ICD-10 for Beginners Four-Part Series2016 JLU Health Record Systems 3 Neoplasms – Official Coding Guidelines The neoplasm table in the Alphabetic Index should be referenced first

2016 JLU Health Record Systems 1

ICD-10 for Beginners

Four-Part Series

© 2016 JLU Health Records Systems

www.jluhealth.com 1


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PRESENTER:

Joan L. Usher, BS, RHIA, COS-C ACE

AHIMA Approved ICD-10-CM Trainer

JLU HEALTH RECORD SYSTEMS

TEL: (781) 829-9632 FAX: (781) 829-9636

www.jluhealth.com

Understanding Common

Diagnostic Areas - Where

Coding Mistakes Occur: Part 1

http://www.jluhealth.com/



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Learning Objectives:

Understand common Home Health & Hospice

coding areas under ICD-10

Including:

Neoplasms

Diabetes

Neuro

Circulatory

Respiratory

Digestive

Neoplasms

C00-D49

Contained in this chapter is codes for most benign and malignant neoplasms

Use Neoplasm Table


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Neoplasms – Official Coding

Guidelines

The neoplasm table in the Alphabetic Index should be

referenced first

Found after “Z” in its own table

However, if the histological term is documented, that

term should be referenced first

For example, if the documentation indicates

“adenoma,” refer to the term in the Alphabetic Index

Read the instructional note to “see also neoplasm, by site,

benign.”


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Neoplasms

Determine if neoplasm is malignant or benign

Reference alphabetical listing

Instructions will state- see also neoplasm by site, malignant

Determine if malignant neoplasm is primary site or secondary site

Code any metastatic sites

Unknown site for primary and secondary exists

Look up code in neoplasm table under the correct column

Use only in situ column, if stated

Use only uncertain behavior or unspecified column, if stated

Mass – see Mass

Tumor – see neoplasm, unspecified behavior, by site

Code any Neoplasm related pain G89.3

If admission is solely for chemotherapy, code Z51.11 as primary



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Neoplasm, Intestine

8


Unknown Site

Malignant (primary)

neoplasm, unspecified C80.1

Cancer NOS

Cancer unspecified site

(primary)

Carcinoma unspecified site

(primary)

Malignancy unspecified site

(primary)

Excludes1:

secondary malignant

neoplasm of unspecified site

(C79.9)

Secondary malignant

neoplasm of unspecified site

C79.9

Metastatic cancer NOS

Metastatic disease NOS

Excludes1:

carcinomatosis NOS (C80.0)

generalized cancer NOS (C80.0)

malignant (primary) neoplasm of

unspecified site (C80.1)


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Current Malignancy Vs.

Personal History

When a primary malignancy has been excised but further treatment

such as an additional surgery for the malignancy, radiation therapy

or chemotherapy is directed to that site

Primary malignancy code should be used until treatment is

completed

When a primary malignancy has been previously excised or

eradicated from its site, there is no further treatment (of the

malignancy) directed to that site, and there is no evidence of any

existing primary malignancy

Z85, Personal history of malignant neoplasm


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Aftercare Following

Surgery Neoplasm

Z48.3

Use additional code to identify the

neoplasm

Z90.– Acquired absence of organ



Test Your Knowledge

1. CA of descending colon mets to breast

2. Small cell lung CA of right lung

3. Leukemia




Answers

1. C18.6 Malignant Neoplasm of

Descending colon, C79.81 Secondary

malignant neoplasm of breast

2. C34.91 Malignant neoplasm of

unspecified part of right bronchus & lung

3. C95.90 Leukemia, unspecified, not

having achieved remission



Diabetes

E08-E13

Diabetes codes are categorized by type of diabetes & associated manifestation




Diabetes Official Coding

Guidelines

If type of diabetes mellitus is not

documented in the medical record,

default is E11.-, Type 2 diabetes mellitus

Code Z79.4, Long-term (current) use of

insulin, should also be assigned to indicate

that any type 2 patient that uses insulin



Diabetes – 5 Categories

1. E08* Due to underlying condition

2. E09* Drug or chemical induced

3. E10 Type 1

4. E11* Type 2

5. E13* Other specified diabetes

*Use additional code to identify any insulin

use Z79.4




Diabetes Uncontrolled

Inadequately Controlled

Out of Control

Poorly Controlled

Code to diabetes by type, with

hyperglycemia E11.65



Test Your Knowledge



1. Diabetes Mellitus, uncontrolled, patient on

insulin

2. Diabetes with Stage II Chronic Kidney Disease

3. Type 1 Diabetic with Right heel ulcer (skin

breakdown only)


Answer Key: Diabetes

1. E11.65 Type 2 diabetes with hyperglycemia,

Z79.4 Long term (current) use of insulin

2. E11.22 Type 2 diabetes with diabetic chronic

kidney disease, N18.2 CKD stage 2

3. E10.621 Type 1 diabetes with foot ulcer,

L97.411 Non-pressure chronic ulcer of right

heel and midfoot limited to skin breakdown


www.jluhealth.com 19 19

Diseases of the

Nervous System

G00-G99




Test Your Knowledge

1. Bell’s Palsy

2. Huntington’s Disease with Dementia with

aggression

3. Multiple Sclerosis



Diseases of Nervous System

1. G51.0 Bell’s Palsy

2. G10 Huntington’s disease,

F02.81 Dementia in diseases classified

elsewhere with behavioral disturbances

3. G35 Multiple Sclerosis




Diseases of the

Circulatory System

I00-I99

Be sure to review the new guidance for Hypertension, Myocardial infarctions, ASHD and angina, sequela of CVAs



To be Coded in Circulatory &

Respiratory Patients


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Use additional code to identify presence of:

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)

24


Ischemic Heart Disease

Arteriosclerotic heart disease, ASHD (I25.10)

Arteriosclerotic heart disease, ASHD with angina

pectoris I25.119 (see Arteriosclerosis, coronary

artery)

Coronary artery disease, CAD (I25.10)

Coronary artery disease, CAD with angina pectoris

I25.119 (see Arteriosclerosis, coronary artery)

Hint: I25.1- includes: Atherosclerotic

cardiovascular disease, ASHD, CAD



Ischemic Heart Disease with

Angina

The 6th character of the code of Ischemic heart disease with angina identifies the type of angina

0 unstable angina

1 angina with documented spasm

8 other forms of angina

9 unspecified angina

I25.110 ASHD with unstable angina




Myocardial Infarction

For encounters occurring while the myocardial infarction is

equal to, or less than, 4 weeks old, including transfers to

another acute setting or a postacute setting, & patient

requires continued care for the myocardial infarction, codes

from category I21 may continue to be reported.

For encounters after the 4 week time frame & patient is still

receiving care related to the MI, the appropriate aftercare

code should be assigned

When documentation is not sufficient to assign a specific

code the default code is I21.3 MI of unspecified site

(NOS)



Myocardial Infarction If a patient with coronary artery disease is admitted due

to an acute myocardial infarction (AMI), the AMI should

be sequenced before the coronary artery disease.

A subsequent MI (I22.-) is utilized when the patient has

a second MI within the 4 week period from the initial MI. Hint: Subsequent in this case is not like a 7th character and does

not mean the episode of care.

For old or healed myocardial infarctions not requiring

further care, code I25.2, Old MI, may be assigned.




Myocardial Infarction

4th character identifies location

I21.- Acute MI

I21.1 IMI

I22 Subsequent acute MI

I23 Certain current complications following acute MI within 4 weeks (28 days)

Subsequent MI (I22) may be used with code from I21 or I23



CHF - More Detailed

Documentation Needed

CHF NOS I50.9

Will state “Heart Failure Unspecified”

In order to code this to a more specific code, documentation

must reflect the type of heart failure and severity






CHF Specifics

Type

Systolic (congestive)

heart failure I50.2x

Diastolic (congestive)

heart failure I50.3x

Combined systolic

(congestive) & diastolic

(congestive) heart failure

I50.4x

Severity

Unspecified I50.20

Acute I50.21

Chronic I50.22

Acute on Chronic I50.23

Exacerbation

Decompensated



Sequelae

Late Effect CVA NOS




Cerebrovascular diseases (I60-I69)



Use additional code to identify presence of:

alcohol abuse and dependence (F10.-)

exposure to environmental tobacco smoke (Z77.22)

history of tobacco use (Z87.891)

hypertension (I10-I15)

occupational exposure to environmental tobacco smoke

(Z57.31)

tobacco dependence (F17.-)

tobacco use (Z72.0)

Excludes1:

transient cerebral ischemic attacks and related syndromes

(G45.-)

traumatic intracranial hemorrhage (S06.-)

Dominant Vs.

Non-Dominant Side

Should the affected side be documented, but not

specified as dominant or non-dominant, and the

classification system does not indicate a default, code

selection is as follows:

For ambidextrous patients, the default should be

dominant.

If the left side is affected, the default is non-dominant.

If the right side is affected, the default is dominant.




Test Your Knowledge

1. Dysphagia following Late Effect CVA

2. Late Effect CVA with hemiparesis right

dominant side, ambidextrous patient

3. Late Effect CVA with left sided neglect



Answers

1. I69.391 Dysphagia following cerebral

infarction, R13.10 Dysphagia

2. I69.351 Hemiplegia and hemiparesis

following cerebral infarction right

dominant side

3. I69.398 Other sequelae of cerebral

infarction, R41.4 Neurologic neglect

syndrome (left sided neglect)






Diseases of the

Respiratory

System

J00-J99



COPD

J44 Other Chronic Obstructive Pulmonary Disease

Includes: asthma with chronic obstructive pulmonary disease

chronic asthmatic (obstructive) bronchitis

chronic bronchitis with airways obstruction

chronic bronchitis with emphysema

chronic emphysematous bronchitis

chronic obstructive asthma

chronic obstructive bronchitis

Code also type of asthma, if applicable (J45.-)

Excludes1: bronchiectasis (J47.-)

chronic bronchitis NOS (J42)

chronic simple and mucopurulent bronchitis (J41.-)

chronic tracheitis (J42)

emphysema without chronic bronchitis (J43.-)

lung diseases due to external agents (J60-J70)




COPD

J44.0

Chronic obstructive pulmonary disease with acute lower

respiratory infection

Use additional code to identify the infection

J44.1

Chronic obstructive pulmonary disease with (acute) exacerbation

Decompensated COPD

Decompensated COPD with (acute) exacerbation

Excludes2: chronic obstructive pulmonary disease [COPD] with

acute bronchitis (J44.0)

J44.9

Chronic obstructive pulmonary disease, unspecified

Chronic obstructive airway disease NOS

Chronic obstructive lung disease NOS



Test Your Knowledge

1. Chronic bronchitis with emphysema

2. Chronic bronchitis

3. Emphysema




Answers

1. J44.9

2. J42

3. J43.9



Diseases of the

Digestive

System

K00-K95

There is no Official Coding Guidelines for this chapter however remember to follow the coding conventions




Digestive

Ulcers K25-K28

Gastric, duodenal, peptic, gastrojejunal,

Acute, chronic

With hemorrhage, perforation

Ulcerative Colitis K51

Rectal bleeding, intestinal obstruction, abscess,

other

Excludes1 Crohn’s Disease K50-



Crohn’s Disease

ICD-10-CM

K50.919 Crohn’s Disease, unspecified, with

unspecified complications

K50 Crohn’s Disease

4th character -site (small intestine, large

intestine)

5th character-with or without complications

6th character- with fistula, abscess, rectal

bleeding




Test Your Knowledge

1. Chronic peptic ulcer

2. Regional Enteritis

3. Crohn’s Disease with fistula



Answers

1. K27.7 Chronic peptic ulcer, site

unspecified, without hemorrhage or

perforation

2. K50.90 Crohn’s disease unspecified

without complications

3. K50.913 Crohn’s disease unspecified

with fistula






Chronic

pain due to

coding

class

G89.29



Questions????




Next Session Understanding Common Diagnostic

Areas - Where Coding Mistakes Occur:

Part 2



Class Companion:

Rapid Reference Guide

Available for beginners & for quick reference.

Allows for easy look-up of home health codes. Pages are organized how clinicians think and by medical abbreviation. Book includes coding updates for 2016.

Cost is for Webinar participants only is $74 (5% discount) including s/h. Offer valid until September 15, 2016.

To download order blank, go to www.jluhealth.com Use discount code NH.



Resources

Coding

Coding Guidelines

http://www.cdc.gov/nchs/icd/icd

10cm.htm

CMS Materials

https://www.cms.gov/Medicare/

Coding/ICD10/Downloads/ICD1

0ListservCodingResources.pdf

Rapid Reference Guide © 2016

www.jluhealth.com

OASIS

HHA Final Rule 2016 CMS-1625-F

https://www.cms.gov/Medicare/Medi

care-Fee-for-Service-

Payment/HomeHealthPPS/Home-

Health-Prospective-Payment-

System-Regulations-and-Notices-

Items/CMS-1625-F.html

Home Health Agency Center

https://www.cms.gov/center/provide

r-Type/home-Health-Agency-HHA-

Center.html

OASIS Manual

https://www.cms.gov/Medicare/Qual

ity-Initiatives-Patient-Assessment-

Instruments/OASIS/index.html



ABOUT THE SPEAKER:

JOAN L. USHER, BS, RHIA, ACE, President,

JLU Health Record Systems, Pembroke, MA

Degree in Health Information Management

Certified OASIS and Coding Specialist over 9

years

AHIMA Approved ICD-10-CM Trainer

Author, Rapid Reference Coding Guide, 2016

edition www.jluhealth.com © 2016

Author, Online ICD Coding Courses in

partnership with Libman Education 2012-2016

http://www.libmaneducation.com/healthcare-

education-training/home-health-coding/

Author, ICD-10 Essentials for Home Care:

Your Guide to Preparation & Implementation

www.hcmarketplace.com © 2011

Author, ICD-10 for Home Health: A Guide to

Medical Necessity and Payment

http://www.beaconhealth.org © 2014

Author/Editor Online E-Learning Coding

Courses: Home Health Diagnostic Coding;

Home Health Reimbursement Methods, Home

Health Documentation & Health Record

Requirements AHIMA www.ahimastore.org

© 2011

Contributing editor, Schraffenberger/Keuhn, Effective Mgmt of Coding Services, AHIMA, © 2009

Editor & Contributing Author, MaHIMA, Medicio- Legal Guide to Health Record Information, © 2004, Contributing Author © 2016

Massachusetts Health Information Management Association (MaHIMA), BOD 2004-2011

President , 2006, under her leadership, MA received 4 national awards from AHIMA in Continuing Education Programs, Support for Accredited HIM Education Programs, Legislative Advocacy and Electronic Communications

Co-Chair ICD-10 Task Force 2013-2015

Professional Achievement Award Recipient, MaHIMA, 2008

American Health Information Management Association (AHIMA) delegate 2002-2006

Taught ICD coding for over 20 years and has educated over 17,000 people nationwide

Home Care Alliance of MA, Board of Director 2012-2017, member QI Committee, Facilitator ICD-10 Group 2013-2016

Hospice & Palliative Care Federation MA, Board of Director 2008-2017

©2016 JLU Health Record Systems


http://www.cdc.gov/nchs/icd/icd10cm.htm



https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD10ListservCodingResources.pdf





https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulations-and-Notices-Items/CMS-1625-F.html































https://www.cms.gov/center/provider-Type/home-Health-Agency-HHA-Center.html













https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/OASIS/index.html











http://www.libmaneducation.com/healthcare-education-training/home-health-coding/









http://www.hcmarketplace.com/

http://www.beaconhealth.org/

http://www.beaconhealth.org/

http://www.ahimastore.org/

Documents

ICD-10 for Beginners Four-Part Series2016 JLU Health Record Systems 3 Neoplasms – Official Coding Guidelines The neoplasm table in the Alphabetic Index should be referenced first