April 3, 2012

2012 ICD-10-CM Coding Guidelines, Part 3


This is the third 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 10:  Diseases of the Respiratory System (J00–J99)

Due to certain identified influenza viruses, changes have been made to codes in the category J09 as well as the guideline language. The phrase “certain identified influenza viruses” has replaced the previous language of “avian influenza, or novel H1N1 or swine flu.”

As before, confirmation does not require documentation of positive laboratory testing specific for avian or other novel influenza A.  However, coding is based on inclusion of the provider’s diagnostic statement that the patient has avian influenza or other novel influenza A.

Category J11 is assigned to identify influenza due to unidentified influenza virus.

Chapter 11:  Diseases of the Digestive System (K00–K95)

This chapter is reserved for future guideline expansion.

Chapter 12:  Diseases of the Skin and Subcutaneous Tissue (L00–L99)

No changes are noted in this chapter for 2012.

Chapter 13:  Diseases of the Musculoskeletal System and Connective Tissue (M00–M99)

No changes are noted in this chapter for 2012.

Chapter 14:  Diseases of Genitourinary System (N00–N99)

No changes are noted in this chapter for 2012.

Chapter 15:  Pregnancy, Childbirth, and the Puerperium (O00–O9A)

This chapter includes a few minor changes. The subsection, previously titled “Fetal Extensions,” is now titled “7th Character for Fetus Identification.” The guideline for the assignment of the seventh character remains the same.

The term “injury” has been added to the subsection entitled “Poisoning, Toxic Effects, Adverse Effects and Underdosing in a Pregnant Patient” and may be coded as an additional diagnosis. This assignment captures the identified injury in addition to the first code assigned from subcategory O9A.2, which  describes an injury, poisoning, toxic effect, or underdosing in a pregnant patient.  Again, the previous language of “late effect” has been replaced with “sequela.”

Chapter 16:  Certain Conditions Originating in the Perinatal Period (P00–P96)

The title for Chapter 16 has been revised from “Newborn (Perinatal) Guidelines” to the above.  An additional instruction is included about the need to assign codes to specify the weeks of gestation that the provider documented. A code from P05 and codes from PO7.2 and PO7.3 may be assigned. This additional instruction is added to the Prematurity and Fetal Growth Retardation section.

Chapter 17:  Congenital Malformations, Deformations, and Chromosomal Abnormalities (Q00–Q99)

No changes are noted in this chapter for 2012.

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

A specific guideline has been added for direction in assigning code R40.24—Glasgow coma scale, total score—when documentation in the medical record notes only the total score and not the individual score(s).

Chapter 19:  Injury, Poisoning, and Certain Other Consequences of External Causes (S00–T88) continued from part 3

Throughout this chapter, the terminology for code “extensions” has been replaced with “characters.” Also, the word “condition” has replaced the previous term “injury.”

The “Application of 7th Characters” subsection also notes that the categories for traumatic fractures have additional seventh-character values that include open fracture, routine or delayed healing, and nonunion. Further guidance is also specified for assignment of the aftercare Z codes, which should not be used for conditions where seventh characters are provided to identify subsequent care. The guidelines also note an example for use.

The subsection, Coding of Injuries, further specifies that, in the inpatient setting, unspecified multiple injuries code T07 should not be assigned unless information is not available for a more specific code.

A key difference is identified in the sequencing of codes for an adverse effect of a drug that has been correctly prescribed and administered properly. The first code assigned should describe the nature of the adverse effect such as tachycardia, delirium, vomiting, or hypokalemia. This code should then be followed by the appropriate code for the adverse effect of the drug (T36–T50). The drug code should also have a fifth or sixth character of “5” (e.g., T36.0X5_). The seventh character denotes initial encounter, subsequent encounter, or sequela.

The summary of chapter 9 will be continued in the next ICD10monitor eNews.

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.