Chapter-specific guidelines (ICD-10-CM chapters 11-14)

CHAPTER 5


Chapter-specific guidelines (ICD-10-CM chapters 11-14)




Learning objectives


After completing this chapter you should be able to


1. Examine the digestive system coding.


2. Review coding the skin and subcutaneous tissue diseases.


3. Understand diseases of the musculoskeletal system and connective tissue coding.


NOTE: The 2012 ICD-10-CM DRAFT was used in this text.



Diseases of the digestive system


Chapter 11, Diseases of the Digestive System, in the Tabular of the I-10 describes diseases or conditions affecting the digestive system. Digestion starts when food is taken into the mouth and follows the gastrointestinal tract until it leaves the body through the anus. The categories in the I-10 are sequenced in a manner that follows that path, starting with disorders of the teeth. The blocks in Chapter 16 are as illustrated in Figure 5–1.


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FIGURE 5–1 Blocks of Chapter 11, Diseases of the Digestive System (K00-K94) of the ICD-10-CM. (From Buck CJ: 2012 ICD-10-CM Standard Edition DRAFT (Softbound), St. Louis, 2012, Saunders.)


Hemorrhage


Throughout the chapter, as in other chapters, you must pay close attention to additional characters to be assigned, the use of combination codes, and carefully read the Excludes/Includes notes and any other instructions. Also important in the chapter is the presence of hemorrhage (bleeding) and/or perforation associated with the disease. Code K92.2, Gastrointestinal hemorrhage, unspecified, is not assigned when codes for site-specific bleeding exist. Assign this code only when the physician states “gastric hemorrhage,” “intestinal hemorrhage,” etc., and no further site is specified. Also, because the physician may not always indicate the presence of hemorrhage, the coder must review the record and then clarify the documentation with the physician before code assignment. There are also combination codes to report conditions with hemorrhage.



Example

















Diagnosis: Diverticulitis of the colon with perforation and abscess with hemorrhage
Index: Diverticulitis (acute), intestine K57.92, large K57.32, with, abscess, perforation, or peritonitis K57.20, with bleeding K57.21
Tabular:
Code: K57.21 Diverticulitis of colon with perforation and abscess with hemorrhage


image



If you begin a search for the above diagnosis of “Diverticulitis of the colon with hemorrhage” using the main term “Hemorrhage, gastrointestinal,” you are directed to K92.2. When you reference K92.2 in the Tabular, you will find a list of Excludes1 under the code. Note that in the list of Excludes1 is “diverticular disease with hemorrhage (K57.-).” This means that you cannot assign K92.2, gastrointestinal hemorrhage, when there is a mention of diverticulitis of the large intestine (K57.-). If you are reporting a diagnosis of gastrointestinal (GI) hemorrhage with any of the diagnoses listed in the Excludes1 and if the hemorrhage is due to the GI condition, do not report K92.2.



HEMORRHAGE Example

















Diagnosis: Gastrointestinal hemorrhage due to acute antral ulcer
Index: Ulcer, antral—see Ulcer, stomach
  Ulcer, stomach (eroded) (peptic) (round) K25.9 acute, with, hemorrhage K25.0
Tabular:


image



The combination code K25.0 reports both the acute gastric ulcer and the hemorrhage, so no further code is required to report the GI hemorrhage due to acute antral ulcer.


For a hemorrhage to be reported there does not have to be active bleeding; however, there must be documentation in the medical record that supports the fact that active bleeding has occurred and the physician must identify the source of bleeding for a combination code to be assigned.


It is so important to verify code assignment in the Tabular. It is only when you reference the Tabular that you know the Includes and Excludes of a code, which are not listed anywhere else. This is also where you will find additional characters to be assigned. Be certain to always, always check the Tabular before assigning a code.



imageExercise 5-1   Diseases of the Digestive System


Complete the following in Chapter 5 of your “ICD-10-CM Online Training Modules:”


Online Lesson 1, Screens 1-4



Diseases of the skin and subcutaneous tissue


Chapter 12, Diseases of the Skin and Subcutaneous Tissue (L00-L99), in the Tabular of the I-10 describes diseases or conditions of the integumentary system. Conditions affecting the nails, sweat glands, hair, and hair follicles are included in this chapter. Congenital conditions of skin, hair, and nails are classified in category Q80-Q89, Other congenital malformations. Neoplasms of skin are classified in Chapter 2 of I-10. The blocks of Chapter 12 include those displayed in Figure 5–2.


image
FIGURE 5–2 Blocks of Chapter 12, Diseases of the Skin and Subcutaneous Tissue (L00-L99) of the ICD-10-CM. (From Buck CJ: 2012 ICD-10-CM Standard Edition DRAFT (Softbound), St. Louis, 2012, Saunders.)

A “Use additional code” preceding L00 directs the coder to identify the infectious agent (B95-B97) in addition to the code in the categories L00-L08, making multiple coding necessary.



MULTIPLE CODING Example














Diagnosis: Cellulitis right small finger due to Staphylococcus aureus
Index: Cellulitis, finger (intrathecal) (periosteal) (subcutaneous) (subcuticular) L03.01-
Tabular:


image



To locate the code for the causative organism, reference the main term “Infection” in the Index.



The code for the organism is assigned as an additional code and is sequenced after the disease or condition.



Pressure ulcers


Pressure ulcers develop when the circulation to an area is decreased by the application of pressure to the area. Patients restricted to bed or unable to change position often develop pressure ulcers. As the sores ulcerate, the deeper layers of tissue, such as fascia, muscle, and bone, may be affected. Pressure ulcers are graded and reported based on the depth of ulcer and categorized in stages as illustrated in Figure 5–3. The stages are:


image
FIGURE 5–3 Stages 1, 2, 3, and 4 of pressure ulcers


Figure 5–4 illustrates the codes to report pressure ulcer of the left hip that include the stages in the code description.


image
FIGURE 5–4 Left hip pressure ulcer codes by stage. (From Buck CJ: 2012 ICD-10-CM Standard Edition DRAFT (Softbound), St. Louis, 2012, Saunders.)


imageExercise 5-2   Diseases of the Skin and Subcutaneous Tissue


Complete the following in Chapter 5 of your “ICD-10-CM Online Training Modules:”


Online Lesson 2, Screens 1-4



Diseases of the musculoskeletal system and connective tissue


Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue, in the I-10 Tabular describes diseases or conditions of the bone, joints, and muscle, and the blocks are displayed in Figure 5–5.


image
FIGURE 5–5 Blocks of Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue (M00-M99), of the ICD-10-CM. (From Buck CJ: 2012 ICD-10-CM Standard Edition DRAFT (Softbound), St. Louis, 2012, Saunders.)

Related posts:

  1. ICD-10-CM outpatient coding and reporting guidelines
  2. An overview of ICD-10-CM
  3. Chapter-specific guidelines (ICD-10-CM chapters 15-21)
  4. Chapter-specific guidelines (ICD-10-CM chapters 1-10)

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Apr 17, 2017 | Posted by in NURSING | Comments Off on Chapter-specific guidelines (ICD-10-CM chapters 11-14)

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