ICD-10-CM Webinar Series Session IV - FHA · ICD-10-CM Series, Session IV Original Presentation Date: ... - F70-F79 Intellectual disabilities ... – 317-319 Mental retardation 13

ICD-10-CM Series, Session IV Original Presentation Date: November 30, 2012

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Session IV:2012 ICD-10-CM

Session IV:Chapter 5: Mental, Behavioral, and

Neurodevelopmental Disorders (F01-F99)

Chapter 6: Diseases of the Nervous System (G00-G99)

November 30, 2012

Your Presenters Today

Barbara Flynn, RHIA, CCSAHIMA Approved ICD-10-CM/PCS Trainer & AmbassadorVice President/Health Information and Denial Management

Services Florida Hospital Association Management Corporation

307 Park Lake Circle, Orlando, FL 32803407.841.6230 p 407.792.6272

www.fha.organd

Linda Renn, RHIT, CCS, CPC, CPC-H, HITPro – TRAHIMA Approved ICD-10-CM/PCS Trainer & Ambassador

Vice President Education & CommunicationsVice President, Education & CommunicationsSTAT Solutions, Inc.

P.O. Box 0397New Port Richey FL 34656-0397

1-888-297-7212www.statsolutionsinc.com

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Barbara Flynn, RHIA, CCS, is the Vice President for Health Information Management Services and Denial Management Services for the Florida Hospital Association Management Corporation (FHAMC). Barbara joined the professional staff of the Florida Hospital Association (FHA) in January 1991, where she developed service lines to assist member hospitals with HIM staffing, coding and billing compliance, interim management, educational programs documentation improvement programs and insurance and RAC

Speaker Introductions

educational programs, documentation improvement programs, and insurance and RAC denial appeals. Barbara developed “Denial Management Services” in January 2008, to mitigate and assist member hospitals to appeal RAC coding and medical necessity denials . Barbara became an AHIMA ICD‐10‐CM/PCS Trainer and Ambassador in March 2010.

Linda L. Renn, RHIT, CCS, CPC, CPC‐H, HIT Pro – TR is the Vice President of Education and Communication for STAT Solutions, Inc. and Professional Outsourcing, Inc. She serves FHIMA as the Advocacy Chair., and she currently holds RHIT, CCS, CPC , CPC‐H and HIT Pro –TR credentials. Additionally, Linda is an AHIMA approved ICD‐10‐CM/PCS Trainer and Ambassador, as well as a HITECH Trainer from the Office of the National Coordinator. Her 37

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,years in HIM has led her to work in various roles, domains and clinical aspects of inpatient, outpatient and physician practice settings.

Preparation is Your Key to Success

Course Objectives•Understand the mechanism of the disease processprocess•Understand and Apply

– Chapter-Specific Coding Guidelines for:• Chapter 5: Mental, Behavioral, and

Neurodevelopmental Disorders (F01-F99)• Chapter 6: Diseases of the Nervous System (G00-

G99)G99)

– General coding guidelines for specific diagnoses

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Preparation is Your Key to Success

Course Objectives (continued)• Identify the Anatomy, Function and Common

Diseases and Disorders of the Nervous System• Identify Common Mental and Behavioral

Disorders• Correctly Assign ICD‐10‐CM Codes for Mental,

Behavioral, and Neurodevelopmental Disorders (F01-F99)( )

• Correctly Assign ICD‐10‐CM Codes for Diseases of the Nervous System (G00-G99)

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Review Your Understanding of the gICD-10-CM/PCS Compliance Date

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CMS Delays ICD-10 Compliance Date by One Year

• Friday, August 24, 2012– The Centers for Medicare &

Medicaid Services (CMS) one-year delay in implementation of ICD-10-CM/PCS to October 1, 2014.

– Applies to both diagnosis and procedure codes - ICD-10-CM and ICD 10 PCS *ICD-10-PCS.*

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Introduction toChapter 5: Mental, Behavioral, and

Neurodevelopmental Disorders (F01-F99)

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Chapter 5: Terms to Know (F01-F99) • Abuse is the problematic use of drugs or alcohol but

without dependence.• Dependence is the increased tolerance to drugs or• Dependence is the increased tolerance to drugs or

alcohol with a compulsion to continue taking the substance despite the cost; withdrawal symptoms often occur upon cessation.

• Somatoform disorder is a chronic, but fluctuating, neurotic disorder that begins early in life, h t i d b t d lti l ticharacterized by recurrent and multiple somatic

complaints for which medical attention is sought, but are not due to any apparent physical illness.

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Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders

(F01-F99)• Mental disorders of all types are classified inMental disorders of all types are classified in

Chapter 5 of ICD-10-CM• Remember… Although coding assignments for

mental disorders are made according to ICD-10-CM, Psychiatrists ordinarily state diagnoses in accordance with the nomenclature used in the “Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (DSM-IV-TR) (1)

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Chapter 5: Categories (F01-F99)

• Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders contains 11 code families with the first character “F” and are arranged in the following blocks: – F01-F09 Mental disorders due to known

physiological conditions– F10-F19 Mental and behavioral disorders due to

h ti b tpsychoactive substance use– F20-F29 Schizophrenia, schizotypal, delusional, and

other non-mood psychotic disorders– Cont…

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Chapter 5: Categories (F01-F99)- F30-F39 Mood [affective] disorders- F40-F48 Anxiety, dissociative, stress-related,

somatoform and other nonpsychotic mental disordersF50 F59 B h i l d i d i h- F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors

- F60-F69 Disorders of adult personality and behavior- F70-F79 Intellectual disabilities- F80-F89 Pervasive and specific developmental

disorders- F90-F98 Behavioral and emotional disorders with

onset usually occurring in childhood and adolescence- F99-F99 Unspecified mental disorder

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Chapter 5: Category Restructuring (F01-F99)

• Chapter 5 underwent a number of revisions, including expansion of the number of subchapters and code groupings (i.e., sections, blocks). (1)

• The next slide illustrates how the ICD-10-CM code families listed contrast with the current ICD-9-CM classifications below:– 290-299 Psychoses– 290-294 Organic psychotic conditions– 295-299 Other psychoses– 300-316 Neurotic disorders, personality disorders, and other

nonpsychotic mental disorders– 317-319 Mental retardation

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Chapter 5: Mental, Behavioral, and Neurodevelopmental DisordersICD‐9‐CM ICD‐10‐CM 290‐299 Psychoses290‐294 Organic psychotic conditions295‐299 Other psychoses

F01‐F09 Mental disorders due to known physiological conditionsF10‐F19 Mental and behavioral disorders due to295 299 Other psychoses

300‐316 Neurotic disorders, personality disorders, and other nonpsychotic mental disorders317‐319 Mental retardation

F10 F19 Mental and behavioral disorders due to psychoactive substance useF20‐F29 Schizophrenia, schizotypal, delusional, and other non‐mood psychotic disordersF30‐F39 Mood [affective] disordersF40‐F48 Anxiety, dissociative, stress‐related, somatoform and other nonpsychotic mental disordersF50‐F59 Behavioral syndromes associated with physiological disturbances and physical factorsF60‐F69 Disorders of adult personality and behavior

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F60‐F69 Disorders of adult personality and behaviorF70‐F79 Intellectual disabilitiesF80‐F89 Pervasive and specific developmental disordersF90‐F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescenceF99‐F99 Unspecified mental disorder


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Chapter 5: Organizational Adjustments (F01-F99)

• When comparing ICD-9-CM to ICD-10-CM, some codes have been added deleted combined andcodes have been added, deleted, combined, and moved.

• The code for tension headache was found in ICD-9-CM chapter 5 under the subchapter “Neurotic Disorders, Personality Disorders, and Other Nonpsychotic Mental Disorders (300-316).”

• The code for this condition has been moved in ICD-10-CM and is now located in Chapter 6, “Diseases of the Nervous System.” (1)

• Cont… 15


• For example:• ICD-9-CM Chapter 5. Mental Disorders (290-319)

307 Special symptoms or syndromes, not elsewhere classified307.8 Pain disorders related to psychological factors

307.81 Tension headache

• ICD-10-CM Chapter 6. Diseases of the Nervous System (G00-G99)

G44 Other headache syndromesG44.2 Tension-type headache

G44.20 Tension‐type headache, unspecifiedG44.21 Tension‐type headache, unspecified, intractableG44.209 Tension‐type headache, unspecified, nonintractable

Tension headache NOS

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• For example: (1)

• ICD-9-CM Chapter 5. Mental Disorders (290-319)ICD 9 CM Chapter 5. Mental Disorders (290 319)315 Specific delays in development

315.3 Developmental speech or language disorder315.32 Mixed receptive‐expressive language disorder

Central auditory processing disorder

• ICD-10-CM Chapter 8. Diseases of the Ear and Mastoid Process (H60-H95)

H93 Other disorders of ear, not elsewhere classifiedH93.25 Central auditory processing disorder

Congenital auditory imperceptionWord deafness

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• For example: (1)

• ICD-9-CMICD 9 CM306.52 Psychogenic dysmenorrhea

• ICD-10-CMF45.8 Other somatoform disorders

Psychogenic dysmenorrheaPsychogenic dysphagia, including “globus hystericus”Psychogenic pruritus

h llPsychogenic torticollisSomatoform autonomic dysfunctionTeeth‐grinding

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Coding Guidance: Pain Disorders Related to Psychological Factors

• Pain Disorders Related to Psychological Factors (1)Factors (1)

– Assign code F45.41 for pain that is exclusively psychological.– Draft official guidelines state that code F45.41 should be

assigned following the appropriate code from category G89 Pain, not elsewhere classified, if a psychological component is documented for a patient with acute or chronic pain.

– An instructional note at code F45.42 states to code also any associated acute or chronic pain (G89 )associated acute or chronic pain (G89.-)

– An instructional note at category G89 Pain, not elsewhere classified states to also code related psychological factors associated with pain (F45.42).

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Coding Guidance: Psychoactive Substance Use, Abuse & Dependence• Psychoactive Substance Use, Abuse and

Dependence (1)

D d l h l b d d d d l– Drug and alcohol abuse and dependence codes no longer identify continuous or episodic use. Instead, other data have been identified of greater value of reporting purposes.

– Combination codes for drug and alcohol use include associated conditions (e.g., withdrawal, sleep disorders and psychosis)

– Unique classification subcategories exist for specific status: use abuse and dependenceuse, abuse, and dependence.

– History of drug or alcohol dependence is classified as “in remission.”

– An additional code is necessary to report blood alcohol level (Y90.-), when documented.

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Coding Guidance: Psychoactive Substance Use, Abuse & DependenceCode block F10-F19 Mental and behavioral disorders due to psychoactive substance use, includes the following code categoriesincludes the following code categories.

– F10 Alcohol related disorders– F11 Opioid related disorders – F12 Cannabis related disorders – F13 Sedative, hypnotic, or anxiolytic related disorders – F14 Cocaine related disorders – F15 Other stimulant related disorders – F16 Hallucinogen related disorders – F17 Nicotine dependence – F18 Inhalant related disorders – F19 Other psychoactive substance related disorders (1)

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Coding Guidance: Psychoactive Substance Use, Abuse & Dependence

• Where applicable, sixth-place characters further if th f t i li tispecify the presence of certain complications,

including:– Delirium– Delusions– Hallucinations

Perceptual disturbance (1)– Perceptual disturbance (1)

– Cont…

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Coding Guidance: Psychoactive Substance Use, Abuse & Dependence• When the provider documentation refers to use, abuse

and dependence of the same psychoactive substance,and dependence of the same psychoactive substance, report only one code as documented, per substance in accordance with the highest degree of clinical hierarchy.

• In those circumstances where the provider does not document abuse or dependence, the condition is classified to the “use” subcategory, as appropriate.

• Substance use may progress to substance abuse which• Substance use may progress to substance abuse, which may result in dependence. Substance use status lies at the lowest severity end of the substance status scale, with dependence at the highest level of severity. (1)

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• Excludes 1 notes are listed at each subcategory g ylevel, to indicate that use, abuse, and dependence of the same substance (classified within a subcategory) is not allowed.

• Note that an Excludes 1 notes may be interpreted as “not coded here.” (1)

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• For example:• For example:– Diagnosis: Chronic alcohol abuse with dependence– F10.20 Alcohol dependence, uncomplicated

• Since dependence represents a disease progression in severity from abuse to dependence only the dependence is reported (1)dependence, only the dependence is reported. (1)

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• For example:– Diagnosis: Cannabis abuse with cannabis-induced

anxiety disorder.– F12.180 Cannabis abuse with cannabis-induced

anxiety disorder.• Since abuse represents a disease progression

in severity from use to abuse only the abuse isin severity from use to abuse, only the abuse is reported. (1)

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Coding Guidance: Mental & Behavioral Disorders Due to Psychoactive Substance Use

• Mental and Behavioral Disorders Due to Psychoactive Substance Use:Psychoactive Substance Use:– Codes for psychoactive substance use should only be

assigned when supported by provider documentation, and when the substance use meets the definition of a reportable diagnosis. (1)

– According to coding guidelines, codes F10.9-, F11.9-, F12.9-, F13.9-, F14.9-, F15.9-, and F16.9- should onlyF12.9 , F13.9 , F14.9 , F15.9 , and F16.9 should only be reported when the physician documents an association between the psychoactive substance and a mental or behavioral disorder. (2)

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Coding Guidance: Mental Retardation

• Mental Retardation:– ICD-10-CM instructional notes state a change in– ICD-10-CM instructional notes state a change in

sequencing of mental retardation codes (F70-F79) from previous ICD-9-CM instruction. (1)

– For Example:• ICD-9-CM

– Mental Retardation (317-319): Use additional code(s) to identify any associated psychiatric or physical condition

• ICD-10-CM– Mental Retardation (F70-F79): Code first any associated physical or

developmental disorders

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Coding Guidance: Level of Detail in Coding Chapter 5

• As in ICD-9-CM, diagnosis codes are to be used and reported to the highest degree ofused and reported to the highest degree of specificity available.

• ICD-10-CM provides, in the majority of cases, an exponentially increased level of specificity than ICD-9-CM.

• In Chapter 5 this code expansion is intendedIn Chapter 5, this code expansion is intended to facilitate identification of specific types or manifestations of disease that are now separately identifiable.

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ICD‐9‐CM ICD‐10‐CM 307.46 Sleep arousal disorder F51.3 Sleepwalking [somnambulism]

F51.4 Sleep terrors [night terrors]

Illustration 1: (1)

ICD‐9‐CM ICD‐10‐CM 300.29 Other isolated or specific phobias

F40.210 ArachnophobiaF40.218 Other animal type phobiaF40.220 Fear of thunderstormsF40.228 Other natural environmental type h bi

Illustration 2: (2)

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phobiaF40.230 Fear of bloodF40.231 Fear of infections and transfusions


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Coding Guidance: Multiple Coding

• Instructional notes appear throughout the text to id i i t ti h thprovide sequencing instruction when more than

one code is necessary to report the diagnosis incompletion.

• Many codes classified to Chapter 5 either necessitate or require the assignment of more than one code to report the condition in itsthan one code to report the condition in its entirety. (1)

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• For example:• F01 Vascular dementia

C d fi t th d l i h i l i l diti– Code first the underlying physiological condition or sequelae of cerebrovascular disease

• F02 Dementia in other diseases classified elsewhere– Code first the underlying physiological condition, such

as:» Alzheimer’s» Cerebral lipidosis (E75.4)

Creutzfeldt Jakob disease (A81 0 )» Creutzfeldt-Jakob disease (A81.0-)

• F04 Amnestic disorder due to known physiological condition– Code first the underlying physiological condition

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Chapter 5: Mental, Behavioral, & Neurodevelopmental Disorders

(F01-F99)

• Coding Guideline I.C.5.a Pain disorders related to psychological factors• Excludes1 note under category G89

Should not be assigned with code F45.41• F45.42 used with a code from category G89

Psychological component for a patient with acute or

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chronic pain


(F01-F99)

N C d• New Codes:– F03.90 Unspecified dementia without behavioral

disturbance– F03.91 Unspecified dementia with behavioral

disturbance

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(F01-F99)

• Wording change in categories (F70-F79)• F70 Mild intellectual disabilities• F71 Moderate intellectual disabilities• F72 Severe intellectual disabilities• F73 Profound intellectual disabilities• F78 Other intellectual disabilities

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• F79 Unspecified intellectual disabilities

Mental Disorders Due To Known Physiological Conditions

• Categories F01 through F09, Mental disorders d t k h i l i l diti i l ddue to known physiological conditions, include a range of mental disorders grouped together on the basis of having a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction.

• The cerebral dysfunction may be primary or• The cerebral dysfunction may be primary or secondary. (1)

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Mental Disorders Due To Known Physiological Conditions: Organic Brain

Syndrome• Organic brain syndrome is an older general term used to

describe decreased mental function due to a medical disease other than a psychiatric illness. (1)

• Organic brain syndrome, not otherwise specified, is coded to F09, Unspecified mental disorder due to known physiological condition.

• The underlying physiological condition should be coded first.

• Posttraumatic organic brain syndrome is coded to F07.81, Postconcussional syndrome, with an additional code to identify any associated posttraumatic headache.

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Mental Disorders Due To Known Physiological Conditions: Organic Anxiety

Disorder

• Organic anxiety disorder is a transientOrganic anxiety disorder is a transient organic psychosis characterized by clinically significant anxiety.

• It is considered to be the direct physiological effect of a general medical condition. (1)

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Mental Disorders Due To Known Physiological Conditions: Dementia in Other Diseases Classified Elsewhere

• Subcategory F02.8, Dementia in other diseases g yclassified elsewhere, specifically identifies the presence of or absence of behavioral disturbances such as aggressive behavior, violent behavior, wandering off, or combative behavior.

• The dementia classified in subcategory F02.8 is due to direct physiological effects of a general medical condition. (1)

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Altered Mental State

• An alteration in level of consciousness not i t d ith d li i th id tifi dassociated with delirium or another identified

condition is classified to category R40 in Chapter 18 of ICD-10-CM.

• Category R40 is further subdivided to indicate whether it is identified as somnolence (R40.0), stupor (R40 1) coma (R40 2 ) persistentstupor (R40.1), coma (R40.2-), persistent vegetative state (R40.3), or transient alteration of awareness (R40.4). (1)

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Transient Global Amnesia

• Transient global amnesia is a distinct form fTransient global amnesia is a distinct form f amnesia of unknown etiology, characterized by a sudden loss of memory function.

• During an episode, the patient is unable to form memories or remember recent events and may ask the same question over and over because qno memories of previous answers are formed. (1)

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Schizophrenic Disorders

• Schizophrenia is a severe mental illness h t i d b i t f tcharacterized by a variety of symptoms

including, but not limited to:• Loss of contact with reality• Bizarre behavior• Disorganized thinking• Disorganized speech• Decreased emotional expressiveness• Diminished or loss of contact with reality• Diminished or total social withdrawal

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Schizophrenic Disorders

• Schizophrenic disorders are classified in category F20, with a fourth character indicating g y , gthe type of schizophrenia as follows:

• F20.0 Paranoid schizophrenia (1)

• F20.1 Disorganized schizophrenia (2)

• F20.2 Catatonic schizophrenia (3)

• F20.3 Undifferentiated schizophrenia (4)

• F20.5 Residual schizophrenia (5)p ( )

• F20.8 Other schizophrenia– F20.81 Schizophreniform disorder (6)– F20.89 Other schizophrenia (7)

• F20.9 Schizophrenia, unspecified (8)

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Affective Disorders

• Affective disorders are common mental diseases ith lti l t i l di bi l i lwith multiple aspects, including biological,

behavioral, social, and psychological factors.• Major depressive disorder, bipolar disorders,

and anxiety disorders are the most common affective disorders.Aff ti di d lt i t• Affective disorders can result in symptoms ranging from the mild and inconvenient to the severe and life threatening. (1)

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Major Depressive Disorder• Major depressive disorder (MDD) is

also known as monopolar depression or unipolar affective disorder. (1)

– MDD is classified in ICD-10-CM as:• F32.- Major depressive disorder,

single episode• F33.- Major depressive disorder,

recurrent

– Categories F32 and F33 are furtherCategories F32 and F33 are further subdivided with fourth characters (or fifth characters) to provide information about the current severity of the disorder (2)

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Bipolar Affective Disorder• Bipolar affective diseases are divided into

various types according to the symptoms displayed. (1)

• ICD-10-CM classifies bipolar disorders under the following categories/codes:

• F30.- Manic episode (includes bipolar disorder, single manic episode, and mixed affective episode)

• F31.- Bipolar disorder (includes manic-depressive illness, manic-depressive psychosis, and manic-depressive reaction

• F34 Persistent mood [affective] disorders• F34.- Persistent mood [affective] disorders (includes cyclothymic disorder and dysthymic disorder)

• F39 Unspecified mood [affective] disorder (includes affective psychosis not otherwise specified) (2)

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Four Basic Types of Bipolar Disorder• Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least

seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically p y p p p yp ylasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.

• Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.

• Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior. p g

• Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

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Nonpsychotic Mental Disorder

• A variety of anxiety, dissociative, stress related, t f d th h ti t lsomatoform, and other nonpsychotic mental

disorders are classified in categories F40 through F48. These include such conditions as phobic anxiety disorders, reaction to stress, dissociative and conversion disorders, somatoform disorders and other nonpsychoticsomatoform disorders, and other nonpsychotic mental disorders. (1)

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Anxiety Disorders

• Anxiety disorders are common psychiatry disorders and are considered to be one of the most undertreated and overlooked health problems. (1)

– F40 Phobic anxiety– F41 Other anxiety disorders

F42 Ob i l i di d– F42 Obsessive-compulsive disorder

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Reaction to Stress

• ICD-10-CM provides category F43 for coding ti t t d dj t treaction to severe stress and adjustment

disorders.• Code F43.0, Acute stress reaction, classifies

acute reaction to stress, including acute crisis reaction, combat fatigue, crisis state, and psychic shockpsychic shock. (1)

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Posttraumatic Stress Disorder

• Posttraumatic stress disorder (PTSD) is l ifi d i ICD 10 CM t b t F43 1classified in ICD-10-CM to subcategory F43.1,

with fifth characters for unspecified, acute, or chronic.

• PTSD is a severe anxiety disorder that can develop after exposure to any event resulting in psychological traumapsychological trauma. (1)

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Adjustment Disorders

• Adjustment disorders are a psychological t id tifi bl t fresponse to an identifiable stressor or group of

stressors that cause(s) significant emotional or behavioral symptoms. (1)

• The following situations fall into this category:– F43.21 Patient depressed over death of son

F43 24 Child d t d f f i t ff i– F43.24 Child adopted from a foreign country, suffering from culture shock with conduct disturbance

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Dissociative and Conversion Disorders

• ICD-10-CM classifies dissociative and i di d t t F44conversion disorders to category F44. (1)

– F44.0 Dissociative amnesia– F44.1 Dissociative fugue– F44.2 Dissociative stupor– F44.81 Dissociative identity disorder (2)– F44.4 Conversion disorder with motor symptom or deficit– F44.5 Conversion disorder with seizures or convulsions– F44.6 Conversion disorder with sensory symptom or deficitF44.6 Conversion disorder with sensory symptom or deficit– F44.7 Conversion disorder with mixed symptom presentation– In addition, two codes are available for other (F44.89) and unspecified

(F44.9) dissociative and conversion disorders

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Somatoform Disorders

• Somatoform disorders are mental disorders characterized by physical symptoms that mimiccharacterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause. (1)

• F45.8 Psychogenic diarrhea• F45.8 Psychogenic dysmenorrhea• F45.20 Hypochondriacal disorder (2)

F i h i l i l h l i l i• For pain that is exclusively psychological, assign code F45.41, Pain disorder exclusively related to psychological factors.

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Behavioral Syndromes Associated with Physiological Disturbances and

Physical Factors• Categories F50 through F59 are devoted to

behavioral syndromes associated with physiologicalbehavioral syndromes associated with physiological disturbances and physical factors. (1)

– F50.- Eating disorders (such as anorexia nervosa and bulimia nervosa)– F51.- Sleep disorders not due to a substance or known physiological

condition– F52.- Sexual dysfunction not due to a substance or known physiological

condition– F53 - Puerperal psychosis– F53.- Puerperal psychosis– F54 Psychological and behavioral factors associated with disorders or

diseases classified elsewhere– F55.- Abuse of nonpsychoactive substances– F59 Unspecified behavioral syndromes associated with

physiological disturbances and physical factors (2)

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Substance Abuse Disorders

• Substance abuse and dependence are classified t l di d i ICD 10 CM Thas mental disorders in ICD-10-CM. These

disorders are classified to categories F10 through F19.

• Although the terms “abuse” and “dependence” may be used interchangeably in certain treatment programs they are different conditionstreatment programs, they are different conditions and are coded differently in ICD-10-CM.

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Alcohol Dependence and Abuse• Alcohol-related disorders are classified in ICD-10-CM

to category F10.• An additional code for blood alcohol level may be

assigned, if applicable (Y90.-).• Alcohol abuse refers to the recurring use of alcoholic

beverages despite negative consequences.• Alcohol dependence, as described in the DSM-IV, is a

psychiatric diagnosis describing a condition in whichpsychiatric diagnosis describing a condition in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship. (1)

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Alcohol

• 38 y/o – 17 years of heavy weekend use

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Marked overall decreased activity on all views

Underside surface views Front surface view


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Alcohol Dependence and Abuse

• Alcohol abuse is classified in ICD-10-CM under b t F10 1 Al h l b hil l h lsubcategory F10.1, Alcohol abuse, while alcohol

dependence is classified under subcategory F10.2, Alcohol dependence.

• If alcohol use is documented without further specificity as to abuse or dependence, it is classified to subcategory F10 9 Alcohol useclassified to subcategory F10.9, Alcohol use, unspecified. (1)

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Drug Dependence and Abuse

• ICD-10-CM classifies drug dependence and abuse in the following categories according to the class of drug:– F11 Opioid related disorders– F12 Cannabis related disorders– F13 Sedative, hypnotic or anxiolytic related disorders– F14 Cocaine related disorders– F15 Other stimulant related disorders– F16 Hallucinogen related disordersF16 Hallucinogen related disorders– F17 Nicotine dependence– F18 Inhalant related disorders– F19 Other psychoactive substance related disorders (1)

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Heroin & Methadone

Normal View 39 y/o 25 yr hx of frequent heroin useNormal Viewtop down surface viewfull symmetrical brain activity

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39 y/o -- 25 yr. hx of frequent heroin usetop down surface view marked overall decreased brain activity

Drug Dependence and Abuse

• ICD-10-CM provides combination codes that include both the alcohol or substance abuse/dependenceboth the alcohol or substance abuse/dependence and any associated complications. For example:– F10.231 Alcoholic withdrawal delirium due to alcohol

dependence– F10.180 Alcohol-induced anxiety disorder due to alcohol abuse– F11.250 Heroin dependence with heroin-induced psychosis and

delusions

• Category F19, Other psychoactive substance related disorders, may be used when the specific drug class is not specified. (1)

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Psychoactive Substance Abuse

• In addition to the codes for psychoactive substance abuse and dependence ICD 10 CM provides codesabuse and dependence, ICD-10-CM provides codes for psychoactive substance use:– F10.9-, – F11.9-, – F12.9-, – F13.9-, – F14.9-, – F15.9-, – F16.9-). (1)

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Psychoactive Substance Use, Abuse, and Dependence Code Hierarchy

• When the provider documentation refers to use, abuse and dependence of the same substanceabuse, and dependence of the same substance (e.g., alcohol, opioid, cannabis), only one code should be assigned to identify the pattern of use, based on the following hierarchy:– If both use and abuse are documented, assign only the code for abuse.– If both abuse and dependence are documented, assign only the code for

dependence.p– If use, abuse, and dependence are all documented, assign only the code for

dependence– If both use and dependence are documented, assign only the code for

dependence.

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Selection of Principal Diagnosis• The designation of the principal diagnosis for patients

with either substance abuse or substance dependence is determined by the circumstances of the admission, as defined in the following examples:1. When a patient is admitted for detoxification or rehabilitation for both drug

and alcohol abuse or dependence, and both are treated, either condition may be designated as the principal diagnosis.

2. When a patient with a diagnosis of substance abuse or dependence is admitted for treatment or evaluation of a physical complaint related to the substance use, follow the directions in the Alphabetic Index for conditions described as alcoholic or due to drugs; sequence the physical condition first, followed by the code for abuse or dependence.

3. When a patient with a diagnosis of alcohol or drug abuse or dependence is admitted because of an unrelated condition, follow the usual guidelines for selecting a principal diagnosis.

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Substance Abuse Therapy

• Treatment for patients with a diagnosis of• Treatment for patients with a diagnosis of substance abuse or dependence consists of detoxification, rehabilitation, or both.

• The abuse or dependence is the principal diagnosis for a patient admitted for such programs. (1)programs. (1)

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Introduction toChapter 6: Diseases of the NervousChapter 6: Diseases of the Nervous

System (G00-G99)

69

Chapter 6: Chapter Overview (G00-G99)

• Nervous system diseases can be found in Chapter 6 of ICD 10 CMChapter 6 of ICD-10-CM.

• Dual coding is often required for infectious diseases of the central nervous system.

• Pain can be coded by recording the site of the pain.

Codes for pain not elsewhere classified (G89) can be used for– Codes for pain, not elsewhere classified (G89), can be used for coding pain control or management

– If the cause is known but not treated during the encounter, code it as an additional diagnosis. (1)

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36

Chapter 6: Terms to Know (G00-G99)

• Central nervous system: the brain and spinal cordcord

• Conductive hearing loss: hearing loss due to a problem with a part of the ear

• Peripheral nervous system: all elements of the nervous system except the brain and spinal cordS i l h i l i h i l• Sensorineural hearing loss: is hearing loss due to a problem with the sensory part of the ear or the nerves associated with hearing

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Chapter 6: Terms to Know (G00-G99)

• Epilepsy: Brain disorder characterized by electrical-like disturbances; may include ; yoccasional impairment or loss of consciousness, abnormal motor phenomena and psychic or sensory disturbances. (1)

• Migraine: Benign vascular headache of extreme pain; commonly associated with irritability, nausea, vomiting and often photophobia; premonitory visual hallucination of a crescent in the visual field (scotoma).

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37

Chapter 6: Anatomy and Physiology Terms to Know (G00-G99)

ICD‐10‐CM Nervous System

G00‐G47; G80‐G99 Central nervous system (brain and spinal cord)

G50‐G73 Peripheral nervous system (all other neural elements in the rest of the body)

73

Chapter 6: Anatomy and Physiology Terms to Know (G00-G99)

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38

The Central Nervous System

75

Lobes of the Brain

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39

Parts of the Brain

77

Brain Hemispheric Specialization

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40

Spinal Cord

79

Peripheral Nervous System

80


41

Peripheral Nervous System

81

The Human Nervous System

Organ Sympathetic System Parasympathetic System

Dil t ilEye

Tear glands

Salivary glands

Lungs

Heart

Dilates pupil

No effect

Inhibits saliva production

Dilates bronchi

Speeds up heart rate

Inhibits peristalsis

Constricts pupil

Stimulates tear secretion

Stimulates saliva productionConstricts bronchi

Slows down heart rate

Gut

Liver

Bladder

Inhibits peristalsis

Stimulates glucose

production

Inhibits urination

Stimulates peristalsis

Stimulates bile production

Stimulates urination

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42

Plexus

83

Nerves

Nerves ofthe shoulder

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43

Nerve Cells (Neurons)

85

Three Types of NeuronsSensory neuron Interneuron Motor Neuron

Length of Fibers

Long dendrites and short axon

Short dendrites and short or long anxon

Short dendrites and long axonsg g

Location

Cell body and dendrite are outside of the spinal cord; the cell body is located in a dorsal root ganglion

Entirely within the spinal cord or CNS

Dendrites and the cell body are located in the spinal cord; the axon is outside of the spinal cord

F i Conduct impulse toInterconnect the sensory neuron with Conduct impulse to

Function Conduct impulse to the spinal cord

sensory neuron with appropriate motor neuron

an effector (muscle or gland

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44

Neuron Cell Body, Axons and Dendrites

• There are several differences between axons and dendrites:

Axons Dendrites

• Take information away from the cell

body

• Smooth Surface

• Generally only 1 axon per cell

• Bring information to the cell body

• Rough Surface (dendritic spines)

• Usually many dendrites per cell

H ib

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y y

• No ribosomes

• Can have myelin

• Branch further from the cell body

• Have ribosomes

• No myelin insulation

• Branch near the cell body

The Reflex Arc

• The Reflex Arc: The three types of neurons are arranged in circuits and networks, the simplest of which is the reflex arc.

• Reflex arc can also be represented by a simple flow diagram:e e a c ca a so be ep ese ted by a s p e o d ag a

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Chapter 6: Introduction (G00-G99) • Diseases of the nervous system are classified in

Chapter 6 of ICD-10-CM. • Eye and adnexa diseases can be found in

Chapter 7 of ICD-10-CM, and diseases of the ear and mastoid process are found in Chapter 8.– G00-G47, G80-G99 Central nervous system (brain

and spinal cord)and spinal cord)– G50-G73 Peripheral nervous system (all

other neural elements in the rest of thebody) (1)

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Chapter 6: Categories (G00-G99) • Chapter 6 contains 11 code families with the first

character of “G,” and they are:– G00-G09 Inflammatory diseases of the central

nervous system– G10-G14 Systemic atrophies primarily affecting the

central nervous system– G20-G26 Extrapyramidal and movement disorders– G30-G32 Other degenerative diseases of theG30 G32 Other degenerative diseases of the

nervous system– G35-G37 Demyelinating diseases of the central

nervous system

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46

Chapter 6: Categories (G00-G99) – G40-G47 Episodic and

paroxysmal disorders– G50-G59 Nerve, nerve root and ,

plexus disorders– G60-G65 Polyneuropathies and

other disorders of the peripheral nervous system

– G70-G73 Diseases of myoneural junction and muscle

– G80-G83 Cerebral palsy andG80 G83 Cerebral palsy and other paralytic syndromes

– G89-G99 Other disorders of the nervous system

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Chapter 6: Category & Chapter Restructuring

• ICD-10-CM contains many changes to the classification of diseases of the nervous system yand special senses. (1)

ICD‐9‐CM ICD‐10‐CM Chapter 6. Disease of the Nervous System and Sense Organs (320‐389)

Chapter 6: Diseases of the Nervous System (G00‐G99)Chapter 7: Diseases of the Eye and Adnexa (H00‐H59)

92

H59)Chapter 8. Diseases of the Ear and Mastoid Process (H60‐H95)


47

Chapter 6: Category & Chapter Restructuring

• Throughout ICD-10-CM, certain disease categories have been restructured in such a way as to bring together related conditions into contiguous classifications.

• Toward the end of Chapter 6, new categories for intraoperative complications and post procedural disorders specific to the nervous system were created. In ICD-9-CM, these conditions were divided between two separate chapters. Complications that are specific to the

l ifi d h i hnervous system are now classified together with diseases of the nervous system in ICD-10-CM as the illustration on the next slide demonstrates.

93

ICD‐9‐CM ICD‐10‐CM349.0 Reaction to spinal or lumbar puncture349.1 Nervous system complications from surgically implanted device997 Nervous system complications

G97 Intraoperative and post procedural complications and disorders of nervous system, not elsewhere classified• G97.0 Cerebrospinal fluid leak from spinal

puncture• G97 1 Other reaction to spinal and lumbar997.Nervous system complications

• 997.00 Nervous system complication, unspecified

• 997.01 Central nervous system complication

• 997.02 Iatrogenic cerebrovascular infarction or hemorrhage

• G97.1 Other reaction to spinal and lumbar puncture

• G97.2 Intracranial hypotension following ventricular shunting

• G97.3 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a procedureo G97.31 Intraoperative hemorrhage and

94

• 997.09 Other nervous system complications

hematoma of a nervous system organ or structure complicating a nervous system procedure

o G97.32 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating other procedure

• G97.4 Continued…


48

Chapter 6: Category Title Changes

• A number of category title revisions were made in Chapter 6in Chapter 6.

• Titles were changed to better reflect categorical content. (1)

– ICD-9-CM• 354 Mononeuritis of upper limb and mononeuritis mutiplex

– ICD-10-CM• G56 Mononeuopathies of upper limb

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Chapter 6: Organizational Adjustments

• After reviewing the different disease categories, the developers of ICD-10-CM restructured some of pthem to bring together those groups that are more closely related by underlying pathology.

• ICD-10-CM maintains separation of conditions primarily affecting the central nervous system from those affecting the peripheral nervous system; h diti ti t ( i )however, conditions representing symptoms (pain) and operative complications have been restructured toward the end of the chapter.

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ICD‐9‐CM ICD‐10‐CM 320‐326 Inflammatory Diseases of the Central Nervous System327 Organic Sleep Disorders330‐337 Hereditary and Degenerative Diseases of the Central Nervous System338 Other Headache Syndromes340‐349 Other Disorders of the

G00‐G09 Inflammatory diseases of the central nervous systemG10‐G14 Systemic atrophies primarily affecting the central nervous systemG20‐G26 Extrapyramidal and movement disordersG30‐G32 Other degenerative diseases of the central nervous system

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340 349 Other Disorders of the Central Nervous System

the central nervous system G35‐G37 Demyelinating diseases of the central nervous systemG40‐G47 Episodic and paroxysmal disorders


ICD‐9‐CM ICD‐10‐CM 330 1 Cerebral lipidosis E75 0 GM2 gangliosidosis330.1 Cerebral lipidosis

Amaurotic (familial) idiocyDisease:

BattenJansky‐Bielschowsky

E75.0 GM2 gangliosidosisE75.00 GM2 gangliosidosis, unspecifiedE75.01 Sandhoff diseaseE75.02 Tay‐Sachs disease

E75.1 Other and unspecified gangliosidosis

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BielschowskyKufs’Spielmeyer‐VogtTay‐SachsGangliosidosis

gangliosidosisE75.10 Unspecified gangliosidosisE75.11 Mucolipidosis IVE75.19 Other Gangliosidosis


50


ICD‐9‐CM ICD‐10‐CM 322 1 Eosinophilic meningitis Meningitis G03 9

• The code for eosinophilic meningitis has been

322.1 Eosinophilic meningitis Meningitis G03.9Eosinophilic B83.2

B83.2 Angiostrongyliasis due to Parastrongylus cantonensis

Eosinophilic meningoencephalitis due to Parastrongylusm cantonensis

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p greassigned in ICD-10-CM and is now classified in Chapter 1, “Certain Infectious and Parasitic Diseases” as seen here.


ICD‐10‐CMG30 Alzheimer’s disease

INCLUDES Alzheimer’s dementia senile and presenile forms Use additional code to identify:

delirium, if applicable (F05)dementia with behavioral disturbance (F02.81)dementia without behavioral disturbance (F02.80)

EXCLUDES 1 senile degeneration of brain NEC (G31.1)senile with behavioral disturbance (F02.81)

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senile with behavioral disturbance (F02.81)senility NOS (R41.81)

G30.0 Alzheimer’s disease with early onsetG30.1 Alzheimer’s disease with late onsetG30.8 Other Alzheimer’s diseaseG30.9 Alzheimer’s disease, unspecified


51


ICD‐10‐CMG43 Migraine

G43.7‐‐ Chronic migraine without auraG43.A Cyclical vomitingG43.B Ophthalmoplegic migraineG43.C Periodic headache syndromes in child or adultG43.D Menstrual migraine

101

G43.8 Other migraineG43.9 Migraine, unspecified


• Although the subcategory of disease status in il ( i t t bl t i t t bl ithepilepsy (e.g., intractable, not intractable, with or

without status migrainosus) remains similar to that of ICD-9-CM, the hierarchy within code categories has been restructured. For example, localization-related epilepsy (G40.0-G40.2) has been sequenced before generalized epilepsybeen sequenced before generalized epilepsy (G40.3-G40.4) in ICD-10-CM. (1)

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ICD‐9‐CM ICD‐10‐CM

435.0 Basilar artery syndrome G45.0 Vertebro‐basilar artery syndrome

435.1 Vertebral artery syndrome

G45.0 Vertebro‐basilar artery syndrome

435.3 Vertebrobasilar artery syndrome

G45.0 Vertebro‐basilar artery syndrome

435 8 Other specified transient G45 1 Carotid artery syndrome

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435.8 Other specified transient cerebral ischemias

G45.1 Carotid artery syndromeG45.2 Multiple and bilateral precerebral artery syndromes

362.34 Amaurosis fugax G45.3 Amaurosis fugax437.7 Transient global amnesia G45.4 Transient global amnesia


ICD‐9‐CM ICD‐10‐CM 435.2 Subclavian steal syndrome G45.8 Other transient cerebral ischemic attacks and y

related syndromes435.8 Other transient cerebral ischemias G45.8 Other transient cerebral ischemic attacks and

related syndromes435.9 Unspecified transient cerebral ischemias

G45.9 Transient cerebral ischemic attack, unspecified

435.8 Other transient cerebral ischemias G46.0 Middle cerebral artery syndrome435.8 Other transient cerebral ischemias G45.1 Anterior cerebral artery syndrome

G46.2 Posterior cerebral artery syndrome437.8 Other ill‐defined cerebrovascular G46.3 Brain stem stroke syndrome

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diseasey

G46.4 Cerebellar stroke syndromeG46.5 Pure motor lacunar syndromeG46.6 Pure sensory lacunar syndromeG46.7 Other lacunar syndromesG46.8 Other vascular syndromes of brain in cerebrovascular diseases


53

Chapter 6: New Codes

• New codes for ICD-10-CM:– G40.A Absence epileptic syndrome

• Expansion to 6th character

– G40.B Juvenile myoclonic epilepsy• Expansion to 6th character

– G43.8- Menstrual migraine• 5th character – intractable, status migrainosus

– G70.8- Lambert-Eaton syndrome• Expansion to 5th character

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Coding Guidance: Chapter 6 Official Guidelines

• The ICD-10-CM official guidelines for Chapter 6 i il t th i ICD 9 CM Alth h thare similar to those in ICD-9-CM. Although the

guidelines for reporting pain (category G89) have been reorganized, the concepts and sequencing rules remain the same.

• However, the addition of laterality to the reporting hemiparesis and monoplegia hasreporting hemiparesis and monoplegia has resulted in some significant changes. (1)

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• Similar to ICD-9-CM, certain codes within this h t i ith lti l d ifichapter require either multiple codes or specific

sequencing in order to properly report the condition.

• However, due to the increased data granularity (specificity) of the ICD-10 system, manifestation code edits have been reduced in numbercode edits have been reduced in number. (1)

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• In the following example, ICD-10-CM requires lti l di h ICD 9 CM l ifi d thmultiple coding, whereas ICD-9-CM classified the

condition to a single, specific classification code. (1)

ICD‐9‐CM ICD‐10‐CM 321.1 Meningitis in other fungal diseases

G02 Meningitis in other infectious & parasitic diseases classified elsewhere

321.2 Meningitis due to viruses G02 Meningitis in other infectious & parasitic

108

3 . e g t s due to usesNEC

G0 e g t s ot e fect ous & pa as t cdiseases classified elsewhere

321.3 Meningitis due to trypanosomiasis

G02 Meningitis in other infectious & parasitic diseases classified elsewhere

321.4 Meningitis in sarcoidosis G02 Meningitis in other infectious & parasitic diseases classified elsewhere


55

Coding Guidance: Unspecified Codes

• Certain ICD-10-CM classifications differentiate specific conditions that were previously classified together. For p y gexample, 323.9, Unspecified causes of encephalitis, myelitis and encephalomyelitis, is equivalent to two possible codes in ICD-10-CM. For example:– ICD-9-CM

323.9 Unspecified causes of encephalitis, myelitis and encephalomyelitisp y

– ICD-10-CMG04.90 Encephalitis and encephalomyelitis, unspecifiedG04.91 Myelitis, unspecified

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Coding Guidance: Drug-Induced Conditions

• Unique codes have been established throughout thi h t t diff ti t d i d dthis chapter to differentiate drug-induced nervous system disorders from those otherwise specified, including extrapyramidal and abnormal movement disorders:– G24.02 Drug-induced acute dystonia

G24 09 Other drug induced dystonia– G24.09 Other drug induced dystonia– G25.1 Drug-induced tremor– G25.4 Drug-induced chorea– G25.61 Drug-induced tics

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Coding Guidance: Drug-Induced Conditions

• ICD-9-CM (1)

333 92 Neuroleptic malignant syndrome– 333.92 Neuroleptic malignant syndromeUse additional E code to identify drugEXCLUDES neuroleptic induced Parkinsonism (332.1)

• ICD-10-CM– G21.0 Malignant neuroleptic syndrome

Code first (T43.3-T43.5) to identify drugEXCLUDES 1 neuroleptic induced Parkinsonism (G21.11)

• Diagnosis: Initial encounter for neuroleptic malignant syndrome dueDiagnosis: Initial encounter for neuroleptic malignant syndrome due to adverse effects in therapeutic use of haloperidol– T43.4X5A Adverse effect of butyrophenone and thiothixene

neuroleptics– G21.0 Malignant neuroleptic syndrome

111

Coding Guidance: Epilepsy and Migraine

• Classifications for epilepsy, migraine and h d h ll i il b theadache are generally similar between systems.

• However, ICD-10-CM includes expanded character extensions, which differentiate headache as “intractable” or “not intractable,” by type similar to existing classifications fortype similar to existing classifications for epilepsy and migraine. (1)

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113

Coding Guidance: Cluster Headache• ICD-10-CM classifications for headache syndromes are

similar to their ICD-9-CM counterparts, with the exception of a sixth-character severity indicator thatexception of a sixth character severity indicator that differentiates between intractable versus non-intractable presentations. (1)

ICD‐9‐CM ICD‐10‐CM 339.00 Cluster headache syndrome, intractable

G44.001 Cluster headache syndrome, unspecified, intractableG44.009 Cluster headache syndrome, unspecified

114

y , pnot intractable

339.01 Episodic cluster headache G44.011 Episodic cluster headache, intractableG44.019 Episodic cluster headache, not intractable

339.02 Chronic cluster headache G44.021 Chronic cluster headache, intractableG44.029 Chronic cluster headache, not intractable


58

Inflammatory Diseases of the Central Nervous System

• Infectious diseases of the central nervous t l ifi d i l d it isystem are classified in several ways, and it is

imperative that the coder carefully follow the directions provided by the Alphabetic Index and Tabular List.

• Dual coding is frequently required, with the code for the underlying condition sequenced firstfor the underlying condition sequenced first, followed by a manifestation code. (1)

115

Inflammatory Diseases of the Central Nervous System

• Bacterial meningitis due to certain organisms h P St t dsuch as Pneumococcus, Streptococcus, and

Staphylococcus is classified in category G00, with a fourth character indicating the responsible organism.

• Codes G00.2-G00.8 also require an additional code to further specify the organismcode to further specify the organism. (1)

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Types of Meningitis

Bacterial Meningitis

Caused by bacteria, like Neisseria meningitidis and Streptococcus pneumoniae. It can be a life-threatening infection that needs immediate medical attention. There are vaccines to prevent some kinds of bacterial meningitis.

Viral Meningitis

Caused by viruses, like enteroviruses and herpes simplex viruses. It’s serious, but rarely fatal in people with normal immune systems. There are vaccines to prevent some kinds of viral meningitis.

Fungal Meningitis

Caused by fungi like Cryptococcus and Histoplasma. Usually acquired by inhaling fungal spores from the environment. People with certain medical conditions like diabetes, cancer, or HIV are at higher risk of fungal meningitis. *Multistate Outbreak of Fungal Meningitis and Other Infections Associated with Contaminated Steroid Medication Links: http://emergency.cdc.gov/HAN/han00335.asp and http://www.fda.gov/Drugs/DrugSafety/FungalMeningitis/default.htm

Parasitic Meningitis

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gCaused by parasites and less common in developed countries. Parasites, like Angiostrongylus cantonensis can contaminate food, water and soil

Non-infectious Meningitis

Not spread from person to person, but can be caused by cancers, systemic lupus erythematosus (lupus), certain drugs, head injury, and brain surgery.

Parkinson’s Disease• Parkinson’s disease, also known

as parkinsonism, is a chronic, i di d f thprogressive disorder of the

central nervous system characterized by a fine, slowly spreading involuntary tremor, postural instability, and muscle weakness and rigidity.Parkinson’s disease is assigned• Parkinson’s disease is assigned to code G20 and includes primary parkinsonism. (1)

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Alzheimer’s Disease• Alzheimer’s disease is a process of

progressive atrophy involving the degeneration of nerve cells.

• This degeneration leads to mentalThis degeneration leads to mental changes that range from subtle intellectual impairment to dementia with loss of cognitive functions and failure of memory.

• Alzheimer’s disease is coded to category G30. (1)

– G30.9 Alzheimer’s disease [without any [ ymention of dementia]

– G30.1 + F02.81 Dementia with behavioral disturbance due to late onset Alzheimer’s disease

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Epilepsy

• Epilepsy is a paroxysmal disorder of cerebral f ti h t i d b t ifunction characterized by recurrent seizures.

• Coders must not assume, however, that any diagnostic statement describing convulsions or seizures should be coded to epilepsy; as these conditions also occur in a number of other diseases such as brain tumor cerebrovasculardiseases, such as brain tumor, cerebrovascular accident, alcoholism, electrolyte imbalance, and febrile conditions. (1)

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Epilepsy Cont…• When the diagnosis is stated

only in terms of convulsion or seizure without any further identification of the cause,identification of the cause, code R56.9, Unspecified convulsions, should be assigned. (1)

• Please note that the classification assigns seizure disorder and recurrent seizures to epilepsy G40.909, whereas the main term “seizure(s)” is indexed to R56.9 (2)

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Headache and Migraine• A diagnosis of headache without

any further specificity is classified to Chapter 18 of ICD 10 CM andto Chapter 18 of ICD-10-CM and coded to R51, Headache.

• Migraines are classified to category G43, while specific headaches are classified to category G44, Other headache g ysyndromes, in Chapter 6, Diseases of the Nervous System. (1)

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Headache and Migraine Cont…• ICD-10-CM classifies migraines to category G43 as

follows:– G43.001-G43.019 Migraine without aurag– G43.101-G43.119 Migraine with aura

• Specific headaches are classified to Chapter 6 of ICD-10-CM under Other headache syndromes (category G44) as follows:– G44.001-G44.099 Cluster headaches and other trigeminal autonomic

cephalgiasG44 10 G44 11 V l h d h t l h l ifi d– G44.10-G44.11 Vascular headache, not elsewhere classified

• Headache following lumbar puncture is assigned to code G97.1, Other reaction to spinal or lumbar puncture.

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Narcolepsy• Narcolepsy is a chronic neurological

disorder characterized by the inability to regulate sleep and wakefulnessto regulate sleep and wakefulness normally. (1)

• ICD-10-CM distinguishes between subcategory G47.41- (narcolepsy) and G47.42- (narcolepsy in conditions classified elsewhere).

• Fifth characters distinguish betweenFifth characters distinguish between narcolepsy with cataplexy (G47.411, G47.421) and without cataplexy (G47.419, G47.429).

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Hemiplegia/Hemiparesis

• Hemiplegia is paralysis of one side of the body.It i l ifi d t t G81 ith fifth h t t• It is classified to category G81, with a fifth character to indicate the side affected and whether the affected side is dominant or non-dominant. (1)

• Hemiplegia occurring in connection with a cerebrovascular accident (CVA) often clears quickly and is sometimes called a transient hemiplegia. (2)

I66 9 + G81 91 C b l th b i ith h i l i i ht d i t• I66.9 + G81.91 Cerebral thrombosis with hemiplegia right dominant side

• I69.952 Hemiplegia of left dominant side due to previous CVA

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Pain• Pain may be coded by reporting the site of pain.• These codes may be found in the symptom

chapter (e g headache R51) or in thechapter (e.g., headache, R51) or in the appropriate body system chapter (e.g., pain in limb, M79.609).

• Codes from category G89, Pain, not elsewhere classified, may be used in conjunction with the site of pain codes if the category G89 codesite of pain codes if the category G89 code provides more detail about acute and chronic pain and neoplasm-related pain unless otherwise indicated as follows: (1)

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Encounter/Admission for Pain Control Management

• Category G89 codes may be used as the principal diagnosis or first-listedthe principal diagnosis or first listed code when pain control or pain management is the reason for the admission/encounter.

• These encounters are typically not for diagnostic workup or treatment of the underlying condition but for

t f imanagement of pain.• In these situations, if the underlying

cause of the pain is known, report it as an additional diagnosis. (1)

127

Encounter/Admission for Pain Control Management Cont…

• If the admission is for control of pain related to, i t d ith d t li dassociated with, or due to a malignancy, code

G89.3, Neoplasm related pain (acute)(chronic), should be assigned. (1)

• If the admission or encounter is for a procedure to treat the underlying condition, the underlying condition should be assigned as the principal orcondition should be assigned as the principal or first-listed diagnosis. (2)

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Encounter/Admission for Pain Control Management Cont…

• Patients with chronic pain whose conservative therapies have failed may undergo insertion of neurostimulators forundergo insertion of neurostimulators for pain control. In such cases, the appropriate pain code is assigned as the principal or first-listed diagnosis. (1)

• If the encounter is for any other reason except pain control or pain management and a related definitive diagnosis for the

( f )pain has not been established (confirmed) by the provider, the code for the specific site of pain should be assigned first, followed by the appropriate code from category G89. (2)

129

Postoperative Pain• Post-thoracotomy pain and

other postoperative pain are classified to s bcategoriesclassified to subcategories G89.1 and G89.2, depending on whether the pain is acute or chronic. (1)

• Postoperative pain may be reported as the principal or first listed diagnosis when thefirst-listed diagnosis when the reason for the encounter or admission is postoperative pain control/management. (2)

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Autonomic Dysreflexia

• Autonomic dysreflexia is a syndrome characterized by ansyndrome characterized by an abrupt onset of excessively high blood pressure caused by an uncontrolled sympathetic nervous system discharge in persons with spinal cord injury, usually at or above the T6 level. (1)above the T6 level. (1)

• Code G90.4, Autonomic dysreflexia, is used to report this condition (2)

131

Hydrocephalus

• Normal pressure hydrocephalus (NPH) or secondary NPH can be caused by any condition in which the flow of cerebrospinal fluid (CSF) is blocked, such as subarachnoid hemorrhage, head trauma, cerebral infarction, infection, tumor, or complications of surgery.p g y

• Assign code G91.0, Communicating hydrocephalus, for secondary NPH. (1)

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Encephalopathy

• Encephalopathy is a general term used to d ib di d f b l f tidescribe any disorder of cerebral function. (1)

– G93.1, Anoxic brain damage, not elsewhere classified– G31.2 Degeneration of nervous system due to alcohol– G93.41, Metabolic encephalopathy– G92, Toxic encephalopathy

F51 2 Wernicke’s encephalopathy– F51.2, Wernicke s encephalopathy– G93.40, Encephalopathy, unspecified

133

Disorders of the Peripheral Nervous System

• Disorders of the peripheral nervous system are l ifi d t t i G50 th h G73classified to categories G50 through G73

according to the condition and the nerves involved.

• Many codes in this section are manifestations of other diseases and are assigned as additional codes with the underlying condition listed firstcodes, with the underlying condition listed first.

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Critical Illness Polyneuropathy

• Critical illness polyneuropathy is commonly i t d ith li ti f i dassociated with complications of sepsis and

multiple organ failure.• It is considered to be secondary to systemic

inflammatory response syndrome. (1)

• Assign code G62.81, Critical illness l th f thi ditipolyneuropathy, for this condition.

135

Critical Illness Myopathy

• Critical illness myopathy is also associated with i It i f diffi lt i isepsis. It is a cause of difficulty in weaning

patients from mechanical ventilation and prolonged recovery after illness.

• It is also associated with neuromuscular blocking agents and corticosteroids (in asthma and organ transplant patients) and neuropathyand organ transplant patients), and neuropathy.

• Code G72.81, Critical Illness myopathy, is used to report this condition.

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Audience Questions

November 30, 2012

137

The End

November 30, 2012

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ICD-10-CM

ResourcesandReferences

139

ICD-10-CM Resources & References

• ICD-10-CM Draft Official Guidelines for Coding and Reporting 2012and Reporting 2012

• 2012 Release of ICD-10-CM Code– http://www.cdc.gov/nchs/icd/icd10cm.htm– Guidelines, Addenda, List of Codes, GEMS

• HHS Announces Intent to Delay ICD-10-CM/PCS Compliance Date– http://www.cms.gov/apps/media/pressreleases.asp– Search for the February 16, 2012 press release

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2012 ICD-10-CM is available at http://www.cdc.gov/nchs/icd/icd10cm.htm or http://www cms hhs gov/ICD10http://www.cms.hhs.gov/ICD10

• 2012 ICD-10-CM Index to Diseases and Injuries• 2012 ICD-10-CM Tabular List of Diseases and Injuries

– Instructional Notations• 2012 Official Guidelines for Coding and Reporting • 2012 Table of Drugs and Chemicals• 2012 Neoplasm Table • 2012 Index to External Causes• 2012 Mapping “ICD-9-CM to ICD-10-CM” and

“ICD-10-CM to ICD-9-CM”

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• General ICD-10 Information– http://www cms gov/ICD10– http://www.cms.gov/ICD10

• General Equivalence Mappings and User’s Guides– http://www.cms.gov/ICD10/13_201

0_ICD10PCS.asp– http://www cms gov/ICD10/12 201http://www.cms.gov/ICD10/12_201

0_ICD_10_CM.asp

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ICD-10-CM: The Complete Official Draft Code Set 2012 (by OptumInsight, formerly Ingenix)

• Introduction • ICD-10-CM Draft Conventions • ICD-10-CM Official Guidelines for Coding and Reporting

(Draft 2012)• ICD-10-CM Index to Diseases and Injuries • ICD-10-CM Neoplasm Table • Table of Drugs and Chemicals • ICD-10-CM Index to External Causes • ICD-10-CM Tabular List of Diseases and Injuries

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• 2013 Release of ICD-10-CM• The National Center for Health Statistics has posted

some of the 2013 ICD-10-CM files, including the ICD-10-CM Addenda and the 2013 version of ICD-10-CM in PDF and XML format.

• Watch for further updates as additional 2013 ICD-10-CM files are posted, including mapping files and the updated ICD-10-CM coding guidelinesthe updated ICD 10 CM coding guidelines.

• Click here to access the 2013 ICD-10-CM files: http://www.cdc.gov/nchs/icd/icd10cm.htm#10update

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Documents

ICD-10-CM Webinar Series Session IV - FHA · ICD-10-CM Series, Session IV Original Presentation Date: ... - F70-F79 Intellectual disabilities ... – 317-319 Mental retardation 13