Tag Archives: ICD 10

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

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