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Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition

Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition. Chapter 6 : Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders. Learning Objectives. Review the chapter’s learning objectives

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Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition

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  1. Basic ICD 10-CM/PCS and ICD-9-CM Coding, 2015 Edition Chapter 6: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders

  2. Learning Objectives • Review the chapter’s learning objectives • At the conclusion of this chapter, what must you know about the coding of endocrine, nutritional and metabolic diseases and immunity disorders?

  3. ICD-9-CM Chapter 3 Categories and Sections • Categories 240–246, Disorders of Thyroid Gland • Categories 249–259, Diseases of Other Endocrine Glands • Categories 260–269, Nutritional Deficiencies • Categories 270–279, Other Metabolic and Immunity Disorders

  4. ICD-9-CM Categories 240–246 • Review category titles within this section • Goiter/Hyperthyroidism • Hypothyroidism • Congenital • Acquired • Thyroiditis • Other disorders

  5. ICD-9-CM Categories 249–259 • This section contains codes for • Diabetes mellitus and Secondary diabetes mellitus • Other disorders of pancreatic internal secretion • Disorders of other endocrine glands • Parathyroid • Pituitary • Thymus • Adrenal • Ovarian • Testicular

  6. ICD-9-CM and Diabetes Mellitus • A metabolic disease; pancreas does not produce insulin normally • Cause can be hereditary or nonhereditary • Symptoms produced by too much sugar in blood and urine • Treatment may include insulin, oral antidiabetic agents, and/or controlled diet

  7. ICD-9-CM Diabetes Mellitus (continued) • ICD-9-CM subcategory codes 250.0–250.9 • Fourth-digit subcategories • Identify the presence or absence of complications and/or manifestations • 250.0 indicates no mention of complication • 250.1, 250.2, 250.3 indicate a primary complication exists • 250.4, 250.5, 250.6, 250.7, 250.8 indicate specific types of manifestations from diabetes • 250.9 indicates unspecified complication

  8. ICD-9-CM Diabetes Mellitus (continued) • Two types of diabetes: Type I and Type II • Type I or type 1 diabetes • Previously described as insulin-dependent diabetes • Also known as juvenile type • Condition typically originates in childhood or young adult years • Absolute lack of insulin production or absence of pancreatic beta cells • Insulin must be administered • Cause is unknown • Less common form of diabetes; Type II more common

  9. ICD-9-CM Diabetes Mellitus (continued) • Type II or type 2 diabetes • Previously described as non-insulin-dependent diabetes • Also known as adult onset type • Condition typically originates in older adults but has been diagnosed in younger people recently • Lack of proper functioning of pancreatic beta cells • Insulin not usually required but may be administered • Risk factors include obesity and heredity but exact cause is unknown

  10. ICD-9-CM Diabetes Mellitus (continued) • Diabetic ketoacidosis, code 250.13 • Typically ketoacidosis develops in type I or type 1 diabetes and is, by definition, uncontrolled diabetes • Doctor may specifically document the type of diabetes as type II or type 2 but less likely to develop ketoacidosis

  11. ICD-9-CM Diabetes Mellitus (continued) • ICD-9-CM Fifth-digit subclassifications • Fifth digit of “0” • Type II or 2 • Unspecified type – type not stated in record • Out-of-date terminology: non-insulin dependent, NIDDM, or adult onset diabetes • Use Type II or 2 even if patient requires insulin • Not stated as “uncontrolled” • Use additional code, if applicable, for associated long-term (current) insulin use, V58.67 • If insulin is given temporarily to bring a type II patient’s blood sugar under control, V58.67 is not assigned.

  12. ICD-9-CM Diabetes Mellitus (continued) • ICD-9-CM Fifth-digit subclassifications • Fifth digit of “1” • Type I or 1 • Juvenile type • Out-of-date terminology that may be used to describe Type I diabetes: Insulin dependent type or IDDM • Not stated as “uncontrolled”

  13. ICD-9-CM Diabetes Mellitus (continued) • ICD-9-CM Fifth-digit subclassifications • Fifth digit of “2” • Type II or 2 • Unspecified type—type not stated in record • Out-of-date terminology to describe Type II diabetes: non-insulin dependent, NIDDM, or adult-onset • Use if Type II patient requires insulin • Stated as “uncontrolled” or out of control • Use additional code, if applicable, for associated long-term (current) insulin use, V58.67 • If insulin is given temporarily to bring a type II patient’s blood sugar under control, V58.67 is not assigned

  14. ICD-9-CM Diabetes Mellitus (continued) • ICD-9-CM Fifth-digit subclassifications • Fifth digit of “3” • Type I or 1 • Juvenile type • Out-of-date terminology: Insulin dependent type or IDDM • Stated as “uncontrolled” or out of control

  15. ICD-9-CM Diabetes Mellitus (continued) • ICD-9-CM Complications and manifestations • If causal relationship exists • First code from 250 category • Second code for the complication or manifestation • Alphabetic Index entry “Diabetes, Diabetic” • Second code in brackets • Use Alphabetic Index for other conditions that does not appear under main term of diabetes, diabetic

  16. Secondary Diabetes Mellitus and ICD-9-CM • ICD-9-CM Category 249 • Secondary means caused by another disease • Secondary means this form of diabetes is due to another disease • Occurs in patients with cystic fibrosis, Cushing’s Syndrome, a malignant neoplasm, and certain genetic disorders

  17. Secondary Diabetes Mellitus and ICD-9-CM (continued) • ICD-9-CM Category 249 • Same fourth digits as category 250 codes for complications and manifestations • Two fifth digit codes: • 0 for not stated as uncontrolled, or unspecified • 1 for uncontrolled • Types I and II do not apply to secondary diabetes

  18. ICD-9-CM Categories 260–269 • Review category titles within this section • Nutritional deficiencies • Kwashiorkor • Marasmus • Malnutrition • Vitamin deficiencies

  19. ICD-9-CM Categories 270–275 • Review category titles within this section • Other metabolic and immunity disorders • Amino-acid transport • Carbohydrate transport • Lipoid metabolism • Plasma protein metabolism • Mineral metabolism

  20. ICD-9-CM Category 274 • Various acute and chronic conditions caused by gout • Gout is a disorder in which uric acid or urate crystals are deposited in soft tissues with resulting inflammation and degenerative changes • Most commonly affect the joints such as the large joint of the big toe • Associated with hyperuricemia

  21. ICD-9-CM Category 276 • Disorders of fluid, electrolyte, and acid-base balance • Usually symptoms of a larger disease • Usually coded as additional diagnosis • Can be coded as principal diagnosis if it is the reason for admission or treatment when underlying condition does not require admission or treatment

  22. ICD-9-CM Category 277–279 • Other disorders of metabolism • Cystic fibrosis • Obesity • Disorders involving the immune mechanism • Humoral immunity • Cell-mediated immunity • Autoimmune disease

  23. ICD-9-CM Category 279 • Graft-versus-host disease (GVHD) • Reported as an additional code after complication of transplanted organ (usually bone marrow) or complication of blood transfusion • Three forms • Acute GVHD • Chronic GVHD usually begins more than 3 months after transplant • Acute on Chronic GVHD • Additional codes are used to describe the associated manifestations of GVHD

  24. ICD-10-CM Chapter 4: Endocrine, Nutritional and Metabolic Diseases Chapter 4 of ICD-10-CM: Endocrine, Nutritional, and Metabolic Diseases, E00–E89 Includes common disorders of thyroid gland, obesity, dehydration and diabetes mellitus Other conditions coded to chapter 4 include intraoperative complications of endocrine system, malnutrition, metabolic disorders, and postprocedural endocrine and metabolic compliations, not elsewhere classified

  25. ICD-10-CM and Diabetes Significant change in ICD-10-CM is the classification of diabetes mellitus Each type of diabetes has a category of codes E08, Diabetes mellitus due to underlying condition E09, Diabetes or chemical induced diabetes mellitus E10, Type 1 diabetes mellitus E11, Type 2 diabetes mellitus E13, Other specified diabetes mellitus

  26. Coding Guidelines and Instructional Notes for ICD-10-CM Chapter 4 Chapter specific guidelines Diabetes mellitus codes are combination codes that include the type of diabetes, the body system affected and the complication affecting that body system Assign as many codes from categories E08–E13 as needed to identify all of the associated conditions that the patient had

  27. Coding Guidelines and Instructional Notes for ICD-10-CM Chapter 4 Chapter specific guidelines Notes appear under Diabetes categories E08 Diabetes mellitus due to underlying condition Code first the underlying condition Use additional code to identify any insulin use E09 Drug or chemical induced diabetes mellitus Code first poisoning due to drug or toxin if applicable Use additional code for adverse effect to identify drug Use additional code to identify any insulin use

  28. ICD-10-CM and Diabetes Significant change in ICD-10-CM is the classification of diabetes mellitus Five categories for diabetes mellitus Expanded to reflect manifestations and complications of diabetes by using 4th or 5th characters rather than using an additional code. ICD-10-CM does not classify diabetes as out of control, poorly controlled or inadequately controlled Use codes in ICD-10-CM to report uncontrolled status by using code for diabetes mellitus, by type, with hyperglycemia

  29. ICD-10-CM Five Categories for Diabetes Mellitus • E08, Diabetes mellitus due to underlying condition • E09, Drug or chemical induced diabetes mellitus • E10, Type 1 diabetes mellitus • E11, Type 2 diabetes mellitus • E13, Other specified diabetes mellitus

  30. Coding Overview for ICD-10-CM, Chapter 4 • In ICD-10-CM, the diabetes mellitus codes are combination codes • Type 1 and Type 2 diabetes codes contain the details about the type of diabetes and most of the associated complications. • A few diabetes codes require the use of an additional code, for example, to identify the stage of chronic kidney disease caused by diabetes

  31. Coding Overview for ICD-10-CM, Chapter 4 • For other types of diabetes, the underlying condition is listed first, followed by the diabetes code that indicates any associated complication • For example: • E08, Diabetes mellitus due to underlying condition • Code first the underlying condition, such as Cushing’s • E09, Diabetes or chemical induced diabetes mellitus • Code first (T36–T65) to identify drug or chemical

  32. Coding Overview for ICD-10-CM, Chapter 4 • Other forms of diabetes are coded elsewhere in ICD-10-CM: • Gestational diabetes, O24.44 • Neonatal diabetes, P70.2 • ICD-10-CM diabetes codes include one or more of the complications or manifestations that exist in a particular body system

  33. Coding Overview for ICD-10-CM, Chapter 4 • Coder may assign as many codes from categories E08–E13 as needed to identify all the associated conditions that a patient may have treated • Additional code (Z79.4) is available to indicate the use of insulin, except with Type 1 diabetes

  34. Coding Overview for ICD-10-CM, Chapter 4 • Additional codes in Chapter 4 may be used as additional codes to indicate: • Functional activity by neoplasms and ectopic endocrine tissue, • Hyperfunction or hypofunction of endocrine glands associated with neoplams and oather conditions classified elsewhere

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