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ICD-10 Knowledge Center

Putting Together the Pieces of What We Know

ICD-10 Knowledge Center is a growing body of knowledge - a place to access our collective understanding of ICD-10 coding. The Knowledge Center, with assistance from our ICD-10 experts, facilitates to bring the benefit of collective experience of our team. The questions featured in this Knowledge Center are those submitted by our Members and uses our ICD-10 experts' input, comments, and feedback to create a contually evolving body of ICD-10 knowledge.

1) How do I code acute streptococcal tonsillitis with peritonsillar abscess in ICD-10-CM?

ICD-10-CM code for acute streptococcal tonsillitis is J03.00. But the excludes 1 at category J03 do not permit code for peritonsillar abscess J36 to be coded along with any code from J03. In our view, treatment management will have to do here some help for deciding the code. If the treatment is simply an antibiotic therapy as in tonsillitis, code it as J03.00. Instead if there is surgical drainage done for the abscess, code J36. In cases above like this, it would be prudent to consult the rendering physician also especially when reporting J03.00.

2) What is the code for retained products of conception (parts of placenta) after delivery without hemorrhage in ICD-10-CM?

3) I am confused here about a code for vomiting with colonic content in the vomitus to be selected in ICD-10-CM.

Colonic content in vomitus means fecal matter. Do select code R11.3, other vomiting without nausea for this condition.

4) What code will replace 250.00 of ICD-9-CM, the most common diagnosis of my physician when ICD-10-CM codes will become effective?

E11.9, type 2 diabetes mellitus without complication is the most appropriate replacement as per my understanding.

5) Cradle cap dermatitis in infants is coded in ICD-10-CM with code?

Code L21.0, seborrhea capitis is the code for cradle cap dermatitis or crusta lactea as per ICD-10-CM.

6) How should I code the diagnosis of primary carcinoma of left ovary with abnormally high secretion of estrogens in ICD-10-CM system?

One of the most important features that make ICD-10-CM different from ICD-9-CM is laterality. Codes are different for the same conditions on the organs of right & left side of the body. ICD-10-CM code for primary carcinoma of left ovary is C56.1, and E28.0 is for hyperestrogenism.

7) My physician has documented a diagnosis statement as fever associated with sickle-disease. Please help me in coding as per ICD-10-CM.

You can code D57.1, sickle-cell disease for sickle-cell disease and code R50.8, other specified fever for the associated fever. Code D57.1 should be first listed and R50.8 should be the additional diagnosis.

8) How shall I code for an encounter of a patient for removal of internal fixations placed to treat a displaced oblique fracture of right humerus?

As per ICD-10-CM coding guidelines the codes for aftercare should not be used for aftercare for injuries. Instead the injury code with 7th character D should be selected to indicate the encounter as subsequent encounter for fracture with routine healing. So the correct code for this encounter should be S42.33xD.

9) Can you please provide the ICD-10-CM code for idiopathic respiratory distress syndrome in a newborn?

The most appropriate code for this condition would be P22.0.

10) Suggest a suitable code for the diagnosis ruptured abdominal aortic aneurysm in a patient with syphilis with cardiovascular complication.

ICD-10-CM provides combination codes for syphilis in different stages of the disease along with different complications of the disease. Code A52.01, syphilitic aneurysm of aorta is the most appropriate code for this condition.

11) How do I code an initial encounter visit of a patient with prosthetic valve endocarditis due to Staphylococcus aureus as per ICD-10-CM?

You should code T82.6xxA, infection and inflammatory reaction due to cardiac valve prosthesis as first listed diagnosis and B95.6, Staphylococcus aureus as the cause of diseases classified elsewhere as additional diagnosis for this diagnostic statement. Since code T82.6xxA states that the complication is due to prosthetic valve, so no additional code is required to put a status Z code to indicate the prosthetic heart valve status of the patient.

12) ICD-10-CM provides codes for under-dosage effect of different drugs. My patient developed non-ketotic hyperglycemic hyperosmolar coma due to under dosage of insulin lente because of noncompliance due to financial constraints, initial encounter. How can I code this?

Yes, ICD-10-CM has provisions of coding for the effects of underdosing of drugs. You can code the said condition as T38.3x6A Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs as the first listed code, followed by E09.01, drug or chemical induced diabetes mellitus with hyperosmolarity with coma as additional code and also code Z91.120, patientÂ’s intentional underdosing of medication regimen due to financial hardship to indicate the intent. ICD-9-CM lacks such codes for underdosing effects of drugs.

13) How do I code secondary malignancy of parietal pleura with malignant pleural effusion in ICD-10-CM?

Code the said condition with code C78.2, secondary malignant neoplasm of pleura as first listed diagnosis, followed by code J91.0, malignant pleural effusion as additional diagnosis.

14) How can I code for metronidazole-resistant intestinal giardiasis as per ICD-10-CM?

ICD-10-CM has provisions for coding of resistance of the organisms to antimicrobial drugs along with code for the infection. So for the above said condition report code A07.1, Giardiasis [lambliasis] as first listed diagnosis and code Z16, infection with drug-resistant organisms as additional diagnosis. Remember that Z16 should always be additional diagnosis, not be the first listed diagnosis.

15) How different is the coding for late effects of burn injuries in ICD-10-CM compared to ICD-9-CM?

In ICD-10-CM coding of late effects or burn injuries require generally two codes. The first code should be for the condition or nature of the late effect followed by the late effect code for burn. Whereas in ICD-10-CM, such encounters should be coded with a burn injury code with 7th character extension S to indicate the sequelae or late effect.

16) I am a bit confused here with ICD-10-CM codes. My physician documents on most of his patients records coronary artery disease or ASHD. I was coding this condition with code 414.00 in ICD-9-CM. I am trying to find the code for the same in ICD-10, please suggest.

Since ICD-10-CM is more specific about the documentation requirements, it is better to get more details about the diagnosis. You may code the same condition in ICD-10-CM as I25.10, atherosclerotic heart disease of native coronary artery without angina pectoris.

17) How is hypertension coded in ICD-10-CM?

Coding guidelines for ICD-10-CM are more or less similar to that of ICD-9-CM. But ICD-10-CM does not provide any table for hypertension. One has to select the codes with the help of alphabetic index and tabular list. Also there is no differentiation of hypertension - benign or malignant. So the diagnosis hypertension can be coded with code I10, essential (primary) hypertension.

18) How do I code diabetic retinopathy in type II diabetes in ICD-10-CM? In ICD-9-CM, the same condition I was coding with two codes 250.50 [362.01] but I am not finding any slanted brackets in alphabetic index, and there is no [use additional code] instructional notes also in ICD-10-CM with the code for diabetes.

There are no slanted brackets used in the alphabetic index of ICD-10-CM. Moreover, ICD-10-CM codes for diabetes with complications are combination codes. Diabetes retinopathy may be coded with a single code only in ICD-10-CM. You can code this condition in ICD-10 with code E11.319, type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema.

19) How do I code for the encounter for cardiac clearance for electroconvulsive therapy (ECT) in ICD-10-CM? I was coding the same condition in ICD-9-CM with a V code. But what surprises me there is I found in ICD-10-CM V codes are external cause of injury codes?

Yes. V codes in ICD-10-CM are not for the conditions of V codes from ICD-9. This is also one of the major changes in ICD-10-CM. Z codes of ICD-10-CM are the codes for factors influencing health status and contact with health services. You can select code Z01.810, encounter for preprocedural cardiovascular examination for this encounter.

20) Where do I find a code in ICD-10-CM for a follow-up visit for forearm burn injury of second degree treated by surgical debridement in the first encounter? Can I code it with code Z09?

ICD-10-CM codes for burn injuries are coded with 7 digits, with a 7th character extension for episode of care. You can report the said condition with the injury code T22.219 as it is coded for active injury with the 7th character extension D for subsequent encounter. The 7th character extension D is used to indicate the encounter as for follow up visit. So the complete code will be T22.219D, burn of second degree of unspecified forearm, subsequent encounter.