ICD-10 CM Training
Nephrology
ICD-10-CM Compliance Dates
• ICD-10-CM will be valid for dates of service on or
after October 1, 2015
– Outpatient dates of service of October 1, 2015 and
beyond.
– Inpatient hospital service claims, is effective for dates of
discharge after September 30, 2015
Covered and Non-Covered Entities
• Covered Entities
– Everyone covered by the Health Insurance Portability
Accountability Act (HIPPA)
• Non-Covered Entities
– Worker’s Compensation
– Auto Insurance
– Non covered HIPAA entities are exempt but are
encouraged to adapt the new code set
ICD-10 Code Structure
• 21 Chapters
• Alpha-numeric codes; not case-sensitive
– Codes begin with Alpha letter, A-Z, excluding U
– Common errors
• I verses 1
• O verses 0
• “X” Placeholder
• 3 to 7 characters
– Decimal following 3rd character
ICD-10 Code Structure
• Placeholder “X”
– Used for future expansion of a code
– Fills in empty characters when a 6th and/or 7th 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
• 7th Character
– 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
• Laterality
– Some ICD-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
• “Other” Codes
– 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.
• “Unspecified” Codes
– 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
• Excludes Notes
– 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 together
– 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
• “Code First” and “Use Additional Code”
– ICD-10 has a coding convention that requires the
underlying condition be sequenced first followed
by the manifestation.
– These instructional notes indicate the proper
sequencing order of the codes.
OGCR section 1.A.13
• The “-” indicates there are additional reporting
options
Most Common Diagnosis Codes
Hypertension
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
401.1
401.9
401.0
I10
Essential (Primary)
Hypertension
Includes: high blood
pressure, Hypertension
(arterial) (benign)
(essential) (malignant)
(systemic)
•
•
•
•
Hypertensive Diseases
Categories (I10-I15)
The use additional codes
and Excludes1 codes apply
for all categories.
(I10-I15)
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)
•
•
•
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)
•
Essential (primary)
hypertension involving
vessels of brain (I60-I69)
Essential (primary)
hypertension involving
vessels of eye (H35.0-)
Hypertension cont.
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
402.01
402.11
402.91
I11.0
Hypertensive Heart Disease
with heart failure
• Use additional code to
identify type of heart
failure (I50.-)
N/A
N/A
402.00
402.10
402.90
I11.9
Hypertensive Heart Disease
without heart failure
N/A
N/A
403.01
403.11
403.91
I12.0
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.-)
403.00
403.10
403.90
I12.9
•
•
•
•
Hypertension cont.
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
404.01
404.11
404.91
I13.0
Hypertensive heart and
chronic kidney disease with
heart failure and stage 1-4
chronic kidney disease, or
unspecified chronic kidney
disease
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
•
•
404.00
404.10
404.90
I13.10
Hypertensive Heart and
Chronic Kidney Disease
without heart failure, with
stage 1-4 chronic kidney
disease, or unspecified
chronic kidney disease.
•
404.02
404.12
404.92
I13.11
I13.2
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.
•
404.03
404.13
404.93
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)
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)
Hypertension cont.
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
405.01
405.11
405.91
I15.0
Renovascular Hypertension
• Code also underlying
condition
Postprocedural
hypertension (I97.3)
•
•
405.91
405.99
405.09
405.19
405.99
405.99
I15.1
I15.2
I15.8
I15.9
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)
•
•
•
•
•
•
•
•
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
»
– I13.-
Hypertensive Heart and CKD
»
– I15.-
Further subdivided by stage of kidney disease
Further subdivided by stage of kidney disease
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
Acute kidney failure, unspecified
ICD-9 Code
ICD-10
Code
Description
Excludes1
Excludes2
584.9
N17.9
Acute kidney failure,
unspecified
•
•
Posttraumatic
renal failure
(T79.5)
traumatic kidney injury (S37.0-)
Applicable To:
•
Acute kidney
injury
(nontraumatic)
There are more specific code choice selections below:
585.5
N17.0
Acute kidney failure with tubular necrosis
583.6
584.6
N17.1
Acute kidney failure with acute cortical necrosis
583.7
584.7
N17.2
Acute kidney failure with medullary necrosis
584.8
N17.8
Other acute kidney failure
Documentation Tips
• Indicate any associated underlying condition
• Indicate acute renal failure type
Chronic kidney disease
ICD-9 Code
ICD-10
Code
Description
Excludes1
Excludes2
585.9
N18.9
Chronic kidney disease, unspecified
N/A
N/A
Applicable To:
• Chronic renal disease
• Chronic renal failure NOS
• Chronic renal insufficiency
• Chronic uremia
There are more specific code choice selections below:
585.1
N18.1
Chronic kidney disease, stage 1
585.2
N18.2
Chronic kidney disease, stage 2 (mild)
585.3
N18.3
Chronic kidney disease, stage 3 (moderate)
585.4
N18.4
Chronic kidney disease, stage 4 (severe)
585.5
N18.5
Chronic kidney disease, stage 5
585.6
N18.6
End stage renal disease
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)
Documentation Tips
• If both a stage of CKD and ESRD are documented, assign code N18.6 only.
• Chronic kidney disease and kidney transplant status
– Patients who have undergone kidney transplant may still have some form of chronic
kidney disease (CKD) because the kidney transplant may not fully restore kidney
function. Therefore, 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 T86.1- should be assigned for documented complications of a
kidney transplant.
Documentation Tips
• 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.
– 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.
– If a patient has hypertensive chronic kidney disease and acute renal failure, an additional
code for the acute renal failure is required.
Edema
ICD-9 Code
ICD-10
Code
Description
Excludes1
Excludes2
782.3
R60.9
Edema, unspecified
•
•
•
•
N/A
Applicable To:
• Fluid retention NOS
•
•
•
•
•
•
•
•
•
•
Angioneurotic edema (T78.3
Ascites (R18.-)
Cerebral edema (G93.6)
Cerebral edema due to birth
injury (P11.0)
Edema of larynx (J38.4)
Edema of nasopharynx
(J39.2)
Edema of pharynx (J39.2)
Gestational edema (O12.0-)
Hereditary edema (Q82.0)
Hydrops fetalis NOS (P83.2)
Hydrothorax (J94.8)
Nutritional edema (E40-E46)
Newborn edema (P83.3)
Pulmonary edema (J81.-)
There are more specific code choice selections below:
782.3
R60.0
Localized edema
782.3
R60.1
Generalized edema
Documentation Tips
Identify:
• Edema type
• Malnutrition type
• Trimester (Gestational)
Documentation Tips
Use of 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, 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.
Combination codes that include symptoms
• ICD-10-CM contains a number of combination codes that identify both the definitive
diagnosis and common symptoms of that diagnosis. When using one of these combination
codes, an additional code should not be assigned for the symptom.)
Anemia in chronic diseases
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
285.21
D63.1
Anemia in chronic kidney
disease
•
N/A
•
Applicable to:
Erythropoietin resistant
anemia (EPO resistant
anemia)
refractory anemia
(D46.-)
refractory anemia
with excess blasts in
transformation
[RAEB T] (C92.0-)
Code first
underlying chronic kidney
disease (CKD) (N18.-)
There are more specific code choice selections below:
285.29
D63.8
Anemia in other chronic diseases classified elsewhere
Code first underlying disease, such as:
• diphyllobothriasis (B70.0)
• hookworm disease (B76.0-B76.9)
• hypothyroidism (E00.0-E03.9)
• malaria (B50.0-B54)
• symptomatic late syphilis (A52.79)
• tuberculosis (A18.89)
Anemia, unspecified Documentation Tips
• Identify:
–
–
–
–
–
Anemia type
Nutritional Deficiency Anemia type
Bone Marrow Failure Anemia type
Hemolytic Anemia type
Other causes of Anemia
Heart failure, unspecified
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
428.0
I50.9
Heart failure, unspecified
•
N/A
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)
Heart failure, unspecified
Documentation Tips
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.
Secondary hyperparathyroidism of renal origin
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
588.81
N25.81
Secondary
hyperparathyroidism of
renal origin
•
•
•
Metabolic
disorders
classifiable to E70E88
Secondary
hyperparathyroidis
m, non-renal
(E21.1)
disorders of kidney
and ureter with
urolithiasis (N20-N23)
Diabetes
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
250.00
E11.9
Type 2 Diabetes mellitus
without complications
•
Diabetes (mellitus)
due to insulin
secretory defect
•
Diabetes (NOS)
•
Insulin resistant
diabetes (mellitus)
•
N/A
•
•
•
Use additional code to
identify any insulin use
(Z79.4)
•
•
•
•
Diabetes mellitus due
to underlying
condition (E08.-)
Drug or chemical
induced diabetes
mellitus (E09.1-)
Gestational diabetes
(O24.4-)
Neonatal diabetes
mellitus (P70.2)
Postpancreatectomy
diabetes mellitus
(E13.-)
Postprocedural
diabetes mellitus
(E13.-)
Secondary diabetes
mellitus NEC (E13.-)
Type 1 diabetes
mellitus (E10.-)
Diabetes Documentation Tips
Diabetes is a chronic condition that requires multi-specialty
management.
• The documentation should indicate relevant details regarding the
management of each case as it relates to the services rendered or
actions taken to coordinate the patients care.
• The HPI, at a minimal, should include some indication of the
historical timeline or duration of the illness, levels as it relates to
the date of service, manifestations or impairments associated with
the condition and effectiveness of current medication regimen.
• The examination should notate any physical signs related to the
diabetic conditions. (Ulcers, nails, edema, discoloration, sensitivity
to touch)
Other disorders of fluid, electrolyte and acid-base balance
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
276.9
E87.8
Other disorders of electrolyte
and fluid balance, not elsewhere
classified
•
•
N/A
Applicable to:
• Electrolyte imbalance NOS
• Hyperchloremia
• Hypochloremia
•
•
diabetes insipidus (E23.2)
electrolyte imbalance
associated with hyperemesis
gravidarum (O21.1)
electrolyte imbalance
following ectopic or molar
pregnancy (O08.5)
familial periodic paralysis
(G72.3)
There are more specific code choice selections below:
276.0
E87.0
Hyperosmolality and hypernatremia
276.1
E87.1
Hypo-osmolality and hyponatremia
276.2
E87.2
Acidosis
276.3
E87.3
Alkalosis
276.4
E87.4
Mixed disorder of acid-base balance
276.7
E87.5
Hyperkalemia
276.8
E87.6
Hypokalemia
276.69
E87.70
Fluid overload, unspecified
276.61
E87.71
Transfusion associated circulatory overload
276.69
E87.79
Other fluid overload
Atherosclerotic heart disease of native coronary artery without angina pectoris
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
414.00
I25.10
N/A
•
•
414.01
I25.10
Atherosclerotic heart
disease of native
coronary artery without
angina pectoris
Applicable To:
• Atherosclerotic heart
disease NOS
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)
Use additional code to identify:
• presence of hypertension (I10-I15)
• 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)
atheroembolism (I75.-)
atherosclerosis of coronary artery
bypass graft(s) and transplanted heart
(I25.7-)
Documentation Tips
• Identify:
– Coronary Disease Associated Artery/Lesion Type
– Native verses transplanted heart
– Associated Angina
Hyperlipidemia
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
272.4
E78.4
Other
Hyperlipidemia
• Familial
combined
hyperlipidemia
•
N/A
272.4
E78.5
Hyperlipidemia,
unspecified
Sphingolipidosis
(E75.0-E75.3)
There are more specific code choice selections available below:
272.0
E78.0
Pure Hypercholesterolemia
272.1
E78.1
Pure Hypercholesterolemia
272.2
E78.2
Mixed Hyperlipidemia
272.3
E78.3
Hyperchylomicronemia
272.5
E78.6
Lipoprotein deficiency
Hyperlipidemia Documentation Tips
• Type
– Mixed
– Other
– Unspecified
Hypotension
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
458.9
I95.9
Hypotension, unspecified
•
•
N/A
•
cardiovascular collapse (R57.9)
maternal hypotension
syndrome (O26.5-)
nonspecific low blood pressure
reading NOS (R03.1)
There are more specific code choice selections available below:
I95.0
Idiopathic hypotension
I95.1
Orthostatic hypotension
I95.2
Hypotension due to drugs
Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with
fifth or sixth character 5)
I95.3
Hypotension of hemodialysis
I95.81
Postprocedural hypotension
I95.89
Other hypotension
Other and unspecified abnormal findings in urine
ICD-9 Code
ICD-10 Code
Description
Excludes1
Excludes2
791.9
R82.90
Unspecified
abnormal
findings in urine
•
N/A
•
•
•
R82.99
abnormal findings on antenatal
screening of mother (O28.-)
diagnostic abnormal findings classified
elsewhere - see Alphabetical Index
specific findings indicating disorder of
amino-acid metabolism (E70-E72)
specific findings indicating disorder of
carbohydrate metabolism (E73-E74)
Other abnormal
findings in urine
There are more specific code choice selections available below:
R82.0
Chyluria
R82.1
Myoglobinuria
R82.2
Biliuria
R82.3
Hemoglobinuria
R82.4
Acetonuria
R82.5
Elevated urine levels of drugs, medicaments and biological substances
R82.6
Abnormal urine levels of substances chiefly nonmedicinal as to source
R82.7
Abnormal findings on microbiological examination of urine
R82.8
Abnormal findings on cytological and histological examination of urine
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
–
–
–
–
–
•
•
Indicate acute or chronic
Indicate underlying or external cause factors
–
–
–
–
•
Exacerbation
Manifestations
Relapse
Status
Stages
Medication
Smoke
Accidents
Mechanical failure
Laterality
– Bilateral
– Right
– Left
Documentation – Start Now
• Episode of Care for injuries, poisoning, external
causes and other conditions
– Initial Encounter
• 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
– Subsequent Encounter
• 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
– Sequela
• Used for complications or conditions that arise as a direct result of
a condition, late effect
Documentation – Start Now
• Combination codes that capture
– Etiology and manifestation
– Related conditions
– Disease, injury or other medical condition and
complications
– Disease or other medical conditions and common signs or
symptoms
• Add ICD-10 Codes to patient Problem List
Official Guidelines for Coding and Reporting
Underdosing
Underdosing refers to taking less of a medication than is prescribed by a provider or a
manufacturer’s instruction. For underdosing, assign the code from categories T36-T50
(fifth or sixth character “6”).
Codes for underdosing should never be assigned as principal or first-listed codes. If a
patient has a relapse or exacerbation of the medical condition for which the drug is
prescribed because of the reduction in dose, then the medical condition itself should
be coded.
Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.6-Y63.9) codes are to be
used with an underdosing code to indicate intent, if known.
OGCR Section 1.C.19.e.5.c
Questions
codingresource@g1hs.com
Centers for Disease Control and Prevention (ICD-10-CM)
http://www.cdc.gov/nchs/icd/icd10cm.htm