ICD-10-CM Compliance Dates
•
– Outpatient dates of service of October 1, 2015 and beyond.
– Inpatient hospital service claims, is effective for dates of discharge after September 30, 2015

•
– Everyone covered by the Health Insurance Portability
Accountability Act (HIPPA)
•
– Worker’s Compensation
– Auto Insurance
– Non covered HIPAA entities are exempt but are encouraged to adapt the new code set

ICD-10 Code Structure
•
•
– Codes begin with Alpha letter, A-Z, excluding U
– Common errors
• I verses 1
• O verses 0
•
•
– Decimal following 3 rd character

ICD-10 Code Structure
•
– Used for future expansion of a code
– Fills in empty characters when a 6 th and/or 7 th character apply
– The placeholder may be used in different scenarios but should never serve as the final character.
Example: W19.XXXA Unspecified fall, Initial Encounter

ICD-10 Code Structure
•
th
– Provides specified information regarding the clinical visit
– Is required for certain categories and must be reported in the seventh position
– May be alpha or numeric
– Has different meanings depending on the coding category

ICD-10 Code Structure
•
– Some I CD-10-CM codes indicate laterality, specifying whether the condition occurs on the left, right or is bilateral .
– If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.
– If the side is not identified in the medical record, assign the code for the unspecified side
OGCR section 1.B.13

ICD-10 Code Structure
•
– Codes titled “other” or “other specified” are for use when the information in the medical record provides detail for which a specific code does not exist.
•
– Codes titled “unspecified” are for use when the information in the medical record is insufficient to assign a more specific code
OGCR section 1.A.9.a.b

ICD-10 Structure
•
– Excludes1
• A type 1 Excludes note is a pure excludes note
• It means “NOT CODED HERE”
• The code excluded should never be used at the same time
• When two conditions cannot occur togethe r
– Excludes2
• Represents “Not included here”
• The condition excluded is not part of the condition represented by the code
• It is acceptable to use both the code and the excluded code together, when appropriate
OGCR section 1.A.12.a.b

ICD-10 Code Structure
•
–
–
OGCR section 1.A.13
•

Chest pain
ICD-9 Code ICD-10 Code Description
786.50
R07.9
Chest pain, unspecified
Excludes1
• epidemic myalgia
(B33.0)
Excludes2
• jaw pain R68.84
• pain in breast (N64.4)
There are more specific code choice selections:
786.51
786.52
R07.2
R07.1
Precordial pain
Chest pain on breathing
786.52
786.59
786.59
R07.81
R07.82
R07.89
Pleurodynia
Intercostal pain
Other chest pain

Documentation Tips
•
– Chest pain due to myocardial ischemia
– Chest pain on breathing
– Intercostal pain
– Pleurodynia
– Precordial chest pain
Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.
Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.
OGCR Section I.C.18.b

Atherosclerotic heart disease of native coronary artery without angina pectoris
ICD-9 Code ICD-10 Code Description Excludes1 Excludes2
414.00
414.01
I25.10
I25.10
Atherosclerotic heart disease of native coronary artery without angina pectoris
N/A • atheroembolism (I75.-)
• atherosclerosis of coronary artery bypass graft(s) and transplanted heart
(I25.7-)
Applicable To:
• Atherosclerotic heart disease NOS
No ICD-10 code exists for unspecified vessel; native or bypass graft must be indicated
Use additional code, if applicable, to identify:
• coronary atherosclerosis due to calcified coronary lesion (I25.84)
• coronary atherosclerosis due to lipid rich plaque (I25.83)
• chronic total occlusion of coronary artery (I25.82)
• exposure to environmental tobacco smoke (Z77.22)
• history of tobacco use (Z87.891)
• occupational exposure to environmental tobacco smoke (Z57.31)
• tobacco dependence (F17.-)
• tobacco use (Z72.0)

• Associated Artery/Lesion Type
– Native artery
– Bypass graft
– Bypass graft, autologous artery
– Bypass graft, autologous vein
– Bypass graft, nonautologous biological
– Bypass graft, other
– Due to calcified coronary lesion
– Due to lipid rich plaque
• Native vs Transplanted Heart
• Associated angina
– Without angina
– With unstable angina
– With angina and spasm

Atrial fibrillation
ICD-9 Code ICD-10 Code Description Excludes1
427.31
I48.91
Unspecified atrial fibrillation
N/A
There are more specific code choice selections available below:
I48.0
Paroxysmal atrial fibrillation
I48.1
I48.2
Persistent atrial fibrillation
Chronic atrial fibrillation
Permanent atrial fibrillation
Excludes2
N/A

• Type
– Chronic (I48.2)
– Paroxysmal (I48.0)
– Persistent (I48.1)

Cardiac Arrhythmias
ICD-9 Code ICD-10 Code Description
427.89
427.89
I49.8
R00.1
Excludes1
•
•
•
Other specified cardiac arrhythmias
Applicable To:
• Coronary sinus rhythm disorder
• Ectopic rhythm disorder
• Nodal rhythm disorder
Bradycardia, unspecified
Applicable To:
Sinoatrial bradycardia
Sinus bradycardia
Slow heart beat
• Vagal bradycardia
• bradycardia NOS (R00.1)
• neonatal dysrhythmia
(P29.1-)
• sinoatrial bradycardia
(R00.1)
• sinus bradycardia (R00.1)
• vagal bradycardia (R00.1)
• abnormalities originating in the perinatal period (P29.1-)
• specified arrhythmias (I47-
I49)
• neonatal bradycardia
(P29.12)
Excludes2
N/A
N/A
There are more code choice selections below:
427.9
I49.9
Cardiac arrhythmia, unspecified

Cardiac Arrhythmias Documentation Tips
•
– Atrial fibrillation
– Atrial flutter
– Premature depolarization
– Re-entry ventricular arrhythmia
– Sick sinus syndrome
– Supraventricular tachycardia
– Ventricular fibrillation
– Ventricular flutter
– Ventricular tachycardia
– Paroxysmal tachycardia
– Cardiac arrhythmia

Cardiac Arrhythmias Documentation Tips
• Fibrillation Type
– Chronic
– Paroxysmal
– Persistent
• Flutter Type
– Typical
– Atypical
• Premature Depolarization Type
– Atrial
– Junctional
– Ventricular

Cardiac Arrhythmias Documentation Tips
•
•
– Abortion or ectopic or molar pregnancy (O00-O07, O08.8)
– Obstetric surgery and procedures (O75.4)

Abnormal electrocardiogram [ECG] [EKG]
ICD-9 Code ICD-10 Code Description
794.31
R94.31
Abnormal electrocardiogram [ECG]
[EKG]
Excludes1
• long QT syndrome
(I45.81)
• abnormal findings on antenatal screening of mother (O28. -)
Excludes2
• abnormal findings on antenatal screening of mother (O28.-)
• certain conditions originating in the perinatal period (P04-
P96)
• signs and symptoms classified in the body system chapters
• signs and symptoms of breast (N63,
N64.5)

Documentation Tips
• Symptom Codes
– Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established
(confirmed) by the provider.
• Use of a symptom code with a definitive diagnosis code
– Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis code.
• Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

424.1
424.1
424.1
424.1
Aortic Valve Disorders Nonrheumatic
ICD-9 Code ICD-10 Code Description Excludes1 Excludes2
424.1
I35.0
Nonrheumatic aortic (valve) stenosis
There are more specific code choice selections below:
• Aortic valve disorder of unspecified cause but with diseases of mitral and/or tricuspid valve(s) (I08.-)
• Aortic valve disorder specified as congential
(Q23.0, Q23.1)
• Aortic valve disorder specified as rheumatic (I06.-)
• Hypertrophic subaortic stenosis (I42.1)
N/A
I35.1
I35.2
I35.8
I35.9
Nonrheumatic aortic (valve) insufficiency
Nonrheumatic aortic (valve) stenosis with insufficiency
Other nonrheumatic aortic valve disorders
Nonrheumatic aortic valve disorder, unspecified

Documentation Tips
•
– Stenosis
– Insufficiency
– Stenosis with insufficiency
– List other

Shortness of breath
ICD-9 Code ICD-10 Code Description Excludes1
786.05
R06.02
Shortness of breath • abnormalities originating in the perinatal period (P29.1-)
• specified arrhythmias (I47-I49)
• acute respiratory distress syndrome (J80)
• respiratory arrest (R09.2)
• respiratory arrest of newborn
(P28.81)
• respiratory distress syndrome of newborn (P22.-)
• respiratory failure (J96.-)
• respiratory failure of newborn
(P28.5)
• tachypnea NOS (R06.82)
• transient tachypnea of newborn (P22.1)
There are more specific code choice selections below:
786.09
R06.00
Dyspnea, unspecified
786.02
786.09
R06.01
R06.09
Orthopnea
Other forms of dyspnea
Excludes2
N/A

Documentation Tips
•
– Shortness of breath
– Orthopnea
– Other forms

Ventricular premature depolarization
ICD-9 Code ICD-10 Code Description
427.69
I49.3
Ventricular premature depolarization
Excludes1
• bradycardia NOS (R00.1)
• neonatal dyrhythmia
(P29.1-)
• sinoatrial bradycaria
(R00.1)
• sinus bradycaria (R00.1)
• vagal bradycaria (R00.1)
Excludes2
N/A
There are more specific code choice selections below:
427.69
I49.49
Other premature depolarization
Code first cardiac arrhythmia complicating:
• Abortion or ectopic or molar pregnancy (O00.-O07, O08.8)
• Obstetric surgery and procedures (O75.4)

Documentation Tips
•
– Atrial premature depolarization (I49.1)
– Junctional premature depolarization (I49.2)
– Ventricular premature depolarization (I49.3)
– Other specified cardiac arrhythmias (I49.8)

Ventricular tachycardia
ICD-9 Code ICD-10 Code Description Excludes1
427.1
I47.2 Ventricular tachycardia • tachycardia NOS
(R00.0)
• Sinoatrial tachycaria (R00.0)
• sinus tachycardia
(R00.0)
Code first cardiac arrhythmia complicating:
• Abortion or ectopic or molar pregnancy (O00.-O07, O08.8)
• Obstetric surgery and procedures (O75.4)
Excludes2

Other cardiomyopathies
ICD-9 Code ICD-10 Code Description
425.4
I42.8
Primary cardiomyopathies,
NEC
Excludes1
• Ischemic cardiomyopathy
(I25.5)
• Peripartum cardiomyopathy
(O90.3)
Excludes2
• Ventricular hypertrophy (I51.7)
There are more specific code choice selections below:
425.4
I42.2
Other hypertrophic cardiomyopathy
425.4
I42.5
Other restrictive cardiomyopathy
425.4
I42.9
Cardiomyopathy, unspecified (familial)(idiopathic)
Code first pre-existing cardiomyopathy complicating pregnancy and puerperium (O99.4)

Syncope and collapse
ICD-9 Code ICD-10 Code Description
780.2
R55 Syncope and collapse
Applicable To:
• Blackout
• Fainting
• Vasovagal attack
Excludes1 Excludes2
• cardiogenic shock (R57.0)
• carotid sinus syncope
(G90.01)
• heat syncope (T67.1)
• neurocirculatory asthenia
(F45.8)
• neurogenic orthostatic hypotension (G90.3)
• orthostatic hypotension
(I95.1)
• postprocedural shock
(T81.1-)
• psychogenic syncope
(F48.8)
• shock NOS (R57.9)
• shock complicating or following abortion or ectopic or molar pregnancy
(O00-O07, O08.3)
• shock complicating or following labor and delivery
(O75.1)
• Stokes-Adams attack (I45.9)
• unconsciousness NOS
(R40.2-)
• abnormal findings on antenatal screening of mother (O28.-)
• certain conditions originating in the perinatal period (P04-
P96)
• signs and symptoms classified in the body system chapters
• signs and symptoms of breast (N63,
N64.5)

Documentation Tips
•
– Carotid sinus syncope (G90.01)
– Heat syncope
• Initial encounter (T67.1XXA)
• Subsequent encounter (T67.1XXD)
• Sequela (T67.1XXS)
– Psychogenic syncope (F48.8)
– Stokes-Adams syncope (I45.9)
– Vasovagal syncope (R55)

Cardiomegaly
ICD-9 Code ICD-10 Code Description
429.3
I51.7 Cardiomegaly
Applicable To:
• Cardiac dilatation
• Cardiac hypertrophy
• Ventricular dilatation
Excludes1
N/A
Excludes2
• certain conditions originating in the perinatal period (P04-P96)
• certain infectious and parasitic diseases (A00-B99)
• complications of pregnancy, childbirth and the puerperium
(O00-O9A)
• congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
• endocrine, nutritional and metabolic diseases (E00-E88)
• injury, poisoning and certain other consequences of external causes
(S00-T88)
• neoplasms (C00-D49)
• symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
• systemic connective tissue disorders (M30-M36)
• transient cerebral ischemic attacks and related syndromes (G45.-)

Hypertension
ICD-9 Code
401.1
401.9
401.0
ICD-10 Code
I10
Hypertensive Diseases
Categories (I10-I15)
The use additional codes and Excludes1 codes apply for all categories.
(I10-I15)
Description
Essential (Primary)
Hypertension
Includes: high blood pressure, Hypertension
(arterial) (benign)
(essential) (malignant)
(systemic)
Use additional code to identify:
• Exposure to environmental tobacco smoke (Z77.22)
• History of tobacco use
(Z87.891)
• Occupational exposure to environmental tobacco smoke (Z57.31)
• Tobacco dependence
(F17.-)
• Tobacco use (Z72.0)
Excludes1
• Hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11,
O13-O16)
• Neonatal hypertension
(P29.2)
• Primary pulmonary hypertension (I127.0)
• Hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11.
O13-O16)
• Neonatal hypertension
(P29.2)
• Primary Pulmonary hypertension (I27.0)
Excludes2
• Essential (primary) hypertension involving vessels of brain (I60-I69)
• Essential (primary) hypertension involving vessels of eye (H35.0-)

Hypertension cont.
ICD-9 Code
402.01
402.11
402.91
ICD-10 Code
I11.0
402.00
402.10
402.90
403.01
403.11
403.91
I11.9
I12.0
403.00
403.10
403.90
I12.9
Description Excludes1
Hypertensive Heart Disease with heart failure
• Use additional code to identify type of heart failure (I50.-)
Hypertensive Heart Disease without heart failure
N/A
N/A
Excludes2
N/A
N/A
Hypertensive Chronic
Kidney Disease with stage 5
Chronic Kidney Disease or end stage renal disease.
• Use additional code to identify the stage of chronic kidney disease
(N185.5, N18.6)
• Hypertension due to
Kidney Disease (I15.0,
I15.1)
• Renovascular
Hypertension (I15.0)
• Secondary Hypertension
(I115.-)
Acute Kidney Failure (N17.-)
Hypertensive Chronic
Kidney Disease with stage
1-4 Chronic Kidney Disease, or unspecified Chronic
Kidney Disease.
• Use additional code to identify the stage of chronic kidney disease
(N18.1-N18.9)
• Hypertension due to
Kidney Disease (I15.0,
I15.1)
• Renovascular
Hypertension (I15.0)
• Secondary Hypertension
(I115.-)
Acute Kidney Failure (N17.-)

Hypertension cont.
ICD-9 Code
404.01
404.11
404.91
ICD-10 Code
I13.0
404.00
404.10
404.90
404.02
404.12
404.92
404.03
404.13
404.93
I13.10
I13.11
I13.2
Description
Hypertensive heart and chronic kidney disease with heart failure and stage 1-4 chronic kidney disease, or unspecified chronic kidney disease
• Use additional code to identify type of heart failure (I50.-)
• Use additional code to identify stage of chronic kidney disease
(N18.1-NN18.4, N18.9)
Hypertensive Heart and
Chronic Kidney Disease without heart failure, with stage 1-4 chronic kidney disease, or unspecified chronic kidney disease.
• Use additional code to identify the stage of chronic kidney disease (N18.1-N18.4, N18.9)
Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease or end stage renal disease.
• Use additional code to identify the stage of chronic kidney disease (N18.5, N18.6)
Hypertensive heart and chronic kidney disease with heart failure and with stage
5 chronic kidney disease, or end stage renal disease.
• Use additional code to identify type of heart failure (I50.-)
• Use additional code to identify the stage of chronic kidney disease (N18.5. N18.6)
Excludes1
N/A
N/A
N/A
N/A
Excludes2
N/A
N/A
N/A
N/A

Hypertension cont.
ICD-9 Code ICD-10 Code
405.01
405.11
405.91
I15.0
405.91
I15.1
405.99
405.09
405.19
405.99
405.99
I15.2
I15.8
I15.9
Description
Renovascular Hypertension
• Code also underlying condition
Excludes1
Postprocedural hypertension (I97.3)
Hypertension secondary to other renal disorders
• Code also underlying condition
Postprocedural hypertension (I97.3)
Hypertension secondary to endocrine disorders
• Code also underlying condition
Postprocedural hypertension (I97.3)
Other secondary hypertension
• Code also underlying condition
Postprocedural hypertension (I97.3)
Secondary hypertension, unspecified
• Code also underlying condition
Postprocedural hypertension (I97.3)
Excludes2
• Secondary hypertension involving vessels of brain
(I60-I69)
• Secondary hypertension involving vessels of eye
(H35.0-)
• Secondary hypertension involving vessels of brain
(I60-I69)
• Secondary hypertension involving vessels of eye
(H35.0-)
• Secondary hypertension involving vessels of brain
(I60-I69)
• Secondary hypertension involving vessels of eye
(H35.0-)
• Secondary hypertension involving vessels of brain
(I60-I69)
• Secondary hypertension involving vessels of eye
(H35.0-)
• Secondary hypertension involving vessels of brain
(I60-I69)
• Secondary hypertension involving vessels of eye
(H35.0-)

Hypertension Documentation Tips
• Hypertension is no longer classified as benign, malignant or unspecified.
• ICD-10 Codes have been grouped according to disease progression:
– I10
– I11.-
– I12.-
Essential Hypertension
Hypertensive Heart Disease
Hypertensive CKD
» Further subdivided by stage of kidney disease
– I13.Hypertensive Heart and CKD
» Further subdivided by stage of kidney disease
– I15.Secondary Hypertension
• Transient Hypertension
– A code for hypertension is NOT assigned unless the patient has a documented, established diagnosis of hypertension.
• R03.0 Elevated blood pressure reading without diagnosis of hypertension
• Document requirements
– Type
– Current Status
– Associated relationships

272.0
272.1
272.2
272.3
272.5
Hyperlipidemia
ICD-9 Code ICD-10 Code Description
272.4
E78.4
Other
Hyperlipidemia
• Familial combined hyperlipidemia
272.4
E78.5
Hyperlipidemia, unspecified
There are more specific code choice selections available below:
Excludes1 Excludes2
• Sphingolipidosis
(E75.0-E75.3)
N/A
E78.0
E78.1
E78.2
E78.3
E78.6
Pure Hypercholesterolemia
Pure Hypercholesterolemia
Mixed Hyperlipidemia
Hyperchylomicronemia
Lipoprotein deficiency

•
– Mixed
– Other
– Unspecified

Heart failure, unspecified
ICD-9 Code ICD-10 Code Description Excludes1
428.0
I50.9
Heart failure, unspecified
Applicable To:
• Biventricular (heart) failure NOS
• Cardiac, heart or myocardial failure NOS
• Congestive heart disease
• Congestive heart failure NOS
• Right ventricular failure
(secondary to left heart failure)
•
• Cardia arrest
(I46.-)
Neonatal cardiac failure
(P29.0)
• fluid overload
(E87.70)
Code first:
• Heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8)
• Heart failure following surgery (I97.13-)
• Heart failure due to hypertension (I11.0)
• Heart failure due to hypertension with chronic kidney disease (I13.-)
• Obstetrics surgery and procedures (O75.4)
• Rheumatic heart failure (I09.81)
Excludes2
N/A

• Type
– Systolic
– Diastolic
– Combined
• Chronicity
– Acute
– Chronic
– Acute on chronic

1) Hypertension with Heart Disease
Heart conditions classified to I50.- or I51.4-I51.9, are assigned to a code from category I11, Hypertensive heart disease, when a causal relationship is stated (due to hypertension) or implied (hypertensive). Use an additional code from category I50, Heart failure, to identify the type of heart failure in those patients with heart failure.

2) Hypertensive Chronic Kidney Disease
Assign codes from category I12, Hypertensive chronic kidney disease, when both hypertension and a condition classifiable to category N18, Chronic kidney disease (CKD), are present. Unlike hypertension with heart disease,
ICD-10-CM presumes a cause-and-effect relationship and classifies chronic kidney disease with hypertension as hypertensive chronic kidney disease.
The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease.
See Section I.C.14. Chronic kidney disease.
If a patient has hypertensive chronic kidney disease and acute renal failure, an additional code for the acute renal failure is required.

Monitor Claims
• Outpatient claims cannot have crossover dates
• Outpatient claims will be coded according to date of service
• Inpatient facility claims will be coded per date of discharge

Claim Denial and Management
•
•
•
•

Client Responsibilities
•
– Templates
– Order Sets
– Superbills
– Favorites
•
– Remove ICD-9 code add ICD-10 code

Documentation – Start Now
All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.
• Site specificity
• Document notation of qualifiers
– Exacerbation
– Manifestations
– Relapse
– Status
– Stages
• Indicate acute or chronic
• Indicate underlying or external cause factors
– Medication
– Smoke
– Accidents
– Mechanical failure
• Laterality
– Bilateral
– Right
– Left

Documentation – Start Now
•
–
• Use while the patient is receiving active treatment of the condition
– Active treatment includes surgical treatment, an emergency encounter, and evaluation and treatment by a new physician
–
• Used on encounter after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.
– Medication adjustments, aftercare, device adjustments, cast change
–
• Used for complications or conditions that arise as a direct result of a condition, late effect

Documentation – Start Now
•
– Etiology and manifestation
– Related conditions
– Disease, injury or other medical condition and complications
– Disease or other medical conditions and common signs or symptoms
•

Questions