1. ICD-10-CM: PRL Training Session 1 Practice Resources, LLC 20151

2. Objectives Understanding how to utilize the ICD-10 book – Includes notes. – Excludes 1 & Excludes 2. – Code First explanations. – Code also – Additional characters required. – Place holders. Practice Resources, LLC 20152

3. Where to start Look up term in alphabetic index Pay attention to parenthetical terms & instructions Do not code from alphabetic index- go to tabular section to verify accuracy of code Read all the instructional material associated with that code Consult guidelines Practice Resources, LLC 20153

4. Includes Notes Appear directly under certain categories in the tabular list – Example code J36 Peritonsillar abscess INCLUDES INCLUDESabscess of tonsil peritonsillar cellulitis quinsy Practice Resources, LLC 20154

5. Inclusion Terms – These are listed under certain codes. They may be considered synonyms with the code title or conditions that can be used for that code number. They are similar to the ‘includes notes’ - Example code G44.00: Cluster headache syndrome, unspecified Ciliary neuralgia Cluster headache NOS Histamine cephalgia Lower half migraine Migrainous neuralgia Note this code needs 6 th digit Practice Resources, LLC 20155

6. Excludes 1 Translates to NOT CODED HERE These are mutually exclusive codes that cannot be reported together Example- a congenital form of disease cannot be coded with an acquired form of the same condition – M20 Acquired deformities of fingers and toes – EXCLUDES 1 acquired absence of fingers and toes (Z89.-) congenital absence of fingers and toes (Q71.3-, Q72.3-) congenital deformities and malformations of fingers and toes (Q66-, Q68-Q70, Q74-) Practice Resources, LLC 20156

7. Excludes 2 Translates to NOT INCLUDED HERE These are not normally coded together. However patient may have both conditions at the same time. – Example J03 Acute tonsillitis EXCLUDES 2 EXCLUDES 2 Chronic tonsillitis (J35.0) Practice Resources, LLC 20157

8. Code First/Use additional code These will be in red and will provide instructions on sequencing. You may need to code another diagnosis first or use an additional code to help paint a better picture of the patient’s condition Example- J44 Other chronic obstructive pulmonary disease Code also type of asthma, if applicable (J45.-) Use additional code to identify: exposure to environmental tobacco smoke (Z77.22) history of tobacco use (Z87.891) tobacco dependence (F17.-) tobacco use (Z72.0) Practice Resources, LLC 20158

9. Example of Code First J17 Pneumonia in diseases classified elsewhere Code first underlying disease, such as: Q fever (A78) rheumatic fever (I00) schistosomiasis (B65.0- B65.9) Practice Resources, LLC 20159

10. Edit for Medent -There will be edits in the new version of Medent to flag providers about the code first or additional code needed -You also may see this edit when billing through the ebill if provider did not add in the additional code Practice Resources, LLC 201510

11. Additional Characters The additional character symbol indicates that the code is required to have another digit to accurately code the symptom. Could have additional 4 th, 5 th, 6 th or 7 th digit you need to choose. – Example R11 Nausea and vomiting Requires 4 th additional digit – R11.0 Nausea – R11.1 Vomiting Vomiting further requires 5 th additional digit – R11.10 Vomiting unspecified – R11.11 Vomiting without nausea – R11.12 Projectile vomiting – R11.13 Vomiting of fecal matter – R11.14 Bilious vomiting Practice Resources, LLC 201511

12. Place Holders Also called ‘dummy placeholders’ Character ‘X’ used in the 5 th or 6 th position of the code to keep that 7 th character in the correct position. – Example T59.91XA Toxic effect of unspecified gases, fumes and vapors, accidental (unintentional) initial encounter Box with symbol will be blue in ICD-10 book to show place holder is needed Practice Resources, LLC 201512

13. Extra tips Unspecified diagnosis will be in yellow Other specified diagnosis will be in gray For codes that designate laterality – Right will be the number 1 – Left will be the number 2 Example 1 M76.51 Patellar tendinitis, right knee 2 M76.52 Patellar tendinitis, left knee Practice Resources, LLC 201513

14. Additional symbols Age and Sex symbols N – Newborn Age: 0 symbol N P – Pediatric Age: 0-17 symbol P M – Maternity Age: 12-55 symbol M A – Adult Age: 15-124 symbol A ♂ – Male diagnosis only ♂ ♀ – Female diagnosis only ♀ *For example go to code N41.2- Abscess of prostate Practice Resources, LLC 201514

15. Guidelines Located in the beginning of the ICD-10 book Formatted into Sections and chapters Indexes Normal Index Neoplasm Table Table of Drugs and Chemicals External Cause Index Practice Resources, LLC 201515

16. Time to Code Practice Resources, LLC 201516

17. Diabetes Mellitus Coding Five Categories E08 Diabetes mellitus due to an underlying condition E09 Drug or chemical induced diabetes mellitus E10 Type 1 diabetes mellitus E11 Type 2 diabetes mellitus E13 Other specified diabetes mellitus All categories above except E10 include a note to direct you to use additional code to identify any insulin use and directs you to code Z79.4 Z79.4 Long term (current) use of insulin Practice Resources, LLC 201517

18. Example A 37 year old female patient presents to office for follow up on her diabetes. No complaints, glucose levels have been well controlled. Provider does an expanded problem focused history and examination on patient. Tells patient to continue with same dosage of Lantus* and continue following diet with exercise. She should continue monitoring her levels and return in 3 months. What diagnosis code(s) are needed for this? * Clue for the non-family practice billers- Lantus is insulin Practice Resources, LLC 201518

19. Asthma Coding Has expanded to include different types of severity needed to correctly code for ICD-10. – Mild Intermittent – Mild Persistent – Moderate Persistent – Severe Persistent Will further break down to uncomplicated, exacerbation or status asthmaticus Practice Resources, LLC 201519

20. Asthma Table Practice Resources, LLC 201520

21. Example A 19 year old non-smoking male presents to the office with complaints of worsening asthma. Pollen in the air has been worse the past few weeks which has triggered his asthma. He has had asthmatic episodes 2-3 times a week where he needed to use his inhaler. Admits to only minor limitations with activities, but has woke up a few times in the night by his symptoms in the past month. Inhaler does help with his episodes. Patient not having any difficulty at present time. Provider performs detailed exam and history. Provider refills script for Advair and tells patient to follow up in 3 months or sooner if symptom become more frequent. What diagnosis code(s) would be correct for this? Practice Resources, LLC 201521

22. Answers Slide 17- E11.9 Type 2 diabetes without complications, Z79.4 Long term (current) use of insulin Slide 20- J45.31 Mild persistent asthmas with (acute) exacerbation Practice Resources, LLC 201522