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ICD-10-CM Expert for SNF, IRF, and LTCH The complete official code set Codes valid from October 1, 2018 through September 30, 2019

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ITSN_ITSN19_CVR.indd 1 12/4/17 2:54 PM Contents

Preface ...... iii ICD-10-CM Index to Diseases and Injuries ...... 1 ICD-10-CM Official Preface ...... iii Characteristics of ICD-10-CM ...... iii ICD-10-CM Neoplasm Table ...... 331

What’s New for 2019 ...... iv ICD-10-CM Table of Drugs and Chemicals ...... 349 Official Updates ...... iv Proprietary Updates ...... vii ICD-10-CM Index to External Causes ...... 397

Introduction ...... ix ICD-10-CM Tabular List of Diseases and Injuries ...... 433 History of ICD-10-CM ...... ix Chapter 1. Certain Infectious and Parasitic Diseases (A00-B99) ...... 433 How to Use ICD-10-CM Expert for Skilled Nursing Chapter 2. Neoplasms (C00-D49) ...... 457 Facilities, Inpatient Rehabilitation Services, and Inpatient Hospice 2019 ...... x Chapter 3. Diseases of the Blood and Blood-forming Organs and Certain Disorders Involving the Use of Official Sources ...... x Immune Mechanism (D50-D89) ...... 495 Steps to Correct Coding ...... x Chapter 4. Endocrine, Nutritional and Metabolic Diseases Organization ...... x (E00-E89) ...... 505 Introduction ...... x Chapter 5. Mental, Behavioral, and Neurodevelopmental Official ICD-10-CM Conventions and Guidelines...... x Disorders (F01-F99) ...... 525 Alphabetic Index to Diseases ...... x Neoplasm Table...... x Chapter 6. Diseases of the Nervous System (G00-G99) ...... 549 Table of Drugs and Chemicals ...... x Chapter 7. Diseases of the Eye and Adnexa (H00-H59) ...... 569 Index to External Causes ...... xi Chapter 8. Diseases of the Ear and Mastoid Process Tabular List of Diseases ...... xi (H60-H95) ...... 605 Appendixes...... xi Chapter 9. Diseases of the Circulatory System (I00-I99) ...... 617 Illustrations...... xi Chapter 10. Diseases of the Respiratory System (J00-J99) ...... 657 Overview of ICD-10-CM Official Conventions ...... xii Chapter 11. Diseases of the Digestive System (K00-K95) ...... 673 Format ...... xii Chapter 12. Diseases of the Skin and Subcutaneous Tissue Punctuation ...... xii (L00-L99) ...... 695 Abbreviations ...... xii Chapter 13. Diseases of the Musculoskeletal System and NEC ...... xii Connective Tissue (M00-M99) ...... 715 NOS ...... xii Chapter 14. Diseases of the Genitourinary System Typeface ...... xii (N00-N99) ...... 803 General Notes ...... xii Chapter 15. Pregnancy, Childbirth and the Puerperium Includes Notes ...... xii (O00-O9A) ...... 821 Inclusion Terms...... xii Chapter 16. Certain Conditions Originating in the Perinatal Excludes Notes...... xii Period (P00-P96) ...... 857 Note...... xiii Default Codes...... xiii Chapter 17. Congenital Malformations, Deformations and Syndromes...... xiii Chromosomal Abnormalities (Q00-Q99) ...... 869 And ...... xiii Chapter 18. Symptoms, Signs and Abnormal Clinical and With ...... xiii Laboratory Findings, Not Elsewhere See and See Also ...... xiii Classified (R00-R99) ...... 887 Instructional Notes Used in the Tabular List ...... xiii Chapter 19. Injury, Poisoning and Certain Other Consequences Code Assignment and Clinical Criteria ...... xiii of External Causes (S00-T88) ...... 907 Chapter 20. External Causes of Morbidity (V00-Y99)...... 1115 Additional AnnotationsSample ...... xiv Page Chapter 21. Factors Influencing Health Status and Contact Code-Level Notations ...... xiv With Health Services (Z00-Z99) ...... 1177 Italics ...... xiv Color Coding/Symbols...... xiv Appendixes ...... Appendixes–1 Footnotes...... xvi Appendix A: 10 Steps to Correct Coding ...... Appendixes–1 Chapter-Level Notations ...... xvi Appendix B: Valid 3-character ICD-10-CM Chapter-Specific Guidelines with Coding Examples...... xvi Codes ...... Appendixes–3 Muscle Tendon Table ...... xvi Appendix C: Pharmacology List 2018...... Appendixes–5 Index Notations...... xvi Appendix D: Z Codes for Long-Term Drug Use Following References...... xvi with Associated Drugs...... Appendixes–21 Appendix E: Z Codes Only as Principal/First-Listed ICD-10-CM Official Guidelines for Coding Diagnosis ...... Appendixes–24 and Reporting 2017 ...... Coding Guidelines–1 Appendix F: Hospice Criteria for Medicare Coverage of Noncancer Hospice Care ...... Appendixes–25

ICD-10-CM 2019 ICD-10-CM 2019 Madness

Lymphangitis — continued Lymphogranulomatosis (malignant) (see also Lym- Lymphoma — continued Index acute — continued phoma, Hodgkin) non-leukemic variant of B-CLL C83.0- S hip — see Lymphangitis, acute, lower limb benign (Boeck's sarcoid) (Schaumann's) D86.1 peripheral T-cell, not classified C84.4- S jaw (region) L03.212 Lymphohistiocytosis, hemophagocytic(familial) D76.1 primary cutaneous knee — see Lymphangitis, acute, lower limb Lymphoid — see condition anaplastic large cell C86.6 leg — see Lymphangitis, acute, lower limb Lymphoma (of) (malignant) C85.90 CD30-positive large T-cell C86.6 lower limb L03.12- S adult T-cell (HTLV-1-associated) (acute variant) primary effusion B-cell C83.8- S toe — see Lymphangitis, acute, toe (chronic variant) (lymphomatoid variant) SALT C88.4 navel L03.326 (smouldering variant) C91.5- S skin-associated lymphoid tissue [SALT-lymphoma] neck (region) L03.222 anaplastic large cell C88.4 orbit, orbital — see Cellulitis, orbit ALK-negative C84.7- S small cell B-cell C83.0- S pectoral (region) L03.323 ALK-positive C84.6- S splenic marginal zone C83.0- S perineal, perineum L03.325 CD30-positive C84.6- S subcutaneous panniculitis-like T-cell C86.3 scalp (any part) L03.891 primary cutaneous C86.6 T-precursor C83.5- S shoulder — see Lymphangitis, acute, upper limb angioimmunoblastic T-cell C86.5 true histiocytic C96.A (following C96.6) specified site NEC L03.898 BALT C88.4 Lymphomatosis — see Lymphoma thigh — see Lymphangitis, acute, lower limb B-cell C85.1- S Lymphopathia venereum, veneris A55 thumb (intrathecal) (periosteal) (subcutaneous) blastic NK-cell C86.4 Lymphopenia D72.810 (subcuticular) — see Lymphangitis, acute, blastic plasmacytoid dendritic cell neoplasm (BPDCN) Lymphoplasmacytic leukemia — see Leukemia, finger C86.4 chronic lymphocytic, B-cell type toe (intrathecal) (periosteal) (subcutaneous) (sub- B-precursor C83.5- S Lymphoproliferation, X-linked disease D82.3 cuticular) L03.04- S bronchial-associated lymphoid tissue [BALT-lym- Lymphoreticulosis, benign (of inoculation) A28.1 trunk L03.329 phoma] C88.4 Lymphorrhea I89.8 abdominal wall L03.321 Burkitt (atypical) C83.7- S Lymphosarcoma (diffuse) (see also Lymphoma) back (any part) L03.322 Burkitt-like C83.7- S C85.9- S buttock L03.327 centrocytic C83.1- S Lymphostasis I89.8 chest wall L03.323 cutaneous follicle center C82.6- S Lypemania — see Melancholia groin L03.324 cutaneous T-cell C84.A- S (following C84.7) Lysine and hydroxylysine metabolism disorder E72.3 perineal, perineum L03.325 diffuse follicle center C82.5- S Lyssa — see Rabies umbilicus L03.326 diffuse large cell C83.3- S umbilicus L03.326 anaplastic C83.3- S upper limb L03.12- S B-cell C83.3- S M axilla — see Lymphangitis, acute, axilla CD30-positive C83.3- S Macacus ear Q17.3 finger — see Lymphangitis, acute, finger centroblastic C83.3- S Maceration, wet feet, tropical (syndrome) T69.02- S thumb — see Lymphangitis, acute, finger immunoblastic C83.3- S MacLeod's syndrome J43.0 wrist — see Lymphangitis, acute, upper limb plasmablastic C83.3- S Macrocephalia, macrocephaly Q75.3 breast subtype not specified C83.3- S Macrocheilia, macrochilia (congenital) Q18.6 gestational — see Mastitis, obstetric T-cell rich C83.3- S chancroidal A57 Macrocolon (see also Megacolon) Q43.1 enteropathy-type (associated) (intestinal) T-cell C86.2 Macrocornea Q15.8 chronic (any site) I89.1 extranodal marginal zone B-cell lymphoma of mucosa- due to with glaucoma Q15.0 associated lymphoid tissue [MALT-lymphoma] Macrocytic — see condition Brugia (malayi) B74.1 C88.4 timori B74.2 Macrocytosis D75.89 extranodal NK/T-cell, nasal type C86.0 Macrodactylia, macrodactylism (fingers) (thumbs) Wuchereria bancrofti B74.0 follicular C82.9- S following ectopic or molar pregnancy O08.89 Q74.0 grade toes Q74.2 penis I C82.0- S acute N48.29 Macrodontia K00.2 II C82.1- S gonococcal (acute) (chronic) A54.09 Macrogenia M26.05 S puerperal, postpartum, childbirth O86.89 III C82.2- Macrogenitosomia (adrenal) (male) (praecox) E25.9 strumous, tuberculous A18.2 IIIa C82.3- S congenital E25.0 subacute (any site) I89.1 IIIb C82.4- S Macroglobulinemia (idiopathic) (primary) C88.0 tuberculous — see Tuberculosis, lymph gland specified NEC C82.8- S monoclonal (essential) D47.2 Lymphatic (vessel) — see condition hepatosplenic T-cell (alpha-beta) (gamma-delta) C86.1 Waldenström C88.0 Lymphatism E32.8 histiocytic C85.9- S Macroglossia (congenital) Q38.2 Lymphectasia I89.0 true C96.A (following C96.6) acquired K14.8 Lymphedema (acquired) (see also Elephantiasis) Hodgkin C81.9 S Macrognathia, macrognathism (congenital) congenital Q82.0 lymphocyte depleted (classical) C81.3- S (mandibular) (maxillary) M26.09 hereditary (chronic) (idiopathic) Q82.0 lymphocyte-rich (classical) C81.4- S Macrogyria (congenital) Q04.8 postmastectomy I97.2 mixed cellularity (classical) C81.2- S Macrohydrocephalus — see Hydrocephalus praecox I89.0 nodular Macromastia — see Hypertrophy, breast secondary I89.0 lymphocyte predominant C81.0- S Macrophthalmos Q11.3 surgical NEC I97.89 sclerosis (classical) C81.1- S in congenital glaucoma Q15.0 postmastectomy (syndrome) I97.2 nodular sclerosis (classical) C81.1- S Macropsia H53.15 Lymphoblastic — see condition specified NEC (classical) C81.7- S Macrosigmoid K59.39 Lymphoblastoma (diffuse) — see Lymphoma, lym- intravascular large B-cell C83.8- S congenital Q43.2 phoblastic (diffuse) Lennert's C84.4- S Macrospondylitis , acromegalic E22.0 giant follicular — see Lymphoma, lymphoblastic (dif- lymphoblastic (diffuse) C83.5- S Macrostomia (congenital) Q18.4 fuse) lymphoblastic B-cell C83.5- S Macrotia (external ear) (congenital) Q17.1 macrofollicular — see Lymphoma, lymphoblastic lymphoblastic T-cell C83.5- S Macula (diffuse) Samplelymphoepithelioid C84.4- S Pagecornea, corneal — see Opacity, cornea Lymphocele I89.8 lymphoplasmacytic C83.0- S degeneration (atrophic) (exudative) (senile) (see also Lymphocytic with IgM-production C88.0 Degeneration, macula) chorioencephalitis (acute) (serous) A87.2 MALT C88.4 hereditary — see Dystrophy, retina

choriomeningitis (acute) (serous) A87.2 mantle cell C83.1- S Maculae ceruleae B85.1 — Madness Lymphangitis meningoencephalitis A87.2 mature T-cell NEC C84.4- S Maculopathy, toxic — see Degeneration, macula, toxic Lymphocytoma, benign cutis L98.8 mature T/NK-cell C84.9- S Madarosis (eyelid) H02.729 Lymphocytopenia D72.810 specified NEC C84.Z- S (following C84.7) left H02.726 Lymphocytosis (symptomatic) D72.820 mediastinal (thymic) large B-cell C85.2- S lower H02.725 infectious (acute) B33.8 Mediterranean C88.3 upper H02.724 Lymphoepithelioma — see Neoplasm, malignant, by mucosa-associated lymphoid tissue [MALT-lymphoma] right H02.723 site C88.4 lower H02.722 Lymphogranuloma (malignant) (see also Lymphoma, NK/T cell C84.9- S upper H02.721 Hodgkin) nodal marginal zone C83.0- S Madelung's chlamydial A55 non-follicular (diffuse) C83.9- S deformity (radius) Q74.0 inguinale A55 specified NEC C83.8- S disease venereum (any site) (chlamydial) (with stricture of non-Hodgkin (see also Lymphoma, by type) C85.9- S radial deformity Q74.0 rectum) A55 specified NEC C85.8- S symmetrical lipomas, neck E88.89 Madness — see Psychosis

2 Subterms under main terms may continue to next column or page S Additional Character Required — Refer to the Tabular List for Character Selection 215 Chapter 3. Diseases of the Blood and Blood-forming Organs D63–D68.311

A A 499

Fibrin Injury site Unspecified Code Unspecified D63–D68.311 circulating circulating B intrinsic Platelets other clotting factors Autoimmune hemophilia Autoimmune inhibitors to clotting factors hemophilia Secondary deficiency Acquired hemophilia Acquired Coagulation deficiency capillary fragility (hereditary) (D69.8) (hereditary) fragility capillary (D66) NOS deficiency VIII factor (D66) defect functional with deficiency VIII factor

the puerperium (O45.0, O46.0, O67.0, O72.3) O67.0, O46.0, (O45.0, the puerperium pregnancy (O00-O07, O08.1) anticoagulants, antibodies, anticoagulants, inhibitors or antibodies, D68.311

tor VIII deficiency VIII tor IX tor Abnormal blood coagulation caused by deficient blood blood deficient by caused coagulation blood Abnormal coagulation defects complicating pregnancy, childbirth and and childbirth pregnancy, complicating defects coagulation factor VIII deficiency with vascular defect (D68.0) defect vascular with deficiency VIII factor (R79.1) profile coagulation abnormal molar or ectopic or abortion complicating defects coagulation Red blood cells AC globulin deficiency afibrinogenemia Congenital [fibrinogen] I factor ofDeficiency [prothrombin] II factor Deficiency of factorDeficiency V [labile] of [stable] factor VII Deficiency of X [Stuart-Prower] factor Deficiency of [Hageman] XII factor Deficiency of stabilizing]factorDeficiency [fibrin XIII of (congenital) Dysfibrinogenemia Hypoproconvertinemia disease Owren's Proaccelerin deficiency 1 DEF: factor VII; congenital; symptoms include excess or prolonged bleeding. Angiohemophilia defect vascular with deficiency VIII Factor Vascular hemophilia Hemophilia C deficiency [PTA] antecedent thromboplastin Plasma disease Rosenthal’s Page XI factor Hereditary D68.31 Hemorrhagic disorder due to 2016, 1Q, 14 1Q, 2016, Hereditary, sex-linked lack of antihemophilic globulin (AHG) (factor Do not assign to identify routine therapeutic anticoagulation effects; AHA: TIP: assign only for documented adverse effects. d Classical hemophilia Classical defect) (with functional VIII Deficiency factor Hemophilia A Hemophilia NOS 1 DEF: VIII); causes abnormal coagulation characterized by increased bleeding, tract; gastrointestinal nose, mouth, in bleeding skin, of large bruises function. and impaired in swelling resulting joints, into hemorrhages disease Christmas defect) functional (with deficiency IX Factor Hemophilia B [PTC] deficiency component Plasma thromboplastin 1 White blood cell White D68.0disease Willebrand's Von D68.1 D68.3 to anticoagulants due Hemorrhagic disorder circulating Hereditary fac Hereditary fac Hereditary D68.2 of deficiency Hereditary c D66 D67 D68 defects coagulation Other b

B A A Diseases of the Blood and Blood-forming Organs Blood-forming and the Blood of Diseases Chapter 3. e puerperium (O45.0, O46.0, O46.0, (O45.0, e puerperium due to drugsandtoxins due to disease to due

anemia chemotherapy (D61.1) chemotherapy x

anemia antineoplastic chemotherapy anemia anemia anemia in neoplastic disease (D63.0) in neoplastic anemia aplastic anemia due to antineoplastic antineoplastic due to anemia aplastic anemias (D64.81) Sample (D61.1) Placeholder Alert RUG IV Special Care High Dx RUG IV Clinically Complex Dx RUG IV Special Care Low Dx Manifestation Code 2014, 4Q, 22 4Q, 2014, (D65-D69) chronic diseases classified elsewhere Reversible adverse effect of chemotherapy, of chemotherapy, effect adverse Reversible Blackfan-Diamond syndrome (D61.01) syndrome Blackfan-Diamond Di Guglielmo's disease (C94.0) anemia due to antineoplastic chemotherapy (D64.81) chemotherapy to antineoplastic due anemia chemotherapy antineoplastic due to anemia aplastic g anemia due to antineoplastic chemotherapy chemotherapy to antineoplastic anemia due O67.0, O72.3) O67.0, 2 AHA: DEF: causing inhibition of bone marrow production; decrease adequate prevents production cell blood red in oxygenation of the tissues and organs causing fatigue, conditions. medical of other and exacerbation SOB, Antineoplastic chemotherapy induced anemia 1 Infantile pseudoleukemia Infantile w neoplastic disease chronic kidney disease kidney chronic [RAEB T] (C92.0-) [RAEB

2017, 1Q, 7 1Q, 2017, abortion or ectopic or molar pregnancy (O00-O07, O08.1) (P60) newborn in th pregnancy, and childbirth with fifth or sixth character 1-4 or 6) or sixth character fifth with 5) character sixth or fifth with (T36-T50 drug sideroblastic specified anemias specified disseminated intravascular coagulation (complicating): coagulation intravascular disseminated refractory anemia (D46.-) anemia refractory transformation blasts in excess with anemia refractory diphyllobothriasis (B70.0) (B76.0-B76.9) disease hookworm hypothyroidism (E00.0-E03.9) (B50.0-B54) malaria (A52.79) syphilis late symptomatic (A18.89) tuberculosis Dyshematopoietic anemia(congenital) Sideroblastic anemia NOS anemia Sideroblastic NEC anemia sideroblastic Pyridoxine-responsive Code first poisoningdrug dueor to toxin,applicable if (T36-T65 identify to applicable, if effect, adverse for code additional Use Code first underlying disease, such as: such disease, underlying Code first Sex-linked hypochromic sideroblastic anemia sideroblastic hypochromic Sex-linked underlying disease Code first Erythropoietin resistant anemia (EPO resistant anemia) resistant (EPO anemia resistant Erythropoietin (CKD) (N18.-)disease kidney underlying chronic Codefirst AHA: 1 1 2 Code first neoplasm (C00-D49) neoplasm first Code Congenital dyserythropoietic Secondary sideroblastic sideroblastic Secondary Hereditary sideroblastic Hereditary Other D64.81 Anemia due to D64.89 Other specified anemias 1 Afibrinogenemia, acquired Afibrinogenemia, coagulopathy Consumption Diffuse ordisseminated intravascular coagulation[DIC] Fibrinolytic hemorrhage, acquired Fibrinolytic purpura fulminans Purpura 1 2019 2019 D64.4 D64.3 Other D64.1 D64.2 D63.8 Anemia other in D64.0 syndrome] D64.8 D63.1 Anemia in D63.0 Anemia in D64.9 Anemia, unspecified c D65 [defibrination coagulation intravascular Disseminated D64 Other anemias D63 elsewhere classified diseases chronic in Anemia Additional Character Required Coagulation defects, purpura and other hemorrhagic conditions b b ICD-10-CM ICD-10-CM ICD-10-CM S G71.12–G81.14 Chapter 6. Diseases of the Nervous System ICD-10-CM 2019 G71.12 Myotonia congenita % G73.3 Myasthenic syndromes in other diseases classified elsewhere Acetazolamide responsive myotonia congenita Code first underlying disease, such as: Dominant myotonia congenita [Thomsen disease] neoplasm (C00-D49) Myotonia levior thyrotoxicosis (E05.-) Recessive myotonia congenita [Becker disease] G73.7 Myopathy in diseases classified elsewhere G71.13 Myotonic chondrodystrophy % Code first underlying disease, such as: Chondrodystrophic myotonia hyperparathyroidism (E21.0, E21.3) Congenital myotonic chondrodystrophy hypoparathyroidism (E20.-) Schwartz-Jampel disease glycogen storage disease (E74.0) G71.14 Drug induced myotonia % lipid storage disorders (E75.-) Use additional code for adverse effect, if applicable, 1 myopathy in: to identify drug (T36-T50 with fifth or sixth rheumatoid arthritis (M05.4-) character 5) sarcoidosis (D86.87) G71.19 Other specified myotonic disorders % scleroderma (M34.82) Myotonia fluctuans sicca syndrome [Sjögren] (M35.03) Myotonia permanens systemic lupus erythematosus (M32.19) Neuromyotonia [Isaacs] Paramyotonia congenita (of von Eulenburg) Cerebral palsy and other paralytic syndromes (G80-G83) Pseudomyotonia Symptomatic myotonia b G80 Cerebral palsy G71.2 Congenital myopathies % 1 hereditary spastic paraplegia (G11.4) Central core disease G80.0 Spastic quadriplegic cerebral palsy % Fiber-type disproportion Congenital spastic paralysis (cerebral) Chapter 6. Diseases of the Nervous System Nervous the of Diseases 6. Chapter Minicore disease G80.1 Spastic diplegic cerebral palsy % Multicore disease Spastic cerebral palsy NOS Myotubular (centronuclear) myopathy Nemaline myopathy G80.2 Spastic hemiplegic cerebral palsy % 1 arthrogryposis multiplex congenita (Q74.3) G80.3 Athetoid cerebral palsy % Double athetosis (syndrome) G71.3 Mitochondrial myopathy, not elsewhere classified Dyskinetic cerebral palsy 1 Kearns-Sayre syndrome (H49.81) Dystonic cerebral palsy Leber's disease (H47.21) Vogt disease Leigh's encephalopathy (G31.82) mitochondrial metabolism disorders (E88.4-) G80.4 Ataxic cerebral palsy % Reye's syndrome (G93.7) G80.8 Other cerebral palsy % G71.8 Other primary disorders of muscles Mixed cerebral palsy syndromes B G71.9 Primary disorder of muscle, unspecified B G80.9 Cerebral palsy, unspecified Hereditary myopathy NOS Cerebral palsy NOS G81 Hemiplegia and hemiparesis b G72 Other and unspecified myopathies b 0 This category is to be used only when hemiplegia 1 arthrogryposis multiplex congenita (Q74.3) (complete)(incomplete) is reported without further dermatopolymyositis (M33.-) specification, or is stated to be old or longstanding but of ischemic infarction of muscle (M62.2-) Pageunspecified cause. The category is also for use in multiple myositis (M60.-) coding to identify these types of hemiplegia resulting from polymyositis (M33.2-) any cause. G72.0 Drug-induced myopathy % 1 congenital cerebral palsy (G80.-) Use additional code for adverse effect, if applicable, to identify hemiplegia and hemiparesis due to sequela of cerebrovascular drug (T36-T50 with fifth or sixth character 5) disease (I69.05-, I69.15-, I69.25-, I69.35-, I69.85-, I69.95-) G72.1 Alcoholic myopathy % AHA: 2015, 1Q, 25 Use additional code to identify alcoholism (F10.-) c G81.0 Flaccid hemiplegia G72.2 Myopathy due to other toxic agents % G81.00 Flaccid hemiplegia affecting unspecified side AB Code first (T51-T65) to identify toxic agent RIC Excl: 01 Stroke G72.3 Periodic paralysis % G81.01 Flaccid hemiplegia affecting right A Familial periodic paralysis dominant side Hyperkalemic periodic paralysis (familial) RIC Excl: 01 Stroke Hypokalemic periodic paralysis (familial) G81.02 Flaccid hemiplegia affecting left A Myotonic periodic paralysis (familial) dominant side Normokalemic paralysis (familial) RIC Excl: 01 Stroke Potassium sensitive periodic paralysis G81.03 Flaccid hemiplegia affecting right A 1 paramyotonia congenita (of von Eulenburg) (G71.19) nondominant side c G72.4 Inflammatory and immune myopathies, not elsewhere RIC Excl: 01 Stroke classified G81.04 Flaccid hemiplegia affecting left A G72.41 Inclusion body myositis [IBM] nondominant side RIC Excl: 01 Stroke G72.49 Other inflammatory and immune myopathies, not elsewhere classified c G81.1 Spastic hemiplegia Inflammatory myopathy NOS G81.10 Spastic hemiplegia affecting unspecified side AB Sample RIC Excl: 01 Stroke c G72.8 Other specified myopathies G72.81 Critical illness myopathy G81.11 Spastic hemiplegia affecting right A Acute necrotizing myopathy dominant side Acute quadriplegic myopathy RIC Excl: 01 Stroke Intensive care (ICU) myopathy G81.12 Spastic hemiplegia affecting left A Myopathy of critical illness dominant side G72.89 Other specified myopathies RIC Excl: 01 Stroke G81.13 Spastic hemiplegia affecting right G72.9 Myopathy, unspecified B A nondominant side b G73 Disorders of myoneural junction and muscle in diseases RIC Excl: 01 Stroke classified elsewhere G81.14 Spastic hemiplegia affecting left A G73.1 Lambert-Eaton syndrome in neoplastic disease nondominant side Code first underlying neoplasm (C00-D49) RIC Excl: 01 Stroke 1 Lambert-Eaton syndrome not associated with neoplasm (G70.80-G70.81) G71.12–G81.14

8 Newborn 9 Pediatric x Maternity y Adult % RIC Dx 7 Noncancer Dx u Primary Dx A RIC CC Condition wx Revised Text l New Code s Revised Code Title 564 ICD-10-CM 2019 Chapter 10. Diseases of the Respiratory System 657

Guidelines and Examples and Guidelines clear as to whether the patient has patient the whether as to clear to whether acute respiratory failure failure respiratory acute whether to her identified influenza, then the

Pneumonia due to Streptococcus pneumoniae Pneumonia Streptococcus due to with unspecified whether failure, respiratory Acute or hypercapnia hypoxia : Acute respiratory failure may be listed as a secondary as a secondary listed may be failure respiratory Acute : Page ) may be applied be in these) may situations. Influenza due to identified novel influenza A virus with with A virus influenza novel identified due to Influenza pneumonia : Codes in category J09 Influenza due to certain identified Acute pneumococcal pneumonia with subsequent development of of development subsequent with pneumonia pneumococcal Acute failure respiratoryacute J13 J96.00 Explanation diagnosis if it after occurs admission, or if it is admissionon present but does not meet the definition of principal diagnosis. Section II, C. (J00–J99) When a patient is admitted with respiratory failure and another acute acute another and failure respiratory with is admitted When a patient accident, infarction, cerebrovascular myocardial condition, (e.g., in same be not the will diagnosis the principal pneumonia), aspiration every situation. This applies whether the other conditionacute is a respiratory or nonrespiratory Selectioncondition. of the principal If bothof admission. diagnosis will be circumstances dependent on the the respiratory failure and the other acute condition are equally occasioningand responsiblethe are there admission to the hospital, for or two guideline regarding the sequencing rules, chapter-specific no more diagnoses equally that the meet definition principalfor diagnosis ( If the documentation is not clear as is not clear documentation If the the occasioning for responsible equally are condition and another admission, query the provider for clarification. Aswith all proceduralor postprocedural complications, code assignment documentation of the betweenis based relationship onthe provider’s the conditionand procedure. the only assigned be should pneumonia, associated Ventilator J95.851, Code pneumonia associated ventilator documented has the provider when (VAP). An additional code to identify the Pseudomonasorganism (e.g., aeruginosa, code B96.5) should also be Do assigned. not assign an additional code from categories J12-J18 to identify the type of pneumonia. has the patient where cases for be assigned notshould J95.851 Code not has provider and the ventilator a mechanical is on and pneumonia specifically stated that the pneumonia is ventilator-associated is un the documentation pneumonia. If complicationaa pneumonia the is attributable that to mechanical query provider. the ventilator, Influenza due to avian influenza virus with pneumonia virus influenza to avian due Influenza J09.X1 Explanation influenza viruses should be only assigned for cases. confirmed positive laboratorydoes specific not require of a testing “Confirmation” diagnostic provider’s the on based be to need does but virus influenza or “probable,” “possible,” such as not include which should terms statement, “suspected.” 3) another and acute condition respiratoryacute failure Sequencing of Code only confirmed cases of influenza due to certain identified influenza (category virus influenza identified other to due and J09), (category viruses hospitalthe inpatient guideline to SectionH. exception is an II, J10).This (Uncertain Diagnosis). documentationof positiverequire not does “confirmation” In this context, laboratory avian or other influenza A or novel testing specific for other coding should be basedidentified on influenzathe provider’s However, virus. other novel or influenza, avian has the patient that diagnostic statement influenza A, categoryfor J09, or has another particular identified ofstrain for or variant,influenza,H3N2, H1N1 but such as or not identified novel as J10. category avian “probable” or or “possible” “suspected” If provider records the ot or influenza, novel or influenza, unidentified to due Influenza J11, category from code influenza appropriate due Influenza categoryJ09, from A code assigned. be should virus, influenza nor shouldassigned a shouldto certain influenza not beidentified viruses, virus. influenza identified to other due Influenza J10, category from code 1) Documentation of ventilator associated pneumonia c. viruses influenza identified Influenza certain to due d. pneumonia associated Ventilator Diseases of the Respiratory System Respiratory the of Diseases Chapter 10. -CM Official Guidelines for 0 exacerbation, and those with status

treatment upon admission to the -CM uses combination codes to create create combination to -CM codes uses Sample 10 Moderate persistent asthma asthmaticus status persistent with Moderate Chronic obstructive pulmonary disease with (acute) exacerbation asthma, persistent Moderate uncomplicated of management and adjustment for Encounter catheter access vascular Pneumonia due to methicillin resistant Pneumoniamethicillin resistant due to Staphylococcus aureus obstructiveChronic pulmonary disease with acute lower respiratory infection : Category J45 Asthma includes severity-specific : ICD- 2019 organism-specific classifications for many types of pneumonia. of types many for classifications organism-specific COPDCategory exacerbated, is J44 distinguishesbetween that COPD withoutof a mention COPD respiratory infection, and lower with acute respiratoryis infection lower a (unspecified).complication When present and COPD is diagnosed, two codes would be J44.0 required, and the codethe for infection. Sequencing willdependent be the on of focus is the conditionthat post-acute which setting, in this case is the MRSA pneumonia. Exacerbation of moderate persistent asthma with status asthmaticus J45.42 Explanation between to distinguish codes fifth-character and subcategories acute in those cases, uncomplicated An acute exacerbation is a worsening or decompensation of a chronic of a chronic decompensation or a worsening is exacerbation An acute conditionmustandspecified such. beby provider When as the both acute an reports provider the and diagnosed are asthma and COPD exacerbation an acuteCOPD, of exacerbation of asthma cannotbe the provider. by assumed specifically unless stated asthmaticus. Z45.2 Explanation J15.212 J44.0 J44.1 J45.40 Patient admittedforPatient continued IV antibiotic administration and physical of exacerbation acute with pneumonia MRSA of diagnoses with therapy Provider documentation indicates comorbidCOPD. moderate persistent asthma. The codesThe in categories J44 and J45 distinguish between uncomplicated a is exacerbation acute An exacerbation. acute in those and cases worsening or a decompensation of a chronic condition. An acute chronic on a superimposed infection to an not equivalent is exacerbation condition, though an exacerbation may be triggered by an infection. A code from subcategory J96.0,Acute respiratoryfailure, or subcategory a principal as assigned be may failure, respiratory chronic and Acute J96.2, diagnosis when it is the condition established after study to be chiefly the and hospital, the admission the to occasioning for responsible However, List. Tabular and Index Alphabetic the by is supported selection chapter-specific coding guidelines (such as obstetrics, HIV, poisoning, newborn) that provide sequencing direction precedence. take Respiratory may failure be listeda as secondary it diagnosis after if occurs admission, or if it is present on admission, but does not meet the definition of principal diagnosis. 1) and asthma bronchitis obstructive exacerbation of chronic Acute 1) diagnosis as failure principal respiratory Acute 2) Acute respiratory failure as secondary diagnosis The chapter specific guidelines from the ICD-1the chapter guidelines specific from The Chapter 10. Diseases of the Respiratory System System Respiratory the of 10. Diseases Chapter Examples Coding with Guidelines Specific Chapter Coding and Reporting Along have been with theseprovided below. guidelines developed been have that boxes, shaded the in contained examples, coding are helptheto illustrate coding sequencing and/or in these found guidance guidelines. a. pulmonary Chronic obstructive [COPD] disease asthma and ICD-10-CM 2019 ICD-10-CM ICD-10-CM b. failure respiratory Acute Chapter 19. Injury, Poisoning and Certain Other Consequences of External Causes S05.4–S06.2X8

B B

921 % % % % % % % % % % % % % % % % % 7 7

% % 24 %

% Unspecified Code Unspecified S05.4–S06.2X8 B without without greater greater any duration causeprior to 6 hours to any duration with with duration any cause prior to 30 minutes or less or minutes 30 Traumatic cerebral edemaTraumatic NOS cerebral Concussion NOS Concussion cerebral edema cerebral loss of consciousness of unspecified unspecified of consciousness of loss duration than 24 hours without return to to return without hours 24 than with level conscious pre-existing surviving patient of consciousness of loss of consciousness of of consciousness of without loss of consciousness 30 minutesof consciousness of loss less or 31 minutesof consciousness of loss to 59minutes to 1 hour of consciousness of loss 5 hours 59 minutes to 6 hours of consciousness of loss hours 24 than greater consciousness of loss hours with return to pre-existing levels conscious with loss of consciousness any duration of consciousness of loss to prior injury to brain due death with consciousness regaining other to due death with consciousness regaining consciousness of consciousness duration of unspecified consciousness consciousness of loss 30 minutesof consciousness of loss less or 31 minutesof to consciousness of loss minutes 59 to 1 hour of consciousness of loss 5 hours 59 minutes of consciousness of loss than 24 greater consciousness of loss hours with return to pre-existing level conscious than 24 greater consciousness of loss to pre-existing return without hours surviving patient with level conscious with duration any of consciousness of to death injury due prior brain to consciousness regaining other to due death consciousness regaining 24 hours 24 traumatic brain injury brain traumatic

traumatic diffuse cerebral edema (S06.1X-) edema cerebral diffuse traumatic

S06.2X8 brain Diffuse traumatic injury with S06.1X9 with edema cerebral Traumatic S06.2X0injury brain traumatic Diffuse S06.2X1 brain Diffuse traumatic injury with S06.2X2 brain Diffuse traumatic injury with S06.2X3 brain Diffuse traumatic injury with S06.2X4 brain Diffuse traumatic injury with S06.2X5 brain Diffuse traumatic injury with S06.2X6 brain Diffuse traumatic injury S06.2X7 brain Diffuse traumatic injury with S06.0X9 of loss with Concussion S06.1X0 edema cerebral Traumatic S06.1X1 with edema cerebral Traumatic S06.1X2 with edema cerebral Traumatic S06.1X3 with edema cerebral Traumatic S06.1X4 with edema cerebral Traumatic S06.1X5 with edema cerebral Traumatic S06.1X6 with edema cerebral Traumatic S06.1X7 loss with edema cerebral Traumatic S06.1X8loss with edema cerebral Traumatic S06.0X1 of loss with Concussion Diffuse

e e e e e e e e e e e e e e e e e e e e e 1 Diffuse axonal brain injury Diffuse traumatic cerebral edema cerebral traumatic Diffuse edema cerebral traumatic Focal Page S06.2X S06.1X Traumatic 4,9 4,9 d d S06.2 brain injury Diffuse traumatic S06.1 edema cerebral Traumatic c c

B B B B B B B B

% % % % % % % % % % % % % % % % % % %

right left of eyeball eye and orbit eye and orbit of eyeball right left eye and orbit x eye and orbit without loss of loss without

right left eye with or without foreign body foreign without or with deficits, followed by the appropriate eye eye

eye right left Chapter 19. Injury, Poisoning and CertainPoisoning Chapter 19. OtherInjury, of External Consequences Causes right left of orbit consciousness and orbit Sample Sample S06.81-, S06.6-, to S06.1- subcategories injury intracranial specified to S06.82-code wound in orbit (H05.5-) in orbit wound Placeholder Alert RUG IV Special Care High Dx RUG IV Clinically Complex Dx RUG IV Special Care Low Dx Manifestation Code injuries of of andeye orbit injuries eyeball concussion with intracranial injuries classified in in classified injuries intracranial with concussion retained (old) intraocular foreign body (H44.6-, H44.7) retained (old) foreign body following penetrating penetrating following body foreign (old) retained g eyeball injury of eyeand orbit S06.0X0 Concussion Other S05.8X1 Other injuries of S05.8X2 Other injuries of S05.8X9 eye of unspecified injuries Other orbit unspecified eyeball unspecified eyeball right left foreign body, unspecified eye unspecified body, foreign foreign body, foreign body, eyeball eyeball unspecified 7th characters D and S do not apply to codes in category S06 S06 category in codes to apply not do and S D characters 7th to prior 7 injury to due death 6th character – brain with cause to other due – death orconsciousness, 8 regaining prior to regaining consciousness injury brain traumatic (S09.90) NOS injury head e e e e w equired Injury of eye NOS 1 2 2 Commotio cerebri Commotio Traumatic enucleation injury duct Lacrimal Ocular penetration NOS penetration Ocular R 2017, 1Q, 42; 2015, 3Q, 37 3Q, 2015, 42; 1Q, 2017, Unspecified Penetrating woundPenetrating foreignwith body woundPenetrating foreignwithout body Penetrating woundPenetrating S06.0X Concussion S05.91 of injury Unspecified S05.92 of injury Unspecified S05.70 Avulsion of unspecified eye S05.71 Avulsion of S05.72 Avulsion of S05.8X S05.90 and eye of unspecified injury Unspecified S05.50 Penetrating wound foreignwith body of S05.51 Penetrating wound foreignwith body of S05.52 Penetrating wound foreignwith body of S05.60 Penetrating wound without foreign body of S05.61 Penetrating wound without foreign body of S05.62 Penetrating wound without foreign body of S05.40 without or with orbit of wound Penetrating S05.41 without or with orbit of wound Penetrating S05.42 without or with orbit of wound Penetrating When residual conditions persist as a result of intracranial injury, injury, of as a result intracranial persist conditions When residual openhead of wound (S01.-) skull fracture(S02.-) The appropriate 7th character is is be to added to7th character each code appropriate The from S06.category AD encounter initial Ssequela encounter subsequent d 0 1 1 AHA: TIP: residual the to identify codes assign identify to S character 7th using injury intracranial the identify to code S06 injury, brain of traumatic history Personal Z87.820 not assign Do sequelae. are present. conditions residual when d Code also any associated: also Code g g g g g g g g g g g g g g g S06.0 Concussion S05.9 S05.8 of andeye orbit injuries Other S05.7 Avulsion of eye S05.6 S05.5 S05.4 c c c c c c c S06 Intracranial injury Hospice noncancer diagnosis with 7th character indicating subsequent encounter. subsequent indicating character 7th with diagnosis noncancer Hospice Additional Character encounter subsequent indicating character 7th = High With Care Special 4 9 ICD-10-CM 2019 b 2019 ICD-10-CM

S ICD-10-CM 2019 Illustrations Chapter 10. Diseases of the Respiratory System (J00–J99)

Respiratory System

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Sample

ICD-10-CM 2019 Illustrations–27