ICD-10-CM Code Updates Handout 090618.pdf

Conditions that are not an integral part of a disease

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Conditions that are NOT an integral part of a disease process Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present. ©2018 Practice Management Institute® 8 Practice Management Institute Webinar/Audio Conference September 6, 2018 4
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Coding Guidelines (cont.) Multiple codes for a single condition In addition to the etiology/manifestation convention that requires two codes to fully describe a single condition that affects multiple body systems, there are other single conditions that also require more than one code. “Use additional code” notes are found in the Tabular List at codes that are not part of an etiology/manifestation pair where a secondary code is useful to fully describe a condition. The sequencing rule is the same as the etiology/manifestation pair, “use additional code” indicates that a secondary code should be added, if known. ©2018 Practice Management Institute® 9 “Code first” notes are also under certain codes that are not specifically manifestation codes but may be due to an underlying cause. “Code, if applicable, any causal condition first”, notes indicate that this code may be assigned as a principal diagnosis when the causal condition is unknown or not applicable. ©2018 Practice Management Institute® 10 Practice Management Institute Webinar/Audio Conference September 6, 2018 5
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Coding Guidelines (cont.) Acute and Chronic Conditions If the same condition is described as both acute and chronic, code both. The acute is coded first. Combination Codes Used to classify two diagnoses, or a diagnosis with an associated secondary process (manifestation) Only assign the combination code when that code fully identifies the diagnostic conditions involved or when the Alphabetic Index so directs. ©2018 Practice Management Institute® 11 Coding Guidelines (cont.) Sequelae (Late Effect) Residual effect of a condition, ie: a scar as a result of a burn Coding a sequelae generally requires two codes: The condition/nature of the late effect is coded first, the late effect code is second – EXCEPTIONS When the code for the late effect is followed by a manifestation code in the tabular list and title When the late effect code has been expanded to the 4 th , 5 th or 6 th character levels to include the manifestation ©2018 Practice Management Institute® 12 Practice Management Institute Webinar/Audio Conference September 6, 2018 6
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