ICD-10-CM: An Introduction for Coders

© Irene Mueller, EdD, RHIA

By attending this workshop, participants will

• Identify the– Reasons for implementing ICD-10-CM in the

United States– Settings that will require ICD-10-CM– Knowledge that coders will need to apply ICD-10-

CM– Similarities between ICD-9-CM and ICD-10-CM– Differences between ICD-9-CM and ICD-10-CM

• Receive– ICD-10-CM Coding Examples and Cases– ICD-10-CM Resources Listing for future use

Why Change to ICD-10-CM?

• ICD-9-CM out of space to accommodate new codes – Advances in medical

knowledge– New technology– Newly identified diseases

• Limited space = Lack sufficient clinical detail– Severity or complexity of

diagnoses

http://www.chiropracticmakati.com/Concept-Four.html

Why Change to ICD-10-CM?

• Updated classification system allows ability to– Measure quality of care – Initiate pay-for-performance– Evaluate resource utilization– Track public health threats, such as avian flu – Identify medical errors and patient safety issues– Exchange meaningful health data with other

organizations and government agencies

Reasons for ICD-10-CM Implementation

• Represents significant improvement – Designed to overcome issues & limitations of

ICD-9-CM – Updates healthcare coding with unambiguous

codes for conditions– More flexibility in adding new codes

• Has greater specificity and clinical detail – Major improvements in quality & usefulness of

coded data

Reasons for ICD-10-CM Implementation

• Updated Medical terminology & classification of diseases to reflect current clinical practice

• Improved structure & capacity for capturing technological advances – More flexible – Accommodates revisions necessitated by

medical advances

Why Change to ICD-10-CM?• 1990 - ICD-10 first published by WHO• 1999 – Australia• 1999 – US for death certificate coding• 2000 – Canada• 2005 – France• 2007 - Thailand• 2008 – Korea• 25 countries use ICD-10 for healthcare

reimbursement & resource allocation • ICD-11 – development from now thru 2015

ICD-10-CM Implementation

• Compliance date = – Date of discharge for inpatient claims – Date of service for outpatient claims

ICD-10-CM Control

• Cooperating Parties for ICD-10-CM

• AHA• AHIMA• CMS• NCHS

ICD10CM

Settings requiring ICD-10-CM

• ALL healthcare settings, because ICD-10-CM required for ALL diagnosis coding when implemented

• Will affect every part of HCOs, not just coders

Knowledge Base for ICD-10-CM

• CMS Final rule - Recommends 50 hours of training for Inpt Coders (16 for Outpt Coders)– PRESUMES coding

professionals already possess required knowledge in biomedical sciences needed to correctly apply codes using ICD-10-CM

• Anatomy• Physiology• Pathophysiology• Pharmacology• Medical terminology

Knowledge Base for ICD-10-CM

• Inpatient coders MUST– Have sufficient foundational knowledge of

biomedical sciences– Learn how to apply ICD-10-CM codes

correctly on inpatient encounters– Understand how to apply maps and

crosswalks between ICD-9-CM and ICD10 systems

Knowledge Base for ICD-10-CM

• Outpatient coders MUST – Have sufficient foundational knowledge of

biomedical sciences– Learn how to apply ICD-10-CM codes

correctly on outpatient encounters– Understand how to apply maps and

crosswalks between ICD-9-CM and ICD-10-CM

Similarities

Basic ICD-10-CM Coding Steps• ID all main terms in dx statement• ID all modifiers (subterms) in dx statement• Locate mainterm(s) in AI• Locate subterm(s) (site, etiology, clinical type)• Follow any cross-references IF not under 1st

code• Verify tentative code in TL• Follow any instructions• Assign codes to highest level of specificity

Code Structure

• Categories• Subcategories• Codes• Three-character category without any

subdivision = Code• Codes w/o correct # of characters = INVALID

– Codes assigned MUST have highest # of characters available/highest level of specificity

Structure and Conventions

• Much of hierarchical structure similar

• Many conventions similar

• Tabular List– Chapters– Subchapters (Blocks in ICD-

10-CM)

• Alphabetic Index– Two parts

• Index to Diseases and Injuries

– Neoplasm Table– Table of Drugs & Chemicals

• Index to External Causes

Similar AI Conventions

• Boldface Mainterms

• Indented subterms/essential modifiers

• Non-essential modifiers in ( )

• See• See Also• See Condition

Similar Conventions• Abbreviations

– NEC (Other Specified)• AI and TL

– NOS (Unspecified)• TL only

• Instructional Notes– Includes

• Examples• Location

– Code first– Use add’l code– Code Also

• No Sequencing

Instructional Notes Examples

Instructional Notes Examples

Similar Conventions• Punctuation

– Brackets [ ]• TL

– Parentheses ( )• AI and TL

– Colon :• TL Notes

• And = And/Or (TL)• With = Associated with/due to

– Code Title, AI, TL– Subterm sequencing

G73. 7

Similar Conventions Examples• Brackets

• Parentheses

Differences

ICD-10-CM Codes

• Sub-catergories = 4 or 5 characters• Codes are 3 – 7 characters• 1st character is LETTER

– O IS used; U is NOT used• Code format

Which of the followingis a valid ICD-10-CM code?

• 428.9• L03.313• T37.0XX1A• M12X.58

Tabular List• TL = 21 chapters

– List of blocks at beginning of each chapter• Axes of Classification

– Body/organ system– Etiology/Disease process– E & V codes NOT supplemental

• Order of Chapters – some reordering• Some chapters reordered

– Injuries = 1st by specific site, then type of injury– Postop complications moved to procedure-specific

body system (mostly)

Dashes in AI and TL

• AI – Dash at end of code = incomplete code– MUST review TL– Ex: Fracture, pathologic

• Ankle M84.47-• Carpus M84.44-

• TL - Dash preceded by decimal point (.-) = incomplete code– MUST review referenced code in TL– Ex: J43 Emphysema

• Excludes1: emphysematous (obstructive) bronchitis (J44.-)

Exclusion Notes• Two types

– Located at category, subcategory, or code level• Excludes1 – Pure, NOT CODED HERE!

– NEVER used with code above note– Two conditions can’t occur together

• Congenital and Aquired

• Excludes2 – Not coded here– Condition excluded is NOT INCLUDED HERE– Patient may have both at same time– Can code both if both present

Excludes Notes Examples

Morphology Codes

• No longer listed in AI with descriptors and standard ICD-10-CM codes

• No longer separate appendix in ICD-10-CM

NEC and NOS Separated

• Other Specified and Unspecified each have their own code

• Example:

Placeholder Character (X)

• Two uses– Future expansion WITHOUT disturbing overall

code structure (5th character for some 6-character codes)

– Code with less than 6 characters that requires a 7th character extension• Obstetrics, Injuries, and External causes of injuries

Placeholder Examples

• T37.0X1A, Poisoning by sulfonamides, accidental (unintentional), initial encounter

• T56.0X2S, Toxic effect of lead and its compounds, intentional self-harm, sequela

• W42.0XXA, Exposure to supersonic waves, initial encounter

Placeholder Example -TL

Category Code X12 with 7th Character Extension

Pregnancy Trimester Coding

• Inclusion of trimesters in obstetrics codes– Episode of Care 5th Digits Eliminated

• Examples:– O10.012, Pre-existing essential hypertension

complicating pregnancy, second trimester– O99.013, Anemia complicating pregnancy,

third trimester

Pregnancy Trimester Example

Seventh Character

• SOME ICD-10-CM categories require 7th character to further specify condition– May be number or letter– MUST always be 7th character

• Examples: – O65.0XX1, Obstructed labor due to deformed

pelvis, fetus 1– S02.110B, Type I occipital condyle fracture, initial

encounter for open fracture– T17.220D, Food in pharynx causing asphyxiation,

subsequent encounter

Specificity

• Laterality • Other expanded detail• Combining in single code

– Etiology and manifestations– Poisoning and external cause– Diagnosis and symptoms

• Code titles and language complement accepted clinical practice

Specificity Examples

RU, LU, RL, LL

Specificity Examples

Specificity Examples

Timeframe Changes for Some Codes

• Examples:– AMI - Time period changed from 8 wks to 4 wks

– Abortion vs fetal death – Time period changed from 22 weeks to 20 weeks

Timeframe Examples

Abortion/Fetal Death - TL

ICD-10-CM Coding Guidelines

• Section I– Structure and

conventions of classification

– General guidelines that apply to entire classification

– Chapter-specific guidelines that correspond to chapters as arranged in classification

• Section II– Selection of principal

diagnosis for non-outpatient settings.

• Section III– Reporting additional

diagnoses in non-outpatient settings

• Section IV– Outpatient coding and

reporting

ICD-10-CM Coding Guidelines• Similar to ICD-9-CM, EXCEPT

• Laterality (New)

• Documentation of Complications of Care

Laterality Guideline

• For bilateral sites, final character of codes indicates laterality

• Unspecified site code also provided if side not identified in medical record

• If no bilateral code provided and condition bilateral, assign separate codes for both left and right side

Documentation of Complications of Care

• Code assignment based on provider’s documentation of relationship bet. condition and care or procedure

• Guideline extends to any complications of care, regardless of chapter where code located

• Important to note NOT all conditions occurring during/following medical care/surgery are classified as complications

• There must be cause-and-effect relationship between care provided & condition, and indication in documentation that it is complication

• Query provider for clarification, if complication not clearly documented

Break Time

ICD-10-CM Coding Case 1

• Pt seen w/ amenorrhea, characteristics of masculinization, and high levels of serum testosterone. Pelvic ultrasound revealed a left discrete ovarian mass.

• GYN performed laparoscopic unilateral salpingo-oophorectomy as outpatient.

• Pathologic diagnosis returned as ovarian Sertoli-Leydig cell tumor.

Case 1 Coding Process - AI

• Tumor —see also Neoplasm, unspecified behavior, by site– Sertoli-Leydig cell —see Neoplasm, benign, by

site

• Main Term = Tumor• Sub Term = Sertoli- Leydig Cell• Neoplasm Site = Ovary

Case 1 Coding Process – Neoplasm Table

D27. - What does Dash tell coder???

Case 1 Coding Process - TL• D 27 Benign neoplasm of ovary

– Use additional code to identify any functional activity - ????

• Excludes2:– corpus albicans cyst (N83.2)– corpus luteum cyst (N83.1)– endometrial cyst (N80.1)– follicular (atretic) cyst (N83.0)– graafian follicle cyst (N83.0)– ovarian cyst NEC (N83.2)– ovarian retention cyst (N83.2)

Case 1 Coding Process -TL

• D27.0 Benign neoplasm of right ovary• D27.1 Benign neoplasm of left ovary• D27.2 Benign neoplasm of unspecified

ovary

• Do we need a code for masculinization as a functional activity of the tumor?

• Per Use Add’l Code note at D27

Case 1 ANSWER

• D27.1 Benign neoplasm of left ovary

Do we need a code for masculinization as a functional activity of the tumor? Per Use Add’l Code note at D27

NO – Mainterm Masculinzation or Virilization goes to D27.-

Coding Case 2

• Doctor 16-y-o pt w/ myasthenia gravis & adolescent idiopathic thoracic scoliosis. Surgery for spinal fusion cancelled after pt had positive TB skin test during preop workup, suggesting latent TB.

• Today’s visit – pt started on Isoniazid 300 mg daily & instructed on possible side effects. Will reschedule surgery after two months of INH treatment.

Case 2 Coding Process - AI

• Findings, abnormal, inconclusive, without diagnosis —see also Abnormal– tuberculin skin test (without active tuberculosis)

R76.11• Myasthenia G70.9

– gravis G70.00

Case 2 Coding Process - AI• Scoliosis (acquired)

(postural) M41.9– adolescent (idiopathic) —see

Scoliosis, idiopathic, juvenile– idiopathic M41.20

- - adolescent M41.129

- - - cervical region M41.122

- - - lumbar region M41.126

- - - thoracic region M41.124

• - - juvenile M41.119

Case 2 Coding Process - TL

• M41 Scoliosis– Includes: Kyphoscoliosis– Excludes1: congenital scoliosis NOS (Q67.5)

congenital scoliosis due to bony malformation (Q76.3)

postural congenital scoliosis (Q67.5)

kyphoscoliotic heart disease (I27.1)

postprocedural scoliosis (M96.-)

FYI Juvenile vs Adolescent

• Juvenile idiopathic scoliosis usu. occurs from about age 4 to puberty-about age 10 or 11 for girls, age 12 for boys. Usu. R thoracic curves.

• Adolescent idiopathic scoliosis usu. occurs in early puberty, w/ most rapid worsening during early growth spurt. Females more than males – 5:1. Also, usu. R thoracic curves.

Case 2 ANSWER

• R76.11 Findings, abnormal, inconclusive, without diagnosis, tuberculin skin test (without active tuberculosis)

• G70.00 Myasthenia gravis• M41.124 Adolescent idiopathic scoliosis,

thoracic region

Why are codes for this case sequenced in this order?

Coding Case 3

• 62-y-o female visits her family practice physician for annual physical and follow-up on her chronic gout with tophi. She has her annual Pap smear and flu shot for the season.

Case 3 Coding Process - AI

• Examination (for) (following) (general) (of) (routine) Z00.00-– annual (adult) (periodic) (physical) Z00.00

- - with abnormal findings Z00.01

- - gynecological Z01.419

- - - with abnormal findings Z01.411

Can both Z00.- and Z01.- be coded?

Case 3 Coding Process - AI• Z01 Encounter for other special examination w/o

complaint, suspected or reported diagnosis Includes: routine examination of specific system

Note: Codes from category Z01 represent reason for encounter. A separate procedure code is required to id any exam or procedures performed

Excludes1:encounter for examination for administrative purposes (Z02.-)

encounter for examination for suspected conditions, proven not to exist (Z03.-)

encounter for laboratory and radiologic examinations as a component of general medical examinations (Z00.0-)

encounter for laboratory, radiologic and imaging examinations for sign(s) and symptom(s) - code to sign(s) or symptom(s)

screening examinations (Z11-Z13)

Case 3 Coding Process - AI• Z01.4 Encounter for gynecological examination• Excludes2: pregnancy examination or test (Z32.0-)

routine exam for contraceptive maintenance (Z30.4-)• Z01.41 Encounter for routine gynecological examination

– Encounter for general gynecological examination w/wo cervical smear– Encounter for gynecological examination (general) (routine) NOS– Encounter for pelvic examination (annual) (periodic)– 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-)

– Excludes1:gynecologic examination status-post hysterectomy for malignant condition (Z08)

screening cervical pap smear not a part of a routine gynecological exam Z12.4)

Case 3 Coding Process - AI

• Gout, gouty (acute) (attack) (flare) (see also Gout, chronic) M10.9-

- tophi —see Gout by type

• Gout, chronic (see also Gout, gouty) M1A.9

Case 3 Coding Process – AI & TL

• Flu Shot• Immunization —see also Vaccination

– encounter for Z23

• Z 23 Encounter for immunization

Code First: any routine childhood examination

Note: procedure codes are required to identify the types of immunizations given

Case 3 Coding Process - TL

• Persons encountering health services for examinations (Z00-Z13)– Nonspecific abnormal findings disclosed at the

time of these examinations are classified to categories R70-R94.

– Excludes1: examinations related to pregnancy and reproduction (Z30-Z36, Z39.-)

Case 3 Coding Process - TL

• Z00 Encounter for general examination without complaint, suspected or reported diagnosis

Excludes1: encounter for examination for administrative purposes (Z02.-)

Excludes2: encounter for pre-procedural examinations (Z01.81-)

special screening examinations (Z11-Z13)

Case 3 Coding Process - TL

• Z00.0 Encounter for general adult medical examination– Encounter for adult periodic

examination (annual) (physical) and any associated laboratory and radiologicexaminations

• Excludes1: encounter for examination of sign or symptom- code to sign or symptom

general health check-up of infant or child (Z00.12.-)

• Z00.00 Encounter for general adult medical examination without abnormal findings– Encounter for adult health

check-up NOS

• Z00.01Encounter for general adult medical examination with abnormal findings– Use additional code to

identify abnormal findings

Case 3 Coding Process –Documentation Issue

• Gout, chronic– drug-induced M1A.20– idiopathic M1A.00– in (due to)renal impairment M1A.30– lead-induced M1A.10– primary —see Gout, chronic, idiopathic– saturnine —see Gout, chronic, lead-induced– secondary NEC M1A.40– syphilitic (see also subcategory M14.8-) A52.77– tophi —see Gout by type

These sub-terms require body part and laterality

Case 3 Coding Process - TL

• M1A Chronic gout The appropriate 7th character is to be added

to each code from category M1A– 0 - without tophus (tophi)– 1 - with tophus (tophi)

• M1A.9 Chronic gout, unspecified

Case 3 ANSWER

• Z01.419 Examination (for) (following) (general) (of) (routine), annual (adult) (periodic) (physical), gynecological

• M1A.9XX1 Gout, chronic, with tophi

• Z23 Vaccination (prophylactic), encounter for

Coding Case 4

• Office Visit; 36-y-o male pt, primary care physician.• Hx: Pt here for follow-up of lab work from earlier in

week. Bitten by tick last month & has had body aches, some swelling to R upper arm, pain & stiffness in R elbow, as well as feeling fatigued. Had + Lyme test; pt to have repeat blood test (Western Blot), as 2ndary follow-up.

• PE: Alert & in no acute distress. Temp 98.4. Pulse 108. Resp 20. BP 118/70.

http://www.nlm.nih.gov/medlineplus/magazine/issues/sprsum10/articles/sprsum10pg24.html

Coding Case 4

• PE: Weight 296 on a 5’ 9” frame. Up 3 pounds from last week & 22 pounds up since beginning of year. Arm continues to display circular erythematous lesion with 2+ pitting edema. Lesion hasn’t grown outside perimeter markings from first visit.

• Impression:• 1. Localized arthritis, right elbow in Lyme disease

due to tick bite• 2. Morbid obesity, BMI of 43.7

Coding Case 4

• Pt has blood drawn & was put on Doxycycline 100 mg b.i.d. × 4 weeks.

• Additional educational material on Lyme disease given. Should follow-up immediately if affected area grows larger than current, marked area or if any new symptoms develop.

• We discussed again need for exercise program, when able, & portion control due to over-nourishment status.

•

Case 4 Coding Process - AI

• Localized arthritis, right elbow in Lyme disease due to tick bite

• Arthritis, arthritic (acute) (chronic) (nonpyogenic) (subacute) M19.90

- due to or associated with

- - Lyme disease A69.23

Case 4Coding Process - AI

• Bite (s) (animal) (human)

- arm (upper) S41.15-

- - lower —see Bite, forearm

- - superficial NEC S40.87-

- - - insect S40.86-

Case 4 Coding Process – AI for External Causes

• Bite, bitten by– insect (nonvenomous) W57

• TL = Exposure to animate mechanical forces (W50-W64)

Excludes1: Toxic effect of contact with venomous animals and plants (T63.-)

Case 4 Coding Process -TL

• W57 Bitten or stung by nonvenomous insect and other nonvenomous arthropods

Excludes1: contact with venomous insects and arthropods (T63.2-, T63.3-, T63.4-)

The appropriate 7th character is to be added to code W57

A - initial encounter

D - subsequent encounter

S - sequela

Case 4 Coding Process - AI

• Morbid obesity, BMI of 43.7

• Obesity E66.9

- morbid E66.01

- - with alveolar hypoventilation E66.2

- - due to excess calories E66.01

Case 4 Coding Process - TL

Case 4 Coding Process – AI • BMI, 43.7 – Use Add’l

Note at E66 = Z68.-Body, bodies

- mass index (BMI)

- - adult

- - - 19 or less Z68.1

- - - 20.0-20.9 Z68.20

- - - 21.0-21.9 Z68.21

- - - 22.0-22.9 Z68.22- - - 23.0-23.9 Z68.23

- - - 24.0-24.9 Z68.24

- - - 25.0-25.9 Z68.25

- - - 26.0-26.9 Z68.26

- - - 27.0-27.9 Z68.27

- ------------

- - - 35.0-35.9 Z68.35

- - - 36.0-36.9 Z68.36

- - - 37.0-37.9 Z68.37

- - - 38.0-38.9 Z68.38

- - - 39.0-39.9 Z68.39

- - - 40.0-44.9 Z68.41

- - - 45.0-49.9 Z68.42

- - - 50.0-59.9 Z68.43

- - - 60.0-69.9 Z68.44

- - - 70 and over Z68.45

Coding Case 4 ANSWER• A69.23 Arthritis, arthritic, (acute) (chronic)

(nonpyogenic) (subacute) due to or associated with Lyme disease

• S40.861S Bite(s), (animal) (human), arm (upper), superficial NEC, insect..

• E66.01 Obesity, morbid• Z68.41 Body, bodies, mass index (BMI), adult, 40–

44.9• W57.XXXS Index to External Causes, Bite, bitten by,

insect, (nonvenomous)

Coding Case 5 • 49-y-o female with CC of painful mouth

ulcers over last month. Treated with acyclovir for 10 days and penicillin on two occasions, including tapering doses of steroids on second occasion. Pt states she feels somewhat better but continues to have these ulcers with pain.

• Denies fever, chills, dysphagia, or lymphadenopathy. No high risk behavior.

Coding Case 5• PE: Reveals whitish patches measuring 1 mm

× 1 mm on buccal musoca and hard palate; erythematous and inflamed.

• Assessment: Aphthous ulcers and herpangina

• Plan: Will start patient on clindamycin orally for buccal cellulitis and Amlexanox 5% as oral paste along with the Xylocaine mouth wash. Patient should follow up with me in 2 weeks.

Case 5 Coding Process - AI• Aphthous ulcers

• Herpangina Is there another diagnosis that needs to be coded?

Case 5 Coding Process - TL

Case 5 ANSWER

• K12.2 Cellulitis (diffuse) (phlegmonous) (septic) (suppurative), mouth (floor)

• K12.0 Ulcer, ulcerated, ulcerating, ulceration, ulcerative, aphthous (oral)(recurrent)

• B08.5 Herpangina Sequencing?

Documentation for ICD-10-CM

• AHA/AHIMA field testing study– Much of detail in ICD-

10-CM is ALREADY incorporated in MR documentation

– NOT currently needed for ICD-9-CM coding

AHIMA Required CEUs

• ICD-10-CM/PCS continuing education units (CEUs)– CHPS – 1 CEU – CHDA – 6 CEUs – RHIT – 6 CEUs – RHIA – 6 CEUs – CCS-P – 12 CEUs – CCS – 18 CEUs – CCA – 18 CEUs

General Resources

• Frazier, M. S. & Drzymkowski, J. W. Essentials of Human Diseases and Conditions, 4th ed., Saunders, 2009

• Gray, H. Anatomy of the Human Body. 1918  – http://www.bartleby.com/107/

• Scott, A. S. & Fong, E. Body Structures and Functions, 11th ed., Delmar, 2009

• Whonamedit? A dictionary of medical eponyms – http://www.whonamedit.com/

Pressure ulcer Case• A 73 year old male is followed

in your clinic Diagnoses– Type II Diabetes Mellitus– Hypertension– Hyperlipidemia– CVA 18 mos ago– Obesity– 54-pack-year smoking

history (quit 2 years ago)– Diabetic neuropathy– Diabetic retinopathy– Diabetic gastroparesis

• Medications– 70/30 insulin bid– Lisinopril– Simvastation– Enteric coated aspirin– Metoclopramide ac and

hs

PU Case

• After stroke 18 months ago, dx w/ depression, tx for 6 months with sertraline, with improvement of mood to normal. Drug discontinued.

• Most recent functional assessment by visiting RN was that pt needed assistance w/bathing,

otherwise independent. HH aide provided assistance w/ bathing & light housework, daughter visited almost every day.

PU Case

• Pt brought into ED by ambulance, after his daughter found him at home lying on floor, unconscious. ED room physician admits him w/ Dx of pneumonia, fall with long lie, dehydration, and altered mental status.

• By 2nd hospital day, he developed new pressure ulcer over right lateral malleolus.

• Examination of ulcer shows a round, 3 cm black eschar that is debrided to an ulcer that extends through dermis.

ICD-9-CM Codes• 486 Pneumonia• 707.06, 707.22 Pressure

Ulcer R lateral malleolus• 276.51 Dehydration• 780.97Altered mental

status• DM type 2

– Neuropathy– Retinopathy– Gastroparesis

• 260.60, 357.2, 563.3• 250.50, 362.01

• 401.9 HTN• 272.4 Hyperlipidemia• 278.00 Obesity• V12.54 Hx CVA• V15.82 Hx Smoking• E888.9 Fall• E849.0 At Home

ICD-10-CM Codes• J18.9 Pneumonia• L89.513 Pressure Ulcer R lateral malleolus• E86.0 Dehydration• R41.82 Altered mental status

– Altered mental status due to known condition - code to condition

• DM type 2– E11.40 Neuropathy– E11.319 Retinopathy -- MUST know w/wo Macular Edema– E11.43 Type 2 diabetes mellitus with diabetic autonomic

(poly)neuropathy• Includes: Type 2 diabetes mellitus with diabetic

gastroparesis

ICD-10-CM Codes

• I10 HTN - LESS Specific• E78.5 Hyperlipidemia• E66.9 Obesity• Z86.73 Hx CVA• Z87.891 Hx Smoking• W19.XXXA Fall• Y92.009 At Home

General Resources

• Frazier, M. S. & Drzymkowski, J. W. Essentials of Human Diseases and Conditions, 4th ed., Saunders, 2009

• Gray, H. Anatomy of the Human Body. 1918  – http://www.bartleby.com/107/

• Scott, A. S. & Fong, E. Body Structures and Functions, 11th ed., Delmar, 2009

• Whonamedit? A dictionary of medical eponyms – http://www.whonamedit.com/

ICD-10-CM Resources• AAPC. ICD-10 Connect (e-Newsletter)

– https://www.aapc.com/icd-10/icd-10-connect.aspx

• AAPC. ICD-10 Implementation– http://www.aapc.com/icd-10/index.aspx

• AHIMA. ICD-10-CM/PCS Implementation Toolkit. 2012.– http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1

_049431.hcsp?dDocName=bok1_049431#reasons

• CDC. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)– http://www.cdc.gov/nchs/icd/icd10cm.htm

• CDC. ICD-10-CM Official Guidelines for Coding and Reporting 2012– http://www.cdc.gov/nchs/data/icd10/10cmguidelines2012.pdf

ICD-10-CM Resources• Clinical Documentation Challenges with ICD-10-CM,

11/2011. ICD-10 Taskforce Bulletin. NCHICA. – http://www.bcbsnc.com/assets/providers/public/pdfs/clinical_docu

mentation_challenges_with_icd-10-cm.pdf

• CMS-AAPC ICD-10 Code-a-thon Video. YouTube. One hour and 16 minutes.– http://www.youtube.com/watch?v=IWLkTQARwTo

• Endicott, M. ICD-10-CM/PCS codes for musculoskeletal system include greater level of specificity. 8/30/2011– http://justcoding.com/270313/redirect

• Giannangelo, K. and Hyde, L. ICD-10’s impact on quality measures. Just Coding. – http://www.justcoding.com/279206/icd10s-impact-on-quality-meas

ures

ICD-10-CM Resources• Grant, C & Wierz, C. An Essential Guide to ICD-10

Implementation. Courtyard Group.– http://www.himss.org/content/files/CourtyardWhitepaperAnEssentialGui

deICD10.pdf

• Gray, L. ICD-10-CM Coding of Physeal Fractures Using the Salter-Harris Classification System– http://www.contexomedia.com/blog/index.php/2011/04/07/icd-10-cm-co

ding-of-physeal-fractures-using-t

he-salter-harris-classification-system/#more-1722• ICD-10 Articles. Just Coding News. HCPro.

– http://www.justcoding.com/icd-10

• ICD10Data.com. Free 2012 ICD-10 reference, including all codes, a search engine, ICD-9-CM conversion, all indexes and 10.6 million instant coding notes.• http://www.icd10data.com/

ICD-10-CM Resources• Kostick, K. M. Coding Diabetes Mellitus in ICD-10-CM

• http://journal.ahima.org/2012/05/16/coding-diabetes-mellitus-in-icd-10-cm-4/

• Leon-Chisen, N. ICD-10 Overview and How Does ICD-10 Impact Departments? AHA. 11/03/2011– http://www.gchc.org/wp-content/uploads/2011/10/11-3-11-I

CD-10-Cincinnati_FINAL-Leon-Chisen.pdf• Let's Get The Terms Straight. National Scoliosis Foundation.

– http://www.scoliosis.org/resources/medicalupdates/terms.php

• Role-based Model for ICD-10 Implementation: Inpatient Coders. AHIMA.– http://library.ahima.org/xpedio/groups/public/documents/ahi

ma/bok1_045928.hcsp?dDocName=bok1_045928

ICD-10-CM Resources• Role-based Model for ICD-10 Implementation: Outpatient

Coders. AHIMA.– http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_0

45929.h

csp?dDocName=bok1_045929• Schraffenberger, L. Basic ICD-10-CM/PCS and ICD-9-CM

Coding, 2012 ed. Chicago: AHIMA • Schreck, B. Late Effects (Sequela) in ICD-10-CM August 10,

2011 – http://www.contexomedia.com/b

log/index.php/2011/08/10/late-effects-sequela-in-icd-10-cm/

• Simmons, C. R. The Musculoskeletal System and ICD-10-CM. ICD TEN, April 2011.AHIMA.– https://newsletters.ahima.org/newsletters/ICDTen/2011/April/April_ICD.

html

ICD-10-CM Resources

• WHO. International Classification of Diseases (ICD)– http://www.who.int/classifications/icd/en/

• Zeisset, A. Coding Injuries in ICD-10-CM.– http://library.ahima.org/xpedio/groups/public/documents

/ahima/bok1_048533.hcsp?dDocName=bok1_048533

• Zeisset, A. ICD-10-CM Enhancements: A Look at the Features That Will Improve Coding Accuracy– http://library.ahima.org/xpedio/groups/public/documents

/ahima/bok1_042626.hcsp?dDocName=bok1_042626

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