Part 4: 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. Yesterday we looked at the ICD-10-CM Chapter 9 and today we will focus on the fourth area with the most coding opportunities found during HIA reviews.
- 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 4 of this 5-part series, we will look at Chapter 10 within ICD-10-CM—J00-J99—Diseases of the Respiratory System. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
Chapter 10: J00-J99—Diseases of the Respiratory System:
Chapter 10 in ICD-10-CM has 11 sections. In looking through the recommendations made, it looks like sequencing of the PDX and specificity are the most common recommendations, followed by additions and deletions. This chapter covers acute respiratory infections and conditions as well as chronic respiratory diseases. Below are a few areas where coding opportunities were identified during HIA client and internal quality reviews.
- Sequencing of pneumonia or determining if pneumonia was ruled in/out
- Queries to clarify the clinical significance or clinical indicators for pneumonia and acute respiratory failure
- Re-sequencing of acute respiratory failure
- Re-sequencing of COPD diagnoses
- Further specificity on type of pneumonia or organism responsible
- Reporting a poisoning as PDX when due to drugs or other external causes/agents
- Reporting a new PDX from another chapter within ICD-10-CM such as from Chapter 1
- Querying to clarify if the condition is a postprocedural complication
- Not following the latest guidelines on sequencing when patient presents with COPD exacerbation and pneumonia
- Pneumonia being ruled out in the body of the record or diagnosis dropped without documented reason
- Multiple missed opportunities
In addition to the Official Coding Guidelines for ICD-10-CM for FY 2020, Pages 52-55 that address specific chapter guidelines to follow for reporting diseases of the respiratory system, there are multiple AHA Coding Clinics that discuss some of these in detail. Here are a few of these:
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2016 Pages: 10-11, 14-16
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2017 Pages: 96-98
- ICD-10-CM/PCS Coding Clinic, First Quarter 2019 Pages: 34-37
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2019 Pages: 6-7, 28, 31-32
- ICD-10-CM/PCS Coding Clinic, First Quarter 2017 Pages: 24-27
- ICD-10-CM/PCS Coding Clinic, Second Quarter 2015 Pages: 15-16
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2016 Pages: 9-10
- ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2013 Page: 121
- ICD-10-CM/PCS Coding Clinic, First Quarter 2016 Page: 38
- ICD-10-CM/PCS Coding Clinic, First Quarter 2015 Page: 21
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2019 Page: 37
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2018 Pages: 24-25
- ICD-10-CM/PCS Coding Clinic, Third Quarter 2014 Page: 4
Coding Tips for Chapter 10: J00-J99-Diseases of the Respiratory System:
- Follow all instructional notes within ICD-10-CM for sequencing and to determine if additional codes would be reported
- Exacerbation/decompensation is a worsening of a chronic condition
- Acute respiratory failure is a life-threatening condition may be the PDX if the focus of treatment is towards the failure (such as BiPAP or mechanical ventilation) unless there are chapter-specific guidelines that direct otherwise (such as obstetrics, poisoning, HIV and newborn)
- If admitted with acute respiratory failure and another acute condition the selection of PDX will depend on the circumstances of admission and may not be the same in every situation. If both conditions are equally responsible and the focus of care, and there are no chapter-specific sequencing rules, either condition may be sequenced as the PDX (Section II, C.)
- When documentation is unclear a query is necessary
- If there are no clinical indicators present to support acute respiratory failure, pneumonia or other condition in chapter 10, but the diagnosis is documented, a query is necessary to clarify the diagnosis and/or follow facility process on these situations (send to physician liaison or CDI)
- Only confirmed cases of certain identified influenza viruses or other influenza virus should be coded (category J09 and J10)
- When the provider documents “suspected,” “possible” or “probable” avian, novel or other identified influenza the appropriate code from category J11 for unidentified influenza virus should be assigned
- Ventilator associated pneumonia is only reported when clearly documented as such by the provider
- Emphysema is a specified form of COPD
- COPD exacerbation and emphysema diagnosed is assigned to J43.9—emphysema
- Aspiration bronchitis is reported with J69.0—pneumonitis due to inhalation of food and vomit
- Lobar pneumonia is only coded when the diagnosis is specifically documented by the physician as such
- If COPD and unspecified asthma are documented, only the code for COPD would be reported following the instructional note under category J44. If the asthma is documented as a specified type, then both COPD and asthma may be reported
- Pleural effusion associated with heart failure is a common finding and should only be reported when the effusion is specifically addressed or requires therapeutic intervention or diagnostic testing
- If the patient is status post lung transplant and now has pneumonia in the transplanted lung this is considered a complication of the transplanted lung since the pneumonia would affect the function of the organ
Most of the tips above are for pneumonia/COPD but there are many more diagnosis in this chapter of ICD-10-CM. Respiratory diseases are a tough area for coders since there are so many diseases in such a small area of the body. A lot of these diseases intertwine together and it is difficult to know which one to report or if multiple conditions may be reported. Following the instructional notes within ICD-10-CM is a must in this chapter.
Be on the lookout for Part 5 of this series. In that part, we will look at E00-E89—Endocrine, Nutritional and Metabolic Disorders.
References listed above.
Happy Coding!
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.
Popular Posts
New Rule Helps Medicare ACOs During COVID-19 Pandemic
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Part 5: Reasons for AKI Denials and Prevention | AKI Series
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
Part 4: Is Documentation Present to Report Acute Kidney Injury/Failure? | AKI Series
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
Coding Tip: Z Code Reporting for COVID-19
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
Part 3: Clinical Indicators for Acute Kidney Injury/Failure | AKI Series
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
Subscribe to our weekly newsletter
Latest News
New Rule Helps Medicare ACOs During COVID-19 Pandemic
One common element in many value-based programs is risk adjustment using Hierarchical Condition Categories (HCCs) to create a Risk Adjustment Factor (RAF) score. This method ranks diagnoses into categories that represent conditions with similar cost patterns.
Part 5: Reasons for AKI Denials and Prevention | AKI Series
Why are so many AKI records being denied? It’s hard to give one answer for why so many AKI records are being denied lately, but most appear to be due to the multiple sets of criteria available for use in determining if a patient has AKI, as well as physician documentation. As stated in Part 3 of this series, there are three main criteria/classifications used to diagnose AKI.
Part 4: Is Documentation Present to Report Acute Kidney Injury/Failure? | AKI Series
In previous parts of this series we looked at the definitions of AKI/ARF, causes, coding and sequencing, and the common clinical indicators that patients present with that are diagnosed with this condition. In Part 4, we will look at the documentation that should be present to report the diagnosis without fear of denial, as well as when a query is needed to clarify the diagnosis.
Coding Tip: Z Code Reporting for COVID-19
If the facility does a COVID-19 test, and test is negative, do I need a diagnosis code. The answer is yes, you will report a Z-code. The Z-code depends on the record documentation and circumstances of testing. For any patient receiving a COVID-19 test, if negative, there MUST e a Z-code to describe why the test was taken. (Test negative for COVID-19 and MD does not override negative results).
Part 3: Clinical Indicators for Acute Kidney Injury/Failure | AKI Series
In the first parts of this series we looked at definitions of AKI/ARF, causes, coding and sequencing. In Part 3, we will look at what clinical indicators would possibly be present to support the diagnosis of AKI/ARF.
FY2021 Proposed Rule and Code Changes Highlights
The FY2021 IPPS Proposed Rule is out and here are some highlights from it regarding ICD-10 Code proposals. We will know if these changes are permanent after the public comment period is over on July 10, 2020 and CMS prepares the Final Rule, usually out by August 1.
Part 2: Specificity Coding of Acute Kidney Injury (AKI) and Sequencing | AKI Series
As discussed in Part 1 of this series, AKI/ARF is a common diagnosis that coders see daily. In Part 2, we are going to focus on the different types/specificity of AKI/ARF. We’ll learn what they mean, as well as how to code the diagnosis.
Part 1: What is Acute Kidney Injury (AKI)? | AKI Series
This is part 1 in a series focused on coding of acute kidney injury (AKI) and/or acute renal failure (ARF). AKI/ARF is reported often, but is also one of the most common diagnosis found in denials.
Coding Tip: Covid-19 Diagnosis Coding Common Scenarios
With the proliferation of COVID-19 cases, we thought we would put together a quick reference listing of some of the common scenarios that coders have asked about. As with all coding, coders should follow Official Guidelines for Coding and Reporting and the COVD-19 Frequently Asked Questions document by the AHA.
Reporting Telehealth Services During the COVID-19 Emergency
Effective March 1, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. This great for providers whose patients are reluctant to visit the office.
Coding Tip: What is Single Path Coding?
The biggest reasons why some hospital systems are moving to single path coding is to eliminate duplicative processes and to optimize productivity. In addition, costs are reduced when only one coder “touches” the record and completes both types of coding.
Coding Tip: Reporting Vaping in ICD-10-CM | Effective on 4/1/2020
Effective with 4/1/2020 discharges, ICD-10-CM code U07.0 is used to report vaping -related disorders. ICD-10-CM code U07.0 (vaping related disorder) should be used when documentation supports that the patient has a lung-related disorder from vaping. This code is found in the new ICD-10-CM Chapter 22. U07.0 will be in listed in the ICD-10-CM manual under a new section: Provisional assignment of new disease of uncertain etiology or emergency use.
Telehealth and the Coronavirus
The US government and public-health officials are urging consumers to utilize telemedicine for remote treatment, fill prescriptions and get medical attention during the new coronavirus pandemic. The goal is to keep people with symptoms at home and to practice social distancing if their condition doesn’t warrant more intensive hospital care.
Coronavirus: Tips for Working from Home
Coronavirus: Tips for working from home. Companies around the world have told their employees to stay home and work remotely. Whether you’re a new to this concept or a work from home veteran, here’s some tips to staying productive from our #HIAfamily.
Part 3: Coder and CDI Communication Example | CDI Series
This is the final part of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we provide an actual example of an effective communication response to CDI.
Part 2: How Coders Can Address Coding Mismatches | CDI Series
This is part two of a three part series in which we address how coders can better interact with Clinical Documentation Improvement (CDI) professionals. In this part, we discuss mismatches and how to best go about resolving them. In part three we will provide a case example of best practice interaction.
Part 1: How Coders Can Better Interact with CDI Teams | CDI Series
This is part one of a three part series in which we address how coders can better interact with Clinical Documentation Integrity (CDI) professionals. Many times these departments are separate and the remote environment makes it difficult to interact efficiently between the two departments. In part one, we will discuss the history and objectives of CDI so the coder has a better understanding of CDI’s role.
Coding Tip: Coding Diagnoses on Outpatient Encounters
One reason that coders should report chronic conditions (including history and status codes) on outpatient records is the HCC’s—Hierarchical Condition Categories. The quick and easy explanation of what HCC’s are is each HCC is mapped to certain ICD-10-CM codes or code ranges. HCC coding is designed to estimate future health care costs for patients.
Part 5: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 5 of this 5-part series, we will look at Chapter 4 within ICD-10-CM—E00-E89—Endocrine, Nutritional, and Metabolic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
Part 3: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 3 of this 5 part series, we will look at Chapter 9 within ICD-10-CM—I00-I99—Diseases of the Circulatory System. This chapter contains so many of the everyday diagnoses that we code such as hypertension, heart disease and stroke.
Part 2: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
For Part 2 of this 5-part series, we will look at Chapter 1 within ICD-10-CM—A00-B99—Certain Infectious and Parasitic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.
Part 1: Top 5 ICD-10-CM Chapters 2019 | Acute Care Reviews
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.
Coding & Quality Measures Tip: Social Determinants of Health
The HIM world has been buzzing recently with discussion of “Social Determinants of Health” and coded data. What does this mean for coders and the HIM field?
CDC Develops ICD-10 Code for 2019 Novel Coronavirus (COVID-19)
The Centers for Disease Control and Prevention (CDC) is in process of developing a new code for the COVID-19 (coronavirus) that will be released October 1, 2020. In the meantime, the CDC has provided advice on coding the COVID-19 coronavirus.
Most Common DRG’s with Recommendations 2019: #1
We’re finally at the #1 most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. Most have probably already guessed what the correct DRG would be with the most recommendations. There are just some diagnoses and DRG’s that will always be a thorn in the side for coders. #1 DRG with the most recommendations during HIA reviews : DRG 871—Septicemia or severe sepsis w/o mechanical ventilation >96 hours with MCC
Most Common DRG’s with Recommendations 2019: #2
We’re now at the second most common DRG with recommendations by HIA for 2019. Just to recap, HIA reviewed over 50,000 inpatient records in 2019. We are counting down to # 1. #2 DRG with the most recommendations during HIA reviews: DRG 872—Septicemia or severe sepsis w/o mechanical ventilation >96 hours w/o MCC.
Most Common DRG’s with Recommendations 2019: #3
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #3 DRG 190—Chronic obstructive pulmonary disease with MCC.
Most Common DRG’s with Recommendations 2019: #4
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #4 is DRG 193—Simple pneumonia & pleurisy with MCC.
Most Common DRG’s with Recommendations 2019: #5
In 2019, HIA reviewed over 50,000 inpatient records. Wow! That is a lot of records. Even with this large number of records, the DRG’s with recommendations are still the ones that coders typically see during audits. #5 DRG with the most recommendations during HIA reviews : DRG 853—Infectious & Parasitic diseases with O.R. procedure with MCC