Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 4: Certain Infectious and Parasitic Diseases (A00–B99)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of certain infectious and parasitic diseases?

3. ICD-10-CM Chapter 1, Certain Infections and Parasitic Diseases, A00–B99 Chapter organized into blocks of codes of bacterial, viral and other types of infections, HIV disease, and parasitic infections

4. ICD-10-CM New block of codes exist for infections with predominantly sexual mode of transmission New block of codes exist for viral hepatitis and other viral diseases

5. ICD-10-CM Term “sepsis” has replaced “septicemia” as an equivalent term Many codes expanded to reflect manifestations of the disease with the use of 4th or 5th characters allowing condition to be coded with one combination code instead of two codes

6. Coding Guidelines • Review ICD-10-CM Official Guidelines for Coding and Reporting • Chapter-specific guidelines exist for coding of certain infectious and parasitic diseases (A00–B99). • Topics included in the guidelines are human immunodeficiency infections, infectious agents as the cause of disease, infections resistant to antibiotics, sepsis, severe sepsis, and septic shock, and MRSA conditions

7. ICD-10-CM Guidelines HIV infection Code only confirmed cases, rules for sequencing Infectious agents as the cause of diseases classified to other chapters Use of categories B95, B96, and B97 Infections resistant to antibiotics Use of category Z16 Sepsis, severe sepsis, and septic shock and sequencing

8. Includes and Excludes Notes • Notes appear at the beginning of ICD-10-CM chapter • Includes: Diseases generally recognized as communicable or transmissible • Use additional code to identify resistance to antimicrobial drugs (Z16.-) • Excludes1 Note: Certain localized infections—see body system-related chapters. Infections and parasitic disease complicating pregnancy, childbirth and the puerperium (O98-). Influenza and other acute respiratory infections (J00-J22) • Excludes2 Note: Carrier or suspected carrier of infectious disease (Z22.-). Infectious and parasitic diseases specific to the perinatal period (P35–P39)

9. Review of the Entire Record • To code these conditions, the entire health record must be reviewed to identify the following: • Body Site • for example, eye, intestine, or blood • Specific organism responsible • for example, bacteria, virus or fungus • Etiology of disease • for example, parasite or food poisoning • Severity of the disease • for example, acute of chronic

10. Combination Codes and Multiple Coding • Combination codes identify both the condition and the causative organism • Mandatory multiple coding is required to describe etiology and manifestation when infectious and parasitic diseases produce a manifestation within another body system • Alphabetic Index identifies two codes

11. Sepsis, Severe Sepsis and Septic Shock in ICD-10-CM • Review definition of “sepsis” • Serious medical condition caused by the body’s immune response to an infection • Coder must review the physician’s documentation to determine if the causative organism is known • If only the term sepsis is documented, code A41.9, Sepsis, unspecified is the appropriate code

12. Sepsis, Severe Sepsis and Septic Shock in ICD-10-CM • Review definition of “severe sepsis” • An infection associated acute organ dysfunction • May also be referred to as systemic inflammatory response syndrome due to an infectious process with acute organ dysfunction • Two codes are required to code severe sepsis

13. Sepsis, Severe Sepsis and Septic Shock in ICD-10-CM • Review what is meant by septic shock • If septic shock is present, additional codes are required to identify the specific acute organ dysfunction, such as acute kidney failure (N17.-) or acute respiratory failure (J96.0-) • The Tabular List states that code R65.20 and R65.21 for severe sepsis without or with septic shock cannot be used as the principal, first-listed or the only code. • A “code first underlying infection” note appears to state to code first the particular infection that produced the severe sepsis.

14. HIV Disease in ICD-10-CM • Review the facts about HIV infection and AIDS • The HIV classification includes categories and codes: • B20 Human immunodeficiency virus [HIV] disease • Z21 Asymptomatic human immunodeficiency virus [HIV] infection status • R75 Inconclusive laboratory evidence of HIV

15. HIV Disease in ICD-10-CM • Follow the coding guidelines for HIV disease • Only confirmed cases of HIV disease are coded • AIDS code B20, followed by additional codes for all reported HIV-related conditions • Coding of pregnancy and HIV disease uses a code from the pregnancy chapter

16. HIV Disease in ICD-10-CM • Patient with HIV disease but treated for an unrelated condition, such as a traumatic injury or a disease not caused by HIV disease. Code B20 for HIV is additional diagnosis • Asymptomatic HIV infection status code Z21 • Patients with inconclusive laboratory evidence of HIV code R75

17. HIV Disease in ICD-10-CM • Testing for HIV • Z22.1, Encounter for screening for HIV • Additional codes may be applicable for high risk sexual behavior and for HIV counseling when provided during the screening encounter • Positive test results • Asymptomatic patient Z21 • Symptomatic patient—code to the disease present

18. Sequelae of Infectious and Parasitic Diseases in ICD-10-CM (B90–B94) • Certain infectious and parasitic diseases leave long-lasting effects after the infection is cured, which may be called a residual condition • Categories B90–B94 are used to identify the original infection that produces the problem or condition that patient has as a result of the infection. • Categories B90–B94 are not used if the original condition is still present or if the condition is identified as a chronic infection. • See “code first” note to code the condition the patient today first with an additional code to identify the sequelae fact

19. Bacterial and Viral Infectious Agents B95–B97 • Series of codes to identify the infective agents causing diseases • Used as additional diagnosis codes to identify the causative organism in diseases classified elsewhere • B95.0–B95.8: Streptococcus, staphylococcus, enterococcus • Example: Methicillin resistant Staphycoccus aureus • B96.0–B96.89: Other bacterial agents • Example: Escherichia coli (E. coli) • B97.0–B9789: Viral agents • Example: Respiratory syncytial virus (RSV)

20. Bacterial and Viral Infectious Agents B95–B97 • Codes are identified in the Alphabetic Index under “infection” or the name of the organism, such as “Streptoccoccus” • Codes from B95–B97 will most likely be used with another code that identifies the site of an infection but does not include the causative organism • For example, the diagnosis of urinary tract infection due to E. coli would require two codes • N39.0 Urinary tract infection, site not specified • B96.20 Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere

21. Infection with Drug Resistant Microorganisms • Coding of bacterial infections that are resistant to current antibiotics • This specificity is necessary to identify all infections documented as antibiotic resistant • Code Z16, Infections with drug resistant microorganisms, is assigned following the infection code for such cases

22. Methicillin Resistant Staphylococus Aureus (MRSA) • Coding of conditions due to MRSA bacteria are coded in one of two ways • A combination code that identifies the infection is due to MRSA • An additional code to identify the MRSA as the causative organism (B95.62) with a code for the site of the infection • Alphabetic Index entries main term of “infection” • Compare MRSA and MSSA—Methicillinsusceptible Staphylococus aureus (B95.61)

23. ICD-10-PCS Coding for Infectious and Parasitic Diseases • Infectious and parasitic diseases are not usually treated with surgical procedures. • However, the conditions are usually treated with medication therapy • Devices must be inserted in the patient for long-term intravenous infusions

24. ICD-10-PCS Coding for Infectious and Parasitic Diseases • There are six root operations that always involve a device: insertion, replacement, supplement, change, removal and revision • The root operation of insertion is putting in a nonbiological device. Inserting a vascular access device (for the infusion) would be coded to the root operation of insertion.

25. ICD-10-PCS Coding for Infectious and Parasitic Diseases • See Table 05H—insertion of a device in an upper vein such as subclavian, brachial, basilic or cephalic • Approach is either open, percutaneous or percutaneous endoscopic • Device is an infusion device • There is no option for a qualifier so Z is used for the seventh character

26. ICD-10-PCS Coding for Infectious and Parasitic Diseases • See Table 0JH—insertion of a infusion device pump or reservoir or vascular access device as another option used for intravenous infusions • Approach is either open or percutaneous • Device character identifies is an infusion device • There is no option for a qualifier so Z is used for the seventh character

27. ICD-10-PCS Coding for Infectious and Parasitic Diseases • When a device is no longer needed, the root operation Removal would be used • See Table 0JP for the body part location, the approach and the device. There is no qualifier option. • Other Tables 05P and 06P may also be used for other removal procedures

28. ICD-10-PCS Coding for Infectious and Parasitic Diseases • The patient may require invasive surgical procedures to treat the underlying condition that has caused the sepsis. • Repairing the intestine by excision, resection or a bypass procedure may also be coded for a patient with sepsis from a gastrointestinal source.

29. Exercises • Practice coding the diagnoses of certain infectious and parasitic diseases and the related procedures using the review exercises for Chapter 4