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
Digestive System
Chapter 11
K00-K95
•
•
•
•
•
•
•
•
•
K00-K14 Diseases of oral cavity and
salivary glands
K20-K31 Diseases of the esophagus,
stomach and duodenum
K35-K38 Diseases of appendix
K40-K46 Hernia
K50-K52 Non-infective enteritis and
colitis
K65-K68 Diseases of peritoneum and
retroperitoneum
K70-K77 Disease of liver
K80-K87 Diseases of gallbladder, biliary
tract and pancreas
K90-K95 Other diseases of the digestive
system
jhmci.com
5
Format/General
Documentation changes
•
•
•
•
•
•
Combination codes with hemorrhage
Acute vs Chronic
Loss of teeth by Class I-IV
Hernia by Site
Unilateral vs. Bilateral
Not specificed as recurrent vs. recurrent
– Example: K57.21, Diverticulitis of large intestine
with perforation and abscess with bleeding
jhmci.com
6
Combination codes with hemorrhage
Acute vs. Chronic
K25 Gastric ulcer
•
•
•
•
•
•
•
K25.0 Acute gastric ulcer with hemorrhage
K25.1 Acute gastric ulcer with perforation
K25.2 Acute gastric ulcer with both hemorrhage and perforation
K25.3 Acute gastric ulcer without hemorrhage or perforation
K25.4 Chronic or unspecified gastric ulcer with hemorrhage
K25.5 Chronic or unspecified gastric ulcer with perforation
K25.6 Chronic or unspecified gastric ulcer with both hemorrhage
and perforation
• K25.7 Chronic gastric ulcer without hemorrhage or perforation
• K25.9 Gastric ulcer, unspecified as acute
jhmci.com
7
Class I
Ideal or minimally
compromised
Classification System for the
Edentulous Patient
Class II
Moderately
compromised
Diagnostic Criteria
1.
2.
3.
Class III
Substantially
compromised
Class IV
Severely
compromised
4.
jhmci.com
Bone height--mandibular
Maxillomandibular
relationship
Residual ridge morphologymaxilla
Muscle attachments
8
Loss of teeth by Class I-IV
•
•
•
•
•
•
•
•
•
K08.10 Complete loss of teeth, unspecified cause
K08.101 …… class I
K08.102 …… class II
K08.103 …… class III
K08.104 …… class IV
K08.109 …… unspecified class
K08.11 Complete loss of teeth due to trauma
K08.111 …… class I
K08.112 …… class II
jhmci.com
9
Hernia
K40 Inguinal hernia
•
•
•
•
•
•
•
•
•
•
•
K40.0 Bilateral inguinal hernia, with obstruction, without gangrene
K40.00 …… not specified as recurrent
K40.01 …… recurrent
K40.1 Bilateral inguinal hernia, with gangrene
K40.10 …… not specified as recurrent
K40.11 …… recurrent
K40.2 Bilateral inguinal hernia, without obstruction or gangrene
K40.20 …… not specified as recurrent
K40.21 …… recurrent
K40.3 Unilateral inguinal hernia, with obstruction, without gangrene
K40.30 …… not specified as recurrent
jhmci.com
10
K11 Diseases of salivary glands
 Use Additional code to identify:
– alcohol abuse and dependence (F10.-)
– exposure to environmental tobacco smoke (Z77.22)
– exposure to tobacco smoke in the perinatal period (P96.81)
– history of tobacco use (Z87.891)
– occupational exposure to environmental tobacco smoke (Z57.31)
– tobacco dependence (F17.-)
– tobacco use (Z72.0)
•
•
•
•
•
•
•
•
•
•
K11.1 Hypertrophy of salivary gland
K11.2 Sialoadenitis
K11.20 …… unspecified
K11.21 Acute sialoadenitis
K11.22 Acute recurrent sialoadenitis
K11.23 Chronic sialoadenitis
K11.3 Abscess of salivary gland
K11.4 Fistula of salivary gland
K11.5 Sialolithiasis
K11.6 Mucocele of salivary gland
jhmci.com
11
K50 Crohn's disease [regional enteritis]
 Use Additional code to identify manifestations, such as: pyoderma
gangrenosum (L88)
• K50.0 Crohn's disease of small intestine
– K50.00 …… without complications
• K50.01 Crohn's disease of small intestine with complications
–
–
–
–
–
–
K50.011 Crohn's disease of small intestine with rectal bleeding
K50.012 Crohn's disease of small intestine with intestinal obstruction
K50.013 Crohn's disease of small intestine with fistula
K50.014 Crohn's disease of small intestine with abscess
K50.018 Crohn's disease of small intestine with other complication
K50.019 Crohn's disease of small intestine
jhmci.com
12
K51.5 Left sided colitis
• K51.50 …… without complications
– K51.51 Left sided colitis with complications
– K51.511 Left sided colitis with rectal bleeding
– K51.512 Left sided colitis with intestinal
obstruction
– K51.513 Left sided colitis with fistula
– K51.514 Left sided colitis with abscess
– K51.518 Left sided colitis with other complication
– K51.519 Left sided colitis with unspecified
jhmci.com
13
K57 Diverticular disease of intestine
• K57.0 Diverticulitis of small intestine with perforation and
abscess
– K57.00 …… without bleeding
– K57.01 …… with bleeding
• K57.1 Diverticular disease of small intestine without
perforation or abscess
– K57.10 Diverticulosis of small intestine without perforation or
abscess without bleeding
– K57.11 Diverticulosis of small intestine without perforation or
abscess with bleeding
– K57.12 Diverticulitis of small intestine without perforation or
abscess without bleeding
– K57.13 Diverticulitis of small intestine without perforation or
abscess with bleeding
jhmci.com
14
K73 Chronic hepatitis, NEC
• K73.0 Chronic persistent hepatitis, not elsewhere
classified
• K73.1 Chronic lobular hepatitis, not elsewhere
classified
• K73.2 Chronic active hepatitis, not elsewhere
classified
• K73.8 Other chronic hepatitis, not elsewhere
classified
• K73.9 Chronic hepatitis, unspecified
jhmci.com
15
Disorders of gallbladder, biliary tract
and pancreas K80-K87
•
•
•
•
•
•
•
K80 Cholelithiasis
K81 Cholecystitis
K82 Other diseases of gallbladder
K83 Other diseases of biliary tract
K85 Acute pancreatitis
K86 Other diseases of pancreas
K87 Disorders of gallbladder, biliary tract and
pancreas in diseases classified elsewhere
jhmci.com
16
K80 Cholelithiasis
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
K80.0 Calculus of gallbladder with acute cholecystitis
K80.00 …… without obstruction
K80.01 …… with obstruction
K80.10 Calculus of gallbladder with chronic cholecystitis without obstruction
K80.11 Calculus of gallbladder with chronic cholecystitis with obstruction
K80.12 Calculus of gallbladder with acute and chronic cholecystitis without obstruction
K80.13 Calculus of gallbladder with acute and chronic cholecystitis with obstruction
K80.18 …… without obstruction
K80.19 …… with obstruction
K80.20 …… without obstruction
K80.21 …… with obstruction
K80.30 …… unspecified, without obstruction
K80.31 …… unspecified, with obstruction
K80.32 Calculus of bile duct with acute cholangitis without obstruction
K80.33 Calculus of bile duct with acute cholangitis with obstruction
K80.34 Calculus of bile duct with chronic cholangitis without obstruction
K80.35 Calculus of bile duct with chronic cholangitis with obstruction
K80.36 Calculus of bile duct with acute and chronic cholangitis without obstruction
K80.37 Calculus of bile duct with acute and chronic cholangitis with obstruction
jhmci.com
17
Chapter-Specific Guidelines Chapter 11
• TRUE/FALSE
• Chapter 11 Diseases of the Digestive System
(K00-K94) contains many combination codes
that require careful reading.
jhmci.com
18
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• Ventral incisional hernia, without obstruction
or gangrene.
• ICD-10-CM Code:____________________
jhmci.com
19
Chapter 6: Chapter-Specific Guidelines
ICD-10-CM Chapters 11
• For hemorrhage to be reported there does not
have to be active bleeding; however, there
must be documentation in the medical record
indicating active bleeding has occurred and
the source of the bleeding must be identified.
jhmci.com
20
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• Crohn’s disease of the small and large bowel
complicated by pyoderma gangrenosum.
• ICD-10-CM Codes:____________________,
___________________
jhmci.com
21
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• Obstructed intestinal hernia with gangrene.
ICD-10-CM Code:____________________
jhmci.com
22
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• Choledocholithiasis (calculus of the bile duct)
with acute and chronic cholangitis.
• ICD-10-CM Code:_____________________
jhmci.com
23
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• Choledochoduodenal fistula.
• ICD-10-CM Code:_____________________
jhmci.com
24
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• Recurrent chronic pancreatitis
• ICD-10-CM Code: ____________________
jhmci.com
25
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• Chronic ulcerative proctitis with fistula.
• ICD-10-CM Code:____________________
jhmci.com
26
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• 23. Acute pseudo-obstruction of the intestine.
• ICD-10-CM Code: ____________________
jhmci.com
27
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• 22. Acute gastrectasis (distention of stomach).
• ICD-10-CM Code: ____________________
jhmci.com
28
Chapter-Specific Guidelines ICD-10-CM
Chapters 11
• Celiac disease.
• ICD-10-CM Code: ___________________
jhmci.com
29
Diseases of the Skin/Subcutaneous Tissue
Chapter 12
National Cancer Institute
30
jhmci.com
Diseases of the skin/subcutaneous
tissue
•
•
•
•
•
•
L00-L08 Infections of the skin and subcutaneous tissue
L10-L14 Bullous disorders
L20-L30 Dermatitis and eczema
L40-L45 Papulosquamous disorders
L49-L54 Urticaria and erythema
L55-L59 Radiation-related disorders of the skin and
subcutaneous tissue
• L60-L75 Disorders of skin appendages
• L76
Intraoperative and postprocedural complications
of skin and subcutaneous tissue
• L80-L99 Other disorders of the skin and subcutaneous
tissue
jhmci.com
31
Infections
• L00 Staphylococcal scalded skin syndrome
Use additional code before L00 directs coder
to report the infection with B95-B97
Use Additional code to identify percentage of
skin exfoliation (L49.-)
jhmci.com
32
Pressure Ulcers
Stage 1: erythema (redness) of skin
Stage 2: partial loss of skin (epidermis or dermis)
Stage 3: full thickness loss of skin (up to but not through fascia)
Stage 4: full thickness loss (extensive destruction and necrosis)
jhmci.com
33
Pressure ulcers elbow
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
L89.00 Pressure ulcer of unspecified elbow
L89.000 …… unstageable
L89.001 …… stage 1
L89.002 …… stage 2
L89.003 …… stage 3
L89.004 …… stage 4
L89.009 …… unspecified stage
L89.01 Pressure ulcer of right elbow
L89.010 …… unstageable
L89.011 …… stage 1
L89.012 …… stage 2
L89.013 …… stage 3
L89.014 …… stage 4
L89.019 …… unspecified stage
L89.02 Pressure ulcer of left elbow
L89.020 …… unstageable
L89.021 …… stage 1
L89.022 …… stage 2
L89.023 …… stage 3
Stage 0-4
jhmci.com
34
Coding Guidelines
• Assign as many codes as necessary from Category L89
to identify multiple pressure ulcers, by anatomical site
and stage.
• Pressure ulcer of the sacrum, stage 2 and right lower
backstage I.
• L89.152 Pressure ulcer of the sacral region, stage 2,
L89.131 Pressure ulcer of the right lower back, stage 1
jhmci.com
35
Coding Guidelines
• Code any associated gangrene: I96 as first listed.
• Unstageable pressure ulcers are ulcers which cannot be staged
determined by the documentation. May be for deep tissue injury
not due to trauma and ulcers covered by an Escher or covered with
a graft of skin or muscle.
• Unstageable are not synonymous with unspecified stage.
• Assign the ulcer stage based on the clinical documentation and
guidance in the alphabetical index list of terms and subterms and
verification of code assignment in the tabular list.
jhmci.com
36
Coding Guidelines
• No code is assigned for a pressure ulcer described
as “healed.”
• Pressure ulcers described as “healing” should be
reported with the appropriate code based upon
the clinical documentation. When the
documentation is unclear as to whether the ulcer
is a healing pressure ulcer, query the provider.
• Diagnosis: Healing pressure ulcer of the left heel,
stage 2 L89.622
jhmci.com
37
Coding Guidelines
• A pressure ulcer that evolves from one stage
to another during the course of the
hospitalization is reported only at the highest
level of severity as supported by the
documentation.
jhmci.com
38
Non-Pressure Ulcers
 If one of the following conditions is documented
with an ulcer, sequence the underlying associated
condition first.
–
–
–
–
–
–
–
Atherosclerosis of the extremities I70.23- to I70.74Chronic venous hypertension I87.31-, I87.33Diabetic ulcers E08.621, E08.622, E09, E10, E11, E13--Gangrene I96
Postphlebetic syndrome I87.01-, I87.03Postthrombotic syndrome I87.01-, I87.03Varicose ulcer I83.0-, I83.2jhmci.com
39
Non-pressure ulcer L97-L98
• Site specific
• Stage specific by definition
–
–
–
–
–
–
–
–
–
–
–
–
L97 Non-pressure chronic ulcer of lower limb, not elsewhere classified
L97.1 Non-pressure chronic ulcer of thigh
L97.10 Non-pressure chronic ulcer of unspecified thigh
L97.101 …… limited to breakdown of skin
L97.102 …… with fat layer exposed
L97.103 …… with necrosis of muscle
L97.104 …… with necrosis of bone
L97.109 …… with unspecified severity
L97.11 Non-pressure chronic ulcer of right thigh
L97.111 …… limited to breakdown of skin
L97.112 …… with fat layer exposed
L97.113 …… with necrosis of muscle
jhmci.com
40
Psoriasis
Further specificity in ICD-10-CM
•
•
•
•
•
•
•
•
•
•
•
•
L40 Psoriasis
L40.0 Psoriasis vulgaris
L40.1 Generalized pustular psoriasis
L40.2 Acrodermatitis continua
L40.3 Pustulosis palmaris et plantaris
L40.4 Guttate psoriasis
L40.5 Arthropathic psoriasis
L40.50 …… unspecified
L40.51 Distal interphalangeal psoriatic arthropathy
L40.52 Psoriatic arthritis mutilans
L40.53 Psoriatic spondylitis
L40.54 Psoriatic juvenile arthropathy
jhmci.com
41
Dermatitis
• L23-L25 classifies dermatitis due to plants, foods, drugs and
medications.
–
–
–
–
–
–
–
–
–
–
L23.0 Allergic contact dermatitis due to metals
L23.1 Allergic contact dermatitis due to adhesives
L23.2 Allergic contact dermatitis due to cosmetics
L23.3 Allergic contact dermatitis due to drugs in contact with skin
L23.4 Allergic contact dermatitis due to dyes
L23.5 Allergic contact dermatitis due to other chemical products
L23.6 Allergic contact dermatitis due to food in contact with the skin
L23.7 Allergic contact dermatitis due to plants, except food
L23.8 Allergic contact dermatitis due to other agents
L23.81 Allergic contact dermatitis due to animal (cat) (dog) dander
• L27 classified dermatitis due to drugs taken internally.
jhmci.com
42
L27 Dermatitis due to substances
taken internally
• L27.0 Generalized skin eruption due to drugs and medicaments taken
internally
– Use Additional code for adverse effect, if applicable, to identify drug (T36-T50
with fifth or sixth character 5)
• L27.1 Localized skin eruption due to drugs and medicaments taken
internally
– Use Additional code for adverse effect, if applicable, to identify drug (T36-T50
with fifth or sixth character 5)
• L27.2 Dermatitis due to ingested food
• L27.8 Dermatitis due to other substances taken internally
• L27.9 Dermatitis due to unspecified substance
jhmci.com
43
Dermatitis due to drug
First: Determine if the condition is:
• An adverse of a drug
• Properly administered
• A Poisioning due to the incorrect use of the
drug T Code for poisoning is listed as first
listed code followed by the adverse effect.
jhmci.com
44
Chapter-Specific Guidelines Chapter 12
• TRUE/FALSE
• A stage II pressure ulcer is considered a full
thickness loss of skin.
jhmci.com
45
Chapter-Specific Guidelines ICD-10-CM
Chapters 12
• Dyskinesia of esophagus.
• ICD-10-CM Code: ____________________
jhmci.com
46
Chapter-Specific Guidelines ICD-10-CM
Chapters 12
• Boil on the face, due to Staphylococcus
epidermidis.
• ICD-10-CM Codes:_____________________,
_____________________
jhmci.com
47
Chapter-Specific Guidelines ICD-10-CM
Chapters 12
• Mucinosis of the skin.
• ICD-10-CM Code: _____________________
jhmci.com
48
Chapter-Specific Guidelines ICD-10-CM
Chapters 12
• Pressure ulcer of right elbow with partial
thickness skin loss involving epidermis and
dermis.
• ICD-10-CM Code: ____________________
jhmci.com
49
Diseases of the Musculoskeletal System
and Connective Tissue, Chapter 13
M00-M99
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
M00-M02 Infectious arthropathies
M05-M14 Inflammatory polyarthropathies
M15-M19 Osteoarthritis
M20-M25 Other joint disorders
M26-M27 Dentofacial anomalies [including malocclusion] and other disorders of jaw
M30-M36 Systemic connective tissue disorders
M40-M43 Deforming dorsopathies
M45-M49 Spondylopathies
M50-M54 Other dorsopathies
M60-M63 Disorders of muscles
M65-M67 Disorders of synovium and tendon
M70-M79 Other soft tissue disorders
M80-M85 Disorders of bone density and structure
M86-M90 Other osteopathies
M91-M94 Chondropathies
M95-M95 Other disorders of the musculoskeletal system and connective tissue
M96-M96 Intraoperative and postprocedural complications and disorders of musculoskeletal
system, not elsewhere classified
M99-M99 Biomechanical lesions, not elsewhere classified
jhmci.com
50
Diseases of the Musculoskeletal System
and Connective Tissue, Chapter 13
M00-M99
• Most codes specify:
– Site: Location on the body
– Laterality: Right, left, unilateral, bilateral
• Site & laterality guideline
• Bone vs. joint guideline
• Acute traumatic vs. chronic or recurrent musculoskeletal conditions
• Osteoporosis guideline (with or without pathologic fracture)
jhmci.com
51
M16 Osteoarthritis of hip
•
•
•
•
•
•
•
M16.0 Bilateral primary osteoarthritis of hip
M16.1 Unilateral primary osteoarthritis of hip
M16.10 Unilateral primary osteoarthritis, unspecified hip
M16.11 Unilateral primary osteoarthritis, right hip
M16.12 Unilateral primary osteoarthritis, left hip
M16.2 Bilateral osteoarthritis resulting from hip dysplasia
M16.3 Unilateral osteoarthritis resulting from hip
dysplasia
• M16.30 …… unspecified hip
• M16.31 …… right hip
• M16.32 …… left hip
jhmci.com
52
Bone versus joint
• For certain conditions, the bone may be
affected at the upper or lower end, (e.g.,
avascular necrosis of bone, M87,
Osteoporosis, M80, M81).
• Though the portion of the bone affected may
be at the joint, the site designation will be the
bone, not the joint.
jhmci.com
53
Acute traumatic versus chronic or
recurrent musculoskeletal conditions
1.
Many musculoskeletal conditions are a result of previous injury or
trauma to a site, or are recurrent conditions.
2.
Bone, joint or muscle conditions that are the result of a healed injury are
usually found in chapter 13.
3.
Recurrent bone, joint or muscle conditions are also usually found in
chapter 13.
4.
Any current, acute injury should be coded to the appropriate injury code
from chapter 19.
5.
Chronic or recurrent conditions should generally be coded with a code
from chapter 13.
jhmci.com
54
Pathological Fractures
• Also known as (AKA): Spontaneous fracture
• Fracture reported in addition to underlying condition
responsible for fracture
• Never assign a code for a traumatic fracture and
pathological fracture of same bone
• 7th character indicates treatment plans, such as A for
initial
jhmci.com
55
Coding Note:ICD-10-CM has three
ICD-10
Pathological or Stress
Fracture Extensions
different categories for pathologic
fractures – due to neoplastic disease,
due to osteoporosis, and due to other
specified disease.
A
• Initial encounter
D
• Subsequent – routine healing
G
• Subsequent – delayed healing
K
• Subsequent – nonunion
P
• Subsequent – malunion
S
• Sequela
jhmci.com
56
Fracture – Episode of Care
• 7th character A (initial encounter)
– Should be used as long as the patient is receiving active treatment for the
fracture
– Surgical treatment
– ER visits
– Evaluation & treatment by new provider
• 7th character D (subsequent routine healing)
–
–
–
–
–
Should be used for encounters after active treatment is completed
Cast change/removal
Removal of fixation device (internal or external)
Medication adjustments
Follow up visit or other aftercare
jhmci.com
57
Coding Note:ICD-10-CM has three
different categories for pathologic
fractures – due to neoplastic disease, due
to osteoporosis, and due to other specified
disease.
jhmci.com
58
Coding of Pathologic Fractures
• 7th character A is for use as long as the patient is receiving active
treatment for the fracture.
•
Examples of active treatment are: surgical treatment, emergency
department encounter, evaluation and treatment by a new physician.
• 7th character, D is to be used for encounters after the patient has
completed active treatment.
• The other 7th characters, listed under each subcategory in the Tabular List,
are to be used for subsequent encounters for treatment of problems
associated with the healing, such as malunions, nonunions, and sequelae.
• Care for complications of surgical treatment for fracture repairs during the
healing or recovery phase should be coded with the appropriate
complication codes.
jhmci.com
59
M84.411 Pathological fracture, right
shoulder
• M84.411A …… initial encounter for fracture
• M84.411D …… subsequent encounter for fracture
with routine healing
• M84.411G …… subsequent encounter for fracture
with delayed healing
• M84.411K …… subsequent encounter for fracture
with nonunion
• M84.411P …… subsequent encounter for fracture
with malunion
• M84.411S …… sequela
jhmci.com
60
M84.51 Pathological fracture in
neoplastic disease, shoulder
• M84.511 Pathological fracture in neoplastic disease, right
shoulder
• M84.511A …… initial encounter for fracture
• M84.511D …… subsequent encounter for fracture with
routine healing
• M84.511G …… subsequent encounter for fracture with
delayed healing
• M84.511K …… subsequent encounter for fracture with
nonunion
• M84.511P …… subsequent encounter for fracture with
malunion
• M84.511S …… sequela
jhmci.com
61
Osteoporosis
• Osteoporosis is a systemic condition, meaning
that all bones of the musculoskeletal system are
affected.
• Therefore, site is not a component of the codes
under category M81, Osteoporosis without
current pathological fracture.
• The site codes under category M80, Osteoporosis
with current pathological fracture, identify the
site of the fracture, not the osteoporosis.
jhmci.com
62
Osteoporosis
• M80 Osteoporosis with current pathological Fx
– Systemic condition that affects bones
– Fracture sustained with trauma that would not usually cause a fx
– Age-related
• M81 Osteoporosis without current pathological Fx
– Systemic condition that affects bones
– Fracture sustained with trauma that would not usually cause a fracture
jhmci.com
63
Osteoporosis without pathological
fracture
• Category M81, Osteoporosis without current pathological
fracture, is for use for patients with osteoporosis who do not
currently have a pathologic fracture due to the osteoporosis,
even if they have had a fracture in the past.
•
• For patients with a history of osteoporosis fractures, status
code Z87.310, Personal history of (healed) osteoporosis
fracture, should follow the code from M81.
jhmci.com
64
Osteoporosis
• M80 Osteoporosis with current pathological Fx
– Systemic condition that affects bones
– Fracture sustained with trauma that would not usually cause a fx
– Age-related
• M81 Osteoporosis without current pathological Fx
– Systemic condition that affects bones
– Fracture sustained with trauma that would not usually cause a fracture
jhmci.com
65
M80.0 Age-related osteoporosis with
current pathological fracture
• M80.00 Age-related osteoporosis with current pathological
fracture, unspecified site
• M80.00XA …… initial encounter for fracture
• M80.00XD …… subsequent encounter for fracture with
routine healing
• M80.00XG …… subsequent encounter for fracture with
delayed healing
• M80.00XK …… subsequent encounter for fracture with
nonunion
• M80.00XP …… subsequent encounter for fracture with
malunion
• M80.00XS …… sequela
jhmci.com
66
Infectious Arthropathies M00-M02
•
•
M00 Pyogenic Arthritis
–
M01 Direct Infection joint
–
–
–
–
–
•
•
Code First underlying disease, such as:
leprosy [Hansen's disease] (A30.-)
mycoses (B35-B49)
O'nyong-nyong fever (A92.1)
paratyphoid fever (A01.1-A01.4)
M02 Postinfective and Reactive
–
–
–
–
–
•
Use Additional code (B95.61-B95.8) to identify bacterial agent
Code First underlying disease, such as:
congenital syphilis [Clutton's joints] (A50.5)
enteritis due to Yersinia enterocolitica (A04.6)
infective endocarditis (I33.0)
viral hepatitis (B15-B19)
Direct infections
–
–
–
Invades synovial tissue
Invades the joint
Invasive organism has been identified
Indirect infections
–
–
Reactive: Microbial infection identified but not in joint
Postinfective: Microbial antigen present, but not constant and no evidence of multiplication
jhmci.com
67
ICD-10
Inflammatory polyarthropathies M05-M14
• M05 Rheumatoid arthritis with rheumatoid factor
–
–
–
–
–
Site
Lung
Heart
Neuropathy
RH Factor
• M06 Other rheumatoid arthritis
– Site
– Juvenile
jhmci.com
68
Chapter-Specific Guidelines Chapter 13
• TRUE/FALSE
• Chapter 13 contains codes for bone, joint and
muscle conditions that are recurrent or
chronic conditions while Chapter 19 contains
codes for current injuries.
jhmci.com
69
Chapter 6: Chapter-Specific Guidelines
Chapters 13
• With indirect infections (Category M02) of
joints due to infectious or parasitic disease
classified elsewhere, the coder is directed to
“code first” the underlying disease.
jhmci.com
70
Chapter-Specific Guidelines ICD-10-CM
Chapters 13
• Staphylococcus aureus arthritis of the left
ankle is an example of when the organism is
reported first, followed by a code to report the
pyogenic arthritis.
jhmci.com
71
Chapter-Specific Guidelines ICD-10-CM
Chapters 13
• A stress fracture is the same as a pathologic
fracture.
jhmci.com
72
Chapter-Specific Guidelines ICD-10-CM
Chapters 13
• Many conditions reported in the
musculoskeletal chapter are a result of
previous injury or trauma to a site, or are
recurrent conditions.
jhmci.com
73
Chapter-Specific Guidelines ICD-10-CM
Chapters 13
• Stress fracture of the right foot, subsequent
encounter with delayed healing.
• ICD-10-CM Code:____________________
jhmci.com
74
Chapter-Specific Guidelines ICD-10-CM
Chapters 13
• Staphylococcal aureus arthritis of the left hip.
• ICD-10-CM Codes:____________________,
___________________
jhmci.com
75
Chapter-Specific Guidelines ICD-10-CM
Chapters 13
• Osteopathy of right lower leg following
poliomyelitis.
• ICD-10-CM Codes:____________________,
____________________
jhmci.com
76
Chapter-Specific Guidelines ICD-10-CM
Chapters 13
• Pathologic fracture of right femur, subsequent
encounter with malunion.
• ICD-10-CM Code:____________________
jhmci.com
77
Chapter-Specific Guidelines ICD-10-CM
Chapters 13
• 9. Initial encounter for a pathologic fracture left
metatarsal due to age-related postmenopausal
osteoporosis. This patient had a previous pathologic
fracture of the hip due to osteoporosis.
• ICD-10-CM Codes:____________________,
____________________
• ANS:
M80.072A, Z87.310
jhmci.com
78
ICD-10-CM
National Cancer Institute Alan Hoofring
DISEASES OF THE GENITOURINARY
SYSTEM
79
jhmci.com
Chapter 14 – Genitourinary System
•
•
•
•
•
•
•
•
•
•
•
N00-N08 Glomerular diseases
N10-N16 Renal tubulo-interstitial diseases
N17-N19 Acute kidney failure and chronic kidney disease
N20-N23 Urolithiasis
N25-N29 Other disorders of kidney and ureter
N30-N39 Other diseases of the urinary system
N40-N53 Diseases of male genital organs
N60-N65 Disorders of breast
N70-N77 Inflammatory diseases of female pelvic organs
N80-N98 Noninflammatory disorders of female genital tract
N99-N99 Intraoperative and postprocedural complications and
disorders of genitourinary system, not elsewhere classified
jhmci.com
80
Additional Codes Required
81
N17
• Code also underlying condition
N18
• Code first etiology
N30
• Additional code infectious agent
N31
• Additional code urinary
incontinence
N33
• Code first underlying disease
N40.1
• Additional code for associated
symptoms
jhmci.com
Stages of chronic kidney disease (CKD)
• Chapter 14 coding guidelines
– ICD-10-CM classifies CKD based on severity
– The severity of CKD is designated by stages 1-5
•
•
•
•
•
•
•
N18 Chronic kidney disease (CKD)
N18.1 Chronic kidney disease, stage 1
N18.2 Chronic kidney disease, stage 2 (mild)
N18.3 Chronic kidney disease, stage 3 (moderate)
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
jhmci.com
82
Stages of chronic kidney disease (CKD)
• If both a stage of CKD and ESRD are
documented, assign code N18.6 only.
jhmci.com
83
Chronic kidney disease and kidney
transplant status
• Patients who have undergone kidney transplant may still have some
form of chronic kidney disease
• The presence of CKD alone does not constitute a transplant
complication.
• Assign the appropriate N18 code for the patient’s stage of CKD and
code Z94.0, Kidney transplant status.
• If a transplant complication such as failure or rejection or other
transplant complication is documented, code complication(s) of a
kidney transplant
jhmci.com
84
Chronic kidney disease with other
conditions
• Patients with CKD may also suffer from other
serious conditions, most commonly diabetes
mellitus and hypertension.
– The sequencing of the CKD code in relationship to
codes for other contributing conditions is based
on the conventions in the Tabular List.
– See I.C.9. Hypertensive chronic kidney disease.
jhmci.com
85
Nephritic syndrome
• A collection of signs (known as a syndrome) associated with
disorders affecting the kidneys, more specifically glomerular
disorders.
• Characterized by having a thin glomerular basement membrane and
small pores in the podocytes of the glomerulus, large enough to
permit proteins (proteinuria) and red blood cells (hematuria) to
pass into the urine.
• By contrast, nephrotic syndrome is characterized by only proteins
(proteinuria) moving into the urine. Nephritic syndrome, like
nephrotic syndrome, may involve hypoalbuminemia due to protein
albumin moving from the blood to the urine.
jhmci.com
86
N00-N08 Glomerular diseases
• Code Also any associated kidney failure (N17-N19).
– Type 1 Excludes hypertensive chronic kidney disease (I12.-)
•
•
•
•
•
•
•
N00 Acute nephritic syndrome
N01 Rapidly progressive nephritic syndrome
N02 Recurrent and persistent hematuria
N03 Chronic nephritic syndrome
N04 Nephrotic syndrome
N05 Unspecified nephritic syndrome
N06 Isolated proteinuria with specified morphological
lesion
• N07 Hereditary nephropathy, not elsewhere classified
• N08 Glomerular disorders in diseases classified elsewhere
jhmci.com
87
N00 Acute nephritic syndrome
•
N00.0 Acute nephritic syndrome with minor glomerular abnormality
•
N00.1 Acute nephritic syndrome with focal and segmental glomerular lesions
•
N00.2 Acute nephritic syndrome with diffuse membranous glomerulonephritis
•
N00.3 Acute nephritic syndrome with diffuse mesangial proliferative glomerulonephritis
•
N00.4 Acute nephritic syndrome with diffuse endocapillary proliferative glomerulonephritis
•
N00.5 Acute nephritic syndrome with diffuse mesangiocapillary glomerulonephritis
•
N00.6 Acute nephritic syndrome with dense deposit disease
•
N00.7 Acute nephritic syndrome with diffuse crescentic glomerulonephritis
•
N00.8 Acute nephritic syndrome with other morphologic changes
•
N00.9 Acute nephritic syndrome with unspecified morphologic changes
jhmci.com
4 character constant
88
N08 Glomerular disorders in diseases
classified elsewhere
• Code First underlying disease, such as:
–
–
–
–
–
–
–
–
–
amyloidosis (E85.-)
congenital syphilis (A50.5)
cryoglobulinemia (D89.1)
disseminated intravascular coagulation (D65)
gout (M1A.-, M10.-)
microscopic polyangiitis (M31.7)
multiple myeloma (C90.0-)
sepsis (A40.0-A41.9)
sickle-cell disease (D57.0-D57.8)
jhmci.com
89
Acute kidney failure
• Code Also associated underlying condition
– N17.0 Acute kidney failure with tubular necrosis
– N17.1 Acute kidney failure with acute cortical
necrosis
– N17.2 Acute kidney failure with medullary
necrosis
– N17.8 Other acute kidney failure
– N17.9 Acute kidney failure, unspecified
jhmci.com
90
N18 Chronic kidney disease (CKD)
 Code First any associated:
– diabetic chronic kidney disease (E08.22, E09.22, E10.22, E11.22,
E13.22)
– hypertensive chronic kidney disease (I12.-, I13.-)
– Use Additional code to identify kidney transplant status, if applicable,
(Z94.0)
•
•
•
•
•
•
•
N18.1 Chronic kidney disease, stage 1
N18.2 Chronic kidney disease, stage 2 (mild)
N18.3 Chronic kidney disease, stage 3 (moderate)
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5
N18.6 End stage renal disease
N18.9 Chronic kidney disease, unspecified
jhmci.com
91
Cystitis
 Use Additional code to identify infectious agent (B95-B97)
• N30.0 Acute cystitis
–
–
–
–
–
–
–
–
–
–
N30.00 …… without hematuria
N30.01 …… with hematuria
N30.1 Interstitial cystitis (chronic)
N30.10 …… without hematuria
N30.11 …… with hematuria
N30.2 Other chronic cystitis
N30.20 …… without hematuria
N30.21 …… with hematuria
N30.3 Trigonitis
N30.30 …… without hematuria
jhmci.com
92
Neuromuscular dysfunction of bladder
 Use Additional code to identify any associated urinary
incontinence (N39.3-N39.4-)
• N31 Neuromuscular dysfunction of bladder, not
elsewhere classified
– N31.0 Uninhibited neuropathic bladder, not elsewhere
classified
– N31.1 Reflex neuropathic bladder, not elsewhere classified
– N31.2 Flaccid neuropathic bladder, not elsewhere
classified
– N31.8 Other neuromuscular dysfunction of bladder
– N31.9 Neuromuscular dysfunction of bladder, unspecified
jhmci.com
93
Bladder disorders in diseases
classified elsewhere N33
Code First underlying disease, such as:
schistosomiasis (B65.0-B65.9)
jhmci.com
94
N40 Enlarged prostate
•
•
N40.0 Enlarged prostate without lower urinary tract symptoms
N40.1 Enlarged prostate with lower urinary tract symptoms
–
–
–
–
–
–
–
–
–
–
–
•
Use Additional code for associated symptoms, when specified:
incomplete bladder emptying (R39.14)
nocturia (R35.1)
straining on urination (R39.16)
urinary frequency (R35.0)
urinary hesitancy (R39.11)
urinary incontinence (N39.4-)
urinary obstruction (N13.8)
urinary retention (R33.8)
urinary urgency (R39.15)
weak urinary stream (R39.12)
N40.2 Nodular prostate without lower urinary tract symptoms
– Additional codes (LUTS)
•
N40.3 Nodular prostate with lower urinary
jhmci.com
95
Questions
jhmci.com
96