Category Archives: ICD 10

ICD -10 Practice Questions

ICD 10 Practice Questions for CPC Exam 2017

Hello Guys!!

I have prepared few questions based on ICD 10. These are based on previous year questions papers and very useful for CPC Exam 2017 and also for CIC , COC , CRC Exam 2017.

These questions are also very useful for beginner students to practice their ICD 10 coding knowledge and skills.

Here we go…

ICD 10 Practice Questions for CPC Exam 2017

  1. Mrs. Smith had a breast cancer was completely treated with chemotherapy and radiation therapy last year and it has been metastasis to bone.
  2. Metastatic lung
  3. Septic shock with respiratory failure
  4. Oral candidiasis secondary to HIV +ve
  5. Diabetic Neuropathy on long term Insulin
  6. DM, Osteomyelitis
  7. Diabetes and nephropathy
  8. Anemia of CKD
  9. Primary Open Angle Glaucoma
  10. HTN, CKD, CHF
  11. CHF due to diastolic dysfunction
  12. Pressure ulcer of Sacrum
  13. Asthma Exacerbation and Status asthmaticus
  14. Continue reading ICD 10 Practice Questions for CPC Exam 2017

ICD 10

ICD 10 – Introduction

The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. This fact sheet provides background on the ICD-10 transition, general guidance on how to prepare for it, and resources for more information.

ICD 10 

ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification/ Procedure Coding System) consists of two parts:

ICD 10 – CM 

ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar.

ICD 10 – PCS

ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9- CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims:

  • Claims for services provided on or after the compliance date should be submitted with ICD-10 diagnosis codes.
  • Claims for services provided prior to the compliance date should be submitted with ICD-9 diagnosis codes.

The change to ICD-10 does not affect CPT coding for outpatient procedures.

ICD-10-CM Indexes

A comprehensive listing of 2015 diagnosis codes can be found in the ICD-10-CM Index to Diseases and Injuries (alphabetical) and ICD-10-CM Tabular List of Diseases and Injuries.

A summary of the chapters found in the Tabular List has been provided below:

Chapter Code Range Estimated # of Codes Description
1 A00-B99 1,056 Certain infectious and parasitic diseases
2 C00-D49 1,620 Neoplasms
3 D50-D89 238 Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
4 E00-E89 675 Endocrine, nutritional and metabolic diseases
5 F01-F99 724 Mental, Behavioral and Neurodevelopmental disorders
6 G00-G99 591 Diseases of the nervous system
7 H00-H59 2,452 Diseases of the eye and adnexa
8 H60-H95 642 Diseases of the ear and mastoid process
9 I00-I99 1,254 Diseases of the circulatory system
10 J00-J99 336 Diseases of the respiratory system
11 K00-K95 706 Diseases of the digestive system
12 L00-L99 769 Diseases of the skin and subcutaneous tissue
13 M00-M99 6,339 Diseases of the musculoskeletal system and connective tissue
14 N00-N99 591 Diseases of the genitourinary system
15 O00-O9A 2,155 Pregnancy, childbirth and the puerperium
16 P00-P96 417 Certain conditions originating in the perinatal period
17 Q00-Q99 790 Congenital malformations, deformations and chromosomal abnormalities
18 R00-R99 639 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
19 S00-T88 39,869 Injury, poisoning and certain other consequences of external causes
20 V00-Y99 6,812 External causes of morbidity
21 Z00-Z99 1,178 Factors influencing health status and contact with health services

References – www.aapc.com, www.cms.gov

depressive disorder

ICD 10 – Coding Tips For Depressive Disorders

Coding for Major Depressive Disorder

 F32. Major depressive disorder, single episode

 According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) , five or more of the symptoms listed below must be present during the same 2‐week time period that represents changes in functioning. At least one symptom is either a depressed mood or loss of interest.

  • Depressed mood most of the day, nearly every day, as indicated in the subjective report or in observation made by others
  • Markedly diminished interest in pleasure in all, or almost all, activities most of the day and nearly every day
  • Significant weight loss when not dieting or weight gain, for example, more than 5 percent of body weight in a month or changes in appetite nearly every day
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness nearly every day
  • Recurrent thoughts of death

 The ICD‐10 classification of Mental and Behavioral Disorders developed in part by the American Psychiatric Association classifies depression by code. In typical, mild, moderate, or severe depressive episodes the patient suffers from lowering of mood, reduction of energy and decrease in activities. Their capacity for enjoyment, interest, and concentration is reduced and is marked by tiredness after even a minimum of effort is common. Sleep patterns are usually disturbed and appetite diminished along with reduced self‐confidence and self‐esteem.

 Final code selection is based on severity (mild, moderate, severe) and status.  Depending on the number and severity of the symptoms, a depressive episode may be specified as mild, moderate, or severe.

For mild depressive episodes two or three symptoms from the data below are usually present. The general criteria for depressive episode must be met.

 At least two of the following three symptoms must be present:

 Depressed mood to a degree that is definitely abnormal to the individual, present for most of the day and almost every day, largely uninfluenced by circumstances, and sustained for at least two weeks

 Loss of interest or pleasure in activities that are normally pleasurable

 Decreased energy or increased fatigability

 An additional symptom or symptoms from the following list should be present to give a total of at least four:

 Loss of confidence or self‐esteem

 Unreasonable feelings of self‐reproach or excessive and inappropriate guilty

 Recurrent thoughts of death or any suicidal behavior

Complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation

Change in psychomotor activity, with agitation or retardation (either subjective or objective)

 Sleep disturbance of any type

 Change in appetite (decrease or increase) with corresponding weight change

 For moderate depressive episodes four or more of the symptoms noted above are usually present and the patient is likely to have great difficulty in continuing with ordinary activities.

 For a classification of in remission the patient has had two or more depressive episodes in the past but has been free from depressive symptoms for several months. This category can still be used if the patient is receiving treatment to reduce the risk of further episodes. It will be based on the provider’s clinical determination and documentation.

 F32.0 Major depressive disorder, single episode, mild

F32.1 Major depressive disorder, single episode, moderate

F32.2 Major depressive disorder, single episode, severe without psychotic features

F32.3 Major depressive disorder, single episode, severe with psychotic features F32.4 Major depressive disorder, single episode, in partial remission

F32.5 Major depressive disorder, single episode, in full remission

 F33 Major depressive disorder, recurrent

 A recurrent depressive disorder is characterized by repeated episodes of depression without any history of independent episodes of mood elevation and increased energy or mania. There has been at least one previous episode lasting a minimum of two weeks and separated by the current episode of at least two months. At no time in the past has there been any hypomanic or manic episodes.

 F33.0 Major depressive disorder, recurrent, mild

F33.1 Major depressive disorder, recurrent, moderate

F33.2 Major depressive disorder, recurrent, severe without psychotic features F33.3 Major depressive disorder, recurrent, severe with psychotic features

 F33.4 Major depressive disorder, recurrent, in remission

 For a classification of in remission the patient has had two or more depressive episodes in the past but has been free from depressive symptoms for several months. This category can still be used if the patient is receiving treatment to reduce the risk of further episodes. It will be based on the provider’s clinical determination and documentation.

 F33.40 Major depressive disorder, recurrent, in remission, unspecified F33.41 Major depressive disorder, recurrent, in partial remission

F33.42 Major depressive disorder, recurrent, in full remission

ICD 10

ICD 10 – Diabetes Mellitus

Diabetes Mellitus in ICD‐10‐CM

 The diabetes mellitus codes are expanded in ICD‐10‐CM. The codes for diabetes mellitus are located in chapter 4, Endocrine, Nutritional, and Metabolic Diseases, in ICD‐10‐CM. Unlike ICD‐9‐CM, the codes in ICD‐10‐CM for diabetes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications of that body system.   There are five categories for diabetes codes in ICD‐10‐CM:

 E08     Diabetes mellitus due to an underlying condition E09      Drug or chemical induced diabetes mellitus

E10     Type 1 diabetes mellitus E11      Type 2 diabetes mellitus

E13      Other specified diabetes mellitus

As many codes as needed to identify all of the associated conditions of the patients should be assigned.

The terms “uncontrolled” and “not stated as uncontrolled” are no longer used in ICD‐10‐ CM. Instead the codes descriptors indicate “with complications” or without complications.”

The subcategories for the complications with the body systems affected by diabetes mellitus are as follows:

Ketoacidosis

o  Without coma

o  With coma

 

  • Kidney complications

o  Diabetic nephropathy

o  Diabetic chronic kidney disease

o  Other diabetic kidney complications

 

 

 

 

  • Ophthalmic complications

o  Diabetic retinopathy

  • Mild nonproliferative with/without macular edema
  • Moderate nonproliferative with/without macular edema
  • Severe nonproliferative with/without macular edema
  • Proliferative with/without macular edema

o  Diabetic cataract

o  Other diabetic ophthalmic complications

 

  • Neurological complications

o  Diabetic neuropathy

  • Diabetic mononeuropathy
  • Diabetic polyneuropathy
  • Diabetic autonomic (poly)neuropathy

o  Diabetic amyotrophy

o  Other diabetic neurological complications

 

  • Circulatory complications

o  Diabetic peripheral angiopathy with/without gangrene

o  Other circulatory complications

 

  • Other specified complications

o  Diabetic arthropathy

  • Diabetic neuropathic arthropathy
  • Other diabetic arthropathy

o  Skin complications

  • Diabetic dermatitis
  • Foot ulcer
  • Other skin ulcer
  • Other skin complication

o  Oral complications

  • Periodontal disease
  • Other oral complications

o  Hypoglycemia

  • With coma
  • Without coma

o  Hyperglycemia

o  Other specified complication

Important Diabetes Mellitus Guidelines (complete guidelines located in the ICD‐10‐CM code book)

Type of diabetes: The age of a patient is not the sole determining factor, though most type 1 diabetics develop the condition before reaching puberty. For this reason type 1 diabetes mellitus is also referred to as juvenile diabetes.

Type of diabetes mellitus not documented: If the type of diabetes mellitus is not documented in the medical record the default is category E11, Type 2 diabetes mellitus.

For example, if the charge ticket states “DM” then code E11.9, Type 2 diabetes mellitus without complications, is the code that must be assigned. It is very important for providers to consistently document the type of diabetes in order to report the proper code(s).

Diabetes mellitus and the use of insulin: If the documentation in a medical record does not indicate the type of diabetes but does indicate that the patient uses insulin, code E11‐, Type 2 diabetes mellitus, should be assigned. Code Z79.4, Long‐term (current) use of insulin, should also be assigned to indicate that the patient uses insulin. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 patient’s blood sugar under control during an encounter.

Example:

A type 2 diabetic patient that has been using Lantus for 3 months to help control his diabetes presents for a recheck. After history and examination, it is decided to have the patient continue to use the Lantus and come back in 3 months. An A1c will be performed before the next visit.

E11.9 Type 2 diabetes mellitus without complications Z79.4 Long‐term (current) use of insulin

In the Table of Drugs and Chemicals in ICD‐10‐CM, a new column has been added for underdosing of medications. This has lead to new guidelines regarding insulin pump malfunction.

Underdose of insulin due to insulin pump failure: An underdose of insulin due to an insulin pump failure should be assigned to a code from subcategory T85.6, Mechanical complication of other specified internal and external prosthetic devices, implants and grafts, that specifies the type of pump malfunction, as the principal or first‐listed code, followed by code T38.3X6‐, Underdosing of insulin and oral hypoglycemic (antidiabetic) drugs.

Additional codes for the type of diabetes mellitus and any associated complications due to the underdosing should also be assigned.

Overdose of insulin due to insulin pump failure: The principal or first‐listed code for an encounter due to an insulin pump malfunction resulting in an overdose of insulin, should also be T85.6‐, Mechanical complication of other specified internal and external prosthetic devices, implants and grafts, followed by code T38.3X1‐ Poisoning by insulin and oral hypoglycemic (antidiabetic) drugs, accidental (unintentional).

 

Example 1:

A type 1 diabetic patient is brought in the emergency department with an insulin pump breakdown, resulting in an underdose of insulin. The patient is now has diabetic ketoacidosis with coma.

T85.614A Breakdown (mechanical) of insulin pump, initial encounter

T38.3X6A Underdosing of insulin and oral hypoglycemic (antidiabetic) drugs, initial encounter

E10.11 Type 1 diabetes mellitus with ketoacidosis with coma

Example 2:

A type 1 diabetic patient is brought in to the emergency department with an insulin pump breakdown, resulting in an accidental overdosing of insulin. The patient is now in a hypoglycemic coma.

T85.614A Breakdown (mechanical) of insulin pump, initial encounter T38.3X1A Poisoning by insulin and oral hypoglycemic (antidiabetic) drugs,accidental (unintentional), initial encounter

E10.641 Type 1 diabetes mellitus with hypoglycemia with coma

Secondary diabetes mellitus: Codes under category E08 Diabetes mellitus due to underlying condition, E09 Drug or chemical induced diabetes mellitus, and E13 Other specified diabetes mellitus, identify complications/manifestations associated with secondary diabetes mellitus. Secondary diabetes mellitus is always caused by another condition or event (eg, cystic fibrosis, malignant neoplasm of pancreas, pancreatectomy, adverse effect of drug, or poisoning).

Assigning and sequencing secondary diabetes codes and its causes: The sequencing of the secondary diabetes odes in relationship to codes for the cause of the diabetes is based on the Tabular List instructions for categories E08, E09, and E13.

Secondary diabetes mellitus due to pancreatectomy: For postpancreatectomy diabetes mellitus (lack of insulin due to the surgical removal of all or part of the pancreas), assign code E89.1 Postprocedural hypoinsulinemia. Assign a code from category E13 and a code from subcategory Z90.41‐ Acquired absence of pancreas, as additional codes.

Secondary diabetes due to drugs: Secondary diabetes may be caused by an adverse effect of correctly administered medications, poisoning or sequela of poisoning.

Example:

A patient presents for a check up. She developed diabetes after a partial pancreatectomy. She is doing well with no particular complaints.

              E89.1 Postprocedural hypoinsulinemia

              E13.9 Other specified diabetes mellitus without complications

              Z90.411 Acquired partial absence of pancreas

Fracture

ICD 10 – Coding Tips For Fracture

Fracture Classification in ICD10CM

 Fracture coding in ICD-10-CM requires documentation  of site, laterality, type of fracture, whether it is displaced or nondisplaced, and the stage of healing (or encounter), which includes open fracture classification. This resource is to assist in the understanding of the classification system utilized in ICD-10-CM for open fractures.

 The procedure for evaluation and management of open fractures is basically a set of principles that involve initial management and subsequent surgical interventions. The purpose of any fracture classification system in the clinical setting is to allow communication that infers fracture morphology and treatment parameters.

 There are multiple classification systems that exist for fractures, including the Gustilo classification, the Tscherne classification, the Mangled Extremity Severity Scale, the Hanover scale, and the AO fracture scale. For ICD-10-CM, the Gustilo classification is utilized in the 7th character extender lists for some fractures. It denotes the energy of the fracture, soft-tissue damage, and the degree of contamination.  It is the most widely used system and is generally accepted as the primary classification system for open fractures.

 Gustilo open fracture classification classifies into three major categories. Below is a description of each of the grades of fracture.

 Gustilo Classification for Open Fractures

 Grade I:

  • wound less than 1 cm with minimal soft tissue injury;
  • wound bed is clean;
  • bone injury is simple with minimal comminution;
  • with intramedullary nailing, average time to union is 21–28 weeks

 Grade II:

  • wound is greater than 1 cm with moderate soft tissue injury;
  • wound bed is moderately contaminated;
  • fracture contains moderate comminution;
  • with intramedullary nailing, average time to union is 26–28 weeks

 Grade III:

The following fracture types automatically results in classification as type III:

  • segmental fracture with displacement
  • fracture with diaphyseal segmental loss;
  • fracture with associated vascular injury requiring repair;
  • farmyard injuries or highly contaminated wounds;
  • high velocity gun shot wound;
  • fracture caused by crushing force from fast moving vehicle;

 Grade IIIA fracture:

  • wound less than 10 cm with crushed tissue and contamination;
  • soft tissue coverage of bone is usually possible;
  • with intramedullary nailing, average time to union is 30–35 weeks;

 Grade IIIB fracture:

  • wound greater than 10 cm with crushed tissue and contamination;
  • soft tissue is inadequate and requires regional or free flap;
  • with intramedullary nailing, average time to union is 30–35 weeks;

 Grade IIIC fracture:

  • fracture in which there is a major vascular injury requiring repair for limb salvage;
  • in some cases it will be necessary to consider BKA following tibial fracture

 It is important to educate providers on the use of this scale for the specific documentation necessary in ICD-10-CM. This will ensure that proper code assignment can be made without multiple queries to the provider.

 Following is the 7th character extender box for category S52, Fracture of the forearm, to exemplify the usage of the

Gustilo classification:

 The appropriate 7th character is to be added to all codes from category S52 (unless otherwise indicated).

 A  initial encounter for closed fracture

B  initial encounter  for open fracture type I or II

initial encounter for open fracture NOS

C  initial encounter for open fracture type IIIA, IIIB, or IIIC

D subsequent encounter for closed fracture with routine healing

E  subsequent encounter for open fracture type I or II with routine healing

F  subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

G  subsequent encounter for closed fracture with delayed healing

H  subsequent encounter for open fracture type I or II with delayed healing

J   subsequent encounter  for open fracture type IIIA, IIIB, or IIIC with delayed healing

K subsequent encounter for closed fracture with nonunion

M subsequent encounter for open fracture type I or II with nonunion

N  subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

P  subsequent encounter for closed fracture with malunion

Q  subsequent encounter for open fracture type I or II with malunion

R  subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S   sequela

 Make sure to look at each 7th character extender box in the fracture section, as not all categories utilize the Gustilo classification because it is not for all bones or all types of fractures (eg, Greenstick fracture or Torus fracture).

 Example:

Patient presents to the ED and Orthopaedics is called for evaluation of a type I open fracture of the shaft of the right radius.

S52.321B    Displaced transverse fracture of the shaft of the right radius, initial encounter for a type I open fracture.

 ExAmplE:

Patient presents for follow-up for a type IIIB oblique displaced fracture of the shaft of the left femur. The fracture is healing well after surgical intervention.

S72.332F    Displaced oblique fracture of the shaft of the left femur, subsequent encounter for a type IIIC open fracture with routine healing.

icd 10

ICD 10 – Coding Tips For Pain

Coding of acute or chronic pain in ICD‐10‐CM are located under category G89, Pain, not elsewhere classified. The subcategories are broken down by type, temporal parameter, and causation.

G89.0 Central pain syndrome G89.11 Acute pain due to trauma G89.12 Acute post‐thoracotomy pain G89.18 Other acute postprocedural pain G89.21 Chronic pain due to trauma G89.22 Chronic post‐thoracotomy pain G89.28 Other chronic postprocedural pain G89.29 Other chronic pain

G89.3 Neoplasm related pain (acute) (chronic)

G89.4 Chronic pain syndrome

There are many guidelines that relate to this category in ICD‐10‐CM.

General Coding Guidelines

Codes in category G89 may be used in conjunction with codes from other categories and chapters to provider more detail about acute or chronic pain and neoplasm‐related pain, unless otherwise indicated in other guidelines.

If the pain is not specified as acute or chronic, post‐thoracotomy, postprocedural, or neoplasm‐related, do not assign a code from category G89.                                                     

EXAMPLE:

John presents with neck pain. He states he has been suffering stiffness for a few days.

M54.2 Cervicalgia

A code from category G89 should not be assigned if the underlying diagnosis is known, unless the reason for the encounter is pain control/management and not management of the underlying condition.

When an admission or encounter is for a procedure aimed at treating the underlying conditions, a code for the underlying condition should be assigned as the principal diagnosis. No code from category G89 should be assigned.

Category G89 Codes as Principal or First‐listed Diagnosis

Category G89 codes are acceptable as principal diagnosis or the first‐listed code:

  • When pain control or pain management is the reason for the admission/encounter. The underlying cause of the pain should be reported as an additional diagnosis, if known.
  • When a patient is admitted for the insertion of a neurostimulator for pain control, assign the appropriate pain code as the principal or first‐listed diagnosis. When an admission or encounter is for a procedure aimed at treating the underlying condition and a neurostimulator is inserted for pain control during the same admission/encounter, a code for the underlying condition should be assigned as the

principal diagnosis and the appropriate pain code should be assigned as a secondary diagnosis.

EXAMPLE:

A patient presents with acute low back pain due to trauma for steroid injections.

G89.11 Acute pain due to trauma

M54.5 Low back pain

Use of Category G89 Codes in Conjunction with Site Specific Pain Codes

Codes from category G89 may be used in conjunction with codes that identify the site of pain if the category G89 code provides additional information. For example, if the code describes the site of the pain, but does not fully describe whether the pain is acute or chronic, then both codes should be assigned.

The sequencing of category G89 codes with site‐specific pain codes is dependent on the circumstances of the encounter/admission as follows:

  • If the encounter is for pain control or pain management, assign the code from

category G89 followed by the code identifying the specific site of pain.

  • If the encounter is for any other reason except pain control or pain management, and a related definitive diagnosis has not been established by the provider, assign the code for the specific site of pain first, followed by the appropriate code from category G89.

EXAMPLE:

A patient presents for evaluation of his chronic bilateral knee pain. The pain has been becoming more severe lately, prompting the visit. The patient will be sent for further testing.

M25.561 Pain in the right knee

M25.562 Pain in the left knee

G89.29 Other chronic pain

Postoperative Pain

The provider’s documentation should be used to guide the coding of postoperative pain. The default for post‐thoracotomy and other postoperative pain not specified as acute or chronic is the code for the acute form.

Routine or expected postoperative pain immediately after surgery should not be coded. Postoperative pain not associated with a specific postoperative complication is assigned to

the appropriate postoperative pain code in category G89.

Postoperative pain associated with a specific postoperative complication is assigned to the appropriate code(s) found in Chapter 19, Injury, poisoning, and certain other consequences of external causes. If appropriate, use additional code(s) from category G89 to identify acute or chronic pain.

EXAMPLE:

After a procedure, a patient complains continuously of severe post‐thoracotomy pain. The pain does not abate with medication, so the patient is sent for testing.

G89.12 Acute post‐thoracotomy pain

Chronic Pain

Chronic pain is classified to subcategory G89.2. There is no time frame defining when pain becomes chronic pain. The provider’s documentation should be used to guide use of these codes.                                                   

Neoplasm Related Pain

Code G89.3 is assigned to pain documented as being related, associated or due to cancer, primary or secondary malignancy, or tumor. This code is assigned regardless of whether the pain is acute or chronic.

This code may be assigned as the principal or first‐listed code when the stated reason for the admission/encounter is documented as pain control/pain management. The underlying neoplasm should be reported as an additional diagnosis.

When the reason for the admission/encounter is management of the neoplasm and the pain associated with the neoplasm is also documented, code G89.3 may be assigned as an additional diagnosis. It is not necessary to assign an additional code for the site of the pain.

EXAMPLE:

A patient presents for bone pain related to bilateral, central breast cancer that has metastasized. She is being treated today for the pain.

G89.3 Neoplasm related pain (acute) (chronic)

C50.111 Malignant neoplasm of central portion of right female breast

C50.112 Malignant neoplasm of central portion of left female breast

C79.9 Secondary malignant neoplasm of unspecified site

Chronic Pain Syndrome

Central pain syndrome (G89.0) and chronic pain syndrome (G89.4) are different than the term “chronic pain” and therefore codes should only be used when the provider has specifically documented this condition.

EXAMPLE:

A patient presents for evaluation. He has been to multiple other physicians and stated that they “did not understand his problem.” He states he has sleeplessness due to his pain and it is constant. He states that all the testing that has been done by the other doctors have all been negative, but his pain is still present. He states he has had little relief with medication. His physical exam does not match his symptomology. The patient is diagnosed with chronic pain syndrome.

G89.4 Chronic pain syndrome

ICD 10 Coding tips for asthma

ICD 10 – Coding Tips For Asthma

The coding of asthma has expanded in ICD‐10‐CM. In order for the most appropriate code to be assigned at the highest level of specificity, documentation must include severity and complication.

In ICD‐10‐CM, asthma is located under category J45.  It is subcategorized by severity.  The subcategories are:

J45.2‐        Mild intermittent

J45.3‐        Mild persistent

J45.4‐         Moderate persistent

J45.5‐         Severe persistent

J45.9‐         Other and unspecified asthma

The subcategories are further broken down by complication:

 

  • Uncomplicated
  • With acute exacerbation
  • With status asthmaticus  The codes are as follows:

J45.20 Mild intermittent asthma, uncomplicated

J45.21 Mild intermittent asthma with (acute) exacerbation  J45.22 Mild intermittent asthma with status asthmaticus  J45.30 Mild persistent asthma, uncomplicated

J45.31 Mild persistent asthma with (acute) exacerbation  J45.32 Mild persistent asthma with status asthmaticus

J45.40 Moderate persistent asthma, uncomplicated

 

J45.41 Moderate persistent asthma with (acute) exacerbation  J45.42 Moderate persistent asthma with status asthmaticus  J45.50 Severe persistent asthma, uncomplicated

J45.51 Severe persistent asthma with (acute) exacerbation 

 

J45.52 Severe persistent asthma with status asthmaticus  J45.901 Unspecified asthma with (acute) exacerbation

J45.902 Unspecified asthma with status asthmaticus

J45.909 Unspecified asthma, uncomplicated

J45.990 Exercise induced bronchospasm

J45.991 Cough variant asthma  J45.998 Other asthma

 

 

 

EXAMPLE:

 

Paula presents to the clinic for an urgent visit. She is wheezing and short of breath. She has severe persistent asthma. She reported using her rescue inhaler but her symptoms are persisting. She cannot complete sentences without stopping for breaths. Two nebulizer treatments were given in the office to the patient with no relief. She is admitted to the hospital with status asthmaticus.

 

J45.52 Severe persistent asthma with status asthmaticus

 

EXAMPLE:

 

Jake presents with his mother for evaluation of his asthma. She says he wakes up a couple nights every month with “coughing fits” and using his inhaler on a weekly basis. He is currently taking Singulair nightly to help with his symptoms. His activities have been somewhat limited due to his symptoms. He is diagnosed with mild persistent asthma.

 

J45.30 Mild persistent asthma, uncomplicated

 

 

In order to assist with determining the severity of a patient’s asthmatic condition, the following graph may be utilized. It was designed by the National Heart Lung and Blood Institute.

Donloadable CPC Practice Exam

Asthma Severity Chart

 

INTERMITTENT MILD

PERSISTENT

MODERATE

PERSISTENT

SEVERE

PERSISTENT

SYMPTOMS 2 or less days

per week

More than 2

days per week

Daily Throughout

the day

NITGHTTIME

AWAKENINGS

2 x’s per

month or less

3 – 4 x’s per

month

More than

once per

week but not nightly

Nightly
RESCUE

INHALER USE

2 or less days

per week

More than 2

days per week, but not daily

Daily Several times

per day

INTERFERENCE

WITH NORMAL ACTIVITY

None Minor

limitation

Some

limitation

Extremely

limited

LUNG

FUNCTION

FEV1>80%

predicted and normal between exacerbations

FEV1>80%

predicted

FEV1 60 –

80%

predicted

FEV1 less

than 60%

predicted