1. ICD-10-CM Chapter 11-14 CRIHB John Hailes
ASC-E/M, CCS, CCS-P, CPC, CPC-H, CIRCC, CPMA, CPC-I, CEMC, CFPC, Trainer
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2. Objectives
Identify areas in ICD-10-CM that include new terminology for clinical documentation
Understanding the coding guidelines that pertain to ICD-10-CM Chapter 11-14
Assign the correct ICD-10-CM codes for the case studies involving chapters 11-14
Define areas in ICD-10-CM that enable improved data capture if more specific conditions are documented
Acuity
Disease type
Site specifity
Disease stage
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Track x – xxx day –

3. Documentation Matters
“If it was not documented, it was not done”
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4. Coding and 7th Character Extensions
2 Numeric
3 - 7 Numeric or Alpha
Additional Characters
Alpha
(Except U) . . A X S M X X 2 X 6 5 X x X A X
Category
Etiology, anatomic
site, severity
Added code extensions (7th character) for obstetrics, injuries, and external causes of injury
3 – 7 Characters
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5. Diseases of the Respiratory System Chapter 10
ICD-10-CM
Diseases of the Respiratory System Chapter 10
National Cancer Institute
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6. Diseases of the Respiratory System
J00-J06 Acute upper respiratory infections
J09-J18 Influenza and pneumonia
J20-J22 Other acute lower respiratory infections
J30-J39 Other diseases of upper respiratory tract
J40-J47 Chronic lower respiratory diseases
J60-J70 Lung diseases due to external agents
J80-J84 Other respiratory diseases principally affecting the interstitium
J85-J86 Suppurative and necrotic conditions of the lower respiratory tract
J90-J94 Other diseases of the pleura
J95-J95 Intraoperative and postprocedural complications and disorders of respiratory system, not elsewhere classified
J96-J99 Other diseases of the respiratory system
Chapter 10 includes diseases and disorders of the respiratory tract.
Beginning with the nasal passages, following a path to the lungs.
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7. Respiratory System ICD-9-CM to ICD-10-CM Model
Acute Anatomic site of infection
Other Severity
Pneumonia Cause
Chronic Acute, other, then chronic
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8. Use Additional code 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)
Infectious agent (B95-B97)
Occupational exposure to environmental tobacco smoke (Z57.31)
Tobacco dependence (F17.-)
Tobacco use (Z72.0)
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9. Diseases of the Respiratory System
Chapter 10 category range = J00-J99
Combination codes = condition and organism
J02.0 Streptococcal pharyngitis
Other codes require separate reporting of organism
Acute sinusitis J01-
Use Additional code (B95-B97) to identify infectious agent.
Chapter 10 includes diseases and disorders of the respiratory tract.
Beginning with the nasal passages, following a path to the lungs.
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10. New terminology for asthma
Respiratory condition in more than 1 site (not specifically indexed) classified to lower anatomic site
Additional code notes
Chapter 10
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11. Asthma ICD-9 ICD-10 493.XX J45.XXX 4th Digit 5th Digit Extrinsic
Intrinsic
Chronic Obstructive
Other
5th Digit
Exacerbation or status asthmatics
J45.XXX
Extrinsic
Intrinsic
Chronic Obstructive
Other
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12. J45 Asthma J45.2 Mild intermittent asthma J45.20 …… uncomplicated
J45.21 …… with (acute) exacerbation
J45.22 …… with status asthmaticus
J45.3 Mild persistent asthma
J45.30 …… uncomplicated
J45.31 …… with (acute) exacerbation
J45.32 …… with status asthmaticus
J45.4 Moderate persistent asthma
J45.40 …… uncomplicated
J45.41 …… with (acute) exacerbation
J45.42 …… with status asthmaticus
J45.5 Severe persistent asthma
5th Character mano-num system
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13. Upper Respiratory Infections
J00 Acute nasopharyngitis [common cold]
J01 Acute sinusitis
J02 Acute pharyngitis
J03 Acute tonsillitis
J04 Acute laryngitis and tracheitis
J05 Acute obstructive laryngitis [croup] and epiglottitis
J06 Acute upper respiratory infections of multiple and unspecified sites
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14. Upper Respiratory Tract
Acute sinusitis by site
Acute recurrent sinusitis by site.
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15. J01 Acute sinusitis J01.0 Acute maxillary sinusitis
J01.00 …… unspecified
J01.01 Acute recurrent maxillary sinusitis
J01.1 Acute frontal sinusitis
J01.10 …… unspecified
J01.11 Acute recurrent frontal sinusitis
J01.2 Acute ethmoidal sinusitis
J01.20 …… unspecified
J01.21 Acute recurrent ethmoidal sinusitis
J01.3 Acute sphenoidal sinusitis
J01.30 …… unspecified
Anatomical Site
Acute
Recurrent
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16. 465.9 Acute upper respiratory infection
J06 Acute upper respiratory infections of multiple and unspecified sites
J06.0 Acute laryngopharyngitis
J06.9 Acute upper respiratory infection, unspecified
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17. J02.0 Streptococcal pharyngitis
462 Acute Pharyngitis
J02.0 Streptococcal pharyngitis
J02.8 Acute pharyngitis due to other specified organisms
J02.9 Acute pharyngitis, unspecified
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18. Instructional note
When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to
J40-J47 Chronic lower respiratory diseases
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19. J40-J47 Chronic lower respiratory diseases
J41 Simple and mucopurulent chronic bronchitis
J42 Unspecified chronic bronchitis
J43 Emphysema
J44 Other chronic obstructive pulmonary disease
J45 Asthma
J47 Bronchiectasis
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20. Allergic rhinitis
Excludes 1: Allergic rhinitis with asthma (bronchial)
Code to the Asthma code. J45.909
J30 Vasomotor and allergic rhinitis
J30.0 Vasomotor rhinitis
J30.1 Allergic rhinitis due to pollen
J30.2 Other seasonal allergic rhinitis
J30.5 Allergic rhinitis due to food Cause and Effect
J30.8 Other allergic rhinitis
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J30.9 Allergic rhinitis, unspecified
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21. Influenza
Influenza may be coded alone or in combination with other codes.
Code only confirmed cases:
Exception to Guideline II, H. (Uncertain Diagnoses)
J09 – Due to certain identified influenza viruses
J10 – Due to other identified influenza viruses
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22. COPD ICD-9-CM - 491.2x or 493.2x ICD-10-CM J44
Asthma with COPD
Chronic asthmatic (obstructive) asthma
Chronic bronchitis with airway obstruction
Chronic bronchitis with emphysema
Chronic obstructive asthma
Chronic obstructive bronchitis
Chronic obstructive tracheobronchitis
J44 Other chronic obstructive pulmonary disease
J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
J44.9 Chronic obstructive pulmonary disease
J44 Includes   
asthma with chronic obstructive pulmonary disease
chronic asthmatic (obstructive) bronchitis
chronic bronchitis with airways obstruction
chronic bronchitis with emphysema
chronic emphysematous bronchitis
chronic obstructive asthma
chronic obstructive bronchitis
chronic obstructive tracheobronchitis
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23. Pneumonia J13 Pneumonia due to Streptococcus pneumoniae
J14 Pneumonia due to Hemophilus influenzae
J15 Bacterial pneumonia, not elsewhere classified
Coded as a combination with the responsible organism
Coded as a dual classification
J13 and J14 = code first influenza (J09, J10, J11) is applicable
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24. Acute Respiratory Failure Coding Guideline 10.b.1
Acute respiratory failure as the principal diagnosis
J96.0 May be assigned as the principal diagnosis when
it is the condition established after study to be chiefly responsible for the admission to the hospital.
The selection of the code is supported by the
Alphabetical and Tabular list.
Chapter specific guidelines take precedence.
Obstetrics, poisonings, HIV and newborn
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25. Acute Respiratory Failure Coding Guideline 10.b.2
Acute respiratory failure as a secondary diagnosis
Respiratory failure may be listed as a secondary diagnosis if it occurs after admission, or is present on admission, but does not meet the definition of the principal diagnosis.
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26. Acute Respiratory Failure Coding Guideline 10.b.3
Sequencing of acute respiratory failure and another acute condition.
When the patient is admitted with respiratory failure and another condition such as myocardial infarction, CVA or aspiration pneumonia, the principal diagnosis will not be the same in every situation. This applies whether the other acute condition is a respiratory or non-respiratory condition. Principle diagnosis will be dependent on the circumstances of the admission. admission. If two conditions are equally responsible and there are no chapter specific guidelines, the guideline for two or more diagnosisthat equally meet the definition of principal diagnosis may be applied.
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27. J96 Respiratory failure J96.0 Acute respiratory failure
J96.00 …… unspecified whether with hypoxia or hypercapnia
J96.01 …… with hypoxia
J96.02 …… with hypercapnia
J96.1 Chronic respiratory failure
J96.10 …… unspecified whether with hypoxia or hypercapnia
J96.11 …… with hypoxia
J96.12 …… with hypercapnia
J96.2 Acute and chronic respiratory failure
J96.20 …… unspecified whether with hypoxia or hypercapnia
J96.21 …… with hypoxia
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28. Questions
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