Updated on: March 14, 2016

2012 ICD-10-CM Coding Guidelines

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Original story posted on: March 16, 2012

This is the second in a series of articles related to the key changes in the 2012 ICD-10-CM Official Guidelines for Coding and Reporting. I’ll be picking up below where I left off last month, which is with a summary of chapter-specific coding guidelines.

 

Chapter 2:  Neoplasms (C00–D49)

General guidelines have been added to include coding guidance specific to primary malignant neoplasms with overlapping site boundaries and malignant neoplasm of ectopic tissue.

A primary malignant neoplasm that overlaps two or more contiguous (next to each other) sites should be classified to the subcategory code of .8 as the fourth digit (i.e., overlapping lesion), unless the combination is specifically indexed elsewhere. A code for each site should be assigned for multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast.

Malignant neoplasms of ectopic tissue should be coded to the site mentioned. For example, the disorder of an ectopic pancreatic malignant neoplasm would be coded to pancreas, unspecified.

A significant change has been made to the sequencing for coding anemia associated with an adverse effect of the administration of chemotherapy or immunotherapy and the only treatment is for the anemia. The anemia code is now sequenced first followed by the appropriate code for the neoplasm and the adverse effect.

However, when the admission or encounter is for management of an anemia associated with a malignancy, and the treatment is only for anemia, the appropriate code to describe the malignancy is sequenced as the principal or first-listed diagnosis followed by the appropriate code for the anemia, such as anemia in neoplastic disease.

The section entitled Leukemia, Multiple Myeloma, and Malignant Plasma Cell Neoplasms in Remission versus Personal History subsection notes a change in the terminology.  The previous term “in remission.” has now been updated in the guidelines to state “indicating whether or not the leukemia has achieved remission.”

Chapter 3:  Disease of the Blood and Blood-forming Organs and Certain Disorders Involving the Immune Mechanism (D50–D89)

This chapter has been reserved for future guideline expansion.

Chapter 4:  Endocrine, Nutritional, and Metabolic Diseases (E00–E89)

The term “late effect” has been revised to “sequela,” which describes secondary diabetes due to drugs that may be caused by an adverse effect of correctly administered medications, poisoning, or sequela of poisoning.

Chapter 5:  Mental, Behavioral and Neurodevelopmental disorders (F01–F99)

The chapter heading has been revised to include neurodevelopmental disorders.

A correction was made regarding the coding of pain that is exclusively related to psychological disorders.  An additional code from category G89 should not be assigned with code F45.41, per the excludes 1 note.  However, an additional code from category G89 may be assigned, if appropriate documentation is present, with code F45.42, pain disorders with related psychological factors.

Chapter 6:  Diseases of the Nervous System (G00–G99)

There are no changes noted in this chapter for 2012.

 


 

Chapter 7:  Diseases of the Eye and Adnexa (H00–H59)

Specific guidelines have been added to this chapter for glaucoma coding.

To identify the type of glaucoma, the affected eye, and the stage, coders may assign as many codes as needed from category H40, glaucoma. Also, seventh characters have been added to some of the glaucoma codes to specify the stage.

When a patient has bilateral glaucoma and both eyes are the same type and stage per the documentation, and there is a code for the bilateral glaucoma, report only that code with the appropriate seventh character to specify the stage.

If the classification does not provide a code for bilateral glaucoma and the patient has it and both eyes are documented as having the same type and stage, report only one code for the type of glaucoma with the appropriate seventh character to specify the stage.

When a patient has bilateral glaucoma and each eye is documented as having a different type or stage, and the classification does distinguish laterality, report the appropriate code for each eye rather than the code for bilateral glaucoma.

When a patient has bilateral glaucoma and each eye is documented as having a different type, and the classification does not distinguish laterality, assign the appropriate code for each type of glaucoma with the appropriate seventh character to specify the stage.

When a patient has bilateral glaucoma of the same type, but a different stage, and the classification does not distinguish laterality, assign a code for the type of glaucoma for each eye with the appropriate seventh character to specify the specific stage documented for each eye.

Assign the code for the highest stage documented if the patient is admitted with glaucoma and the stage progresses during admission.

Glaucoma in a stage that cannot be clinically determined should be assigned the seventh character of 4, which identifies the indeterminate stage. Assignment of this character should be based on the clinical documentation. When there is no documentation regarding the stage,the seventh character of 0, unspecified, should be assigned.  Do not confuse character 4, indeterminate stage, with character 0, unspecified stage.

Chapter 8:  Diseases of the Ear and Mastoid Process (H60–H95)

This chapter is reserved for future guideline expansion.

Chapter 9:  Diseases of the Circulatory System (I00–I99)

Hypertensive retinopathy has been revised to update the code assignment to include the range of codes in category I10I15, hypertensive disease.

The language also has been revised for acute myocardial infarction (AMI) coding specific to the four-week time period.  The guideline now includes transfer to another acute care setting along with the previously noted post-acute care setting.

The detailed instruction has also been deleted from the subsequent AMI subsection. The language now states only “the sequencing of the I22 and I21 codes depends on the circumstances of the encounter.” The previously noted sequencing instructions after this sentence have now been removed from the guidelines.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Lynn Cleasby, RHIT, AHIMA-Approved ICD-10-CM/PCS Trainer

Lynn’s expertise includes inpatient HIM coding audits and coding staff training. She also performs CDIP analysis and CDIP staff and Physician training projects. She is also an AHIMA certified ICD-10 Trainer.