117. Primary Care Most Common Codes ICD-9 to ICD-10

118. Primary Care Most Common Codes ICD-9 to ICD-10

119. Primary Care Most Common Codes ICD-9 to ICD-10

120. ICD-10 Resources CMS.gov provider resources link:
CMS.gov provider implementation timelines and checklists link:
CMS.gov ICD-10 basics for medical practices link:
13[1].pdf
Hospital Association - AHA.org website link:
Specialized training resources (extra cost): American Health Information Association – AHIMA.org and American Association Professional Coders – AAPC.com links:
Coding Tipsheets - AHIMA.org and Californiahia.org links:
American Medical Association – AMA.org website links:
billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set- standards/icd10-code-set.page

121. Questions. Contact: Kathryn Melton CPC meltonk@sutterhealth
Questions? Contact: Kathryn Melton CPC (916)
Visit for upcoming coding classes and much more!