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ICD-10-CM Chapter-Specific Guidelines: Infectious Diseases, Neoplasms, Blood Disorders, Diabetes, Mental Disorders, Pain

This guide provides coding guidelines for specific chapters of the ICD-10-CM, including information on infectious diseases, neoplasms, blood disorders, diabetes, mental disorders, and pain. It includes examples, sequencing guidelines, and coding recommendations.

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ICD-10-CM Chapter-Specific Guidelines: Infectious Diseases, Neoplasms, Blood Disorders, Diabetes, Mental Disorders, Pain

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  1. CHAPTER 5 CHAPTER-SPECIFIC GUIDELINES (ICD-10-CM CHAPTERS 1-10)

  2. Certain Infectious and Parasitic Diseases, Chapter 1 A00-B99 Classified according to etiology (cause) of disease Combination coding = 1 code to fully describe Dx B37.0 Candidiasis infection of mouth Multiple coding = 2 or more to fully describe Dx N39.0 (UTI), B96.2 (E. coli)

  3. Resistant Infections and Sepsis Resistant to antibiotics Examples: Multidrug-resistant Mycobacterium tuberculosis (MDR-TB) Exceptions: Methicillin-resistant Staphylococcus aureus (MRSA) Methicillin-susceptible Staphylococcus aureus (MSSA) First-listed Dx = Infection Followed by code from category Z16, Infection with drug resistant microorganism

  4. Sepsis, Severe Sepsis, and Septic Shock Sepsis = septicemia If unknown organism, report A41.9, Sepsis, unspecified SIRS = inflammatory condition associated with sepsis Severe sepsis = single or multiple organ dysfunction (MOD), must be documented Report infection, followed by an R65.2 code Septic shock = circulatory failure associated with severe sepsis Report infection first, followed by R65.21

  5. Human Immunodeficiency (1 of 2) B20 reports HIV infection and includes AIDS Positive serology or culture, but no symptoms, report: Z21, Asymptomatic HIV status HIV exposure, but no positive serology, report: Z20.6, contact/exposure to HIV Inconclusive serology, R75 Used for newborns of AIDS mothers

  6. Human Immunodeficiency (2 of 2) HIV testing, report Z11.4, Encounter for screening for HIV Assign additional codes for documented high-risk behavior: Z72.51, High-risk heterosexual behavior Z72.52, High-risk homosexual behavior Z72.53, High-risk bisexual behavior

  7. Neoplasms, Chapter 2 C00-D49 C00-C96, Malignant neoplasms Primary and secondary D00-D09, Ca in situ (CIS) Not invasive D10-D3A, Benign D37-D48, Uncertain Not clearly benign or malignant D49, Unspecified behavior Not stated as to behavior

  8. Stages of Neoplasms Staging for renal cancer stages Stage I tumor of kidney capsule only Stage II tumor invading renal capsule/vein but within fascia Stage III tumor extending to regional lymph node/vena cava Stage IV other organ metastasis Pathology report and staging information will be documented in medical record

  9. Sequencing and Complications Treatment directed at primary site, sequence primary first secondary site, sequence secondary first Types: Chemotherapy, Z51.11 Immunotherapy, Z51.12 Radiation therapy, Z51.0 Complications, sequence complication first

  10. History of Neoplasm Codes History of neoplasm codes are only reported when neoplasm eradicated and is no longer present with no active treatment Example: Z85 personal history of malignant neoplasm If active treatment, such as chemo, no history code can be reported

  11. Chapter 3, ICD-10-CM Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism (D50-D89) Frequently reported codes: Anemia, D50-D64 Coagulation Defects, D65-D69 Other Disorders of Blood and Blood-Forming Organs, D70-D77

  12. Endocrine, Nutritional, and Metabolic Diseases, Chapter 4 E00-E89 Diabetes codes E08-E13 Due to conditions classified elsewhere, E08 Drug or chemical induced DM, E09 Type 1 DM, E10 Type 2 DM, E11 Other specified DM, E13

  13. Diabetes Mellitus DM codes are combination codes that include type of DM, body system affected, and complications Example: E10.21 Type 1 diabetes mellitus with diabetic nephropathy If type of DM not stated, query physician

  14. Mental, Behavioral and Neurodevelopmental Disorders, Chapter 5 (1 of 2) F01-F99 Alcohol dependence and use, F10 Opioid, cannabis, sedatives, cocaine, stimulants, hallucinogens, nicotine, F11-F19 Psychological disorders, F20-F29 Mood disorders, F30-F39 Such as Bipolar Disorder

  15. Mental, Behavioral and Neurodevelopmental Disorders, Chapter 5 (2 of 2) Anxiety, stress-related, etc., F40-F48 Behavior syndromes, F50-F59 Such as eating and sleep disorders Adult personality and behavior, F60-F69 Intellectual disabilities, F70-F79 Developmental disorders, F80-F89 Child or adolescent behavioral and emotional disorders, F90-F98 Unspecified mental disorder, F99

  16. Pain Pain disorders related to psychological factors, report G89 for pain and F45.41 for pain related to psychological factors Dementia F01 (vascular dementia) F02 (dementia in diseases classified elsewhere) F03 (unspecified dementia)

  17. Diseases of the Nervous System, Chapter 6 G00-G99 Many combination codes Example G06.0 Intracranial abscess and granuloma Manifestation codes Example G21.11 Neuroleptic induced parkinsonism Use additional code for adverse effect, if applicable (T43.3-T43.5) to identify drug

  18. Non-Psychological Pain Localized pain is reported with codes throughout the I-10 Example, ear pain (H92.0-) or limb pain (M79.6-) Category G89 is NEC pain Example, G89.11 NEC acute pain due to trauma or G89.21 NEC chronic pain due to trauma R52 reports unspecified pain that is: Acute, chronic, generalized, or NOS

  19. Dominant and Nondominant Sides Dominant side: right- or left-handed Paralysis (plegia) is reported based on dominant or nondominant side Example G81.10 Spastic hemiplegia affecting unspecified side G81.11 Spastic hemiplegia affecting right dominant side G81.12 Spastic hemiplegia affecting left dominant side G81.13 Spastic hemiplegia affecting right nondominant side G81.14 Spastic hemiplegia affecting left nondominant side If dominant unknown, report dominant if right-sided

  20. Diseases of the Eye and Adnexa, Chapter 7 H00-H59 Does not contain all the eye and adnexa codes Chapter Excludes2 directs to other categories, such as: injury (trauma) of eye and orbit (S05.-) injury, poisoning and certain other consequences of external causes (S00-T88) neoplasms (C00-D49)

  21. Structure of Eye and Ocular Adnexa Figure 5.15 Eye and Ocular Adnexa

  22. Hordeolum and Chalazion Hordeolum = infection of sebaceous glands (stye) reported on location and type Right or left upper/lower, or unspecified External, report H00.01- Internal, report H00.02- Chalazion = infection of eyelid that forms mass reported on location H00.1

  23. Entropion/Ectropion Entropion = turning inward of eyelid, H02.0- Figure 5.18 • Ectropion = turning outward of eyelid, H02.1- Figure 5.19

  24. Lacrimal System Category H04 Codes reported on right, left, bilateral, unspecified, such as: H04.131 Lacrimal cyst right lacrimal gland H04.132 Lacrimal cyst left lacrimal gland H04.133 Lacrimal cyst bilateral lacrimal glands H04.139 Lacrimal cyst unspecified lacrimal gland Figure 5.17 Lacrimal apparatus

  25. Diseases of the Ear and Mastoid Process, Chapter 8 H60-H95 Excludes2 indicates other categories for reporting other ear conditions, such as: endocrine, nutritional and metabolic diseases (E00-E89) injury, poisoning and certain other consequences of external causes (S00-T88) neoplasms (C00-D49) H60-H95 codes report diseases of external, middle, and inner ear, as well as mastoid, other, and surgical complications NEC

  26. Diseases of the Circulatory System, Chapter 9 I00-I99 Excludes2 note indicates other categories for other circulatory conditions, such as: neoplasms (C00-D49) symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94) systemic connective tissue disorders (M30-M36) I00-I99 reports conditions such as rheumatic fever, hypertension, ischemic heart disease, cerebrovascular diseases, etc.

  27. Hypertension (1 of 2) Report I10; includes arterial, benign, essential, malignant, primary, and systemic Arterial: Increased arterial blood pressure, hypertension Systemic: Arterial BP exceeds norm for several months Primary: Essential, cause unknown Secondary: Due to underlying condition

  28. Hypertension (2 of 2) Transient: Temporary, R03.0, elevated BP without Dx of hypertension During or due to pregnancy, O13.- or O14.-

  29. Hypertension with Heart Disease (1 of 2) I11, Hypertensive heart disease Includes conditions reported with I50.- or I51.4-I51.9 (myocarditis, cardiomegaly, ill-defined or unspecified heart disease) when condition due to hypertension I11.0 Hypertensive heart disease with heart failure Hypertensive heart failure Use additional code to identify type of heart failure (I50.-) I11.9 Hypertensive heart disease without heart failure Hypertensive heart disease NOS

  30. Hypertension with Heart Disease (2 of 2) Same heart condition not stated to be “due to hypertension” or “hypertensive,” report the heart disease and hypertension separately

  31. Chronic Kidney Disease and Hypertension (1 of 2) Assume a relationship between the chronic kidney disease and the hypertension I13, combination code for category hypertensive heart and chronic kidney disease If heart disease is present, assign a category I50 code

  32. Chronic Kidney Disease and Hypertension (2 of 2) CRF/CKD/CRI + hypertension I12.9 + N18.9 CKD stage 1 + hypertension I12.9 + N18.1 CKD stage 2 + hypertension I12.9 + N18.2 CKD stage 3 + hypertension I12.9 + N18.3 CKD stage 4 + hypertension I12.9 + N18.4 CKD stage 5 + hypertension I12.9 + N18.5 CKD stage 6 or ESRD or on dialysis + I12.9 + N18.6 Patient with CKD on any type of dialysis I12.9 + N18.6 + Z99.2

  33. Myocardial Infarction (1 of 2) Acute heart attack with occlusion of coronary artery STEMI, ST elevation MI, most severe, total occlusion Example: I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery NSTEMI, non-ST elevation MI, less severe, partial occlusion Example, I21.4 Non-ST elevation (NSTEMI) myocardial infarction

  34. Myocardial Infarction (2 of 2) Subsequent STEMI or NSTEMI are reported with I22.- Example: I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall Complications within 28 days of initial MI, I23 Example: I23.1 Atrial septal defect as current complication following acute myocardial infarction

  35. Diseases of the Respiratory System, Chapter 10 J00-J99 Some codes are combination codes that identify condition and causative organism Example: J03.01 Acute recurrent streptococcal tonsillitis Other codes require separate reporting of organism Example: J01.01 Acute recurrent maxillary sinusitis (Use additional code (B95-B97) to identify infectious agent )

  36. ConclusionCHAPTER 5 CHAPTER-SPECIFIC GUIDELINES (ICD-10-CM CHAPTERS 1-10)

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