1. Combination Codes HS317b – Coding & Classification of Health Data

2. Combination Codes Dagger/Asterisk Dual Combination Combination Code Two codes to explain disease process  Diagnosis Type 3

3. Possible combinations Infections Pneumonia Septicemia HIV Musculoskeletal

4. Infection Dual Combination Identify infectious organism & manifestation in a local system chapter.  Both must be used together  Example: Ms. B was diagnosed with a candidial infection of the vulva and vagina B37.3† Candidiasis of vulva and vagina (N77.1*) N77.1* Vaginitis, vulvitis and vulvovaginitis in infectious and parasitic diseases classified elsewhere

5. Infection Combination Code One code will indicate manifestation and organism Example:  Patient was diagnosed with streptococcal pharyngitis J02.0 Streptococal pharyngitis

6. Infection – Two Codes Use two codes to identify disease and infectious organism Example: patient was confirmed to have acute cystitis caused by E.Coli  N30.0 Acute Cystitis  B96.2(3) Escherichia coli  (any Dx between B95-B97 = Dx Type 3)

7. Human Immunodeficiency Virus MRDx must be B24 HIV disease Manifestation that is being treated will be sequenced immediately following B24  B24 HIV  F02.4*Dementia in human immunodeficiency virus [HIV] disease

8. HIV Mutually Exclusive B24 Human immunodeficiency virus [HIV] disease (never use Dx Type 2) Z21 asymptomatic human immunodeficiency virus [HIV] infection status R75 nonconclusive serologic evidence of HIV

9. Anemia & Neoplasms D63.0*Anaemia in neoplastic disease (C00-D48†)  Use only if anemia is unspecified.

10. Pneumonia & COPD Combination Code Patient comes into hospital with COPD and pneumonia (or any other acute lower respiratory tract infection)  J44.0Chronic obstructive pulmonary disease with acute lower respiratory infection

11. FYI - COPD J44.0Chronic obstructive pulmonary disease with acute lower respiratory infection J44.1Chronic obstructive pulmonary disease with acute exacerbation, unspecified J44.8Other specified chronic obstructive pulmonary disease J44.9Chronic obstructive pulmonary disease, unspecified

12. Pneumonia & COPD  When infection is a significant condition in its own right an additional code must be used to specify the type of infection for epidemiological purposes. The condition must be assigned to a diagnosis type 1  J18.9 (1) Pneumonia, unspecified

13. Example A 68 year old man with severe COPD contracted the common cold. His condition worsened and he was admitted. Chest X-ray revealed pneumonia. He was subsequently admitted for COPD exacerbation and pneumonia.

14. Example  M - J44.0Chronic obstructive pulmonary disease with acute lower respiratory infection  1 - J18.9Pneumonia, unspecified

15. Sepsis & Pneumonia Patient was being treated in ICU for pneumonia and staphylococcus aureus septicemia Folio lookup – pneumonia – septicemia-  septicemia A41 J17.0* (note: even though A41 does not have a dagger it is considered a dagger/asterisk relationship)

16. Lobar Pneumonia Lobar pneumonia = when pneumonia is documented as complete consolidation of an entire lobe.  Apical, basilar and massive J18.1 Lobar pneumonia, unspecified when organism is unknown.  If organism identified code to pneumonia with organism  Combination Code, i.e. J13 Pneumonia due to Streptococcus pneumonia

17. Bronchopneumonia When inflammation is scattered here and there throughout the lungs, often with bilateral involvement. Terms: catarrhal, confluent, diffuse, disseminated (focal), lobular (segmental) and patchy J18.0Bronchopneumonia, unspecified

18. ARDS & Respiratory Failure Acute respiratory failure (J96.0) is an inherent part of the J80 Adult respiratory distress syndrome.  Syndrome: can include sepsis, systemic inflammatory response syndrome  One code J80 needs to be coded

19. Mechanical Ventilation Mandatory to code if duration is > 96 hours. Indicate through procedure code with attribute ‘extended’ for > 96 hours  1.GZ.31.CA-ND – - EX

20. Bleeding Esophageal Varices Patient with known alcoholic cirrhosis of the liver admitted with bleeding esophageal varices

21. Bleeding Esophageal Varices Varix esophagus (ulcerated) I85.9 – – bleeding I85.0 – – congenital Q27.8 – – in (due to) – – – alcoholic liver disease K70† I98.2* – – – cirrhosis of liver K74† I98.2* – – – schistosomiasis B65 I98.2* – – – toxic liver disease K71† I98.2*

22. K70.3Alcoholic cirrhosis of liver I98.2*Oesophageal varices in diseases classified elsewhere K92.0Haematemesis

23. Gastrointestinal Bleeding Look for combination codes If no combination, code disease and add as Diagnosis type 3: K92.0Haematemesis K92.1Melena K92.2Gastrointestinal haemorrhage, unspecified

24. Pathological Fractures No known traumatic injury Documented as a result of an underlying disease (neoplasm, osteoporosis, Paget’s disease or an endocrine disorder)

25. Fracture bone T14.2 – – in (due to) neoplastic disease NEC (see also Neoplasm) (8000/1) D48.0† M90.7*  M90.7* Fracture of bone in neoplastic disease (C00-D48†)

26. Spinal disease & myopathy Displacement -vertebra – – lumbar, lumbosacral (with) M51.2 – – – myelopathy M51.0† G99.2* – – – neuritis, radiculitis, radiculopathy or sciatica M51.1† G55.1*

27. Sandwiching Codes Peritonitis due to peritoneal dialysis catheter exit site infection. The physician ordered skin and peritoneal fluid cultures (positive for staphylococcus) to confirm the cause of the peritonitis

28. Codes T85.7Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts K65.9Peritonitis, unspecified B95.3Streptococcus pneumoniae as the cause of diseases classified to other chapters Y84.1Kidney dialysis

29. Classification based on MRDx MCC 4 Diseases and Disorder of the Respiratory System MCC 16 Blood and blood forming organs and Immunological Disorders MCC 18 Multisystemic or unspecified site infections MCC 24 HIV Infections (AIDS)  No complexity assigned

30. MCC 4 Respiratory System Factors that can influence CMG assignment  Tuberculosis, Respiratory Failure or respiratory infections and inflammations associated with Cystic Fibrosis (Dagger/asterisk codes) (CMG 487 CF)  CMG 135 Tracheostomy

31. MCC HIV Assignment of CMG based on manifestation diagnosis  Respiratory Disorders will assign case to CMG 860 Respiratory Tract Disorders with HIV  No complexity level assigned