Introduction to ICD-10-CM parts 9 & 10 Disorder’s of the Respiratory & Circulatory System

1. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Respiratory & Circulatory System Diseases of the circulatory and respiratory systems include: §       Acute rheumatic fever (I00-I02) §       Chronic rheumatic heart disease (I105-I09) §       Hypertensive disease (I10-I15) §       Ischemic heart disease (I20-I25) §       Pulmonary heart disease and diseases of pulmonary circulation (I26-I28) §       Other forms of heart disease (I30-I52) §       Cerebrovascular disease (I60-I69) §       Diseases of the arteries, arterioles, and capillaries (I70-I79) §       Diseases of the veins and lymphatic vessels and lymph nodes, not elsewhere classified (I80-I89) §       Other and unspecified disorders of the circulatory system (I95-I99)

2. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Respiratory & Circulatory System • Hypertension is probably the most common condition included in this chapter. There are two broad categories of hypertension: primary (essential) and secondary. Secondary hypertension has an identifiable cause whereas primary hypertension has no known cause (idiopathic). • Hypertension heart conditions classified to I50.- or I51.4 – 151.9 are assigned to a code from category I11 – Hypertensive heart disease • Hypertensive Chronic Kidney Disease -Assign codes from category I12 • The appropriate code from category N18 should be used as a secondary code with a code from category I12 to identify the stage of chronic kidney disease.

3. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Respiratory & Circulatory System • The codes in category I13 – Hypertensive heart and chronic kidney disease, are combination codes that include hypertension, heart disease, and chronic kidney disease. • For patients with both acute renal failure and chronic kidney disease, an additional code for acute renal failure is required • Hypertensive Cerebrovascular Disease -For hypertensive cerebrovascular disease, first assign the appropriate code from category I60-I69, followed by the appropriate hypertension code. • Hypertensive Retinopathy - Subcategory H35.0 – Background retinopathy and retinal vascular changes, should be used with code I10 – Essential (primary) hypertension, to include the systemic hypertension. The sequencing is based on the reason for the encounter.

4. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Respiratory & Circulatory System You may assign an additional code from category I50.- to identify the type of heart failure. More than one code from category I50.- may be assigned if the patient has systolic or diastolic failure and congestive heart failure. High blood pressure in the absence of a diagnosis of hypertension should be coded R03.0 - Elevated blood pressure reading without diagnosis of hypertension. Category I50.- - Heart failure, includes associated pulmonary edema. Hypertensive heart disease is classified as I11.-. Hypertensive heart disease and renal failure are classified as I13.-.

5. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Respiratory & Circulatory System • The guidelines for assigning the correct I22 (subsequent) code are the same as for the initial AMI. The documentation in the patient’s chart should indicate what area of the heart muscle is affected. • For category I21 a fifth character id required. In addition, the instructional note indicates to use an additional code to identify other circumstances such as tobacco use, dependence, or body mass index (BMI). • Subcategories I21.0 – I21.2 and code I21.3 are used for STEMI. Code I21.4 is used for NSTEMI myocardial infarction and transmural MIs • Code I21.3 ST elevation (STEMI) myova5rdial infarction of unspecified site, is the default for the unspecified term “acute myocardial infarction.

6. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Respiratory & Circulatory System • The sequencing of the I22 and I21 codes depends on the circumstances of the encounter. If a patient who is in the hospital due to an AMI has a subsequent AMI while still in the hospital, code I21 would be sequenced first as the reason for admission, with code I22 sequenced as a secondary code. • If a patient has a subsequent AMI after discharge for care of an initial AMI, and the reason for admission is the subsequent AMI, the I22 code should be sequenced first followed y the I21.

7. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Respiratory & Circulatory System • The neurologic deficits caused by cerebrovascular disease may be present from the onset or may arise at any time after the onset of conditions classifiable to categories I60 – I67 • Codes from category I69 may be assigned on a health care record with codes from I60 – I67, is the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease. • Assign code Z86.73 – Personal history of transient Ischemic attack (TIA), and cerebral infarction without residual deficits (and not a code from category I69), as an additional code for history of cerebrovascular disease when no neurologic deficits are present.

8. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Respiratory & Circulatory System • Acute upper respiratory infections (J00 – J06) includes: acute rhinitis, acute nasopharyngitis (common cold), acute sinusitis, acute pharyngitis, acute tonsillitis, acute laryngitis, acute upper respiratory infection, and acute bronchitis. • Pneumonia can be complicated to code. Make sure to determine the cause of the pneumonia before attempting to select the appropriate code. Do not forget to code the infections organism (agent) when coding diseases of the respiratory system. •  When a patient has been exposed to SARS, but nothing in the laboratory findings indicates the disease if present, use Z20.89 because there is not a classification specifically for SARS.

9. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Respiratory & Circulatory System • Chronic obstructive pulmonary disease includes: bronchitis, emphysema, asthma, bronchiectasis, extrinsic allergic alevolitis and chronic airway obstruction, not elsewhere classified. • A code from subcategory J96.0 – Acute respiratory failure, or subcategory J96.2 – acute and chronic respiratory failure, may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital • If a patient is treated for acute respiratory failure, a code from J96.0- is reported as the first listed diagnosis. Respiratory failure may be listed secondary if it is present on admission and not the first listed/principal diagnosis.

10. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Digestive System Diseases of the digestive system (K00 – K94) Tabular List includes the following: • §       Diseases of the Oral Cavity and Salivary lands (K00-L14) • §       Diseases of the Esophagus, Stomach, and duodenum (K20-K38) • §       Diseases of the Appendix (K35-K38) • §       Hernia (K40-K46) • §       Noninfectious Enteritis and Colitis (K50-K52) • §       Other Diseases of Intestines (K55-K63) • §       Diseases of the Peritoneum and Retroperitoneum (K65-K68) • §       Diseases of Liver (K70-K77) • §       Disorders of Gallbladder, Biliary Tract, and Pancreas (K80-K87) • §       Other Diseases of the Digestive System (K90-K94)

11. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Digestive System • Diseases of the esophagus, stomach and duodenum (K20-K31) include ulcers, inflammation, reflux, rupture, perforation and spasms. • There are many types and causes of gastritis; use caution when making a selection. Gastritis and duodenitis are classified as K29.- and require a fifth character when codes are assigned in this category to identify “with or without bleeding.” • Combination coding is used to identify gangrene or obstruction. Documentation indicating that the hernia is “strangulated” and/or “incarcerated” is classified as an obstruction. Incision ventral hernia is classified as recurrent. • Many of the codes require a fifth-digit based on whether he hernia is unilateral or bilateral and whether it is recurrent or not specified as recurrent.

12. Introduction to ICD-10-CM parts 9 & 10Diseases of the Skin & Subcutaneous Tissue • Infections of Skin and Subcutaneous Tissue (L00-L08) •  Bullous Disorders (L10-L14) •   Dermatitis and Eczema (L20-L30) •  Papulosquamous Disorders (L40-L45) •  Urticaria and Erythema (L49-L54) • Radiation-related Disorders of the Skin and Subcutaneous Tissue (L55 L59) •   Disorders of Skin Appendages (L60-L75) •  Intraoperative and Postprocedural Complications of Skin and Subcutaneous Tissue (L76) • Other Disorders of the Skin and Subcutaneous Tissue (L80-L99

13. Introduction to ICD-10-CM parts 9 & 10Diseases of the Skin & Subcutaneous Tissue • Many codes in this category are identified by type of condition and anatomic location on the body. In addition, if an infectious agent is present, the coder is instructed to use an additional code from categories B95-B97 to identify the infectious agent. Pay careful attention to Excludes 1 and Excludes 2 notes in this category. • Codes from category L89, pressure ulcer are combination codes that identify the site of the pressure ulcer as well as the stage of the ulcer • ICD-10-CM classifies pressure ulcer stages based on severity, which is designated by stages 1 through 4, unspecified stage and unstageable. • Assign as many codes from category L89 as needed to identify all the pressure ulcers the patient has, if applicable.

14. Introduction to ICD-10-CM parts 9 & 10Diseases of the Skin & Subcutaneous Tissue • Most of the codes within chapter 13 have site and laterality designations. the site represents that bone, joint, or the muscle involved. For some conditions where more than one bone, joint or muscle is usually involved, such as osteoarthritis, there is a “multiple sites” code available. For categories where no multiple site code is provided and more than one bone, joint or muscle is involved, multiple codes should be used to indicate the different sites involved. • Seventh character A is for use as long as the patient is receiving active treatment for the fracture • Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes.

15. Introduction to ICD-10-CM parts 9 & 10Diseases of the Skin & Subcutaneous Tissue • Osteoporosis is a systemic condition, meaning that all bones of the musculoskeletal system are affected. Therefore, site is not a component of the codes under category M81-Osteoporosis without current pathological fracture. • The site codes under category M80-Osteoporosis with current pathological fracture, identify the site of the fracture, not the osteoporosis. • When the documentation indicates a spontaneous fracture, code the encounter as a pathological fracture. • When the sole purpose is treatment of the pathological or spontaneous fracture, the pathologic fracture if the first listed diagnosis.

16. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Genitourinary System Chapter 10 in the Tabular List includes the following sections: Glomerular Diseases (N00-N08) Renal Tubulo-interstitial diseases (N10-N16) Acute Kidney Failure and Chronic Kidney Disease (N17-N19) Urolithiasis (N20-N23) Other Disorders of Kidneys and Ureters (N25-N29) Other Diseases of the Urinary System (N30-N39) Diseases of Male Genital Organs (N40-N53) Disorders of Breast (N60-N65) Inflammatory disorders of Female Genital Tract (N80-N89) Noninflammatory disorders of Female Genital Tract (N80-N89) Intraoperative and Postprocedural Complications and Disorders of Genitourinary system, Not elsewhere Classified (N99)

17. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Genitourinary System • Diabetes mellitus includes combination codes to identify the type of diabetes mellitus and any associated manifestations. • When a patient has diabetes with chronic kidney disease, there is a combination code to identity the kidney disease and the type of diabetes, which is not coded in the genitourinary chapter but using a diabetes code • Because there is a relationship with other conditions such as hypertension and diabetes mellitus, there are specific coding rules for both conditions when kidney disease is present.

18. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Genitourinary System • The ICD-10-CM classifies CKD based on severity. The severity of CKD is designated by stages 1 through 5. • Code N18.6, end stage renal disease (ESRD) is assigned when the provider has documented ESRD. • If both a stage of CKD and ESRD are documented, assign code N18.6 only. • Patient who have undergone kidney transplant may still have some for of CKD because the kidney transplant many not fully restore kidney function. Therefore, the presence of CKD alone does not constitute a transplant complication. • Assign the appropriate N18 code for the patient’s stage of CKD and code Z94.0 – Kidney transplant status.

19. Introduction to ICD-10-CM parts 9 & 10Disorder’s of the Genitourinary System • Disorders of the Breast: Firboadenomas of the breast are not coded in this section, but are coded in Chapter 2 of ICD-10-CM (Neoplasms). • This section includes benign mammary dysplasia, fibrocystic disease and fibrous masses or cysts of a hormonally mediated proliferative condition. Other diseases of the breast include inflammatory disease (eg, abscess, mastitis, hypertrophy, atrophy, and galactocele. • This section also includes signs and symptoms in the breat that may require further investigation, including mastodynia, lump or mass in breast and nipple discharge.