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2019

ICD-10-CM Professional for Hospitals The complete official code set

Codes valid from October 1, 2018 through September 30, 2019

ICD

-10-C

M Professional

for Hospitals

PROFESSIONAL

ITHB_ITHB19_CVR.indd 1 12/4/17 1:43 PM

© 2018 Optum360, LLC i

Contents

Preface ................................................................................ iiiICD-10-CM Official Preface ........................................................................ iiiCharacteristics of ICD-10-CM .................................................................... iii

What’s New for 2019 .......................................................... ivOfficial Updates ............................................................................................ ivProprietary Updates ...................................................................................vii

Introduction ..................................................................... viiiHistory of ICD-10-CM ...............................................................................viii

How to Use ICD-10-CM Professional for Hospitals 2019 .... ixUse of Official Sources ................................................................................ ixSteps to Correct Coding ............................................................................ ixOrganization ................................................................................................. ix

Introduction .......................................................................................... ixOfficial ICD-10-CM Conventions and Guidelines.......................... ixAlphabetic Index to Diseases ............................................................ ixNeoplasm Table.................................................................................... ixTable of Drugs and Chemicals .......................................................... ixIndex to External Causes .................................................................... ixTabular List of Diseases ...................................................................... ixIllustrations ............................................................................................ ixICD-10-CM Hospital Data Files........................................................... x

Overview of ICD-10-CM Official Conventions .................... xiFormat ................................................................................................. xiPunctuation .................................................................................................. xiAbbreviations ............................................................................................... xi

NEC ......................................................................................................... xiNOS ......................................................................................................... xi

Typeface .................................................................................................. xiBoldface.................................................................................................. xi

General Notes .............................................................................................. xiIncludes Notes ...................................................................................... xiInclusion Terms..................................................................................... xiExcludes Notes...................................................................................... xiNote ........................................................................................................ xiiDefault Codes....................................................................................... xiiSyndromes............................................................................................ xiiAnd ........................................................................................................ xiiWith ........................................................................................................ xiiSee and See Also ................................................................................. xiiInstructional Notes Used in the Tabular List ................................ xiiCode Assignment and Clinical Criteria .......................................... xii

Additional Annotations .................................................... xiiiCode-Level Notations ...............................................................................xiii

Italics .....................................................................................................xiiiColor Coding/Symbols ......................................................................xiiiOther Code Level Notations ............................................................. xvFootnotes .............................................................................................. xv

Chapter-Level Notations ..........................................................................xviChapter-Specific Guidelines with Coding Examples .................xviMuscle Tendon Table .......................................................................xvi

Index Notations ..........................................................................................xviFollowing References ........................................................................xvi

ICD-10-CM Official Guidelines for Coding and Reporting ..................................... Coding Guidelines–1

ICD-10-CM Index to Diseases and Injuries .......................... 1

ICD-10-CM Neoplasm Table ............................................ 331

ICD-10-CM Table of Drugs and Chemicals ...................... 349

ICD-10-CM Index to External Causes ............................... 397

ICD-10-CM Tabular List of Diseases and Injuries ............ 433Chapter 1. Certain Infectious and Parasitic Diseases

(A00-B99) .........................................................................433

Chapter 2. Neoplasms (C00-D49) ...................................................459

Chapter 3. Diseases of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89) .................................499

Chapter 4. Endocrine, Nutritional and Metabolic Diseases(E00-E89) ..........................................................................509

Chapter 5. Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99) .......................................................531

Chapter 6. Diseases of the Nervous System (G00-G99) ............555

Chapter 7. Diseases of the Eye and Adnexa (H00-H59) ............577

Chapter 8. Diseases of the Ear and Mastoid Process(H60-H95) ........................................................................615

Chapter 9. Diseases of the Circulatory System (I00-I99) ...........627

Chapter 10. Diseases of the Respiratory System (J00-J99) .........669

Chapter 11. Diseases of the Digestive System (K00-K95) ...........685

Chapter 12. Diseases of the Skin and Subcutaneous Tissue(L00-L99) ..........................................................................709

Chapter 13. Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) ....................................731

Chapter 14. Diseases of the Genitourinary System (N00-N99) ..821

Chapter 15. Pregnancy, Childbirth and the Puerperium(O00-O9A) ........................................................................839

Chapter 16. Certain Conditions Originating in the Perinatal Period (P00-P96) ............................................................879

Chapter 17. Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99) .................893

Chapter 18. Symptoms, Signs and Abnormal Clinical and Laboratory Findings Not Elsewhere Classified (R00-R99) .......................................................913

Chapter 19. Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) .......................................933

Chapter 20. External Causes of Morbidity (V00-Y99)................. 1155

Chapter 21. Factors Influencing Health Status and Contact With Health Services (Z00-Z99) ............................... 1217

Illustrations ................................................... Illustrations–1Chapter 3. Diseases of the Blood and Blood-forming Organs and

Certain Disorders Involving the Immune Mechanism (D50–D89) .............................. Illustrations–1Red Blood Cells ............................................ Illustrations–1White Blood Cell .......................................... Illustrations–1

Sample

Pag

e

Lymphangitis — continuedacute — continued

hip — see Lymphangitis, acute, lower limbjaw (region) L03.212knee — see Lymphangitis, acute, lower limbleg — see Lymphangitis, acute, lower limblower limb L03.12- S

toe — see Lymphangitis, acute, toenavel L03.326neck (region) L03.222orbit, orbital — see Cellulitis, orbitpectoral (region) L03.323perineal, perineum L03.325scalp (any part) L03.891shoulder — see Lymphangitis, acute, upper limbspecified site NEC L03.898thigh — see Lymphangitis, acute, lower limbthumb (intrathecal) (periosteal) (subcutaneous)

(subcuticular) — see Lymphangitis, acute,finger

toe (intrathecal) (periosteal) (subcutaneous) (sub-cuticular) L03.04- S

trunk L03.329abdominal wall L03.321back (any part) L03.322buttock L03.327chest wall L03.323groin L03.324perineal, perineum L03.325umbilicus L03.326

umbilicus L03.326upper limb L03.12- S

axilla — see Lymphangitis, acute, axillafinger — see Lymphangitis, acute, fingerthumb — see Lymphangitis, acute, finger

wrist — see Lymphangitis, acute, upper limbbreast

gestational — see Mastitis, obstetricchancroidal A57chronic (any site) I89.1due to

Brugia (malayi) B74.1timori B74.2

Wuchereria bancrofti B74.0following ectopic or molar pregnancy O08.89penis

acute N48.29gonococcal (acute) (chronic) A54.09

puerperal, postpartum, childbirth O86.89strumous, tuberculous A18.2subacute (any site) I89.1tuberculous — see Tuberculosis, lymph gland

Lymphatic (vessel) — see conditionLymphatism E32.8Lymphectasia I89.0Lymphedema (acquired) (see also Elephantiasis)

congenital Q82.0hereditary (chronic) (idiopathic) Q82.0postmastectomy I97.2praecox I89.0secondary I89.0surgical NEC I97.89

postmastectomy (syndrome) I97.2Lymphoblastic — see conditionLymphoblastoma (diffuse) — see Lymphoma, lym-

phoblastic (diffuse)giant follicular — see Lymphoma, lymphoblastic (dif-

fuse)macrofollicular — see Lymphoma, lymphoblastic

(diffuse)Lymphocele I89.8Lymphocytic

chorioencephalitis (acute) (serous) A87.2choriomeningitis (acute) (serous) A87.2meningoencephalitis A87.2

Lymphocytoma, benign cutis L98.8Lymphocytopenia D72.810Lymphocytosis (symptomatic) D72.820

infectious (acute) B33.8Lymphoepithelioma — see Neoplasm, malignant, by

siteLymphogranuloma (malignant) (see also Lymphoma,

Hodgkin)chlamydial A55inguinale A55venereum (any site) (chlamydial) (with stricture of

rectum) A55

Lymphogranulomatosis (malignant) (see also Lym-phoma, Hodgkin)

benign (Boeck's sarcoid) (Schaumann's) D86.1Lymphohistiocytosis, hemophagocytic (familial) D76.1Lymphoid — see conditionLymphoma (of) (malignant) C85.90

adult T-cell (HTLV-1-associated) (acute variant)(chronic variant) (lymphomatoid variant)(smouldering variant) C91.5- S

anaplastic large cellALK-negative C84.7- SALK-positive C84.6- SCD30-positive C84.6- Sprimary cutaneous C86.6

angioimmunoblastic T-cell C86.5BALT C88.4B-cell C85.1- Sblastic NK-cell C86.4blastic plasmacytoid dendritic cell neoplasm (BPDCN)

C86.4B-precursor C83.5- Sbronchial-associated lymphoid tissue [BALT-lym-

phoma] C88.4Burkitt (atypical) C83.7- SBurkitt-like C83.7- Scentrocytic C83.1- Scutaneous follicle center C82.6- Scutaneous T-cell C84.A- S (following C84.7)diffuse follicle center C82.5- Sdiffuse large cell C83.3- S

anaplastic C83.3- SB-cell C83.3- SCD30-positive C83.3- Scentroblastic C83.3- Simmunoblastic C83.3- Splasmablastic C83.3- Ssubtype not specified C83.3- ST-cell rich C83.3- S

enteropathy-type (associated) (intestinal) T-cell C86.2extranodal marginal zone B-cell lymphoma of mucosa-

associated lymphoid tissue [MALT-lymphoma]C88.4

extranodal NK/T-cell, nasal type C86.0follicular C82.9- S

gradeI C82.0- SII C82.1- SIII C82.2- SIIIa C82.3- SIIIb C82.4- S

specified NEC C82.8- Shepatosplenic T-cell (alpha-beta) (gamma-delta) C86.1histiocytic C85.9- S

true C96.A (following C96.6)Hodgkin C81.9 S

lymphocyte depleted (classical) C81.3- Slymphocyte-rich (classical) C81.4- Smixed cellularity (classical) C81.2- Snodular

lymphocyte predominant C81.0- Ssclerosis (classical) C81.1- S

nodular sclerosis (classical) C81.1- Sspecified NEC (classical) C81.7- S

intravascular large B-cell C83.8- SLennert's C84.4- Slymphoblastic (diffuse) C83.5- Slymphoblastic B-cell C83.5- Slymphoblastic T-cell C83.5- Slymphoepithelioid C84.4- Slymphoplasmacytic C83.0- S

with IgM-production C88.0MALT C88.4mantle cell C83.1- Smature T-cell NEC C84.4- Smature T/NK-cell C84.9- S

specified NEC C84.Z- S (following C84.7)mediastinal (thymic) large B-cell C85.2- SMediterranean C88.3mucosa-associated lymphoid tissue [MALT-lymphoma]

C88.4NK/T cell C84.9- Snodal marginal zone C83.0- Snon-follicular (diffuse) C83.9- S

specified NEC C83.8- Snon-Hodgkin (see also Lymphoma, by type) C85.9- S

specified NEC C85.8- S

Lymphoma — continuednon-leukemic variant of B-CLL C83.0- Speripheral T-cell, not classified C84.4- Sprimary cutaneous

anaplastic large cell C86.6CD30-positive large T-cell C86.6

primary effusion B-cell C83.8- SSALT C88.4skin-associated lymphoid tissue [SALT-lymphoma]

C88.4small cell B-cell C83.0- Ssplenic marginal zone C83.0- Ssubcutaneous panniculitis-like T-cell C86.3T-precursor C83.5- Strue histiocytic C96.A (following C96.6)

Lymphomatosis — see LymphomaLymphopathia venereum, veneris A55Lymphopenia D72.810Lymphoplasmacytic leukemia — see Leukemia,

chronic lymphocytic, B-cell typeLymphoproliferation, X-linked disease D82.3Lymphoreticulosis, benign (of inoculation) A28.1Lymphorrhea I89.8Lymphosarcoma (diffuse) (see also Lymphoma)

C85.9- SLymphostasis I89.8Lypemania — see MelancholiaLysine and hydroxylysine metabolism disorder E72.3Lyssa — see Rabies

MMacacus ear Q17.3Maceration, wet feet, tropical (syndrome) T69.02- SMacLeod's syndrome J43.0Macrocephalia, macrocephaly Q75.3Macrocheilia, macrochilia (congenital) Q18.6Macrocolon (see also Megacolon) Q43.1Macrocornea Q15.8

with glaucoma Q15.0Macrocytic — see conditionMacrocytosis D75.89Macrodactylia, macrodactylism (fingers) (thumbs)

Q74.0toes Q74.2

Macrodontia K00.2Macrogenia M26.05Macrogenitosomia (adrenal) (male) (praecox) E25.9

congenital E25.0Macroglobulinemia (idiopathic) (primary) C88.0

monoclonal (essential) D47.2Waldenström C88.0

Macroglossia (congenital) Q38.2acquired K14.8

Macrognathia, macrognathism (congenital)(mandibular) (maxillary) M26.09

Macrogyria (congenital) Q04.8Macrohydrocephalus — see HydrocephalusMacromastia — see Hypertrophy, breastMacrophthalmos Q11.3

in congenital glaucoma Q15.0Macropsia H53.15Macrosigmoid K59.39

congenital Q43.2Macrospondylitis , acromegalic E22.0Macrostomia (congenital) Q18.4Macrotia (external ear) (congenital) Q17.1Macula

cornea, corneal — see Opacity, corneadegeneration (atrophic) (exudative) (senile) (see also

Degeneration, macula)hereditary — see Dystrophy, retina

Maculae ceruleae B85.1Maculopathy, toxic — see Degeneration, macula, toxicMadarosis (eyelid) H02.729

left H02.726lower H02.725upper H02.724

right H02.723lower H02.722upper H02.721

Madelung'sdeformity (radius) Q74.0disease

radial deformity Q74.0symmetrical lipomas, neck E88.89

Madness — see Psychosis

Lymphangitis—

Madness

Index

215S Additional Character Required — Refer to the Tabular List for Character Selection2 Subterms under main terms may continue to next column or page

MadnessICD-10-CM 2019

Sample

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Chapter 3. Diseases of the Blood and Blood-form

ing Organs

D63.8–D

68.311ICD-10-CM 2019 Chapter 3. Diseases of the Blood and Blood-forming Organs D63.8–D68.311

SAdditional Character Req g Placeholder Alert Unacceptable PDx Manifestation E-R HAC <CMS-HCC Condition 1Not Coded Here 2Not Included Here

ICD-10-CM 2019 503

D63.8 Anemia in other chronic diseases classified elsewhereCode first underlying disease, such as:

diphyllobothriasis (B70.0)hookworm disease (B76.0-B76.9)hypothyroidism (E00.0-E03.9)malaria (B50.0-B54)symptomatic late syphilis (A52.79)tuberculosis (A18.89)

b D64 Other anemias1 refractory anemia (D46.-)

refractory anemia with excess blasts in transformation [RAEB T] (C92.0-)

D64.0 Hereditary sideroblastic anemia <Sex-linked hypochromic sideroblastic anemia

D64.1 Secondary sideroblastic anemia due to disease <Code first underlying disease

D64.2 Secondary sideroblastic anemia due to drugs and toxins <Code first poisoning due to drug or toxin, if applicable (T36-T65

with fifth or sixth character 1-4 or 6)Use additional code for adverse effect, if applicable, to identify

drug (T36-T50 with fifth or sixth character 5)D64.3 Other sideroblastic anemias <

Sideroblastic anemia NOSPyridoxine-responsive sideroblastic anemia NEC

D64.4 Congenital dyserythropoietic anemiaDyshematopoietic anemia (congenital)1 Blackfan-Diamond syndrome (D61.01)

Di Guglielmo's disease (C94.0)

c D64.8 Other specified anemiasD64.81 Anemia due to antineoplastic chemotherapy

Antineoplastic chemotherapy induced anemia1 aplastic anemia due to antineoplastic

chemotherapy (D61.1)2 anemia in neoplastic disease (D63.0)AHA: 2014, 4Q, 22DEF: Reversible adverse effect of chemotherapy, causing inhibition of bone marrow production; decrease in red blood cell production prevents adequate oxygenation of the tissues and organs causing fatigue, SOB, and exacerbation of other medical conditions.

D64.89 Other specified anemiasInfantile pseudoleukemia

D64.9 Anemia, unspecifiedAHA: 2017, 1Q, 7

Coagulation defects, purpura and other hemorrhagic conditions (D65-D69)

D65 Disseminated intravascular coagulation [defibrination a< syndrome]

Afibrinogenemia, acquiredConsumption coagulopathyDiffuse or disseminated intravascular coagulation [DIC]Fibrinolytic hemorrhage, acquiredFibrinolytic purpuraPurpura fulminans1 disseminated intravascular coagulation (complicating):

abortion or ectopic or molar pregnancy (O00-O07, O08.1)in newborn (P60)pregnancy, childbirth and the puerperium (O45.0, O46.0,

O67.0, O72.3)CC Excl: PDX collection 502

D66 Hereditary factor VIII deficiency a<Classical hemophiliaDeficiency factor VIII (with functional defect)Hemophilia AHemophilia NOS1 factor VIII deficiency with vascular defect (D68.0)DEF: Hereditary, sex-linked lack of antihemophilic globulin (AHG) (factor VIII); causes abnormal coagulation characterized by increased bleeding, large bruises of skin, bleeding in mouth, nose, gastrointestinal tract; hemorrhages into joints, resulting in swelling and impaired function.CC Excl: PDX collection 502

D67 Hereditary factor IX deficiency a<Christmas diseaseFactor IX deficiency (with functional defect)Hemophilia BPlasma thromboplastin component [PTC] deficiencyCC Excl: PDX collection 502

b D68 Other coagulation defects1 abnormal coagulation profile (R79.1)

coagulation defects complicating abortion or ectopic or molar pregnancy (O00-O07, O08.1)

coagulation defects complicating pregnancy, childbirth and the puerperium (O45.0, O46.0, O67.0, O72.3)

AHA: 2016, 1Q, 14

D68.0 Von Willebrand's disease A<AngiohemophiliaFactor VIII deficiency with vascular defectVascular hemophilia1 capillary fragility (hereditary) (D69.8)

factor VIII deficiency NOS (D66)factor VIII deficiency with functional defect (D66)

DEF: Abnormal blood coagulation caused by deficient blood factor VII; congenital; symptoms include excess or prolonged bleeding.

D68.1 Hereditary factor XI deficiency A<Hemophilia CPlasma thromboplastin antecedent [PTA] deficiencyRosenthal’s disease

D68.2 Hereditary deficiency of other clotting factors A<AC globulin deficiencyCongenital afibrinogenemiaDeficiency of factor I [fibrinogen]Deficiency of factor II [prothrombin]Deficiency of factor V [labile]Deficiency of factor VII [stable]Deficiency of factor X [Stuart-Prower]Deficiency of factor XII [Hageman]Deficiency of factor XIII [fibrin stabilizing]Dysfibrinogenemia (congenital)HypoproconvertinemiaOwren's diseaseProaccelerin deficiency

c D68.3 Hemorrhagic disorder due to circulating anticoagulantsd D68.31 Hemorrhagic disorder due to intrinsic circulating

anticoagulants, antibodies, or inhibitorsD68.311 Acquired hemophilia A<

Autoimmune hemophiliaAutoimmune inhibitors to clotting factorsSecondary hemophiliaCC Excl: PDX collection 503

CC Excl: For CC codes in category D68, unless otherwise noted: PDX collection 502

Red blood cells

White blood cell

Platelets

Fibrin

Injury site

Coagulation

Sample

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Chapter 10. Diseases of the Respiratory System

ICD-10-CM 2019 Chapter 10. Diseases of the Respiratory System Guidelines and Examples

ICD-10-CM 2019 669

Chapter 10. Diseases of the Respiratory System (J00–J99)

Chapter Specific Guidelines with Coding ExamplesThe chapter specific guidelines from the ICD-10-CM Official Guidelines for Coding and Reporting have been provided below. Along with these guidelines are coding examples, contained in the shaded boxes, that have been developed to help illustrate the coding and/or sequencing guidance found in these guidelines.

a. Chronic obstructive pulmonary disease [COPD] and asthma1) Acute exacerbation of chronic obstructive bronchitis and asthma

The codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.

b. Acute respiratory failure1) Acute respiratory failure as principal diagnosis

A code from subcategory J96.0, Acute respiratory failure, or subcategory J96.2, Acute and chronic respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.

2) Acute respiratory failure as secondary diagnosisRespiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission, but does not meet the definition of principal diagnosis.

3) Sequencing of acute respiratory failure and another acute conditionWhen a patient is admitted with respiratory failure and another acute condition, (e.g., myocardial infarction, cerebrovascular accident, aspiration pneumonia), the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. Selection of the principal diagnosis will be dependent on the circumstances of admission. If both the respiratory failure and the other acute condition are equally responsible for occasioning the admission to the hospital, and there are no chapter-specific sequencing rules, the guideline regarding two or more diagnoses that equally meet the definition for principal diagnosis (Section II, C.) may be applied in these situations.If the documentation is not clear as to whether acute respiratory failure and another condition are equally responsible for occasioning the admission, query the provider for clarification.

c. Influenza due to certain identified influenza virusesCode only confirmed cases of influenza due to certain identified influenza viruses (category J09), and due to other identified influenza virus (category J10). This is an exception to the hospital inpatient guideline Section II, H. (Uncertain Diagnosis).In this context, “confirmation” does not require documentation of positive laboratory testing specific for avian or other novel influenza A or other identified influenza virus. However, coding should be based on the provider’sdiagnostic statement that the patient has avian influenza, or other novel influenza A, for category J09, or has another particular identified strain of influenza, such as H1N1 or H3N2, but not identified as novel or variant, for category J10.

Vancomycin IV was started to treat a patient with acute pneumonia due to Streptococcus pneumoniae. Patient also with acute exacerbation of COPD continued on home meds.

J13 Pneumonia due to Streptococcus pneumoniae

J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection

J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation

Explanation: ICD-10-CM uses combination codes to create organism-specific classifications for acute pneumonia. Category J44 codes include combination codes with severity components, which differentiate between COPD with acute lower respiratory infection (acute pneumonia), COPD with acute exacerbation, and COPD without mention of a complication (unspecified).

An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection, as in this example. Treatment of the pneumonia necessitated the inpatient admission. Instructional notes at J44.0 say to “code also to identify the infection,” which informs the coder that another code must be assigned if applicable. Sequencing of the pneumonia and COPD exacerbation are governed by the Section II, “Selection of Principal Diagnosis,” guidelines. In this case it was the pneumonia that was “chiefly responsible for occasioning the admission” with the IV vancomycin treatment.

Exacerbation of moderate persistent asthma with status asthmaticus

J45.42 Moderate persistent asthma with status asthmaticus

Explanation: Category J45 Asthma includes severity-specific subcategories and fifth-character codes to distinguish between uncomplicated cases, those in acute exacerbation, and those with status asthmaticus.

Acute hypoxic respiratory failure due to COPD exacerbation

J96.01 Acute respiratory failure with hypoxia

J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation

Explanation: Category J96 classifies respiratory failure with combination codes that designate the severity and the presence of hypoxia and hypercapnia. Code J96.01 is sequenced as the first-listed diagnosis, as the reason for the admission. Respiratory failure may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital and the selection is supported by the Alphabetic Index and Tabular List.

Acute respiratory failure due to accidental oxycodone overdose

T40.2X1A Poisoning by other opioids, accidental (unintentional), initial encounter

J96.00 Acute respiratory failure, unspecified whether with hypoxia or hypercapnia

Explanation: Respiratory failure may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines, such as poisoning, that provide sequencing direction take precedence. When coding a poisoning or reaction to the improper use of a medication (e.g. overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36–T50. Use additional code(s) for all manifestations of the poisoning. In this instance, the respiratory failure is a manifestation of the poisoning and is sequenced as a secondary diagnosis.

Acute pneumococcal pneumonia with subsequent development of acute respiratory failure

J13 Pneumonia due to Streptococcus pneumoniae

J96.00 Acute respiratory failure, unspecified whether with hypoxia or hypercapnia

Explanation: Acute respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or if it is present on admission but does not meet the definition of principal diagnosis.

Acute pneumococcal pneumonia and acute respiratory failure, both present on admission

J96.00 Acute respiratory failure, unspecified whether with hypoxia or hypercapnia

J13 Pneumonia due to Streptococcus pneumoniae

Explanation: When a patient is admitted with respiratory failure and another acute condition, such as a bacterial pneumonia, the principal diagnosis is not the same in every situation. This applies whether the other acute condition is a respiratory or nonrespiratory condition. The principal diagnosis depends on the circumstances of admission.

Sample

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8 Newborn: 0 9 Pediatric: 0-17 x Maternity: 12-55 y Adult: 15-124 a Major CC Condition l PDx acts as own MCC A CC Condition948

m PDx acts as own CC ICD-10-CM 2019

S06–S06.306 Chapter 19. Injury, Poisoning and Certain Other Consequences of External Causes ICD-10-CM 2019S0

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ses b S06 Intracranial injury

0 w7th characters D and S do not apply to codes in category S06 with 6th character 7 – death due to brain injury prior to regaining consciousness, or 8 – death due to other cause prior to regaining consciousnessx

1 traumatic brain injuryCode also any associated:

open wound of head (S01.-)skull fracture (S02.-)

1 head injury NOS (S09.90)AHA: 2017, 1Q, 42; 2015, 3Q, 37

c S06.0 ConcussionCommotio cerebri1 concussion with other intracranial injuries classified in

subcategories S06.1- to S06.6-, S06.81 and S06.82- code to specified intracranial injury

d S06.0X Concussion12 e S06.0X0 Concussion without loss of <

consciousness12 e S06.0X1 Concussion with loss of AI<

consciousness of 30 minutes or less12 e S06.0X9 Concussion with loss of AI<

consciousness of unspecified durationConcussion NOS

c S06.1 Traumatic cerebral edemaDiffuse traumatic cerebral edemaFocal traumatic cerebral edema

d S06.1X Traumatic cerebral edema11 e S06.1X0 Traumatic cerebral edema la<

without loss of consciousnessCC Excl: MCC with 7th character A: PDX collection 612

11 e S06.1X1 Traumatic cerebral laI<edema with loss of consciousness of 30 minutes or less

11 e S06.1X2 Traumatic cerebral laI<edema with loss of consciousness of 31 minutes to 59 minutes

11 e S06.1X3 Traumatic cerebral laI<edema with loss of consciousness of 1 hour to 5 hours 59 minutes

11 e S06.1X4 Traumatic cerebral laI<edema with loss of consciousness of 6 hours to 24 hours

11 e S06.1X5 Traumatic cerebral laI<edemawith loss of consciousness greater than 24 hours with return to pre-existing conscious level

11 e S06.1X6 Traumatic cerebral laI<edema with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving

CC Excl: MCC with 7th character A: PDX collection 1154

e S06.1X7 Traumatic cerebral edema laIwith loss of consciousness of any duration with death due to brain injury prior to regaining consciousness

CC Excl: MCC with 7th character A:PDX collection 1154

e S06.1X8 Traumatic cerebral edema laIwith loss of consciousness of any duration with death due to other cause prior to regaining consciousness

CC Excl: MCC with 7th character A:PDX collection 1154

11 e S06.1X9 Traumatic cerebral laI< edema with loss of consciousness of unspecified duration

Traumatic cerebral edema NOSc S06.2 Diffuse traumatic brain injury

Diffuse axonal brain injury1 traumatic diffuse cerebral edema (S06.1X-)

d S06.2X Diffuse traumatic brain injury11 e S06.2X0 Diffuse traumatic brain injury <

without loss of consciousness11 e S06.2X1 Diffuse traumatic brain injury AI<

with loss of consciousness of 30 minutes or less

11 e S06.2X2 Diffuse traumatic brain injury AI< with loss of consciousness of 31 minutes to 59 minutes

11 e S06.2X3 Diffuse traumatic brain injury AI< with loss of consciousness of 1 hour to 5 hours 59 minutes

11 e S06.2X4 Diffuse traumatic brain injury AI< with loss of consciousness of 6 hours to 24 hours

11 e S06.2X5 Diffuse traumatic brain injury AI< with loss of consciousness greater than 24 hours with return to pre-existing conscious levels

11 e S06.2X6 Diffuse traumatic brain injury aI< with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving

e S06.2X7 Diffuse traumatic brain injury aIwith loss of consciousness of any duration with death due to brain injury prior to regaining consciousness

e S06.2X8 Diffuse traumatic brain injury aIwith loss of consciousness of any duration with death due to other cause prior to regaining consciousness

11 e S06.2X9 Diffuse traumatic brain injury AI< with loss of consciousness of unspecified duration

Diffuse traumatic brain injury NOSc S06.3 Focal traumatic brain injury

1 any condition classifiable to S06.4-S06.6focal cerebral edema (S06.1)

d S06.30 Unspecified focal traumatic brain injury11 e S06.300 Unspecified focal traumatic brain <

injury without loss of consciousness11 e S06.301 Unspecified focal traumatic AI<

brain injury with loss of consciousness of 30 minutes or less

11 e S06.302 Unspecified focal traumatic AI< brain injury with loss of consciousness of 31 minutes to 59 minutes

11 e S06.303 Unspecified focal traumatic AI< brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes

11 e S06.304 Unspecified focal traumatic AI< brain injury with loss of consciousness of 6 hours to 24 hours

11 e S06.305 Unspecified focal traumatic AI< brain injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level

11 e S06.306 Unspecified focal traumatic aI< brain injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving

The appropriate 7th character is to be added to each code from category S06.A initial encounterD subsequent encounterS sequela

CC Excl: For codes in category S06, unless otherwise noted: CC or MCC with 7th character A: PDX collection 1154

CC Excl: For codes in subcategory S06.1, unless otherwise noted: MCC with 7th character A: PDX collection 1155

11 HCC with 7th character indicating initial encounter (A or B - specific to category) OR sequela.12 HCC with 7th character indicating sequela.

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ICD-10-CM 2019 Illustrations

ICD-10-CM 2019 Illustrations–27

Chapter 10. Diseases of the Respiratory System (J00–J99)

Respiratory System

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