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