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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. ICD-10-CM Diseases of the Respiratory SystemChapter 10 National Cancer Institute jhmci.com

  6. Diseases of the Respiratory System J00-J06Acute upper respiratory infections J09-J18 Influenza and pneumonia J20-J22Other acute lower respiratory infections J30-J39 Other diseases of upper respiratory tract J40-J47Chroniclower respiratory diseases J60-J70 Lung diseases due to external agents J80-J84 Other respiratory diseases principally affecting the interstitium J85-J86Suppurative and necrotic conditions of the lower respiratory tract J90-J94 Other diseases of the pleura J95-J95Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified J96-J99 Other diseases of the respiratory system jhmci.com

  7. Respiratory System • ICD-9-CM to ICD-10-CM Model • Acute Anatomic site of infection • Other Severity • Pneumonia Cause • Chronic Acute, other, then chronic jhmci.com

  8. Use Additional code to identify • Exposure to environmental tobacco smoke (Z77.22) • Exposure to tobacco smoke in the perinatal period (P96.81) • History of tobacco use (Z87.891) • Infectious agent (B95-B97) • Occupational exposure to environmental tobacco smoke (Z57.31) • Tobacco dependence (F17.-) • Tobacco use (Z72.0) jhmci.com

  9. Diseases of the Respiratory System • Chapter 10 category range = J00-J99 • Combination codes = condition and organism • J02.0 Streptococcal pharyngitis • Other codes require separate reporting of organism • Acute sinusitis J01- • Use Additional code (B95-B97) to identify infectious agent. jhmci.com

  10. New terminology for asthma • Respiratory condition in more than 1 site (not specifically indexed) classified to lower anatomic site • Additional code notes jhmci.com

  11. Asthma ICD-9 ICD-10 J45.XXX Extrinsic Intrinsic Chronic Obstructive Other • 493.XX • 4th Digit • Extrinsic • Intrinsic • Chronic Obstructive • Other • 5th Digit • Exacerbation or status asthmatics jhmci.com

  12. J45 Asthma 5th Character mano-num system • J45.2Mildintermittent asthma • J45.20 …… uncomplicated • J45.21 …… with (acute) exacerbation • J45.22 …… with status asthmaticus • J45.3Mildpersistent asthma • J45.30 …… uncomplicated • J45.31 …… with (acute) exacerbation • J45.32 …… with status asthmaticus • J45.4Moderatepersistent asthma • J45.40 …… uncomplicated • J45.41 …… with (acute) exacerbation • J45.42 …… with status asthmaticus • J45.5Severe persistent asthma jhmci.com

  13. Upper Respiratory Infections • J00 Acute nasopharyngitis [common cold] • J01 Acute sinusitis • J02 Acute pharyngitis • J03 Acute tonsillitis • J04 Acute laryngitis and tracheitis • J05 Acute obstructive laryngitis [croup] and epiglottitis • J06 Acute upper respiratory infections of multiple and unspecified sites jhmci.com

  14. Upper Respiratory Tract • Acute sinusitis by site • Acute recurrent sinusitis by site. jhmci.com

  15. J01 Acute sinusitis • J01.0 Acute maxillary sinusitis • J01.00 …… unspecified • J01.01 Acute recurrent maxillary sinusitis • J01.1 Acute frontal sinusitis • J01.10 …… unspecified • J01.11 Acute recurrent frontal sinusitis • J01.2 Acute ethmoidal sinusitis • J01.20 …… unspecified • J01.21 Acute recurrent ethmoidal sinusitis • J01.3 Acute sphenoidal sinusitis • J01.30 …… unspecified • Anatomical Site • Acute • Recurrent jhmci.com

  16. 465.9 Acute upper respiratory infection • J06Acute upper respiratory infections of multiple and unspecified sites • J06.0 Acute laryngopharyngitis • J06.9 Acute upper respiratory infection, unspecified jhmci.com

  17. 462 Acute Pharyngitis • J02.0Streptococcal pharyngitis • J02.8 Acute pharyngitis due to other specified organisms • J02.9 Acute pharyngitis, unspecified jhmci.com

  18. Instructional note • When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to J40-J47Chroniclower respiratory diseases jhmci.com

  19. J40-J47Chroniclower respiratory diseases • J41 Simple and mucopurulent chronic bronchitis • J42 Unspecified chronic bronchitis • J43 Emphysema • J44 Other chronic obstructive pulmonary disease • J45 Asthma • J47Bronchiectasis jhmci.com

  20. Allergic rhinitis • Excludes 1: Allergic rhinitis with asthma (bronchial) • Code to the Asthma code. J45.909 • J30 Vasomotor and allergic rhinitis • J30.0 Vasomotor rhinitis • J30.1 Allergic rhinitis due to pollen • J30.2 Other seasonal allergic rhinitis • J30.5 Allergic rhinitis due to food Cause and Effect • J30.8 Other allergic rhinitis • J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander • J30.89 Other allergic rhinitis • J30.9 Allergic rhinitis, unspecified jhmci.com

  21. Influenza • Influenza may be coded alone or in combination with other codes. • Code only confirmed cases: • Exception to Guideline II, H. (Uncertain Diagnoses) • J09 – Due to certain identified influenza viruses • J10 – Due to other identified influenza viruses jhmci.com

  22. COPD ICD-9-CM - 491.2x or 493.2x ICD-10-CM J44 J44 Other chronic obstructive pulmonary disease J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation J44.9 Chronic obstructive pulmonary disease • Asthma with COPD • Chronic asthmatic (obstructive) asthma • Chronic bronchitis with airway obstruction • Chronic bronchitis with emphysema • Chronic obstructive asthma • Chronic obstructive bronchitis • Chronic obstructive tracheobronchitis J44 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 • chronic obstructive tracheobronchitis jhmci.com

  23. Pneumonia J13 Pneumonia due to Streptococcus pneumoniae J14 Pneumonia due to Hemophilusinfluenzae J15 Bacterial pneumonia, not elsewhere classified • Coded as a combination with the responsible organism • Coded as a dual classification • J13 and J14 = code first influenza (J09, J10, J11) is applicable jhmci.com

  24. Acute Respiratory Failure Coding Guideline 10.b.1 • Acute respiratory failure as the principal diagnosis • J96.0 May be assigned as the principal diagnosis when • it is the condition established after study to be chiefly responsible for the admission to the hospital. • The selection of the code is supported by the • Alphabetical and Tabular list. • Chapter specific guidelines take precedence. • Obstetrics, poisonings, HIV and newborn jhmci.com

  25. Acute Respiratory Failure Coding Guideline 10.b.2 • Acute respiratory failure as a secondary diagnosis • Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or is present on admission, but does not meet the definition of the principal diagnosis. jhmci.com

  26. Acute Respiratory Failure Coding Guideline 10.b.3 • Sequencing of acute respiratory failure and another acute condition. • When the patient is admitted with respiratory failure and another condition such as myocardial infarction, CVA or aspiration pneumonia, the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or non-respiratory condition. Principle diagnosis will be dependent on the circumstances of the admission. admission. If two conditions are equally responsible and there are no chapter specific guidelines, the guideline for two or more diagnosisthatequally meet the definition of principal diagnosis may be applied. jhmci.com

  27. J96 Respiratory failure • J96.0Acute respiratory failure • J96.00 …… unspecified whether with hypoxia or hypercapnia • J96.01 …… with hypoxia • J96.02 …… with hypercapnia • J96.1Chronic respiratory failure • J96.10 …… unspecified whether with hypoxia or hypercapnia • J96.11 …… with hypoxia • J96.12 …… with hypercapnia • J96.2Acute and chronic respiratory failure • J96.20 …… unspecified whether with hypoxia or hypercapnia • J96.21 …… with hypoxia jhmci.com

  28. Questions jhmci.com

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