ICD-10-CM Chapter 11
ICD-10-CM Chapter 11-14 CRIHB John Hailes ASC-E/M, CCS, CCS-P, CPC, CPC-H, CIRCC, CPMA, CPCI, CEMC, CFPC, Certifiedjhmci.com @ICD-10-CM/PCS Trainer 1 Objectives • Identify areas in ICD-10-CM that include new terminology for clinical documentation • Understanding the coding guidelines that pertain to ICD10-CM Chapter 11-14 • Assign the correct ICD-10-CM codes for the case studies involving chapters 11-14 • Define areas in ICD-10-CM that enable improved data capture if more specific conditions are documented – – – – Acuity Disease type Site specifity Disease stage jhmci.com Documentation Matters “If it was not documented, it was not done” jhmci.com 3 Coding and 7th Character Extensions Alpha (Except U) M A XS X 0 X 2 Category 2 Numeric 3 - 7 Numeric or Alpha . Additional Characters X 6 X 5 Xx A X Etiology, anatomic site, severity Added code extensions (7th character) for obstetrics, injuries, and external causes of injury 3 – 7 Characters jhmci.com ICD-10-CM National Cancer Institute DISEASES OF THE RESPIRATORY SYSTEM CHAPTER 10 5 jhmci.com Diseases of the Respiratory System • • • • • • • • • • • J00-J06 Acute upper respiratory infections J09-J18 Influenza and pneumonia J20-J22 Other acute lower respiratory infections J30-J39 Other diseases of upper respiratory tract J40-J47 Chronic lower respiratory diseases J60-J70 Lung diseases due to external agents J80-J84 Other respiratory diseases principally affecting the interstitium J85-J86 Suppurative and necrotic conditions of the lower respiratory tract J90-J94 Other diseases of the pleura J95-J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified J96-J99 Other diseases of the respiratory system jhmci.com 6 Respiratory System • • • • • ICD-9-CM to ICD-10-CM Model Acute Anatomic site of infection Other Severity Pneumonia Cause Chronic Acute, other, then chronic jhmci.com 7 Use Additional code to identify • Exposure to environmental tobacco smoke (Z77.22) • Exposure to tobacco smoke in the perinatal period (P96.81) • History of tobacco use (Z87.891) • Infectious agent (B95-B97) • Occupational exposure to environmental tobacco smoke (Z57.31) • Tobacco dependence (F17.-) • Tobacco use (Z72.0) jhmci.com 8 Diseases of the Respiratory System • Chapter 10 category range = J00-J99 • Combination codes = condition and organism – J02.0 Streptococcal pharyngitis • Other codes require separate reporting of organism – Acute sinusitis J01– Use Additional code (B95-B97) to identify infectious agent. jhmci.com 9 • New terminology for asthma • Respiratory condition in more than 1 site (not specifically indexed) classified to lower anatomic site • Additional code notes 10 jhmci.com Asthma ICD-9 • 493.XX ICD-10 • J45.XXX • • • • – 4th Digit • • • • Extrinsic Intrinsic Chronic Obstructive Other Extrinsic Intrinsic Chronic Obstructive Other – 5th Digit • Exacerbation or status asthmatics jhmci.com 11 J45 Asthma • • • • • • • • • • • • • J45.2 Mild intermittent asthma J45.20 …… uncomplicated J45.21 …… with (acute) exacerbation J45.22 …… with status asthmaticus J45.3 Mild persistent asthma J45.30 …… uncomplicated J45.31 …… with (acute) exacerbation J45.32 …… with status asthmaticus J45.4 Moderate persistent asthma J45.40 …… uncomplicated J45.41 …… with (acute) exacerbation J45.42 …… with status asthmaticus J45.5 Severe persistent asthma jhmci.com 5th Character mano-num system 12 Upper Respiratory Infections • • • • • • • J00 Acute nasopharyngitis [common cold] J01 Acute sinusitis J02 Acute pharyngitis J03 Acute tonsillitis J04 Acute laryngitis and tracheitis J05 Acute obstructive laryngitis [croup] and epiglottitis J06 Acute upper respiratory infections of multiple and unspecified sites jhmci.com 13 Upper Respiratory Tract • Acute sinusitis by site • Acute recurrent sinusitis by site. jhmci.com 14 J01 Acute sinusitis • • • • • • • • • • • J01.0 Acute maxillary sinusitis J01.00 …… unspecified J01.01 Acute recurrent maxillary sinusitis J01.1 Acute frontal sinusitis J01.10 …… unspecified J01.11 Acute recurrent frontal sinusitis J01.2 Acute ethmoidal sinusitis J01.20 …… unspecified J01.21 Acute recurrent ethmoidal sinusitis J01.3 Acute sphenoidal sinusitis J01.30 …… unspecified jhmci.com •Anatomical Site •Acute •Recurrent 15 465.9 Acute upper respiratory infection • J06 Acute upper respiratory infections of multiple and unspecified sites • J06.0 Acute laryngopharyngitis • J06.9 Acute upper respiratory infection, unspecified jhmci.com 16 462 Acute Pharyngitis • J02.0 Streptococcal pharyngitis • J02.8 Acute pharyngitis due to other specified organisms • J02.9 Acute pharyngitis, unspecified jhmci.com 17 Instructional note When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to J40-J47 Chronic lower respiratory diseases jhmci.com 18 J40-J47 Chronic lower respiratory diseases • J41 Simple and mucopurulent chronic bronchitis • J42 Unspecified chronic bronchitis • J43 Emphysema • J44 Other chronic obstructive pulmonary disease • J45 Asthma • J47 Bronchiectasis jhmci.com 19 Allergic rhinitis • Excludes 1: Allergic rhinitis with asthma (bronchial) – Code to the Asthma code. J45.909 • J30 Vasomotor and allergic rhinitis – – – – – – – – J30.0 Vasomotor rhinitis J30.1 Allergic rhinitis due to pollen J30.2 Other seasonal allergic rhinitis J30.5 Allergic rhinitis due to food Cause and Effect J30.8 Other allergic rhinitis J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander J30.89 Other allergic rhinitis J30.9 Allergic rhinitis, unspecified jhmci.com 20 Influenza • Influenza may be coded alone or in combination with other codes. Code only confirmed cases: – Exception to Guideline II, H. (Uncertain Diagnoses) • J09 – Due to certain identified influenza viruses • J10 – Due to other identified influenza viruses jhmci.com 21 COPD ICD-9-CM - 491.2x or 493.2x – Asthma with COPD – Chronic asthmatic (obstructive) asthma – Chronic bronchitis with airway obstruction – Chronic bronchitis with emphysema – Chronic obstructive asthma – Chronic obstructive bronchitis – Chronic obstructive tracheobronchitis ICD-10-CM J44 – J44 Other chronic obstructive pulmonary disease – J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection – J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation – J44.9 Chronic obstructive pulmonary disease J44 Includes •asthma with chronic obstructive pulmonary disease •chronic asthmatic (obstructive) bronchitis •chronic bronchitis with airways obstruction •chronic bronchitis with emphysema •chronic emphysematous bronchitis •chronic obstructive asthma •chronic obstructive bronchitis jhmci.com 22 •chronic obstructive tracheobronchitis Pneumonia • Coded as a combination with the responsible organism • Coded as a dual classification • J13 and J14 = code first influenza (J09, J10, J11) is applicable • J13 Pneumonia due to Streptococcus pneumoniae • J14 Pneumonia due to Hemophilus influenzae • J15 Bacterial pneumonia, not elsewhere classified jhmci.com 23 Acute Respiratory Failure Coding Guideline 10.b.1 • Acute respiratory failure as the principal diagnosis • J96.0 May be assigned as the principal diagnosis when • it is the condition established after study to be chiefly responsible for the admission to the hospital. • The selection of the code is supported by the • Alphabetical and Tabular list. • Chapter specific guidelines take precedence. • Obstetrics, poisonings, HIV and newborn jhmci.com 24 Acute Respiratory Failure Coding Guideline 10.b.2 • Acute respiratory failure as a secondary diagnosis • Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or is present on admission, but does not meet the definition of the principal diagnosis. jhmci.com 25 Acute Respiratory Failure Coding Guideline 10.b.3 • Sequencing of acute respiratory failure and another acute condition. • When the patient is admitted with respiratory failure and another condition such as myocardial infarction, CVA or aspiration pneumonia, the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or non-respiratory condition. Principle diagnosis will be dependent on the circumstances of the admission. admission. If two conditions are equally responsible and there are no chapter specific guidelines, the guideline for two or more diagnosisthat equally meet the definition of principal diagnosis may be applied. jhmci.com 26 J96 Respiratory failure • • • • • • • • • • • J96.0 Acute respiratory failure J96.00 …… unspecified whether with hypoxia or hypercapnia J96.01 …… with hypoxia J96.02 …… with hypercapnia J96.1 Chronic respiratory failure J96.10 …… unspecified whether with hypoxia or hypercapnia J96.11 …… with hypoxia J96.12 …… with hypercapnia J96.2 Acute and chronic respiratory failure J96.20 …… unspecified whether with hypoxia or hypercapnia J96.21 …… with hypoxia jhmci.com 27 Questions jhmci.com 28
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