1. History & Coding Conventions
ICD-10-CM 2014
Attendees should be advised that the material has been adapted to focus on long term and post acute care situations.
History & Coding Conventions
ICD-10 Sect IA Conventions for ICD

2. ICD-10 History
The World Health Organization (WHO) adopted ICD-10 (International Classification of Diseases, Tenth Revision) in 1990 and it came into use in 1994 by other countries.
The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) was developed under the oversight of National Center for Health Statistics in 1997 and has undergone several modifications since then.
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ICD-10 Sect IA Conventions for ICD

3. ICD-10-CM History and Updates
In the January 16, 2009 Federal Register the final rule was published to adopt the Medical Data Code Set to ICD-10-CM & ICD-10-PCS.
One last limited code update modification was made for October 2013.
Beginning in October 2014 , ICD-10-CM will have regular annual updates that will go into effect October 1st of each year.
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ICD-10 Sect IA Conventions for ICD

4. 2014 ICD-10-CM is available ator
2014 ICD-10-CM Index to Diseases and Injuries
2014 ICD-10-CM Tabular List of Diseases and Injuries
Instructional Notations
2014 Official Guidelines for Coding and Reporting
2014 Table of Drugs and Chemicals
2014 Neoplasm Table
2014 Mapping ICD-9-CM to ICD-10-CM and ICD-10-CM to ICD-9-CM”
ICD-10 Sect IA Conventions for ICD

5. ICD-10-CM Coding Guidelines
The guidelines are approved by four organizations:
American Hospital Association (AHA)
American Health Information Management Association (AHIMA)
Centers for Medicare and Medicaid Services (CMS), and
National Center for Health Statistics (NCHS)
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ICD-10 Sect IA Conventions for ICD

6. Coding Conventions and Guidelines
ICD-10-CM
ICD-10 Sect IA Conventions for ICD

7. Organization & Structure Changes
21 Chapters
V and E codes incorporated into main ICD-10-CM Classification
Sense Organs (eyes and ears) have separate chapters
Updated terminology and code reassignment to more appropriate chapters
Injuries are classified by site and then type
Postoperative complication codes have been moved to body system
Page of the Instructor & Student Training Guides
ICD-10 Sect IA Conventions for ICD

8. Organization & Structure Changes -2
Alphanumeric – 3 to 7 digits
Addition of placeholder “X”
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ICD-10 Sect IA Conventions for ICD

9. New Features Combination codes for condition and common manifestations
Combination codes for poisonings and external cause
Added laterality
Added 7th digit for episode of care
Expanded codes for: Injuries, diabetes, substance abuse, pressure ulcers and postoperative complications
Changes in time frames in certain codes
Added standard for two types of “excludes” notes
Page of the Instructor & Student Training Guides
ICD-10 Sect IA Conventions for ICD

10. General Equivalency Mapping (GEMS)
Mappings between ICD-9-CM and ICD-10-CM classification systems have been developed to facilitate the transition from one code set to another.
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ICD-10 Sect IA Conventions for ICD

11. General Equivalency Mapping (GEMS)
APPROPRIATE USE
Convert multiple databases from ICD-9- CM to ICD-10-CM
INAPPROPRIATE USE
Crosswalks
There is not a one-to-one match between ICD-9-CM and ICD-10-CM codes, for a multitude of reasons (e.g., new concepts in ICD-10-CM, a single ICD-9-CM code may map to multiple ICD-10-CM codes).
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ICD-10 Sect IA Conventions for ICD

12. Coding in ICD-10-CM Three to five characters Three to seven characters
First digit is numeric but can be alpha (E or V)
First character always alpha
2–5 are numeric
All letters used except U
Always at least three digits
Character 2 always numeric: 3–7 can be alpha or numeric
Decimal placed after the first three characters (or with E codes, placed after the first four characters)
Alpha characters are not case-sensitive
Decimal placed after the first three characters

13. Coding and Seventh Character
2 Numeric
3-7 Numeric or Alpha
Additional Characters
Alpha
(Except U) . . A X S M X X 2 6 X 5 X X x X A
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Category
Etiology, anatomic
site, severity
Added 7th character for obstetrics, injuries, and external causes of injury
3–7 Characters
ICD-10 Sect IA Conventions for ICD

14. Alphabetic Index The Alphabetic Index is divided into two parts:
The Index to Diseases and Injury
The Index to External Causes of Injury
Within the Index to Disease and Injury there is a Neoplasm Table and a Table of Drugs and Chemicals.
There is no Hypertension table.
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ICD-10 Sect IA Conventions for ICD

15. Alphabetic Index -2
Main terms in boldface font are listed in alphabetic order. Then, indented beneath the main term, any applicable subterm or essential modifier will be shown in alphabetical order. The indented subterm is always read in combination with the main term.
Pneumonia J18.9 aspiration J69.0 due to food J69.0
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ICD-10 Sect IA Conventions for ICD

16. Alphabetic Index -3
Nonessential modifiers appear in parentheses ( ) and do not affect the code number assigned.
The “-” at end of an index entry indicates that additional characters are required.
Amblyopia (congenital) (ex anopsia) (partial) (suppression) H53.00-
deprivation H53.01-
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ICD-10 Sect IA Conventions for ICD

17. Alphabetic Index -4
Manifestation codes are included in the alphabetic index by including a second code, shown in brackets [ ] directly after the underlying or etiology code which should always be reported first.
Chorioretinitis – see also inflammation chorioretinal Egyptian B76.9 [D63.8] Histoplasmic B39.9 [H32]
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ICD-10 Sect IA Conventions for ICD

18. Tabular List
21 Chapters
Diseases of the Nervous System and Sense Organs now in three chapters: Nervous System, Eye and Ear
The order of chapters has changed
Within the chapters, category restructuring and code reorganization have occurred
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ICD-10 Sect IA Conventions for ICD

19. Tabular List -2
Chapters are subdivided into subchapters (blocks) that contain three character categories and form the foundation of the code.
Chapter 8 Diseases of the Ear and Mastoid Process (H60 – H95)
This chapter contains the following blocks:
H60 – H62 Disease of external ear
H65 – H75 Disease of middle ear and mastoid
H80 – H83 Disease of inner ear
H90 – H94 Other disorders of ear
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ICD-10 Sect IA Conventions for ICD

20. Tabular List -3
Most but not all categories are further subdivided into four or five character subcategories, e.g. (I10 – Hypertension)
The fourth character when placed after the decimal point of:
8 - (.8) is used to indicate “other specified”, and
9 - (.9) is usually reserved for “unspecified”
Page 12 of the Instructor & Student Training Guide
K52.89 Other specified noninfective gastroenteritis and colitis
K Noninfective gastroenteritis and colitis, unspecified
ICD-10 Sect IA Conventions for ICD

21. Tabular List -4 (NEC) – “not elsewhere classified”
(NOS) – “not otherwise specified”
Both NEC and NOS have their own codes
Five and six character codes provider greater specificity or more information about the condition
Codes must be used to the highest number of characters available or to the highest level of specificity
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ICD-10 Sect IA Conventions for ICD

22. S00.03XD Contusion of scalp, subsequent episode of care
Tabular List -5
Certain categories have an additional seventh character extension. The extension must always be the seventh and final character. When the code contains fewer than seven characters, the place holder “X” must be used to fill the empty character(s).
S00.03XD Contusion of scalp, subsequent episode of care
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ICD-10 Sect IA Conventions for ICD

23. Tabular List Notes Beginning of the chapter – R00-R99
Notes are located at the beginning of chapters or any subdivisions that follow and apply to all the categories within it.
Beginning of the chapter – R00-R99
Beginning of a subchapter – D37-D48
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ICD-10 Sect IA Conventions for ICD

24. ICD-10-CM History & Conventions
Q&A
ICD-10-CM History & Conventions

25. Exercise #1
Which of the following is a true statement regarding ICD-10-CM codes?
a. No decimals are used.
b. The first character is always an alpha.
c. Consist of three to five characters.
d. The second and third characters are always
numeric. 
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ICD-10 Sect IA Conventions for ICD

26. Answer #1 b. Always a letter
Rationale: The first character of an ICD-10-CM code is always an alphabetic letter. All other statements are false because ICD-10-CM codes do have a decimal placed after the first three characters, the codes consist of three to seven characters, and the second is always numeric but the third character can be alpha or numeric.
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ICD-10 Sect IA Conventions for ICD

27. Exercise #2
True or false? The GEMs are a crosswalk between ICD- 9-CM and ICD-10-CM.
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ICD-10 Sect IA Conventions for ICD

28. Answer #2
b. False
Rationale: The GEMs are not a crosswalk between ICD- 9-CM and ICD-10-CM.
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ICD-10 Sect IA Conventions for ICD

29. Coding and Use of Seventh Character
Injury
Either alpha or numeric
Placeholder X
Meanings vary
Injury - Identifies Injury
Initial – Receiving active treatment
Subsequent – Receiving routine care during healing or recovery (after active treatment)
Sequela – Complications or conditions arising as result of a condition

30. Coding Convention Abbreviations
Not Elsewhere Classified “NEC” – A residual category, subdivision, or subclassification that provides a location for “other” types of specified conditions that have not been classified anywhere else in the code set. These residual codes may also contain the term “NEC” as part of their descriptor.
Page 19 of the Instructor & Student Training Guide
E87.8 Other Disorder of electrolyte and fluid balance, not elsewhere classified.
ICD-10 Sect IA Conventions for ICD

31. Coding Convention Abbreviations -2
Not Otherwise Specified “NOS” - for use when the documentation of the condition identified by the provider is insufficient to assign a more specific code.
F03.90 Unspecified Dementia without behavioral disturbance – Dementia, NOS
H65.9 Unspecified nonsuppurative otitis media
Allergic otitis media NOS
Exudative otitis media NOS
Mucoid otitis media NOS
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ICD-10 Sect IA Conventions for ICD

32. Coding Conventions Punctuation
( ) Parentheses – supplemental words that may or may not be present.
[ ] - Brackets – synonyms, alternative workings or explanatory phrases.
I10 – Essential (primary) hypertension
J00 – Acute nasopharygitis (common cold)
Page 19 & 20 of the Instructor & Student Training Guide
G72.41 Inclusion body myositis [IBM]
S62.12 Fracture of lunate [semilunar]
ICD-10 Sect IA Conventions for ICD

33. Coding Conventions Punctuation -2
Colon ( : ) – used after an incomplete term which needs one or more of the modifiers following the colon. Used in both “includes” and “excludes” notes in which the words that precede the colon are not considered complete terms and therefore must be appended by one of the modifiers indented under the statement.
G73.7 Myopathy in diseases classified elsewhere
Excludes1: myopathy in:
rheumatoid arthritis (M05.32) sarcoidosis (D86.87)
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ICD-10 Sect IA Conventions for ICD

34. Coding Conventions Punctuation -3
Dashes ( - ) in the Alphabetic Index, dashes at the end of a code indicates an incomplete code
In the Tabular List, a dash preceded by a decimal point (.-) indicates an incomplete code
Fracture, pathological
ankle M carpus M84.44-
Page 20 of the Instructor & Student Training Guide
J43 Emphysema
Excludes 1: emphysematous (obstructive) bronchitis (J44.-)
ICD-10 Sect IA Conventions for ICD

35. Coding Convention Instructional Notes
Includes notes – used to clarify the condition included within a particular chapter, section, category, subcategory or code. They are not exhaustive and may include diagnoses not listed in the inclusion note. The word “includes” is not preceded by the list of terms at the code level.
K25 Gastric Ulcer
Includes: erosion (acute) of stomach
pylorus ulcer (peptic)
stomach ulcer (peptic)
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ICD-10 Sect IA Conventions for ICD

36. Coding Convention Instructional Notes -2
Excludes 1 – not coded here. Used when two codes cannot occur together.
G59 Mononeuropathy in disease classified elsewhere
Excludes 1:
Diabetic mononeuropathy (E09 – E14 with .41) tuberculous mononeuropathy (A17.83)
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ICD-10 Sect IA Conventions for ICD

37. Coding Convention Instructional Notes -3
Excludes 2 – not included here. Used when the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time.
J01 Acute Sinusitis
Excludes 1 – Sinusitis NOS (J32.9)
Excludes 2 – Chronic Sinusitis (J32.0 – J32.8)
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ICD-10 Sect IA Conventions for ICD

38. Coding Conventions Code First & Use Additional Code
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. The underlying condition is sequenced first followed by the manifestation. The “use additional code” note appears at the etiology and a “code first” note at the manifestation code.
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ICD-10 Sect IA Conventions for ICD

39. Coding Conventions Code First & Use Additional Code -2
G30 Alzheimer’s disease Use additional code to identify: dementia with behavioral disturbance (F02.81) dementia without behavioral disturbance (F02.80) F02 Dementia in other diseases classified elsewhere Code first the underlying physiological condition, such as: Alzheimer’s (G30.-)

40. Coding Conventions Cross Reference Notes
Cross reference notes are used in the Alphabetic Index to advise the coding professional to look elsewhere before assigning a code. There are three terms used: see, see also, see condition
Hemorrhage, cranial – see Hemorrhage, intracranial
Labyrinthitis (circumscribed) (destructive) (diffuse) (inner ear) (latent) (purulent) (suppurative)
– see also subcategory H83.0
Hematoma (traumatic) (skin surface intact) (see also Contusion)
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ICD-10 Sect IA Conventions for ICD

41. Coding Conventions Relational Terms
And – should be interpreted to mean “and/or” when it appears in the code title within the Tabular List.
I80 Phlebitis and thrombophlebitis
I82 Other venous embolism and thrombosis
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ICD-10 Sect IA Conventions for ICD

42. Coding Conventions Relational Terms -2
With – should be interpreted to mean “associated with” or “due to” when it appears in the code title, the Alphabetical Index, or an instructional note in the Tabular List. The term “with” in the Alphabetical Index is sequenced immediately following the main term, not in alphabetical order.
Asthma, asthmatic
with chronic obstructive pulmonary disease J44.9
J44 Other chronic obstructive pulmonary disease
Includes asthma with chronic obstructive pulmonary disease
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ICD-10 Sect IA Conventions for ICD

43. Careful Coding Required
In ICD-10-CM, we are using number zero “0” and capital letter “O”, number one “1” and capital letter “I”
They look very similar, so input and document these numbers and letters carefully!

44. General Coding Guidelines I.C.B.1. Locating a code in ICD-10-CM
Convention General Coding Guidelines and Chapter Specific
Refer to the ICD-10 Section/Convention General Coding Guidelines and chapter specific
Example:
I.C.B.1 = Locating a code in ICD-10-CM

45. General Coding Guidelines I.C.B.1. Locating a code in ICD-10-CM
Locate the term in the Alphabetical Index
Verify the code in the Tabular Index
Read and be guided by the instructional notes in both indexes
The Alphabetical Index does not always provide the full code. Laterality and 7th digit selection can only be done using the Tabular Index. The Alphabetical Index does not always indicate a dash
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

46. General Coding Guidelines I.C.B.2. Level of Detail in Coding
Codes are to be reported at their highest number of characters available
There are 3, 4, 5, 6 and 7 character codes
A code is invalid if it has not been coded to the fullest number of characters required for that code, including the 7th character applicable
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

47. General Coding Guidelines I.C.B.3. Codes A00.0-T88.9, Z00-Z99.8
The appropriate code or codes from A00.0 – T88.9 and Z00 – Z99.8 must be used to identify diagnoses, symptoms, conditions, problems, complaints or other reason(s) for the encounter/visit
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

48. General Coding Guidelines I.C.B.4. Signs and Symptoms
Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider
Chapter R00 – R99 Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified contains many, but not all codes for symptoms
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

49. General Coding Guidelines I.C.B.5. Integral Part of a Disease
Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification.
Examples:
Altered Mental Status due to UTI N39.0
COPD with Shortness of Breath J44.9
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

50. General Coding Guidelines I.C.B.6. Not an Integral Part of Disease -2
Signs and symptoms that may not be associated routinely with a disease process should be coded when present.
Resident has a culture that returned difficile. The resident has diarrhea with additional symptoms of malaise, low-grade fever and frequent diarrhea. The resident was started on Flagyl. The resident is weak, dehydrated, and needs IV fluids.
Infection, Clostridium, difficile, food borne (disease) A04.7
Dehydration E86.0
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

51. General Coding Guidelines I.C.B.7. Multiple Coding
In addition to the etiology/manifestation convention that requires two codes, there are other single conditions that also require more than one code. See “Use additional code” notes in the Tabular List at the code level. These are sequenced secondary to the condition code.
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

52. General Coding Guidelines I.C.B.7. Multiple Coding -2
“Code first” notes are under certain codes that are not specifically manifestation codes but may be due to an underlying cause. When there is a “code first” note and an underlying condition is present, the underlying condition is sequenced first.
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

53. General Coding Guidelines I.C.B.7. Multiple Coding -3
“Code if applicable, any causal condition” notes indicate that this code may be assigned as a principal diagnosis when the causal condition is unknown or not applicable.
If the causal condition is known, then the code for that condition should be sequenced as the principal diagnosis or first-listed diagnosis.
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

54. General Coding Guidelines Multiple Coding Example
Multiple codes may be needed for sequela conditions. See Guideline #10.
E. coli urinary tract infection
Infection, Urinary (tract) N39.0
Use additional code (B95-B97), to identify infectious
agent
Infection, bacterial, Escherichia coli [E. coli] (see also
Escherichia coli) B96.20
Not in the instructor manual
“Use additional code” is part of the tabular, not alpha index
ICD-10 Sect IA Conventions for ICD

55. General Coding Guidelines I.C.B.8. Acute and Chronic Conditions
If the same condition is described as both acute (subacute) and chronic and separate subentries exist in the Alphabetic Index at the same indention level, code both and sequence the acute (subacute) code first
Acute and chronic bronchitis
Bronchitis, acute or subacute (with bronchospasm or obstruction) J20.9
Bronchitis, chronic J42
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

56. General Coding Guidelines I.C.B.9. Combination Code
A combination code is a single code used to classify:
A diagnosis with an associated secondary manifestation, or
E11.69 Type 2 diabetes with other specified complication
Use additional code to identify complication
A diagnosis with an associated complication
J44.0 Acute Bronchitis with COPD
Not in the instructor manual
See Combination codes for poisonings (accidental, intentional self-harm, assault, undetermined)
ICD-10 Sect IA Conventions for ICD

57. General Coding Guidelines I.C.B.9. Combination Code -2
Assign only the combination code that fully identifies the diagnostic conditions involved or when directed by the Alphabetical Index
Multiple coding should not be used when the classification provides a combination code that clearly identifies all the elements documented in the diagnosis
When a combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

58. General Coding Guidelines I.C.B.10. Sequela
“A residual effect (condition produced) after the acute phase of an illness or injury has terminated.”
There is no time limit for the sequela code
The residual may be apparent early or years later
Generally requires two codes:
The condition or nature of the sequela – first
I69.16 Other paralytic syndrome following intracerebral hemorrhage
The sequela code – second
G82.5- Quadriplegia
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

59. General Coding Guidelines I.C.B.10 Sequela
Exception to above guideline.
In instances where the code for the sequela is followed by a manifestation code identified in the Tabular List and title, or the sequela code has been expanded at the 4th, 5th, or 6th character level to include the manifestation. (I69 Sequela of Cerebrovascular Disease)
The code for the acute phase of an illness or injury that led to the sequela is never used with a code for the late effect.
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

60. General Coding Guidelines I.C.B.12. Reporting Same Dx More than 1x
Each unique ICD-10-CM code may be reported only once for an encounter
This applies to bilateral conditions when there are no distinct codes for laterality or two different conditions classified to the same ICD-10-CM diagnosis code
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

61. General Coding Guidelines I.C.B.13. Laterality
Laterality Guidelines
For bilateral sites, the final character of the codes indicates laterality.
An unspecified site code is also provided should the side not be identified in the medical record.
If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side
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ICD-10 Sect IA Conventions for ICD

62. General Coding Guidelines I. C. B. 14
General Coding Guidelines I.C.B.14. Documentation of BMI and Pressure Ulcer Stages
Body Mass Index (BMI) and pressure ulcer stage codes may be based on the medical record documentation from clinicians who are not the patient’s provider, such as a dietician for BMI or licensed nurse for pressure ulcer staging.
Associated conditions (overweight, obesity, or pressure ulcer) must be documented by the patient’s provider. If there is conflicting medical record documentation, either from the same clinician or different clinicians, the patient’s attending provider should be queried for clarification.
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

63. General Coding Guidelines I.C.B.15. Syndromes
Follow the Alphabetical Index for guidance when coding syndromes
If there is no guidance in the Alphabetical Index assign codes for the documented manifestations of the syndrome
Look for the syndrome by its name in the
alphabetical index first and then if
not there, under syndrome
Not in the instructor manual
ICD-10 Sect IA Conventions for ICD

64. Coding Guidelines I.C.B.16. Complications
“Code assignment is based on the provider's documentation of the relationship between the condition and the care or procedure.”
The guideline extends to any complications of care, regardless of the chapter the code is located in.
Note: not all conditions that occur during or following medical care or surgery are classified as complications.
Page 24 of the Instructor & Student Training Guide
Will not always be able to look under “complications” in alpha index
ICD-10 Sect IA Conventions for ICD

65. Coding Guidelines I.C.B.16. Complications -2
There must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a complication. If the complication is not clearly documented, query the provider for clarification.
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ICD-10 Sect IA Conventions for ICD

66. ICD-10-CM Coding Conventions and
Q&A
ICD-10-CM Coding Conventions and
Coding Guidelines
ICD-10 Sect IA Conventions for ICD

67. Exercise #1
The ICD-10-CM code for infection and inflammatory reaction due to other internal orthopedic prosthetic device, implant or graft is T84.7 and requires the use of a seventh character to identify the encounter. Which of the following is the correct code for a subsequent encounter?
a. T84.7D
b. T84.7XD
c. T84.7XXD
d. T84.7
Similar to example on page 89 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

68. Answer #1
Answer: c. T84.7XXD
Rationale: ICD-10-CM Coding Guideline I.A.5 states that the seventh character must always be the seventh character in the data field. If a code that requires a seventh character is not six characters long, a placeholder X must be used to fill in the empty characters. Additionally, Guideline A.4 indicates that ICD-10-CM utilizes a placeholder character X and where a placeholder exists, the X must be used in order for the code to be considered a valid code. All alpha characters in ICD-10-CM are not case sensitive, which means that if the placeholder X is entered in either the upper- or lowercase format, the meaning would not change.
Similar to the example on page 89 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

69. Exercise #2
True or false? When the term “and” is used in a narrative statement it is interpreted to mean only “and.”
Page 91 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

70. Answer #2
Answer: False
Rationale: The word “and” should be interpreted to mean either “and” or “or” when it is used in a narrative statement (ICD-10-CM Coding Guideline I.A.8).
Page 91 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

71. Exercise #3
True or false? In ICD-10-CM all inclusion notes contain all conditions for which a particular code number is to be used and are considered to be “exhaustive.”
Page 91 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

72. Answer #3
Answer: False
Rationale: Inclusion notes contain terms that are the condition for which that code number is to be used. The terms may be synonyms of the code title, or in the case of “other specified” codes, the terms are a list of various conditions assigned to that code. The inclusion terms are not necessarily exhaustive (ICD-10-CM Coding Guideline I.A.11).
Page 91 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

73. Exercise #4
True or false? When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together.
Page 89 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

74. Answer #4
Answer: True
Rationale: An Excludes2 note indicates that the condition excluded is not part of the condition represented, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together if the documentation indicates that the patient has both conditions (ICD-10-CM Coding Guideline I.A.12.b).
Page 89 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

75. Exercise #5
True or false? In ICD-10-CM a “code also” note provides sequencing guidance to the coding professional.
Page 91 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

76. Answer #5
Answer: False
Rationale: ICD-10-CM Coding Guideline I.A.17 states a “code also” note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction. In contrast, the “code first” and “use additional code” notes provide sequencing order of the codes.
Page 91 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

77. Exercise #6
True or false? A causal relationship can be assumed in a patient with both coronary atherosclerosis and angina pectoris and thus, the appropriate combination code should be assigned.
Page 94 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

78. Answer #6
Answer: True
Rationale: ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris. The subcategories for these codes are I25.11, Atherosclerotic heart disease of native coronary artery with angina pectoris and I25.7, Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris. When using one of these combination codes it is not necessary to use an additional code for the angina pectoris.
Page 94 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD

79. Answer #6 -2
Rationale:…A causal relationship can be assumed in a patient with both atherosclerosis and angina pectoris unless the documentation indicates the angina is due to something other than the atherosclerosis (ICD-10-CM Coding Guideline I.C.9.b).
Page 94 of the Instructor & Student Training Guide
ICD-10 Sect IA Conventions for ICD