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ITHA_ITHA20_CVR.indd 1 11/20/18 10:57 AM Contents

Preface ...... iii ICD-10-CM Official Guidelines for Coding ICD-10-CM Official Preface ...... iii and Reporting ...... Coding Guidelines–1 Characteristics of ICD-10-CM ...... iii ICD-10-CM Index to Diseases and Injuries ...... 1 What’s New for 2019 ...... iv Official Updates ...... iv ICD-10-CM Neoplasm Table ...... 331 Proprietary Updates ...... vi

ICD-10-CM Table of Drugs and Chemicals ...... 349 Introduction ...... vii History of ICD-10-CM ...... vii ICD-10-CM Index to External Causes ...... 397 How to Use ICD-10-CM Expert for Home Health and Hospice 2019 ...... viii ICD-10-CM Tabular List of Diseases and Injuries ...... 433 Use of Official Sources ...... viii Chapter 1. Certain Infectious and Parasitic Diseases Steps to Correct Coding ...... viii (A00-B99) ...... 433 Organization ...... viii Chapter 2. Neoplasms (C00-D49) ...... 457 Introduction ...... viii Chapter 3. Diseases of the Blood and Blood-forming Official ICD-10-CM Conventions and Guidelines...... viii Organs and Certain Disorders Involving the Alphabetic Index to Diseases ...... viii Immune Mechanism (D50-D89) ...... 493 Neoplasm Table...... viii Chapter 4. Endocrine, Nutritional and Metabolic Diseases Table of Drugs and Chemicals ...... viii (E00-E89) ...... 503 Index to External Causes ...... viii Chapter 5. Mental, Behavioral, and Neurodevelopmental Tabular List of Diseases ...... viii Disorders (F01-F99) ...... 523 Appendixes...... ix Illustrations...... ix Chapter 6. Diseases of the Nervous System (G00-G99) ...... 547 Chapter 7. Diseases of the Eye and Adnexa (H00-H59) ...... 567 Overview of ICD-10-CM Official Conventions ...... x Chapter 8. Diseases of the Ear and Mastoid Process Format ...... x (H60-H95) ...... 605 Punctuation ...... x Chapter 9. Diseases of the Circulatory System (I00-I99) ...... 617 Abbreviations ...... x Chapter 10. Diseases of the Respiratory System (J00-J99) ...... 657 NEC ...... x Chapter 11. Diseases of the Digestive System (K00-K95) ...... 673 NOS ...... x Chapter 12. Diseases of the Skin and Subcutaneous Tissue Typeface ...... x (L00-L99) ...... 695 General Notes ...... x Chapter 13. Diseases of the Musculoskeletal System and Includes Notes ...... x Connective Tissue (M00-M99) ...... 715 Inclusion Terms...... x Excludes Notes...... x Chapter 14. Diseases of the Genitourinary System (N00-N99) ...... 801 Note...... xi Default Codes...... xi Chapter 15. Pregnancy, Childbirth and the Puerperium Syndromes...... xi (O00-O9A) ...... 819 And ...... xi Chapter 16. Certain Conditions Originating in the Perinatal With ...... xi Period (P00-P96) ...... 855 See and See Also ...... xi Chapter 17. Congenital Malformations, Deformations and Instructional Notes Used in the Tabular List ...... xi Chromosomal Abnormalities (Q00-Q99) ...... 867 Code Assignment andSample Clinical Criteria ...... xi Chapter 18.Page Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Additional Annotations ...... xii Classified (R00-R99) ...... 885 Code-Level Notations ...... xii Chapter 19. Injury, Poisoning and Certain Other Consequences Italics ...... xii of External Causes (S00-T88) ...... 905 Color Coding/Symbols...... xii Chapter 20. External Causes of Morbidity (V00-Y99)...... 1113 Other Code-Level Notations...... xiii Chapter 21. Factors Influencing Health Status and Contact With Footnotes...... xiii Health Services (Z00-Z99) ...... 1175 Chapter-Level Notations ...... xiv Chapter-Specific Guidelines with Coding Examples...... xiv Appendixes ...... Appendixes–1 Muscle and Tendon Table ...... xiv Appendix A: 10 Steps to Correct Coding ...... Appendixes–1 Index Notations...... xiv Appendix B: Valid 3-character ICD-10-CM Codes ...... Appendixes–4 Following References ...... xiv Appendix C: Pharmacology List 2018...... Appendixes–6

ICD-10-CM 2020 i ICD-10-CM 2020 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–D68.311 497

Fibrin Injury site D63–D68.311 circulating circulating Not included here included Not intrinsic 2 Platelets other clotting factors Autoimmune hemophilia Autoimmune inhibitors to clotting factors hemophilia Secondary deficiency Not coded here Not coded 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 1 pregnancy (O00-O07, O08.1) puerperium (O45.0, O46.0, O67.0, O72.3) anticoagulants, antibodies, anticoagulants, inhibitors or antibodies, D68.311 tor IX IX tor Abnormal blood coagulation caused by deficient blood blood deficient by caused coagulation blood Abnormal abnormal coagulation profile (R79.1) profile coagulation abnormal molar or ectopic or abortion complicating defects coagulation the and childbirth pregnancy, 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 Hereditary factor XI factor Hereditary D68.31 Hemorrhagic disorder due to 2016, 1Q, 14 1Q, 2016, Do not assign to identify routine therapeutic anticoagulation effects; d Christmas disease Christmas defect) functional (with deficiency IX Factor Hemophilia B [PTC] deficiency component Plasma thromboplastin AHA: TIP: assign only for documented adverse effects. 1 White blood cell White Unspecified Dx Unspecified D68.1 D68.3 to anticoagulants due Hemorrhagic disorder circulating Hereditary fac Hereditary D68.0disease Willebrand's Von D68.2 of deficiency Hereditary B c D67 D68 defects coagulation Other b B Case-Mix Diagnosis Manifestation Chapter 3. Diseases of the Blood and Blood-forming Organs Blood-forming and the Blood of Diseases 3. Chapter

e puerperium (O45.0, O46.0, O46.0, (O45.0, e puerperium due to drugs and toxins anemia

chemotherapy (D61.1) chemotherapy x Alert anemia antineoplastic chemotherapy anemia due to disease to due anemia anemia in neoplastic disease (D63.0) in neoplastic anemia aplastic anemia due to antineoplastic antineoplastic due to anemia aplastic (D64.81) Page Sample (D61.1) 2014, 4Q, 22 4Q, 2014, (D65-D69) Reversible adverse effect of chemotherapy, of chemotherapy, effect adverse Reversible chronic diseases classified elsewhere Placeholder 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 anemia due to antineoplastic chemotherapy chemotherapy to antineoplastic anemia due O67.0, O72.3) O67.0, Antineoplastic chemotherapy induced anemia 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, 1 Infantile pseudoleukemia Infantile w g 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 tor VIII deficiency with fifth or sixth character 1-4 or 6) or sixth character fifth with 5) character sixth or fifth with (T36-T50 drug

sideroblastic anemias sideroblastic specified anemias specified q disseminated intravascular coagulation (complicating): coagulation intravascular disseminated factor VIII deficiency with vascular defect (D68.0) 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 Re Sideroblastic anemia NOS anemia Sideroblastic NEC anemia sideroblastic Pyridoxine-responsive Dyshematopoietic anemia(congenital) Code first underlying disease, such as: such disease, underlying Code first Code first poisoningdrug dueor to toxin,applicable if (T36-T65 identify to applicable, if effect, adverse for code additional Use Erythropoietin resistant anemia (EPO resistant anemia) resistant (EPO anemia resistant Erythropoietin (CKD) (N18.-)disease kidney underlying chronic Codefirst AHA: 1 1 2 Code first underlying disease Code first Sex-linked hypochromic sideroblastic anemia sideroblastic hypochromic Sex-linked Code first neoplasm (C00-D49) neoplasm first Code Congenital dyserythropoietic Secondary sideroblastic Secondary Hereditary sideroblastic sideroblastic Hereditary Secondary sideroblastic Other D64.81 Anemia due to D64.89 Other specified anemias Hereditary, sex-linked lack of antihemophilic globulin (AHG) (factor Classical hemophilia Classical defect) (with functional VIII Deficiency factor A Hemophilia NOS Hemophilia DEF: VIII); causesabnormalcoagulation characterizedincreasedby bleeding, tract; gastrointestinal nose, in mouth, bleeding of skin, bruises large hemorrhages into joints, resulting in swelling and impaired function. Afibrinogenemia, acquired Afibrinogenemia, coagulopathy Consumption Diffuse ordisseminated intravascular coagulation[DIC] Fibrinolytic hemorrhage, acquired Fibrinolytic purpura fulminans Purpura 1 1 1 D64.4 D64.3 Other D63.8 Anemia other in syndrome] D64.2 D64.0 D64.1 Hereditary fac Hereditary D64.8 D63.1 Anemia in D63.0 Anemia in D64.9 Anemia, unspecified c D66 D65 [defibrination coagulation intravascular Disseminated D64 Other anemias D63 elsewhere classified diseases chronic in Anemia Additional Character Coagulation defects, purpura and other hemorrhagic conditions b b ICD-10-CM 2020 S 2020 ICD-10-CM 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 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 (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 be will 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 (Section II, C.) may be applied in these situations. 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 on the 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 condition acute 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 Sample Page Sample Moderate persistent asthma asthmaticus status persistent with Moderate Pneumonia due to Streptococcus pneumoniaePneumonia due to Streptococcus whether with unspecified failure, respiratory Acute or hypercapnia hypoxia Chronic obstructive pulmonary disease with (acute) exacerbation asthma, persistent Moderate uncomplicated PneumoniaMethicillin due to resistant Staphylococcus aureus obstructiveChronic pulmonary disease with acute lower respiratory infection : Acute respiratory failure may be listed as a secondary secondary a as listed be may failure respiratory Acute : : Category J45 Asthma includes severity-specific : ICD-10-CM create combination uses to codes Explanation Acute pneumococcal pneumoniawith subsequent developmentof acute respiratory failure. J13 J96.00 buton admission is present it admission,or if after it occurs diagnosis if doesdefinitionthe not meet of principal diagnosis. J45.42 Explanation between to distinguish codes fifth-character and subcategories acute in those cases, uncomplicated post-acute which setting, in this case is the MRSA pneumonia. 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 Exacerbation of moderate persistent asthma with status asthmaticus. asthmaticus. Explanation 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 on the be dependent will Sequencing infection. the for code the of focus is the conditionthat J15.212 J44.0 J44.1 J45.40 Patient is admitted for continued IV antibioticadmitted continuedand administration for is Patient acute with pneumonia MRSA of diagnoses with therapy physical documentationindicates comorbid Provider COPD. exacerbation of asthma. persistent moderate 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 2020 ICD-10-CM 2020 ICD-10-CM b. failure respiratory Acute N18–N28.89 Chapter 14. Diseases of Genitourinary System ICD-10-CM 2020 b N18 Chronic kidney disease (CKD) Other disorders of kidney and ureter (N25-N29) Code first any associated: 2 disorders of kidney and ureter with urolithiasis (N20-N23) diabetic chronic kidney disease (E08.22, E09.22, E10.22, E11.22, E13.22) b N25 Disorders resulting from impaired renal tubular function hypertensive chronic kidney disease (I12-, I13-) 1 metabolic disorders classifiable to E70-E88 Use additional code to identify kidney transplant status, if applicable, N25.0 Renal osteodystrophy (Z94.0) Azotemic osteodystrophy AHA: 2013, 1Q, 24 Phosphate-losing tubular disorders TIP: CKD/ESRD occurring in an individual with a history of kidney Renal rickets transplant should not be assumed to be a transplant complication unless Renal short stature specifically indicated as such by provider documentation. 2wmetabolic disorders classifiable to E70-E88x TIP: The term “chronic renal impairment” should not be interpreted as CKD or chronic renal insufficiency and should be coded as N28.9. N25.1 Nephrogenic diabetes insipidus N18.1 Chronic kidney disease, stage 1 1 diabetes insipidus NOS (E23.2) DEF: Type of diabetes due to inability of renal tubules to reabsorb N18.2 Chronic kidney disease, stage 2 (mild) water back into the body; not responsive to vasopressin N18.3 Chronic kidney disease, stage 3 (moderate) (antidiuretic hormone); characterized by excessive thirst and N18.4 Chronic kidney disease, stage 4 (severe) excessive urine production; may develop into chronic renal insufficiency. N18.5 Chronic kidney disease, stage Diseases of Genitourinary System Genitourinary of Diseases N25.8 Other disorders resulting from impaired renal tubular chronic kidney disease, stage 5 requiring chronic c 1 function dialysis (N18.6) DEF: End-stage renal disease (ESRD) with GFR value of 15 ml/min N25.81 Secondary hyperparathyroidism of renal origin or less not yet requiring chronic dialysis. 2wmetabolic disorders classifiable to N18.6 End stage renal disease 7 E70-E88x Chronic kidney disease requiring chronic dialysis DEF: Parathyroid dysfunction caused by chronic renal failure; phosphate clearance is impaired, phosphate is Chapter 14. Chapter Use additional code to identify dialysis status (Z99.2) released from bone, vitamin D is not produced, AHA: 2016, 3Q, 22; 2016, 1Q, 12; 2013, 4Q, 124-125 intestinal calcium absorption is low, and blood levels of 8 N18.9 Chronic kidney disease, unspecified B calcium are lowered, causing excessive production of Chronic renal disease parathyroid hormone. Chronic renal failure NOS N25.89 Other disorders resulting from impaired renal Chronic renal insufficiency tubular function wChronic uremia NOS Hypokalemic nephropathy Diffuse sclerosing glomerulonephritis NOSx Lightwood-Albright syndrome 8 N19 Unspecified kidney failure B Renal tubular acidosis NOS Uremia NOS N25.9 Disorder resulting from impaired renal tubular function, B 1 acute kidney failure (N17.-) unspecified chronic kidney disease (N18.-) chronic uremia (N18.9) b N26 Unspecified contracted kidney extrarenal uremia (R39.2) 1 contracted kidney due to hypertension (I12.-) prerenal uremia (R39.2) diffuse sclerosing glomerulonephritis (N05.8-) renal insufficiency (acute) (N28.9) hypertensive nephrosclerosis (arteriolar) (arteriosclerotic) (I12.-) uremia of newborn (P96.0) small kidney of unknown cause (N27.-) N26.1 Atrophy of kidney (terminal) Urolithiasis (N20-N23) N26.2 Page kidney AHA: 2017, 1Q, 5; 2015, 2Q, 8 N26.9 Renal sclerosis, unspecified B b N20 Calculus of kidney and ureter b N27 Small kidney of unknown cause Calculous pyelonephritis 1 oligonephronia 1 nephrocalcinosis (E83.5) N27.0 Small kidney, unilateral that with hydronephrosis (N13.2) N27.1 Small kidney, bilateral N20.0 Calculus of kidney B Nephrolithiasis NOS N27.9 Small kidney, unspecified Renal calculus b N28 Other disorders of kidney and ureter, not elsewhere classified Renal stone N28.0 Ischemia and infarction of kidney Staghorn calculus Renal artery embolism Renal artery thrombosis Stone in kidney Renal artery obstruction Renal infarct N20.1 Calculus of ureter Renal artery occlusion Ureteric stone 1 atherosclerosis of renal artery (extrarenal part) (I70.1) AHA: 2016, 3Q, 22 congenital stenosis of renal artery (Q27.1) N20.2 Calculus of kidney with calculus of ureter Goldblatt's kidney (I70.1) N20.9 Urinary calculus, unspecified B N28.1 Cyst of kidney, acquired b N21 Calculus of lower urinary tract wCyst (multiple) (solitary) of kidney (acquired)x 1 calculus of lower urinary tract with cystitis and urethritis 1 cystic kidney disease (congenital) (Q61.-) N21.0 Calculus in bladder c N28.8 Other specified disorders of kidney and ureter Calculus in diverticulum of bladder 1 hydroureter (N13.4) Urinary bladder stone ureteric stricture with hydronephrosis (N13.1) staghornSample calculus (N20.0) Pageureteric stricture without hydronephrosis (N13.5) 2 N21.1 Calculus in urethra N28.81 Hypertrophy of kidney 2 calculus of prostate (N42.0) N28.82 Megaloureter N21.8 Other lower urinary tract calculus N28.83 Nephroptosis N21.9 Calculus of lower urinary tract, unspecified B N28.84 Pyelitis cystica 1 calculus of urinary tract NOS (N20.9) N28.85 Pyeloureteritis cystica N22 Calculus of urinary tract in diseases classified elsewhere N28.86 Ureteritis cystica Code first underlying disease, such as: N28.89 Other specified disorders of kidney and ureter gout (M1A.-, M10.-) schistosomiasis (B65.0-B65.9) N23 Unspecified renal colic B

8 Hospice questionable admission diagnosis. N18–N28.89

8 Newborn: 0 9 Pediatric: 0-17 x Maternity: 12-55 y Adult: 15-124 * Nonroutine supply Dx 7 Noncancer Dx u Primary Dx wx Revised Text l New Code s Revised Title 806 ICD-10-CM 2020 ICD-10-CM 2019 Illustrations Chapter 10. Diseases of the Respiratory System (J00–J99)

Respiratory System

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