ICD-10 COST CENTER TRAINING

SEPTEMBER 2015Presented by:

Cynthia H. Robinson IPA III

Department of Public HealthAdministration of Financial Management

Local Health Operations Branch

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General Understanding:

Develop a general understanding of the coding guidelines for those chapters in ICD-10 that will be utilized by HD Staff.

When coding for ICD-10 each Chapter has specific coding guidelines

Let’s go over a few of the Chapters in ICD-10

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Chapter 21:

Factors Influencing Health Status and Contact with Health Services

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Chapter 21:Factors Influencing Health Status and Contact with Health Services Coding Guidelines:Routine and Administrative Exams:

Includes services for routine & admin. Exams(Ex. – pre-employment physical)

Do not use these codes if the exam is for diagnosis of a suspected cond. or treatment

Any condition found during the exam should be coded as an additional code

Some codes for routine health exams distinguish between ‘with’ and ‘without’ abnormal findings Code assignment depends on info known at the time of serviceAdditional code(s) should be coded for code “with abnormal

findings” to ID the specific abnormal finding(s)

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Chapter 21 Code Range: Z00-Z99Z codes represent reasons

(CHIEF COMPLAINT-CC) for encountersCPT code must accompany Z codes if a

procedure is performedFor occasions when circumstances other than

a disease, injury or external cause classifiable to categories A00-Y89 are recorded as problems – This can happen in two main ways:

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Chapter 21 Codes: Z00-Z99When a pt who may or may not be sick

receives services for a specific purpose.- Example : Well Woman Checks, Well Child Exam, Cancer Screen

When determining a problem which influences the pt’s health status, but is not a current illness or injury

- Example : Absence of right breast

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Chapter 21 Codes: Z00-Z99Z00 – Z13 – Pts for Health Services ExaminationsZ20 – Z28 – Pts with potential health hazards related

to communicable diseasesZ66 – Do not resuscitate statusZ67 – Blood typeZ77-Z99 – Pts with potential health hazards related

to family and personal history and certain conditions affecting health status

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Chapter 21 Codes: Z00-Z99Z00 - Encounter for general exam w/o complaint,

suspected or reported diagnosisZ01 – Encounter for other special exam w/o

complaint, suspected or reported diagnosisIncludes Z01.4 ~, Encounter for gynecological

examZ02 – Encounter for administrative exam

Except: Z02.9 – Encounter for admin exams, unspecified

Z32.0 – Encounter for pregnancy test

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Chapter 21 Codes: Z00-Z99Z20 - indicates contact with, and suspected exposure to

communicable diseasesDo not show any sign or symptom of diseaseMay have been exposed by close contact with an infected

individual or are in an area where a disease is epidemicZ20.6 –Contact with and (suspected) exposure to HIV

Z77 – indicates contact with and suspected exposures hazardous to health Z77.011-Contact w/& (suspected exposure to leadZ77.22 Contact with and (suspected) exposure to

environmental tobacco smokeContact/ exposure codes may be used as a first-listed code to

explain an encounter for testing, or, more commonly, as a secondary code to identify potential risk

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Chapter 21 Codes: Z00-Z99Status Codes:• Indicate a client is either • Carrier of a disease Ex. - Z21 – Asymptomatic HIV

infection status• Has a past condition or disease Ex. – Z90.722-

Acquired absence of ovaries, bilateral• Provide information Ex. – Z98.51 – Tubal Ligation

status• Past Treatments Ex. – Z97.5- Presence of IUD• Body Mass Index(BMI) - Z68

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Chapter 21 Codes: Z00-Z99SCREENING CODES:Screening codes are always coded first as the Chief ComplaintShould a condition be found during the screening then the

code for the condition may be assigned as an additional DxZ11.1 – Encounter for screening for respiratory tuberculosis

(TB)Z11.2 – Encounter for screening for bacterial diseases Z11.3 – Encounter for screening for infections with a

predominantly sexual mode of transmission EXCLUDES 2: (HIV) – Z11.4 and (HPV) – Z11.51

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Chapter 21 Codes: Z00-Z99SCREENING CODES Cont.:Z11.4 – Encounter for screening for human immunodeficiency virus

(HIV)Z11.51 – Encounter for screening for human papillomavirus(HPV)Z12.31 – Encounter for screening for mammogram for malignant

neoplasm of breast Z12.4 – Encounter for screening for malignant neoplasm of cervix

Excludes 1 – encounter for screening for human papillomavirus (Z11.51)When screening is part of general gynecological exam (*Z01.41-) *Sixth Digit required*

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Chapter 21 Codes: Z00-Z99Counseling • Patient/ Family member receives assistance

or support is required to handle family/social problems• Not used when counseling component is

considered integral to standard treatment

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Chapter 21 Codes: Z00-Z99Counseling Z codes/ categories:

Z30.0 – Encounter for general counseling and advice on contraception

Z31.5 – Encounter for genetic counselingZ31.6 – Encounter for general counseling and advice on procreationZ32.2 – Encounter for childbirth instructionZ32.3 – Encounter for childcare instructionZ69 – Encounter for mental health services for victim and

perpetrator of abuseZ70 – Counseling related to sexual attitude, behavior and

orientationZ71 – Persons encountering health services for other counseling and

medical advice, not elsewhere classified

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Chapter 21 Codes: Z00-Z99Once we go over a few more ICD-10

Chapters, we will go over in detail the most used ICD-9 codes and what the correct ICD-10 codes change to on the new spreadsheet called:

COST CENTER LISTING

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Chapter 1: Certain Infectious & Parasitic Diseases Codes: A00-B99

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Chapter 1 Certain Infectious & Parasitic Diseases Codes: A00-B99Infectious Diseases – pathogens invade the

body and cause a diseaseParasitic Diseases – parasite lives within a host

organism and causes disease in the hostThis chapter includes communicable or

transmissible diseases

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Chapter 1 Codes: A00- B99A00-A09 Intestinal infectious diseasesA15-A19 TuberculosisA20-A28 Certain zoonotic bacterial diseasesA30-A49 Other bacterial diseasesA50-A64 Infections with a predominantly

sexual mode of transmission

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Chapter 1 Codes: A00- B99B00-B09 Viral infections characterized by skin and

mucous membrane lesionsB10 Other human herpes virusesB15-B19 Viral hepatitisB20 Human immunodeficiency virus (HIV)B25-B34 Other viral diseasesB90-B94 Sequelae of infectious and parasitic diseasesB95-B97 Bacterial and viral infectious agentsB99 Other infectious diseases

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Chapter 2: Neoplasms

Codes: C00 - D49

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Chapter 2: Neoplasms Codes:C00-D49All neoplasms are classified in Chapter 2, whether active or notAn additional code from Chapter 4 may be used, to identify

activity associated with any neoplasmMorphology (Histology)

Neoplasms classified primarily by site, with broad groupings for behavior (e.g., malignant, in situ, benign, etc.)

The Table of Neoplasms should be used to ID the correct code

In a few cases the morphology is included in the category codes (e.g., Category C43-Malignant melanoma

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Chapter 4: Endocrine, Nutritional and Metabolic Diseases

Codes: C00 - D49

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Chapter 4: Codes E00-E89E00-E07 Disorders of the thyroid glandE08-E13 Diabetes MellitusE15-E16 Other disorders of glucose regulation and

pancreatic internal secretionE20-E35 Disorders of other endocrine glandsE40-E46 MalnutritionE50-E64 Other nutritional deficienciesE65-E68 Overweight, obesity and other hyper

alimentationE70-E88 Metabolic disorders

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Chapter 4: Codes E00-E89ICD-9 only had one category for Diabetes;

ICD-10 has 5 categories:-E08 – Diabetes Mellitus due to underlying condition-E09 – Drug or chemical induced Diabetes Mellitus-E10 – Type 1 Diabetes Mellitus-E11 – Type 2 Diabetes Mellitus-E13 – Other specified Diabetes Mellitus

The diabetes mellitus codes are combination codes that include: -type of diabetes mellitus-body system affected-complications affecting that body system

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Chapter 4: Codes E00-E89For Diabetes Mellitus codes:

- 4th Character = underlying conditions with specified complications

- 5th Character = specific manifestations- 6th Character = even further manifestationsAs many codes with a category as are necessary to describe all

of the complications of the disease may be usedMost Type 1 diabetics develop the condition before reaching

puberty but age is not the sole determining factorAll of the categories, except E10, have an instructional note to

use an additional code for any long term insulin use (Z79.4)If the Type is not documented, the default is E11.~, Type 2

Diabetes Mellitus

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Chapter 6: Diseases of the Nervous SystemCodes: G00 – G99

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Chapter 6: Codes G00- G99G00-G09 Inflammatory diseases of the central

nervous systemG10-G14 Systemic atrophies primarily affecting the

central nervous systemG30-G32 Other degenerative diseases of the

nervous systemG40-G47 Episodic and paroxysmal disordersG80-G83 Cerebral palsy and other paralytic

syndromesG89-G99 Other disorders of the nervous system

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Chapter 6: Codes G00- G99 Migraine (G43)

32 available codes Documentation must include the following:

Intractable (pharmacologically resistant, treatment resistant, refractory and poorly controlled)

Not intractable With vomiting Ophthalmologic Menstrual With or without Aura Hemiplegic With or without cerebral infarction Periodic Abdominal

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Chapter 9: Diseases of the Circulatory SystemCodes: I00 – I99

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Chapter 9: Codes I00- I99I00-I02 Acute rheumatic feverI05-I09 Chronic rheumatic heart diseasesI10-I15 Hypertensive diseasesI20-I25 Ischemic heart diseasesI26-I 28 Pulmonary heart disease and diseases of pulmonary

circulationI30-I52 Other forms of heart diseaseI60-I69 Cerebrovascular diseasesI70-I79 Diseases of arteries, arterioles and capillariesI80-I89 Diseases of veins, lymphatic vessels and lymph nodes, not

elsewhere classifiedI95-I99 Other and unspecified disorders of the circ. system

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Chapter 9: Codes I00- I99Hypertension is no longer classified by typeAlso, Additional code for tobacco use of exposure

Hypertensive diseases (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)

Excludes 1: hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-, O11, O13-O16)

neonatal hypertension (P29.2) primary pulmonary hypertension (I27.0)

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Chapter 9: Codes I00- I99 Cont.

I10 Essential (primary) hypertensionIncludes: high blood pressurehypertension (arterial) (benign) (essential) (malignant) (primary) (systemic)

Excludes 1:hypertensive disease complicating pregnancy, childbirth and the puerperiumExcludes 2:essential (primary) hypertension involving vessels of brain (I60-I69) essential (primary) hypertension involving vessels of eye ( H35.0~)

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Chapter 10: Diseases of the Respiratory SystemCodes: J00 – J99

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Chapter 10: Codes J00- J99When a respiratory condition occurs in more than

one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40)

Use additional code, to identify tobacco use or exposure

J00-J06 Acute upper respiratory infectionsJ09-J18 Influenza and pneumoniaJ20-J22 Other acute lower respiratory infectionsJ60-J70 Lung diseases due to external agents

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Chapter 14: Diseases of the Genitourinary SystemCodes: N00 – N99

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Chapter 14: Codes N00- N99N00-N08 Glomerular diseasesN10-N16 Renal tubulo-interstitial diseasesN17-N19 Acute kidney failure and chronic kidney diseaseN25-N29 Other disorders of the kidney and ureterN30-N39 Other diseases of the urinary systemN40-N53 Diseases of the male genitalN60-N65 Disorders of the breastN70-N77 Inflammatory diseases of the female pelvic organsN80-N98 Noninflammatory disorders of the female genital

tract

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Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere ClassifiedCodes: R00 – R99

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Chapter 18: Codes R00- R99R00-R09 Symptoms and signs (S&S) involving the

circulatory and respiratory systemsR10-R19 S&S involving the digestive system and abdomenR20-R23 S&S involving the skin and subcutaneous tissueR25-R29 S&S involving the nervous and musculoskeletal

systemsR30-R39 S&S involving the genitourinary systemR40-R46 S&S involving the cognition, perception,

emotional state and behaviorR37-R49 S&S involving speech and voiceR50-R69 General Symptoms and signs

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Chapter 19: Injury, Poisoning, and Certain Other Consequences of External CausesCodes: S00 – T88

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Chapter 19: Codes S00- T88S00-S09 Injuries to the headS10-S19 Injuries to the neckS20-S29 Injuries to the thoraxS30-S39 Injuries to the abdomen, lower back, lumbar spine,

pelvis and external genitalsS40-S49 Injuries to the shoulder and upper armS50-S59 Injuries to the elbow and forearmS60-S69 Injuries to the wrist, hand and fingersS70-S79 Injuries to the hip and thighS80-S89 Injuries to the knee an lower legS90-S99 Injuries to the ankle and foot

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Chapter 19: Codes S00- T88T07 Injuries involving multiple body regionsT14 Injury of unspecified body regionT15-T19 Effects of foreign body entering through natural orificeT20-T32 Burns and corrosionsT20-T25 Burns and corrosions of external body surface,

specified by siteT26-T28 Burns and corrosions confined to eye and internal

organsT30-T32 Burns and corrosions of multiple and unspecified body

regionsT33-T34 FrostbiteT79 Certain early complications of trauma

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COST CENTER LISTING Spreadsheet:Let’s go over some of the Cost Center

Information…but before we do if you have any questions regarding the previous information…please ask

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AMA Coding Standards in ICD-10 CMOUR CDP SYSTEM HAS BEEN SET UP TO CAPTURE

THE DECIMAL WHEN YOU ARE ENTERING YOUR ICD-10 CODE.

NORMAL ICD-10 CODING IS THAT NO DECIMAL IS REQUIRED AFTER ONLY THREE CHARACTERS

HOWEVER, OUR CDP SYSTEM IS NOT SET UP TO REFLECT THAT. WHEN ENTERING ICD-10 CODES WITH ONLY THREE CHARACTERS, A DECIMAL POINT WILL BE REQUIRED AFTER THE THIRD CHARACTER, EVEN THOUGH NO FOURTH CHARACTER IS REQUIRED.

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EXAMPLES:

AMA: CDP SYS.REQ:

Z23 Z23.Z21 Z21.

Questions?

Local Health Operations @Localhealth.helpdesk@ky.gov