ICD-10-CM Training: Allergy, Asthma, & Immunology Overview

Fundamentals of ICD-10-CM for Allergy, Asthma, and Immunology. Covering compliance dates, entity types, code structure, including placeholders, 7th characters, and laterality indications. Learn how to navigate the unique features within the coding system to accurately document and assign medical codes for clinical visits.

• ICD-10-CM
• Allergy
• Asthma
• Immunology
• Compliance
• Coding

dnas Follow

Uploaded on Feb 27, 2025 | 0 Views

Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.

Presentation Transcript

1. ICD-10 CM Training Allergy, Asthma, & Immunology

2. 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

3. Covered and Non-Covered Entities 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

4. 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 3rdcharacter

5. ICD-10 Code Structure Placeholder X Used for future expansion of a code Fills in empty characters when a 6thand/or 7thcharacter apply The placeholder may be used in different scenarios but should never serve as the final character. Example: W19.XXXA Unspecified fall, Initial Encounter

6. ICD-10 Code Structure 7thCharacter 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

7. 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

8. ICD-10 Code Structure Other 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

9. ICD-10 Structure Excludes Notes Excludes1 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

10. 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

11. Most Common Diagnosis Codes

12. Allergic rhinitis 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 477.0 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 477.8 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

13. Allergic Rhinitis Documentation Tips Type Due to animal hair and dander Due to food Due to pollen Other seasonal allergic Other allergic Unspecified

14. Other chronic allergic conjunctivitis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 372.14 H10.45 Other chronic allergic conjunctivitis keratoconjunctivitis (H16.2-) N/A

15. 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

16. Asthma ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 cystic fibrosis (E84.-) 493.00, 493.10 J45.20 Mild intermittent asthma, uncomplicated or NOS bronchitis due to chemicals, gases, fumes and vapors (J68.0) 493.01, 493.11 J45.22 Mild intermittent asthma with status asthmaticus N/A N/A 493.02, 493.12 J45.21 Mild intermittent asthma with (acute) exacerbation N/A N/A 493.82 J45.991 Cough variant asthma N/A N/A 493.90 J45.909 J45.998 Unspecified asthma, uncomplicated Other asthma N/A N/A cystic fibrosis (E84.-) 493.91 J45.902 Unspecified asthma with status asthmaticus bronchitis due to chemicals, gases, fumes and vapors (J68.0) 493.92 J45.901 Unspecified asthma with (acute) exacerbation bronchitis due to chemicals, gases, fumes and vapors (J68.0) cystic fibrosis (E84.-)

17. 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 2 or less days per week More than 2 days per week, but not daily Daily Several times per day INTERFERENCE WITH NORMAL ACTIVITY None Minor limitation Some limitation Extremely limited LUNG FUNCTION FEVI>80% predicted and normal between exacerbations FEV1>80% predicted FEV1 60 80% predicted FEV1 less than 60% predicted

18. 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)

19. Toxic Effect of Venom ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 989.5 T63.- Toxic effect of unspecified, chiefly nonmedicinal as to source, venom contact with and (suspected) exposure to toxic substances (Z77.-) ingestion of toxic animal or plant (T61.-, T62.-) Includes: bite or touch of venomous animal pricked or stuck by thorn or leaf 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

20. 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.

21. 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

22. 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

23. Cough ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 786.2 R05 Cough Cough with hemorrhage (R04.2) Smoker s Cough (J41.0) N/A

24. 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.

25. Allergy to other foods ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 V15.05 Z91.018 Allergy to other foods 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.-) Applicable To: Allergy to nuts other than peanuts 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

26. Documentation Tips Z91.018 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.

27. 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.

28. Atopic Dermatitis 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-I83.2 691.8 L20.81 Atopic neurodermatitis N/A Applicable To: Diffuse neurodermat itis 691.8 L20.82 Flexural eczema N/A 691.8 L20.84 Intrinsic (allergic) eczema N/A 691.8 L20.89 Other atopic dermatitis N/A

29. Documentation Tips In (L20-L30) codes the terms dermatitis and eczema are used synonymously and interchangeably.

30. Chronic rhinitis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 472.0 J31.0 Chronic rhinitis allergic rhinitis (J30.1-J30.9) vasomotor rhinitis (J30.0) N/A Applicable To: Atrophic rhinitis (chronic) Granulomatous rhinitis (chronic) Hypertrophic rhinitis (chronic) Obstructive rhinitis (chronic) Ozena Purulent rhinitis (chronic) Rhinitis (chronic) NOS Ulcerative rhinitis (chronic) 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)

31. 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).

32. Unspecified acute conjunctivitis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 Ophthalmia neonatorum NOS (P39.1) keratoconjunctivitis (H16.2-) 372.00 H10.33 Unspecified acute conjunctivitis, bilateral N/A There are more specific code choice selections 372.00 H10.30 Unspecified acute conjunctivitis, unspecified eye 372.00 H10.31 Unspecified acute conjunctivitis, right eye 372.00 H10.32 Unspecified acute conjunctivitis, left eye

33. 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

34. Unspecified contact dermatitis, unspecified cause ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 692.9 L25.9 Unspecified contact dermatitis, unspecified cause 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-) perioral dermatitis (L71.0) radiation-related disorders of the skin and subcutaneous tissue (L55-L59) Applicable To Contact dermatitis (occupational) NOS Contact eczema (occupational) NOS 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 692.89 L25.8 Unspecified contact dermatitis due to other agents

35. Allergic Rhinitis Documentation Tips In this block the terms dermatitis and eczema are used synonymously and interchangeably.

36. 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

37. 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

38. Angioneurotic edema ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 995.1 T783XX- Angioneurotic edema serum urticaria (T80.6-) urticaria (L50.-) complications of surgical and medical care NEC (T80-T88) Applicable to: Allergic angioedema Giant urticaria Quincke's edema The appropriate 7th character is to be added to each code from category T78 A - initial encounter D - subsequent encounter S - sequela

39. 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

40. Urticaria 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 708.8 L50.8 Other urticaria

41. Chronic sinusitis ICD-9 Code ICD-10 Code Description Excludes1 Excludes2 473.0 J32.0 Chronic maxillary sinusitis 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) Applicable To: Antritis (chronic) Maxillary sinusitis NOS 473.1 J32.1 Chronic frontal sinusitis, NOS N/A 473.2 J32.2 Chronic ethmoidal sinusitis, NOS N/A 473.3 J32.3 Chronic sphenoidal sinusitis, NOS N/A 473.8, 473.9 J32.4 Chronic pansinusitis N/A Applicable To: Pansinusitis NOS 473.8, 473.9 J32.8 Other chronic sinusitis N/A Applicable To: Sinusitis (chronic) involving more than one sinus but not pansinusitis 473.9 J32.9 Chronic sinusitis, unspecified, NOS N/A Applicable To: Sinusitis (chronic) NOS

42. 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)

43. 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

44. 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

45. Client Responsibilities Client will need to update Templates Order Sets Superbills Favorites Future Orders Remove ICD-9 code add ICD-10 code

46. 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

47. 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

48. 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

49. Questions codingresource@g1hs.com Centers for Disease Control and Prevention (ICD-10-CM) http://www.cdc.gov/nchs/icd/icd10cm.htm