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Objectives

Objectives. Identify areas in ICD-10-CM that include new terminology for clinical documentation Understanding the coding guidelines that pertain to ICD-10-CM Chapter 11-14 Assign the correct ICD-10-CM codes for the case studies involving chapters 11-14

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Objectives

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  1. jhmci.com

  2. Objectives • Identify areas in ICD-10-CM that include new terminology for clinical documentation • Understanding the coding guidelines that pertain to ICD-10-CM Chapter 11-14 • Assign the correct ICD-10-CM codes for the case studies involving chapters 11-14 • Define areas in ICD-10-CM that enable improved data capture if more specific conditions are documented • Acuity • Disease type • Site specifity • Disease stage jhmci.com

  3. Documentation Matters “If it was not documented, it was not done” jhmci.com

  4. Coding and 7th Character Extensions Additional Characters 2 Numeric 3 - 7 Numeric or Alpha Alpha (Except U) . . X X X A M A X S 0 X 2 X X 6 5 x Added code extensions (7th character) for obstetrics, injuries, and external causes of injury Category Etiology, anatomic site, severity 3 – 7 Characters jhmci.com

  5. Digestive SystemChapter 11 K00-K95 K00-K14 Diseases of oral cavity and salivary glands K20-K31 Diseases of the esophagus, stomach and duodenum K35-K38 Diseases of appendix K40-K46 Hernia K50-K52 Non-infective enteritis and colitis K65-K68 Diseases of peritoneum and retroperitoneum K70-K77 Disease of liver K80-K87 Diseases of gallbladder, biliary tract and pancreas K90-K95 Other diseases of the digestive system jhmci.com

  6. Format/General Documentation changes • Combination codes with hemorrhage • Acute vs Chronic • Loss of teeth by Class I-IV • Hernia by Site • Unilateral vs. Bilateral • Not specificed as recurrent vs. recurrent • Example: K57.21, Diverticulitis of large intestine with perforation and abscess with bleeding jhmci.com

  7. Combination codes with hemorrhageAcute vs. ChronicK25 Gastric ulcer K25.0 Acute gastric ulcer with hemorrhage K25.1 Acute gastric ulcer with perforation K25.2 Acute gastric ulcer with both hemorrhage and perforation K25.3 Acute gastric ulcer without hemorrhage or perforation K25.4 Chronic or unspecified gastric ulcer with hemorrhage K25.5 Chronic or unspecified gastric ulcer with perforation K25.6 Chronic or unspecified gastric ulcer with both hemorrhage and perforation K25.7 Chronic gastric ulcer without hemorrhage or perforation K25.9 Gastric ulcer, unspecified as acute jhmci.com

  8. Classification System for the Edentulous Patient Class I Ideal or minimally compromised Class II Moderately compromised • Diagnostic Criteria • Bone height--mandibular • Maxillomandibular relationship • Residual ridge morphology-maxilla • Muscle attachments Class III Substantially compromised Class IV Severely compromised jhmci.com

  9. Loss of teeth by Class I-IV K08.10 Complete loss of teeth, unspecified cause K08.101 …… class I K08.102 …… class II K08.103 …… class III K08.104 …… class IV K08.109 …… unspecified class K08.11 Complete loss of teeth due to trauma K08.111 …… class I K08.112 …… class II jhmci.com

  10. HerniaK40 Inguinal hernia K40.0 Bilateral inguinal hernia, with obstruction, without gangrene K40.00 …… not specified as recurrent K40.01 …… recurrent K40.1 Bilateral inguinal hernia, with gangrene K40.10 …… not specified as recurrent K40.11 …… recurrent K40.2 Bilateral inguinal hernia, without obstruction or gangrene K40.20 …… not specified as recurrent K40.21 …… recurrent K40.3 Unilateral inguinal hernia, with obstruction, without gangrene K40.30 …… not specified as recurrent jhmci.com

  11. K11 Diseases of salivary glands • Use Additional code to identify: • alcohol abuse and dependence (F10.-) • exposure to environmental tobacco smoke (Z77.22) • exposure to tobacco smoke in the perinatal period (P96.81) • history of tobacco use (Z87.891) • occupational exposure to environmental tobacco smoke (Z57.31) • tobacco dependence (F17.-) • tobacco use (Z72.0) • K11.1 Hypertrophy of salivary gland • K11.2Sialoadenitis • K11.20 …… unspecified • K11.21 Acute sialoadenitis • K11.22 Acute recurrent sialoadenitis • K11.23 Chronic sialoadenitis • K11.3 Abscess of salivary gland • K11.4 Fistula of salivary gland • K11.5Sialolithiasis • K11.6Mucocele of salivary gland jhmci.com

  12. K50Crohn's disease [regional enteritis] • Use Additional code to identify manifestations, such as: pyodermagangrenosum (L88) • K50.0Crohn's disease of small intestine • K50.00 …… without complications • K50.01Crohn's disease of small intestine with complications • K50.011Crohn's disease of small intestine with rectal bleeding • K50.012Crohn's disease of small intestine with intestinal obstruction • K50.013Crohn's disease of small intestine with fistula • K50.014Crohn's disease of small intestine with abscess • K50.018Crohn's disease of small intestine with other complication • K50.019Crohn's disease of small intestine jhmci.com

  13. K51.5 Left sided colitis • K51.50 …… without complications • K51.51 Left sided colitis with complications • K51.511 Left sided colitis with rectal bleeding • K51.512 Left sided colitis with intestinal obstruction • K51.513 Left sided colitis with fistula • K51.514 Left sided colitis with abscess • K51.518 Left sided colitis with other complication • K51.519 Left sided colitis with unspecified jhmci.com

  14. K57Diverticular disease of intestine • K57.0 Diverticulitis of small intestine with perforation and abscess • K57.00 …… without bleeding • K57.01 …… with bleeding • K57.1Diverticular disease of small intestine without perforation or abscess • K57.10Diverticulosis of small intestine without perforation or abscess without bleeding • K57.11Diverticulosis of small intestine without perforation or abscess with bleeding • K57.12 Diverticulitis of small intestine without perforation or abscess without bleeding • K57.13 Diverticulitis of small intestine without perforation or abscess with bleeding jhmci.com

  15. K73 Chronic hepatitis, NEC K73.0 Chronic persistent hepatitis, not elsewhere classified K73.1 Chronic lobular hepatitis, not elsewhere classified K73.2 Chronic active hepatitis, not elsewhere classified K73.8 Other chronic hepatitis, not elsewhere classified K73.9 Chronic hepatitis, unspecified jhmci.com

  16. Disorders of gallbladder, biliary tract and pancreas K80-K87 K80Cholelithiasis K81Cholecystitis K82 Other diseases of gallbladder K83 Other diseases of biliary tract K85 Acute pancreatitis K86Other diseases of pancreas K87 Disorders of gallbladder, biliary tract and pancreas in diseases classified elsewhere jhmci.com

  17. K80Cholelithiasis K80.0 Calculus of gallbladder with acute cholecystitis K80.00 …… without obstruction K80.01 …… with obstruction K80.10 Calculus of gallbladder with chronic cholecystitis without obstruction K80.11 Calculus of gallbladder with chronic cholecystitis with obstruction K80.12 Calculus of gallbladder with acute and chronic cholecystitis without obstruction K80.13 Calculus of gallbladder with acute and chronic cholecystitis with obstruction K80.18 …… without obstruction K80.19 …… with obstruction K80.20 …… without obstruction K80.21 …… with obstruction K80.30 …… unspecified, without obstruction K80.31 …… unspecified, with obstruction K80.32 Calculus of bile duct with acute cholangitis without obstruction K80.33 Calculus of bile duct with acute cholangitis with obstruction K80.34 Calculus of bile duct with chronic cholangitis without obstruction K80.35 Calculus of bile duct with chronic cholangitis with obstruction K80.36 Calculus of bile duct with acute and chronic cholangitis without obstruction K80.37 Calculus of bile duct with acute and chronic cholangitis with obstruction jhmci.com

  18. Chapter-Specific Guidelines Chapter 11 • TRUE/FALSE • Chapter 11 Diseases of the Digestive System (K00-K94) contains many combination codes that require careful reading. jhmci.com

  19. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Ventral incisional hernia, without obstruction or gangrene. • ICD-10-CM Code:____________________ jhmci.com

  20. Chapter 6: Chapter-Specific Guidelines ICD-10-CM Chapters 11 • For hemorrhage to be reported there does not have to be active bleeding; however, there must be documentation in the medical record indicating active bleeding has occurred and the source of the bleeding must be identified. jhmci.com

  21. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Crohn’sdisease of the small and large bowel complicated by pyoderma gangrenosum. • ICD-10-CM Codes:____________________, ___________________ jhmci.com

  22. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Obstructed intestinal hernia with gangrene. ICD-10-CM Code:____________________ jhmci.com

  23. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Choledocholithiasis(calculus of the bile duct) with acute and chronic cholangitis. • ICD-10-CM Code:_____________________ jhmci.com

  24. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Choledochoduodenalfistula. • ICD-10-CM Code:_____________________ jhmci.com

  25. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Recurrent chronic pancreatitis • ICD-10-CM Code: ____________________ jhmci.com

  26. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Chronic ulcerative proctitis with fistula. • ICD-10-CM Code:____________________ jhmci.com

  27. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • 23. Acute pseudo-obstruction of the intestine. • ICD-10-CM Code: ____________________ jhmci.com

  28. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • 22. Acute gastrectasis (distention of stomach). • ICD-10-CM Code: ____________________ jhmci.com

  29. Chapter-Specific Guidelines ICD-10-CM Chapters 11 • Celiac disease. • ICD-10-CM Code: ___________________ jhmci.com

  30. Diseases of the Skin/Subcutaneous Tissue Chapter 12 National Cancer Institute jhmci.com

  31. Diseases of the skin/subcutaneous tissue • L00-L08 Infections of the skin and subcutaneous tissue • L10-L14 Bullousdisorders • L20-L30 Dermatitis and eczema • L40-L45 Papulosquamousdisorders • L49-L54 Urticariaand erythema • L55-L59 Radiation-related disorders of the skin and subcutaneous tissue • L60-L75 Disorders of skin appendages • L76 Intraoperativeand postproceduralcomplications of skin and subcutaneous tissue • L80-L99 Other disorders of the skin and subcutaneous tissue jhmci.com

  32. Infections • L00 Staphylococcal scalded skin syndrome • Use additional code before L00 directs coder to report the infection with B95-B97 • Use Additional code to identify percentage of skin exfoliation (L49.-) jhmci.com

  33. Pressure Ulcers Stage 1: erythema (redness) of skin Stage 2: partial loss of skin (epidermis or dermis) Stage 3: full thickness loss of skin (up to but not through fascia) Stage 4: full thickness loss (extensive destruction and necrosis) jhmci.com

  34. Pressure ulcers elbow • L89.00 Pressure ulcer of unspecified elbow • L89.000 …… unstageable • L89.001 …… stage 1 • L89.002 …… stage 2 • L89.003 …… stage 3 • L89.004 …… stage 4 • L89.009 …… unspecified stage • L89.01 Pressure ulcer of right elbow • L89.010 …… unstageable • L89.011 …… stage 1 • L89.012 …… stage 2 • L89.013 …… stage 3 • L89.014 …… stage 4 • L89.019 …… unspecified stage • L89.02 Pressure ulcer of left elbow • L89.020 …… unstageable • L89.021 …… stage 1 • L89.022 …… stage 2 • L89.023 …… stage 3 Stage 0-4 jhmci.com

  35. Coding Guidelines • Assign as many codes as necessary from Category L89 to identify multiple pressure ulcers, by anatomical site and stage. • Pressure ulcer of the sacrum, stage 2 and right lower backstage I. • L89.152 Pressure ulcer of the sacral region, stage 2, L89.131 Pressure ulcer of the right lower back, stage 1 jhmci.com

  36. Coding Guidelines • Code any associated gangrene: I96 as first listed. • Unstageablepressure ulcers are ulcers which cannot be staged determined by the documentation. May be for deep tissue injury not due to trauma and ulcers covered by an Escher or covered with a graft of skin or muscle. • Unstageableare not synonymous with unspecified stage. • Assign the ulcer stage based on the clinical documentation and guidance in the alphabetical index list of terms and subterms and verification of code assignment in the tabular list. jhmci.com

  37. Coding Guidelines • No code is assigned for a pressure ulcer described as “healed.” • Pressure ulcers described as “healing” should be reported with the appropriate code based upon the clinical documentation. When the documentation is unclear as to whether the ulcer is a healing pressure ulcer, query the provider. • Diagnosis: Healing pressure ulcer of the left heel, stage 2 L89.622 jhmci.com

  38. Coding Guidelines • A pressure ulcer that evolves from one stage to another during the course of the hospitalization is reported only at the highest level of severity as supported by the documentation. jhmci.com

  39. Non-Pressure Ulcers • If one of the following conditions is documented with an ulcer, sequence the underlying associated condition first. • Atherosclerosis of the extremities I70.23- to I70.74- • Chronic venous hypertension I87.31-, I87.33- • Diabetic ulcers E08.621, E08.622, E09, E10, E11, E13--- • Gangrene I96 • Postphlebetic syndrome I87.01-, I87.03- • Postthrombotic syndrome I87.01-, I87.03- • Varicose ulcer I83.0-, I83.2- jhmci.com

  40. Non-pressure ulcer L97-L98 • Site specific • Stage specific by definition • L97 Non-pressure chronic ulcer of lower limb, not elsewhere classified • L97.1 Non-pressure chronic ulcer of thigh • L97.10 Non-pressure chronic ulcer of unspecified thigh • L97.101 …… limited to breakdown of skin • L97.102 …… with fat layer exposed • L97.103 …… with necrosis of muscle • L97.104 …… with necrosis of bone • L97.109 …… with unspecified severity • L97.11 Non-pressure chronic ulcer of right thigh • L97.111 …… limited to breakdown of skin • L97.112 …… with fat layer exposed • L97.113 …… with necrosis of muscle jhmci.com

  41. PsoriasisFurther specificity in ICD-10-CM • L40 Psoriasis • L40.0 Psoriasis vulgaris • L40.1Generalized pustularpsoriasis • L40.2Acrodermatitiscontinua • L40.3Pustulosispalmaris et plantaris • L40.4Guttate psoriasis • L40.5Arthropathic psoriasis • L40.50 …… unspecified • L40.51Distal interphalangeal psoriatic arthropathy • L40.52Psoriatic arthritis mutilans • L40.53Psoriatic spondylitis • L40.54Psoriatic juvenile arthropathy jhmci.com

  42. Dermatitis • L23-L25 classifies dermatitis due to plants, foods, drugs and medications. • L23.0 Allergic contact dermatitis due to metals • L23.1 Allergic contact dermatitis due to adhesives • L23.2 Allergic contact dermatitis due to cosmetics • L23.3 Allergic contact dermatitis due to drugs in contact with skin • L23.4 Allergic contact dermatitis due to dyes • L23.5 Allergic contact dermatitis due to other chemical products • L23.6 Allergic contact dermatitis due to food in contact with the skin • L23.7 Allergic contact dermatitis due to plants, except food • L23.8 Allergic contact dermatitis due to other agents • L23.81 Allergic contact dermatitis due to animal (cat) (dog) dander • L27 classified dermatitis due to drugs taken internally. jhmci.com

  43. L27 Dermatitis due to substances taken internally • L27.0 Generalized skin eruption due to drugs and medicaments taken internally • Use Additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) • L27.1 Localized skin eruption due to drugs and medicaments taken internally • Use Additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) • L27.2 Dermatitis due to ingested food • L27.8 Dermatitis due to other substances taken internally • L27.9 Dermatitis due to unspecified substance jhmci.com

  44. Dermatitis due to drug First: Determine if the condition is: • An adverse of a drug • Properly administered • A Poisioning due to the incorrect use of the drug T Code for poisoning is listed as first listed code followed by the adverse effect. jhmci.com

  45. Chapter-Specific Guidelines Chapter 12 • TRUE/FALSE • A stage II pressure ulcer is considered a full thickness loss of skin. jhmci.com

  46. Chapter-Specific Guidelines ICD-10-CM Chapters 12 • Dyskinesia of esophagus. • ICD-10-CM Code: ____________________ jhmci.com

  47. Chapter-Specific Guidelines ICD-10-CM Chapters 12 • Boil on the face, due to Staphylococcus epidermidis. • ICD-10-CM Codes:_____________________, _____________________ jhmci.com

  48. Chapter-Specific Guidelines ICD-10-CM Chapters 12 • Mucinosis of the skin. • ICD-10-CM Code: _____________________ jhmci.com

  49. Chapter-Specific Guidelines ICD-10-CM Chapters 12 • Pressure ulcer of right elbow with partial thickness skin loss involving epidermis and dermis. • ICD-10-CM Code: ____________________ jhmci.com

  50. Diseases of the Musculoskeletal System and Connective Tissue, Chapter 13M00-M99 M00-M02 Infectious arthropathies M05-M14 Inflammatory polyarthropathies M15-M19 Osteoarthritis M20-M25 Other joint disorders M26-M27Dentofacial anomalies [including malocclusion] and other disorders of jaw M30-M36 Systemic connective tissue disorders M40-M43 Deforming dorsopathies M45-M49Spondylopathies M50-M54 Other dorsopathies M60-M63 Disorders of muscles M65-M67 Disorders of synovium and tendon M70-M79 Other soft tissue disorders M80-M85 Disorders of bone density and structure M86-M90 Other osteopathies M91-M94Chondropathies M95-M95 Other disorders of the musculoskeletal system and connective tissue M96-M96Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified M99-M99 Biomechanical lesions, not elsewhere classified jhmci.com

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