May 1, 2012

2012 ICD-10-CM Coding Guidelines, Part 4

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This is the fourth and final article in a series related to the key changes in the 2012 ICD-10-CM Official Guidelines for Coding and Reporting. I’ll be picking up below from last month and a continuation of a summary of chapter-specific coding guidelines, starting with chapter 19.

 

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

The sequencing guideline for assignment of the codes to capture a poisoning or reaction to the improper use of a medication remains the same. Assign first the appropriate code from categories T36–T50. The fifth or sixth character specifies the intent of the poisoning code. Assign additional codes to specify all manifestations of the poisoning.

An update has been made to the code description for code Z04.71, encounter for examination and observation following alleged physical adult abuse, in the subsection of Adult and Child Abuse, Neglect and Other Maltreatment. This makes it consistent with the code description in the tabular section of the code manual.  Also updated is code Z04.72, encounter for examination and observation following alleged child physical abuse.

Refer to the additional Section I.B.16 for the general guidelines pertaining to documentation of complications of care. The “transplant complications” subsection now includes guidelines for conditions that affect the function of the transplanted kidney, other than chronic kidney disease. These conditions should be assigned a code from subcategory T86.1, complications of transplanted kidney organ, followed by a secondary code that identifies the complication.

Chapter 20:  External Causes of Morbidity (V01–Y99)

There are no changes noted in Chapter 20 for 2012 except the term “sequela” now replaces “late effect.”

Chapter 21:  Factors Influencing Health Status and Contact with Health Services (Z00–Z99)

The code descriptor for category Z16 has been changed to read “resistance to antimicrobial drugs.”  The codes from category Z16, which may be used as additional codes, indicate that a patient has a condition that is resistant to antimicrobial drug treatment. The infection code is sequenced first.  This category has also been expanded to identify specific antimicrobial drug codes.

In the personal history Z code category, new code Z91.83—wandering in diseases classified elsewhere—has been added. This is an exception to the personal history codes that explain a patient’s past condition. Specifically, the use of Z91.83 also requires assigning a code first for the underlying disorder, such as Alzheimer’s disease.  This code is also recognized under the “Miscellaneous Z Codes” subsection.

A new code category, Z3A—Weeks of Gestation, has been added to the subsection “Encounter for Obstetrical and Reproductive Services.” These codes, which indicate the weeks of gestation, may only be used on the maternal record and be assigned to provide additional information about the pregnancy. This category includes codes Z3A.00 through Z3A.49.

SECTION II.  SELECTION OF PRINCIPAL DIAGNOSIS

No changes are noted in this section for 2012.

SECTION III.  REPORTING ADDITIONAL DIAGNOSES

No changes are noted in this section for 2012.

SECTION IV.  DIAGNOSTIC CODING AND REPORTING GUIDELINES FOR OUTPATIENT SERVICES

No changes are noted in this section for 2012.

APPENDIX I.  PRESENT ON ADMISSION REPORTING GUIDELINES

One change is included in Appendix I for 2012. The term “categories” replaces the term “codes” in the subsection of Congenital Conditions and Anomalies. This subsection identifies categories Q00–Q99, Congenital Anomalies, which are on the exempt list for reporting because congenital conditions are always considered to be present on admission.

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.