Part 1: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
In 2019, HIA reviewed over 725,600 ICD-10-CM codes from many different facilities including reviews on our own coders. Below are the top five ICD-10-CM Chapters where HIA identified coding opportunities.
- Z00-Z99—Factors influencing health status and contact with health services
- A00-B99—Certain Infectious and Parasitic Diseases
- I00-I99—Disease of the Circulatory System
- J00-J99—Diseases of the Respiratory System
- E00-E89—Endocrine, Nutritional, and Metabolic Diseases
For Part 1 of this 5-part series, we will look at Chapter 21 within ICD-10-CM—Z00-Z99—Factors influencing health status and contact with health services. There is no possible way to include every guideline or coding reference for this chapter, but I’ll do my best to touch on some off the most common issues.
Chapter 21: Z00-Z99—Factors influencing health status and contact with health services:
The “Z” code chapter has 15 sections which are then broken down into categories. Below are a few areas where coding opportunities were identified during HIA client and internal quality reviews.
Z00-Z13–Encounter for examination, observation or screening for disease or malignancy, are often missed in coding or reported incorrectly. Remember this section of “Z” codes is used in the absence of disease or signs and symptoms or the patient is not sick and is being seen to discuss a problem with the physician.
The most common of these are:
- Encounter for observation of suspected disease, condition or injury
- Encounter for screening for malignant neoplasms
In addition to the Official Coding Guidelines for ICD-10-CM for FY 2020, Pages 97-99 that address encounters for observation and screenings, there are multiple AHA Coding Clinics that discuss patients that are presenting for encounters for observation and/or screenings. Here are a few of these:
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2018 Page: 8
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2018 Pages: 32-36
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2019 Page: 11
- ICD-10-CM/PCS Coding Clinic, First Quarter 2017 Pages: 8-9
- ICD-10-CM/PCS Coding Clinic, First Quarter 2015 Pages: 8 & 24
- ICD-10-CM/PCS Coding Clinic, First Quarter 2018 Pages: 6-7
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2016 Page: 17
Z40-Z53—Encounters for other specific health care, is another area that is missed often. These “Z” codes are to be used to indicate a reason for care, aftercare, prophylactic care, care to consolidate treatment or to deal with a residual state (such as artificial openings). One of the most common codes that is either added or re-sequenced is Z51.5—Encounter for palliative care. This is also the section of “Z” codes where coders will find encounter for chemotherapy, immunotherapy, combination of chemotherapy and immunotherapy or radiation therapy.
The most common of these are:
- Encounter for palliative care
- Encounter for attention to artificial openings (tracheostomy, gastrostomy, colostomy, ileostomy, etc.)
- Encounter for fitting and adjustment of external prosthetic devices or implanted devices
- Encounters for orthopedic aftercare
- Persons encountering for services but not carried out
In addition to the Official Coding Guidelines for ICD-10-CM for FY 2020, Pages 99-100 that address encounters for other specific health care, there are multiple AHA Coding Clinics that discuss patients that are presenting for encounters for aftercare, fitting and adjustments, attention to devices or placed on palliative care. Here are a few of these:
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2017 Pages: 103-104
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2015 Pages: 19-20
- ICD-10-CM/PCS Coding Clinic, First Quarter 2017 Pages: 48-49
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages: 90-98
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2015 Page: 38
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2019 Page: 33
- ICD-10-CM/PCS Coding Clinic, First Quarter 2015 Pages: 6-7
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2016 Page: 5
Status codes are used to show the presences of a device, carrier of a disease or a residual of a past condition. Status codes are informative and should be reported when documented by the physician. Reporting of status codes show that the particular status may affect the course of treatment and/or outcome. Status codes are not the same as a history code. A history code indicates that the patient no longer has the condition. The status codes are a wide range of “Z” codes. The history (of) “Z” codes range from Z80-Z92. Here are some of the highlights for status and history reporting:
- Z66—Do not resuscitate (DNR) status is missed often or re-sequenced. This status code should always be reported to show that the patient does not want resuscitative measures performed in the event of cardiac arrest/death. This code may be reported if DNR is documented by the physician at any time during the admission.
- Z68—Body mass index (BMI) should be reported only when there is an associated, reportable diagnosis documented by the physician (such as obesity or malnutrition). The diagnosis must be made by the provider, but the BMI may be documented by clinician’s such as nurses or dietary. Remember, BMI is NOT reported during pregnancy.
- Z79—Long-term (current) drug therapy (LTU) is one of the most common write ups for reviewers. Reporting LTU of medications is important and should be reported anytime there is a specific code for a particular medication. Some (most) facilities will also report the LTU of other drugs when there is not a specific ICD-10-CM code for reporting the drug. LTU does not mean a short period of treatment of antibiotics for an infection or taper dose of steroids. Only report when a drug is being used long term to treat a condition or for a prophylactic measure.
- Z80-Z92— Persons with potential health hazards related to family and personal history and certain conditions influencing health status. History (of) codes are divided into two types, personal and family. Personal history codes are used to report/explain a patient’s past medical conditions that the patient is no longer receiving any treatment for, but has the potential for recurrence and may require monitoring. Family history codes are used to report conditions that a family member has been diagnosed with that may put the patient at a higher risk of contracting the disease. These codes may be used in conjunction with follow up and screening codes to help explain the need for a particular test or procedure. History codes are acceptable on any medical record regardless of the reason for the visit. Per the ICD-10-CM Official Guidelines for Coding and Reporting FY 2020, history of illnesses, even if no longer present, is important information that may affect the treatment ordered or monitoring.
In addition to the Official Coding Guidelines for ICD-10-CM for FY 2020, Pages 92-97 that address status and history codes, there are multiple AHA Coding Clinics that discuss patients that have reportable histories and family histories or are using long term medications. Here are a few of these:
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2016 Pages: 41-42, 72-73, 76-79
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2015 Page: 34
- ICD-10-CM/PCS Coding Clinic, First Quarter 2018 Pages: 6-7
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2019 Pages: 19-20, 53
- ICD-10-CM/PCS Coding Clinic, First Quarter 2017 Page: 9, 14-15
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages: 90-98
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2017 Page: 27-28
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2015 Page: 23
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2013 Page: 124-125, 129
- ICD-10-CM/PCS Coding Clinic, First Quarter 2019 Page: 33-34
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2016 Page: 16-17
- ICD-10-CM/PCS Coding Clinic, First Quarter 2015 Pages: 16-17, 21
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2019 Pages: 16-17
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2017 Pages: 112-114
- ICD-10-CM/PCS Coding Clinic, First Quarter 2016 Pages: 12-13
Be on the lookout for Part 2 of this series. In that part, we will look at A00-B99—Chapter 1: Certain Infectious and Parasitic Disease.
Listed above under each category discussed.
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
In the past, there had been an Excludes1 note at I46.- Cardiac arrest that excluded R57.0, Cardiac shock. HIA had also received a letter from AHA on a case in the past that had stated that only I46.- Cardiac arrest would be coded if both were documented. In addition, the Third Quarter Coding Clinic page 26 had a similar case that asked if both could be coded, and AHA had instructed that only I46.9, cardiac arrest, cause unspecified would be coded if both were documented and that the CDC would be looking at possible revision to the Excludes1 note.
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