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Allergy, Asthma, & Immunology
ICD-10 CM Training Allergy, Asthma, & Immunology
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ICD-10-CM Compliance Dates
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
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Covered and Non-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
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ICD-10 Code Structure 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
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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
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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
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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
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ICD-10 Code Structure “Other” Codes “Unspecified” 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
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ICD-10 Structure Excludes Notes Excludes1 Excludes2
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 appropriate OGCR section 1.A.12.a.b
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ICD-10 Code 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
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Most Common Diagnosis Codes
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Allergic rhinitis 477.0 J30.9 Allergic rhinitis, unspecified
ICD-9 Code ICD-10 Code Description 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 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 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
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Allergic Rhinitis Documentation Tips
Type Due to animal hair and dander Due to food Due to pollen Other seasonal allergic Other allergic Unspecified
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Other chronic allergic conjunctivitis
ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 372.14 H10.45 keratoconjunctivitis (H16.2-) N/A
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Documentation Tips 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
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Asthma ICD-9 Code ICD-10 Code Description Excludes1 Excludes2
493.00, J45.20 Mild intermittent asthma, uncomplicated or NOS bronchitis due to chemicals, gases, fumes and vapors (J68.0) cystic fibrosis (E84.-) 493.01, J45.22 Mild intermittent asthma with status asthmaticus N/A 493.02, J45.21 Mild intermittent asthma with (acute) exacerbation 493.82 J45.991 Cough variant asthma 493.90 J45.909 J45.998 Unspecified asthma, uncomplicated Other asthma 493.91 J45.902 Unspecified asthma with status asthmaticus 493.92 J45.901 Unspecified asthma with (acute) exacerbation
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Asthma Severity Chart INTERMITTENT MILD PERSISTENT MODERATE PERSISTENT
SEVERE PERSISTENT SYMPTOMS 2 or less days per week More than 2 days per week Daily Throughout the day NIGHTIME AWAKENINGS 2 x’s per month or less 3 – 4 x’s per month More than once per week but not nightly Nightly RESCUE INHALER USE week, but not daily Several times per day INTERFERENCE WITH NORMAL ACTIVITY None Minor limitation Some Extremely limited LUNG FUNCTION FEVI>80% predicted and normal between exacerbations FEV1>80% predicted FEV1 60 – 80% FEV1 less than 60%
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Documentation Tips 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)
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Toxic Effect of Venom 989.5 T63.-
ICD-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 T63 A - initial encounter D - subsequent encounter S - sequela
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Documentation Tips 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.
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Other adverse food reactions
ICD-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 T66 A - initial encounter D - subsequent encounter S - sequela
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Documentation Tips 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
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Cough ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 786.2 R05
Cough with hemorrhage (R04.2) Smoker’s Cough (J41.0) N/A
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Cough Documentation Tips
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.
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Allergy to other foods V15.05 Z91.018 Applicable To:
ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 V15.05 Z91.018 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
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Documentation Tips Z 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.
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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.
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Atopic Dermatitis 691.8 L20.0 Besnier's prurigo N/A
ICD-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 L20.81 Atopic neurodermatitis Applicable To: Diffuse neurodermatitis L20.82 Flexural eczema L20.84 Intrinsic (allergic) eczema L20.89 Other atopic dermatitis
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Documentation Tips In (L20-L30) codes the terms dermatitis and eczema are used synonymously and interchangeably.
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Chronic rhinitis 472.0 J31.0 Applicable To:
ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 472.0 J31.0 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)
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Documentation Tips 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).
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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 H10.30 Unspecified acute conjunctivitis, unspecified eye H10.31 Unspecified acute conjunctivitis, right eye H10.32 Unspecified acute conjunctivitis, left eye
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Unspecified acute conjunctivitis, bilateral Documentation Tips
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
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Unspecified contact dermatitis, unspecified cause
ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 692.9 L25.9 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-) 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 L25.8 Unspecified contact dermatitis due to other agents
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Allergic Rhinitis Documentation Tips
In this block the terms dermatitis and eczema are used synonymously and interchangeably.
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Other adverse food reactions
ICD-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 T66 A - initial encounter D - subsequent encounter S - sequela
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Documentation Tips 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
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Angioneurotic edema 995.1 T783XX- Applicable to: Allergic angioedema
ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 995.1 T783XX- 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 T78 A - initial encounter D - subsequent encounter S - sequela
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Documentation Tips 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
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Urticaria 708.9 L50.9 Urticaria, unspecified Lyme disease (A69.2-)
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 L50.8 Other urticaria
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Chronic sinusitis ICD-9 Code ICD-10 Code Description Excludes1
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 473.2 J32.2 Chronic ethmoidal sinusitis, NOS 473.3 J32.3 Chronic sphenoidal sinusitis, NOS 473.8, J32.4 Chronic pansinusitis Pansinusitis NOS J32.8 Other chronic sinusitis Sinusitis (chronic) involving more than one sinus but not pansinusitis 473.9 J32.9 Chronic sinusitis, unspecified, NOS Sinusitis (chronic) NOS
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Chronic sinusitis, unspecified Documentation Tips
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)
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Monitor Claims 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
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Claim Denial and Management
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
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Client Responsibilities
Client will need to update Templates Order Sets Superbills Favorites Future Orders Remove ICD-9 code add ICD-10 code
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Documentation – Start Now
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
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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
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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
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Questions Centers for Disease Control and Prevention (ICD-10-CM) Offical Guidelines, Alpha Index, Tabular Index, Neoplasm Table, Drug Table, External Cause of Injury Index
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