Allergy, Asthma, & Immunology

ICD-10 CM Training

• ICD-10-CM will be valid for dates of service on or after October 1, 2015– Outpatient dates of service of October 1, 2015 and

beyond. – Inpatient hospital service claims, is effective for dates of

discharge after September 30, 2015

ICD-10-CM Compliance Dates

• Covered Entities– Everyone covered by the Health Insurance Portability

Accountability Act (HIPPA)

• Non-Covered Entities– Worker’s Compensation– Auto Insurance– Non covered HIPAA entities are exempt but are

encouraged to adapt the new code set

Covered and Non-Covered Entities

• 21 Chapters• Alpha-numeric codes; not case-sensitive

– Codes begin with Alpha letter, A-Z, excluding U– Common errors

• I verses 1• O verses 0

• “X” Placeholder• 3 to 7 characters

– Decimal following 3rd character

ICD-10 Code Structure

• Placeholder “X”– Used for future expansion of a code– Fills in empty characters when a 6th and/or 7th character

apply– The placeholder may be used in different scenarios but

should never serve as the final character.

Example: W19.XXXA Unspecified fall, Initial Encounter

ICD-10 Code Structure

• 7th Character– Provides specified information regarding the clinical visit– Is required for certain categories and must be reported in

the seventh position– May be alpha or numeric– Has different meanings depending on the coding category

ICD-10 Code Structure

• Laterality– Some ICD-10-CM codes indicate laterality, specifying

whether the condition occurs on the left, right or is bilateral.

– If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.

– If the side is not identified in the medical record, assign the code for the unspecified side.

OGCR section 1.B.13

ICD-10 Code Structure

• “Other” Codes– Codes titled “other” or “other specified” are for use when

the information in the medical record provides detail for which a specific code does not exist.

• “Unspecified” Codes– Codes titled “unspecified” are for use when the

information in the medical record is insufficient to assign a more specific code.

OGCR section 1.A.9.a.b

ICD-10 Code Structure

• Excludes Notes– Excludes1

• A type 1 Excludes note is a pure excludes note• It means “NOT CODED HERE”• The code excluded should never be used at the same time• When two conditions cannot occur together

– Excludes2• Represents “Not included here”• The condition excluded is not part of the condition represented

by the code• It is acceptable to use both the code and the excluded code

together, when appropriateOGCR section 1.A.12.a.b

ICD-10 Structure

• “Code First” and “Use Additional Code”– ICD-10 has a coding convention that requires the

underlying condition be sequenced first followed by the manifestation.

– These instructional notes indicate the proper sequencing order of the codes.

OGCR section 1.A.13

• The “-” indicates there are additional reporting options

ICD-10 Code Structure

Most Common Diagnosis Codes

Allergic rhinitisICD-9 Code ICD-10

CodeDescription Excludes1 Excludes2

477.0 J30.9 Allergic rhinitis, unspecified

• allergic rhinitis with asthma (bronchial) (J45.909)

• rhinitis NOS (J31.0)

N/A

There are more specific code choice selections:

477.9 J30.0 Vasomotor rhinitis

477.0 J30.1 Allergic rhinitis due to pollen

477.8 J30.2 Other seasonal allergic rhinitis

477.1 J30.5 Allergic rhinitis due to food

477.2 J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander

477.8 J30.89 Other allergic rhinitis

Use additional code, where applicable, to identify:• exposure to environmental tobacco smoke (Z77.22)• exposure to tobacco smoke in the perinatal period (P96.81)• history of tobacco use (Z87.891)• occupational exposure to environmental tobacco smoke (Z57.31)• tobacco dependence (F17.-)• tobacco use (Z72.0

• Type– Due to animal hair and dander– Due to food– Due to pollen– Other seasonal allergic– Other allergic– Unspecified

Allergic Rhinitis Documentation Tips

Other chronic allergic conjunctivitisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

372.14 H10.45 Other chronic allergic conjunctivitis

• keratoconjunctivitis (H16.2-)

N/A

• Identify side:– Left– Right– Bilateral– Unspecified

• Use an external cause code following the code for the eye condition, if applicable, to identify the cause of the eye condition

Documentation Tips

AsthmaICD-9 Code ICD-10 Code Description Excludes1 Excludes2

493.00, 493.10 J45.20 Mild intermittent asthma, uncomplicated or NOS

• bronchitis due to chemicals, gases, fumes and vapors (J68.0)

• cystic fibrosis (E84.-)

493.01, 493.11 J45.22 Mild intermittent asthma with status asthmaticus

N/A N/A

493.02, 493.12 J45.21 Mild intermittent asthma with (acute) exacerbation

N/A N/A

493.82 J45.991 Cough variant asthma N/A N/A

493.90 J45.909J45.998

Unspecified asthma, uncomplicatedOther asthma

N/A N/A

493.91 J45.902 Unspecified asthma with status asthmaticus

• bronchitis due to chemicals, gases, fumes and vapors (J68.0)

• cystic fibrosis (E84.-)

493.92 J45.901 Unspecified asthma with (acute) exacerbation

• bronchitis due to chemicals, gases, fumes and vapors (J68.0)

cystic fibrosis (E84.-)

Asthma Severity ChartINTERMITTENT MILD

PERSISTENTMODERATE PERSISTENT

SEVERE PERSISTENT

SYMPTOMS 2 or less daysper week

More than 2days perweek

Daily Throughoutthe day

NIGHTIME AWAKENINGS

2 x’s permonth or less

3 – 4 x’s permonth

More thanonce perweek but notnightly

Nightly

RESCUE INHALER USE

2 or less daysper week

More than 2days perweek, but notdaily

Daily Several timesper day

INTERFERENCE WITH NORMAL ACTIVITY

None Minorlimitation

Somelimitation

Extremelylimited

LUNG FUNCTION FEVI>80% predicted and normal between exacerbations

FEV1>80%predicted

FEV1 60 –80%predicted

FEV1 lessthan 60%predicted

• When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

• Use additional code, where applicable, to identify:– exposure to environmental tobacco smoke (Z77.22)– exposure to tobacco smoke in the perinatal period (P96.81)– history of tobacco use (Z87.891)– occupational exposure to environmental tobacco smoke (Z57.31)– tobacco dependence (F17.-)– tobacco use (Z72.0)

Documentation Tips

Toxic Effect of VenomICD-9 Code ICD-10 Code Description Excludes1 Excludes2

989.5 T63.- Toxic effect of unspecified, chiefly nonmedicinal as to source, venom

Includes:• bite or touch of venomous

animal• pricked or stuck by thorn or

leaf

• contact with and (suspected) exposure to toxic substances (Z77.-)

• ingestion of toxic animal or plant (T61.-, T62.-)

989.5 crosswalks to 152 ICD-10-CM codes

Use additional code(s):• for all associated manifestations of toxic effect, such as: respiratory conditions due to external agents (J60-

J70)• personal history of foreign body fully removed (Z87.821)• to identify any retained foreign body, if applicable (Z18.-)

The appropriate 7th character is to be added to each code from category T63A - initial encounterD - subsequent encounterS - sequela

• When no intent is indicated code to accidental. Undetermined intent is only for use when there is specific documentation in the record that the intent of the toxic effect cannot be determined.

Documentation Tips

Other adverse food reactionsICD-9 Code ICD-10 Code Description Excludes1 Excludes2

995.7 T78.1XX- Other adverse food reactions, not elsewhere classified, initial encounter

• anaphylactic reaction or shock due to adverse food reaction (T78.0-)

• anaphylactic reaction due to food (T78.0-)

• bacterial food borne intoxications (A05.-)

• allergic and dietetic gastroenteritis and colitis (K52.2)

• allergic rhinitis due to food (J30.5)

• dermatitis due to food in contact with skin (L23.6, L24.6, L25.4)

• dermatitis due to ingested food (L27.2)

Use additional code to identify the type of reaction

The appropriate 7th character is to be added to code T66A - initial encounterD - subsequent encounterS - sequela

• Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code

Documentation Tips

CoughICD-9 Code ICD-10 Code Description Excludes1 Excludes2

786.2 R05 Cough • Cough with hemorrhage (R04.2)

• Smoker’s Cough (J41.0)

N/A

• Symptom Codes – Codes that describe symptoms and signs are acceptable for reporting

purposes when a related definitive diagnosis has not been established (confirmed) by the provider.

• Use of a symptom code with a definitive diagnosis code– Codes for signs and symptoms may be reported in addition to a

related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis code.

• Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.

Cough Documentation Tips

Allergy to other foodsICD-9 Code ICD-10 Code Description Excludes1 Excludes2

V15.05 Z91.018 Allergy to other foods

Applicable To:• Allergy to nuts other

than peanuts

N/A • contact with and (suspected) exposures hazardous to health (Z77.-)

• exposure to pollution and other problems related to physical environment (Z77.1-)

• personal history of physical injury and trauma (Z87.81, Z87.82-)

• occupational exposure to risk factors (Z57.-)

• Allergy status to drugs, medicaments, and biological substances (Z88.-)

Code also any follow-up examination (Z08-Z09)

Z91.010 Allergy to peanuts

Z91.011 Allergy to milk products

Z91.012 Allergy to eggs

Z91.013 Allergy to seafood

• Z91.018 is considered unacceptable as a principal diagnosis as it describes a circumstance which influences an individual's health status but not a current illness or injury, or the diagnosis may not be a specific manifestation but may be due to an underlying cause.

Documentation Tips

• Z codes represent reasons for encounters. A corresponding procedure code must accompany a Z code if a procedure is performed. Categories Z00-Z99 are provided for occasions when circumstances other than a disease, injury or external cause classifiable to categories A00-Y89 are recorded as 'diagnoses' or 'problems'. This can a rise in two main ways:

– (a) When a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination (immunization), or to discuss a problem which is in itself not a disease or injury.

– (b) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.

Documentation Tips

Atopic DermatitisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

691.8 L20.0 Besnier's prurigo N/A • chronic (childhood) granulomatous disease (D71)

• dermatitis gangrenosa (L08.0)• dermatitis herpetiformis (L13.0)• dry skin dermatitis (L85.3)• factitial dermatitis (L98.1)• perioral dermatitis (L71.0)• radiation-related disorders of the skin and

subcutaneous tissue (L55-L59)• stasis dermatitis (I83.1-I83.2

691.8 L20.81 Atopic neurodermatitis

Applicable To:• Diffuse

neurodermatitis

N/A

691.8 L20.82 Flexural eczema N/A

691.8 L20.84 Intrinsic (allergic) eczema

N/A

691.8 L20.89 Other atopic dermatitis

N/A

• In (L20-L30) codes the terms dermatitis and eczema are used synonymously and interchangeably.

Documentation Tips

Chronic rhinitisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

472.0 J31.0 Chronic rhinitis

Applicable To:• Atrophic rhinitis

(chronic)• Granulomatous rhinitis

(chronic)• Hypertrophic rhinitis

(chronic)• Obstructive rhinitis

(chronic)• Ozena• Purulent rhinitis

(chronic)• Rhinitis (chronic) NOS• Ulcerative rhinitis

(chronic)

• allergic rhinitis (J30.1-J30.9)

• vasomotor rhinitis (J30.0)

N/A

Use additional code, where applicable, to identify:• exposure to environmental tobacco smoke (Z77.22)• exposure to tobacco smoke in the perinatal period (P96.81)• history of tobacco use (Z87.891)• occupational exposure to environmental tobacco smoke (Z57.31)• tobacco dependence (F17.-)• tobacco use (Z72.0)

• Identify:– Rhinitis type– Allergic Rhinitis type

• When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

Documentation Tips

Unspecified acute conjunctivitis

ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

372.00 H10.33 Unspecified acute conjunctivitis, bilateral

• Ophthalmia neonatorum NOS (P39.1)

• keratoconjunctivitis (H16.2-)

N/A

There are more specific code choice selections

372.00 H10.30 Unspecified acute conjunctivitis, unspecified eye

372.00 H10.31 Unspecified acute conjunctivitis, right eye

372.00 H10.32 Unspecified acute conjunctivitis, left eye

• Conjunctivitis Type• Acute type• Chronic type• Laterality• Use an external cause code following the code for

the eye condition, if applicable, to identify the cause of the eye condition

Unspecified acute conjunctivitis, bilateralDocumentation Tips

Unspecified contact dermatitis, unspecified causeICD-9 Code ICD-10 Code Description Excludes1 Excludes2

692.9 L25.9 Unspecified contact dermatitis, unspecified cause

Applicable To• Contact dermatitis

(occupational) NOS• Contact eczema

(occupational) NOS

• allergic contact dermatitis (L23.-)

• allergy NOS (T78.40)

• dermatitis NOS (L30.9)

• irritant contact dermatitis (L24.-)

• chronic (childhood) granulomatous disease (D71)

• dermatitis gangrenosa (L08.0)• dermatitis herpetiformis (L13.0)• dry skin dermatitis (L85.3)• factitial dermatitis (L98.1)• perioral dermatitis (L71.0)• radiation-related disorders of the skin

and subcutaneous tissue (L55-L59)• stasis dermatitis (I83.1-I83.2)• dermatitis due to ingested substances

(L27.-)• dermatitis of eyelid (H01.1-)• eczema of external ear (H60.5-)• perioral dermatitis (L71.0)• radiation-related disorders of the skin

and subcutaneous tissue (L55-L59)

There are more specific code choice selections

692.81 L25.0 Unspecified contact dermatitis due to cosmetics

692.3 L25.1 Unspecified contact dermatitis due to drugs in contact with skin

692.89 L25.2 Unspecified contact dermatitis due to dyes

692.4 L25.3 Unspecified contact dermatitis due to other chemical products

692.5 L25.4 Unspecified contact dermatitis due to food in contact with skin

692.6 L25.5 Unspecified contact dermatitis due to plants, except food

692.89 L25.8 Unspecified contact dermatitis due to other agents

• In this block the terms dermatitis and eczema are used synonymously and interchangeably.

Allergic Rhinitis Documentation Tips

Other adverse food reactionsICD-9 Code ICD-10 Code Description Excludes1 Excludes2

995.7 T78.1XX- Other adverse food reactions, not elsewhere classified

• anaphylactic reaction or shock due to adverse food reaction (T78.0-)

• anaphylactic reaction due to food (T78.0-)

• bacterial food borne intoxications (A05.-)

• complications of surgical and medical care NEC (T80-T88)

• allergic and dietetic gastroenteritis and colitis (K52.2)

• allergic rhinitis due to food (J30.5)

• dermatitis due to food in contact with skin (L23.6, L24.6, L25.4)

• dermatitis due to ingested food (L27.2)

There are more specific code choice selections below:

T78.0- Anaphylactic reaction due to food

The appropriate 7th character is to be added to code T66A - initial encounterD - subsequent encounterS - sequela

• Use additional code to identify the type of reaction• Use secondary code(s) from Chapter 20, External

causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code

Documentation Tips

Angioneurotic edemaICD-9 Code ICD-10 Code Description Excludes1 Excludes2

995.1 T783XX- Angioneurotic edema

Applicable to:• Allergic angioedema• Giant urticaria• Quincke's edema

• serum urticaria (T80.6-)

• urticaria (L50.-)

• complications of surgical and medical care NEC (T80-T88)

The appropriate 7th character is to be added to each code from category T78A - initial encounterD - subsequent encounterS - sequela

• Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the Tsection that include the external cause do not require an additional external cause code

Documentation Tips

Urticaria ICD-9 Code ICD-10 Code Description Excludes1 Excludes2

708.9 L50.9 Urticaria, unspecified • Lyme disease (A69.2-)• rosacea (L71.-)• allergic contact dermatitis (L23.-)• angioneurotic edema (T78.3)• giant urticaria (T78.3)• hereditary angio-edema (D84.1)• Quincke's edema (T78.3)• serum urticaria (T80.6-)• solar urticaria (L56.3)• urticaria neonatorum (P83.8)• urticaria papulosa (L28.2)• urticaria pigmentosa (Q82.2)

N/A

There are more specific code choice selections below:

708.0 L50.0 Allergic urticaria

708.1 L50.1 Idiopathic urticaria

708.2 L50.2 Urticaria due to cold and heat

708.3 L50.3 Dermatographic urticaria

708.4 L50.4 Vibratory urticaria

708.5 L50.5 Cholinergic urticaria

708.8 L50.6 Contact urticaria

708.8 L50.8 Other urticaria

Chronic sinusitisICD-9 Code ICD-10 Code Description Excludes1 Excludes2

473.0 J32.0 Chronic maxillary sinusitis

Applicable To:• Antritis (chronic)• Maxillary sinusitis NOS

N/A • certain conditions originating in the perinatal period (P04-P96)

• certain infectious and parasitic diseases (A00-B99)

• complications of pregnancy, childbirth and the puerperium (O00-O9A)

• congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

• endocrine, nutritional and metabolic diseases (E00-E88)

• injury, poisoning and certain other consequences of external causes (S00-T88)

• neoplasms (C00-D49)• smoke inhalation (T59.81-)• symptoms, signs and abnormal clinical

and laboratory findings, not elsewhere classified (R00-R94)

473.1 J32.1 Chronic frontal sinusitis, NOS

N/A

473.2 J32.2 Chronic ethmoidal sinusitis, NOS

N/A

473.3 J32.3 Chronic sphenoidal sinusitis, NOS

N/A

473.8, 473.9 J32.4 Chronic pansinusitis

Applicable To:• Pansinusitis NOS

N/A

473.8, 473.9 J32.8 Other chronic sinusitis

Applicable To:• Sinusitis (chronic)

involving more than one sinus but not pansinusitis

N/A

473.9 J32.9 Chronic sinusitis, unspecified, NOS

Applicable To:• Sinusitis (chronic) NOS

N/A

Use additional code, where applicable, to identify:• exposure to environmental tobacco smoke (Z77.22)• exposure to tobacco smoke in the perinatal period (P96.81)• history of tobacco use (Z87.891)• occupational exposure to environmental tobacco smoke

(Z57.31)• tobacco dependence (F17.-)• tobacco use (Z72.0)

Chronic sinusitis, unspecified Documentation Tips

On October 01, 2015 we will monitor claims for date of service rules

• Outpatient claims cannot have crossover dates • Outpatient claims will be coded according to date of

service• Inpatient facility claims will be coded per date of discharge

We will monitor claims to resolve any unanticipated problems with the submission process

Monitor Claims

• We will monitor for claim denials• We will monitor editing trends for ICD-10 Coding

guidelines• We will provide feedback to the physicians regarding

supporting documentation requirements • We will monitor WC or Liability carriers for published

rules on use of ICD-9 or ICD-10 code sets

Claim Denial and Management

• Client will need to update – Templates– Order Sets– Superbills– Favorites

• Future Orders– Remove ICD-9 code add ICD-10 code

Client Responsibilities

All Conditions treated or assessed must be documented in the medical record. In addition to the documentation tips reviewed, below are more areas to document that will ensure proper ICD-10-CM code selection.

• Site specificity• Document notation of qualifiers

– Exacerbation– Manifestations– Relapse– Status– Stages

• Indicate acute or chronic• Indicate underlying or external cause factors

– Medication– Smoke– Accidents– Mechanical failure

• Laterality– Bilateral– Right – Left

Documentation – Start Now

• Episode of Care for injuries, poisoning, external causes and other conditions– Initial Encounter

• Use while the patient is receiving active treatment of the condition– Active treatment includes surgical treatment, an emergency encounter, and

evaluation and treatment by a new physician

– Subsequent Encounter• Used on encounter after the patient has received active treatment of

the condition and is receiving routine care for the condition during the healing or recovery phase.

– Medication adjustments, aftercare, device adjustments, cast change

– Sequela• Used for complications or conditions that arise as a direct result of a

condition, late effect

Documentation – Start Now

• Combination codes that capture– Etiology and manifestation– Related conditions– Disease, injury or other medical condition and

complications– Disease or other medical conditions and common signs or

symptoms

• Add ICD-10 Codes to patient Problem List

Documentation – Start Now

codingresource@g1hs.com

Centers for Disease Control and Prevention (ICD-10-CM)http://www.cdc.gov/nchs/icd/icd10cm.htm

Questions