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ICD-10-CM Coding Guidelines - Certain Infectious and Parasitic Diseases (Chapter 1) and Neoplasms (Chapter 2)
 
 

ICD-10-CM Coding Guidelines - ertain Infectious and Parasitic Diseases (Chapter 1) and Neoplasms (Chapter 2)

 

Certain Infectious and Parasitic Diseases (Chapter 1)

Infectious diseases are caused by pathogenic organisms, such as bacteria, viruses, protozoa, mycosis, helminthes, and parasites. The ICD-10-CM Chapter 1 is titled "Certain Infectious and Parasitic Diseases." The corresponding code categories are A00-B99:

  • A00-A09 Intestinal Infectious Diseases – Codes in this subsection correspond with categories 001-009 of ICD-9-CM. These categories include codes for bacterial foodborne intoxication, salmonella, shigellosis, typhoid fevers, paratyphoid fevers, amebiasis, protozoal intestinal disease, rotoviral enteritis, gastroenteritis, colitis, and cholera.

  • A10-A49 Bacterial Diseases – Codes from this subsection correspond with categories 010-018 of ICD-9-CM. This subsection is divided into categories for tuberculosis, certain zoonotic bacterial diseases, and other bacterial diseases.

  • A50-A64 Infections with a Predominantly Sexual Mode of Transmission – These codes correspond with those in categories 090-099 of ICD-9-CM. Conditions of this subsection include chlamydial infections, syphilis, gonococcal infections, trichomoniasis, herpes, granuloma inguinale, and chancroids.

  • A65-A69 Other Spirochetal Diseases – Codes in this subsection correspond with those in categories 100-104 of ICD-9-CM.These codes include nonvenereal syphilis, pinta, yaws, Lyme disease, and relapsing fevers.

  • A70-A74 Other Diseases caused by Chlamydiae – Codes of this subsection correspond with those in categories 073-079 of ICD-9-CM. These codes are used for non-sexually transmitted chlamydial infections.

  • A75-A79 Rickettsioses – Codes in this subsection correspond with those in categories 080-088 of ICD-9-CM Conditions coded include spotted fever, typhus fever, trench fever, and Q fever.

  • A80-A89 Viral and Prion Infections of the Central Nervous System – Codes in this subsection are scattered throughout the ICD-9-CM. A prion is a protein-based infectious agent that usually invades the central nervous system. Conditions coded include atypical viral infections of eh CNS, as well as rabies, poliomyelitis, and mosquito-borne viral encephalitis.

  • A90-A99 Arthropod-Borne Viral Fevers and Viral Hemorrhagic Fevers – Codes in this subsection correspond with those in categories 060-066 of ICD-9-CM.

  • B00-B09 Viral Infections Characterized by Skin and Mucous Membrane Lesions – Codes in this subsection correspond with those in categories 050-059 of ICD-9-CM. Conditions coded include herpes viral infections, varicella, smallpox, measles, rubella, viral warts, monkey pox, and zoster.

  • B10 Other Human Herpesviruses – Codes in this subsection correspond with those in category 058 of ICD-9-CM. These conditions are human herpesviruses.

  • B15-B19 Viral Hepatitis – Codes in this subsection correspond with those in category 070 of ICD-9-CM. Conditions coded include acute and chronic viral hepatitis. 

  • B25-B34 Other Viral Diseases – Codes in this subsection are scattered throughout ICD-9-CM. These conditions include mumps, mononucleosis, cytomegaloviral diseases, and viral conjunctivitis.

  • B35-B49 Mycoses – Codes in this subsection correspond with those in categories 110-118 of ICD-9-CM. Conditions coded include sporotrichosis, candidiasis, histoplasmosis, mycetoma, Aspergillosis, and others.

  • B50-B65 Protozoal Diseases – Codes in this subsection correspond with those in categories 084-086 of ICD-9-CM. Conditions coded include plasmodium vivax malaria, plasma malariae malaria, plasmodium falciparum malaria, leishmaniasis, Chagas disease, toxoplasmosis, and other protozoal diseases.

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  • B65-B83 Helminthiases – Codes in this subsection correspond with those in categories 120-129 of ICD-9-CM. Conditions coded include fluke infections, tapeworm infections, filariasis, and other helminthiasis infections.

  • B85-B89 Pediculosis, Acariasis, and Other Infestations – Codes in this subsection correspond with those in categories 132-134 of ICD-9-CM. Conditions coded include head lice, body lice, scabies, myiasis, and other parasitic infestations.

  • B90-B94 Sequelae of Infectious and Parasitic Diseases – Codes in this subsection correspond with those in categories 137-139 of ICD-9-CM. Conditions coded include sequelae of leprosy, tuberculosis, and other infectious and parasitic diseases.

  • B95-B97 Bacterial and Viral Infectious Agents – Codes in this subsection correspond with those in categories 040-041 of ICD-9-CM. Conditions coded include infection by Streptococcus, Enterococcus, E. coli, and other bacterial agents.

  • B99 Other Infectious Diseases – Codes in this subsection are not available in ICD-9-CM. They are used for reporting conditions for which more specific codes are not listed Blood disorders include coagulation defects, anemias, and various other disorders of the blood components (Grebner & Suarez, 2013).

General Guidelines

  • Code only confirmed cases of HIV. 

  • Use Asymptomatic HIV, Z21 when the patient does not have any symptoms but is listed as "HIV positive." 

  • Use code Z11.4 when a patient is being tested for HIV, and add codes for any associated high risk behavior. 

  • Use code O98.7 when a patient is admitted during pregnancy because of an HIV-related illness. 

  • Use code Infection with drug resistant microorganisms, Z16 when the bacterial infection is resistant to antibiotics.

  • Assign code A41.9 Sepsis, unspecified for a diagnosis of sepsis without an underlying systemic infection.

  • For severe sepsis, use the code for the underlying systemic infection first, and then use the code R65.21, Sever sepsis with septic shock (Davis, 2011).

Neoplasms (Chapter 2)

A neoplasm is an abnormal tissue growth in the body. If it is benign, it is considered non-cancerous, whereas if it is malignant, it is cancerous. In Chapter 2 of ICD-10-CM titled "Neoplasms," the code categories are C00-D49:

  • C00-C96 Malignant Neoplasms – When coding malignant neoplasms, anatomic terminology is used to identify the neoplasm of lymphoid. hematopoietic, and related tissues. Codes in this subsection correspond with 140-208 in ICD-9-CM. Conditions coded include various sites of the body, as well as unspecified sites, other endocrine glands, and tissue sites.

  • D00-D09 In Situ Neoplasms – Codes in this subsection correspond with those in categories 230-234 in ICD-9-CM. Conditions are coded by site, such as breast, cervix, prostate, and skin. Bowen's disease is a type of in situ squamous cell carcinoma of the skin. Prostatic intraepithelial neoplasia is often documented as in situ prostate neoplasm.

  • D10-D36 Benign Neoplasms – Codes in this subsection correspond with those in categories 209-229 in ICD-9-CM. The coder must use as additional code to identify functional activity when reporting benign neoplasms of eh ovary, testis, pancreas, thyroid, and other endocrine glands.

  • D37-D49 Neoplasms of Uncertain or Unspecified Behavior - Codes in this subsection correspond with those in categories 235-239 in ICD-9-CM. Uncertain behavior indicates that the pathologist cannot determine if the neoplasm is benign or malignant (Grebner & Suarez, 2013).

General Guidelines

  • Neoplasms are classified by site (topography) and identified by behavior, which is malignant, in situ, benign, uncertain, or unspecified. The topography is located in the Neoplasms Table in the Alphabetic Index. 

  • The principal diagnosis for a neoplasm is usually determined by the focus of treatment. When treatment is focused on the primary malignancy site, the appropriate principal diagnosis is that primary site. If the focus of treatment is on a secondary site, then the secondary neoplasm code would be used as the principal diagnosis, with the primary site listed as an additional diagnosis. 

  • When a patient encounter is solely for the administration of treatment, whether it be chemotherapy or radiation, then the coder should use a code from the Z51 category as the first-listed diagnosis. Following that code, the code for the malignancy would be sequenced second. Additionally, the coder should list the primary site first when the encounter is for determination of the extent of the malignancy or for a procedure. 

  • When the reason for the encounter is the metastatic site, the first-listed diagnosis is that site, followed by a code to reflect the primary site. When a pregnant woman with a malignant condition is treated for the neoplasm, the first-listed diagnosis should be assigned from the O94.1- subcategory, Malignant neoplasm complicating pregnancy. This is followed by a code to describe the type of neoplasm (Grebner & Suarez, 2013).

Coding Neoplasm Complications

Complications associated with malignant neoplasms need appropriate coding. Common complications include:

  • Anemia – If a patient with a malignancy develops anemia, the coder must list first the principal diagnosis code, followed by a code for anemia in neoplastic disease (D.63.0). When the anemia is related to treatment, the coder must use the code for the adverse effect first, and then assign the codes for anemia and the malignancy.

  • Dehydration – When dehydration occurs secondary to the malignant condition, the coder assigns the dehydration code first, followed by the malignancy code.

  • Surgical treatment – Complications related to surgical treatment require the coder to list the first-listed code has to be the complication, followed by a code for the malignant neoplasm.  

  • Fracture – If a pathological fracture occurs due to the neoplasm, the sequencing is related to the focus of treatment. For instance, an encounter focused on treating the fracture will be coded first with a code from the subcategory M84.5, followed by the code for the primary neoplasm. If the neoplasm is being treated, the first-listed code will reflect that and be followed by M84.5.

  • Extensive metastasis – When there is extensive metastasis, the coder should assign the code C80.0, Disseminated malignant neoplasm, unspecified. The code used when the physician is unable to determine the site of primary malignancy is C80.1, Malignant neoplasm, unspecified (Grebner & Suarez, 2013).

 

 
 
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