Coding Clinic for ICD-10-CM and ICD-10-PCS

409 Pages·2016·1.45 MB·English

Coding Clinic for ICD-10-CM and ICD-10-PCS
Table of Contents - Fourth Quarter 2012

Acute exacerbation of asthma and status asthmaticus
Ask the editor - ICD-10-CM/PCS
Acute exacerbation of asthma and status asthmaticus
Category I69 - dominant versus non-dominant side
Crohn's disease with rectal abscess
Domino liver transplant
Initial encounter for fracture malunion
Open dislocation of elbow
Placement of subcutaneous implantable cardioverter defibrillator
Resection of rib w/ reconstruction of anterior chest wall
Sequencing of acute and subsequent myocardial infarctions
Sequencing of myocardial infarction codes
Seventh character for fetus identification
Category I69 - dominant versus non-dominant side
Coding Clinic for ICD-10-CM and ICD-10-PCS
Coding Clinic for ICD-10-CM introduction
Long term care coding issues for ICD-10-CM
Coding Clinic for ICD-10-CM introduction
Crohn's disease with rectal abscess
Domino liver transplant
Initial encounter for fracture malunion
Long term care coding issues for ICD-10-CM
Open dislocation of elbow
Placement of subcutaneous implantable cardioverter defibrillator
Resection of rib w/ reconstruction of anterior chest wall
Sequencing of acute and subsequent myocardial infarctions
Sequencing of myocardial infarction codes
Seventh character for fetus identification
Acute exacerbation of asthma and status asthmaticus
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Page: 99 Effective with discharges:
October 1, 2012
Related Information
Question:
Are we to assume that ICD-9-CM guidelines not included in ICD-10-CM will not be valid
beginning when ICD-10-CM is implemented? For example, ICD-9-CM guideline Section
I.C8.a.4, "Acute exacerbation of asthma and status asthmaticus" does not have a counterpart in
the ICD-10-CM guidelines.
Answer:
Every effort was made to carry over the ICD-9-CM guidelines and concepts into ICD-10-CM,
unless there was a specific change in ICD-10-CM that precluded the incorporation of the same
concept into ICD-10-CM. However, some of the guidelines in ICD-9-CM included information
that may have been clinical in nature (as in the example noted in the question) and therefore not
appropriate for coding guidelines.
With respect to the coding of acute exacerbation of asthma and status asthmaticus together, only
the code for the more severe condition (i.e., status asthmaticus) should be assigned.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Category I69 -dominant versus non-dominant side
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages:106-107 Effective with
discharges: October 1, 2012
Question:
We appreciate the guidance provided for codes from category G81, Hemiplegia and hemiparesis,
and subcategories, G83.1, Monoplegia of lower limb, G83.2, Monoplegia of upper limb, and
G83.3, Monoplegia, unspecified, for when the affected side is documented, but not specified as
dominant or nondominant. We wonder if you can provide the same advice (or default) for codes
in category I69, Sequelae of cerebrovascular disease, that relate to hemiplegia, hemiparesis and
monoplegia where the codes distinguish between left and right, and dominant and nondominant.
The documentation will usually specify whether the right or left side was affected, but not
whether it is dominant or nondominant. We are specifically referring to codes in category I69
with fifth digits of 0, 1, 2, 3, 8 and 9, and sixth digits of 3-6 (e.g., I69.03-, I69.13-, I69.04,
I69.14-, etc.).
Answer:
Yes, the same default may be applied to codes in category I69. Should the affected side be
documented, but not specified as dominant or nondominant, and the classification system does
not indicate a default, code selection is as follows:
For ambidextrous patients, the default should be dominant.
If the left side is affected, the default is nondominant.
If the right side is affected, the default is dominant.
Please note that the Official Guidelines for Coding and Reporting is being updated (2013) so
information regarding defaults for the affected side will also appear in the I69 section.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Crohn's disease with rectal abscess
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Page: 104 Effective with discharges:
October 1, 2012
Question:
In ICD-10-CM codes K50.014, K50.114, K50.814 and K50.914 are used to identify Crohn's
disease with intestinal abscess. When a patient presents with Crohn's disease of the small
intestine with a rectal abscess, would it be appropriate to assign an additional code for the rectal
abscess?
Answer:
Yes, it is appropriate to assign code K50.014, Crohn's disease of small intestine with abscess,
along with code K61.1, Rectal abscess, since the additional code provides information regarding
the specific site of the abscess. Codes in category K50 describe intestinal abscess only.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Domino liver transplant
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages: 99-101 Effective with
discharges: October 1, 2012
Related Information
Question:
The patient is a 61-year-old man who was diagnosed with familial amyloid polyneuropathy.
Because of the gradual increase in the severity of his disease, he underwent liver transplantation.
Since his liver function was good with no cirrhosis, the decision was made to transplant his
explanted liver into another patient. The physician used the term "domino liver transplant" to
reflect the chain of events occurring during transplantation. A new liver from a live nonrelated
donor was transplanted and the patient's old liver was removed for donation. Can code Z52.64,
Liver donor, be reported to capture the fact that the patient was a recipient and also a donor?
How should domino liver transplant be coded?
Answer:
Assign code E85.1, Neuropathic heredofamilial amyloidosis, as the principal diagnosis along
with code G63, Polyneuropathy in diseases classified elsewhere, as an additional diagnosis.
Codes in category Z52, Donors of organs and tissues, are only used when the encounter or
admission is specifically for organ donation and are assigned as the principal or first-listed
diagnosis.
Assign code 0FY00Z0, Transplantation of liver, allogeneic, open approach, and code 0FT00ZZ,
Resection of liver, open approach, for the procedures performed. Currently, neither ICD-10- PCS
nor ICD-9-CM has a specific code to describe a domino liver transplant. In ICD-10-PCS,
"transplantation" is defined as putting in a mature and functioning living body part taken from
another individual or animal. A limited number of procedures is represented in the root operation
transplantation and includes only the body parts currently being transplanted. Qualifier values
specify the genetic compatibility of the body part transplanted. The associated explanation that
accompanies the root operation transplantation states that the native body part may or may not be
taken out. Therefore, under normal circumstances the resection procedure would not be coded
separately because it is included in the root operation transplantation. However, the resection
code can be used in this case to indicate a domino liver transplant was performed. Familial
amyloid polyneuropathy (FAP) is an inherited disorder caused by certain genetic mutations and
leading to abnormal amyloidogenic protein. This protein is deposited in tissues and organs,
creating amyloid fibrils, which compromise tissue or organ function. Since the transthyretin
protein that causes most cases of FAP is produced in the liver, many cases can be treated with
liver transplant. The new liver will produce normal transthyretin and organ transplantation
eliminates the source of mutant protein production.
Researchers are currently studying whether previously formed amyloid transport protein
transthyretin (TTR) deposits will resolve following liver transplantation. The recipient of the
liver from an individual with FAP could subsequently develop the disease after 20 or 30 years,
but the domino liver transplant can improve quality of life and prolong survival significantly.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Initial encounter for fracture malunion
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Page: 106 Effective with discharges:
October 1, 2012
Question:
A patient fell and sustained a fracture of his left wrist but did not seek medical treatment for
some time. He now seeks treatment for the first time and he is diagnosed with malunion of
closed fracture of the navicular bone, left wrist. Please provide clarification on the appropriate
seventh character since this is an initial encounter, but malunion is identified with the seventh
character for subsequent encounter, "P," subsequent encounter for fracture with malunion."
Answer:
Assign code S62.002A, Unspecified fracture of navicular [scaphoid] bone of left wrist, initial
encounter for closed fracture. According to the Official Guidelines for Coding and Reporting,
"the appropriate 7th character for initial encounter should be assigned for a patient who delayed
seeking treatment for the fracture or nonunion." The fact that this is an initial encounter takes
precedence and the 7th character describing subsequent encounter for treatment of malunion is
not correct in this instance.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Open dislocation of elbow
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Page:108 Effective with discharges:
October 1, 2012
Question:
A 16-year-old female was seen in the emergency department after she sustained an open anterior
dislocation of the right elbow, which was not associated with any vascular or neural injury. She
fell down after colliding with her dance partner while participating in a dance class at the local
high school. How should this be coded?
Answer:
Assign code S53.114A, Anterior dislocation of right ulnohumeral joint, initial encounter, as the
first-listed diagnosis. Assign codes S51.001A, Unspecified open wound of right elbow, initial
encounter; W03.XXXA, Other fall on same level due to collision with another person, initial
encounter; Y92.213 High school as the place of occurrence of the external cause; Y99.8, Other
external cause status; and Y93.41, Activity, dancing.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Placement of subcutaneous implantable cardioverter defibrillator
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages: 104-105 Effective with
discharges: October 1, 2012
Related Information
Question:
What are the correct ICD-10-PCS codes for insertion/replacement/revision of totally
subcutaneous implantable cardioverter defibrillator, and its various components?
Answer:
The existing ICD-10-PCS codes capture the insertion, replacement, and revision of the totally
subcutaneous implantable cardioverter-defibrillator, and its components. Please note that when
only the leads are replaced, assign codes for the removal of the old lead, as well as for the
insertion of the new lead. When only the pulse generator is replaced, assign codes for the
removal of the old generator as well as the insertion of the new generator. Assign the following
codes for insertion, replacement, and revision of the device and its various components:
Total system placement (generator and electrode)
Insertion of defibrillator generator into chest subcutaneous tissue and fascia, open
0JH608Z
approach

Insertion of cardiac rhythm related device into chest subcutaneous tissue and fascia,
0JH60PZ,
open approach
Placement of defibrillator lead only
Insertion of cardiac rhythm related device into chest subcutaneous tissue and fascia,
0JH60PZ,
open approach
Placement of defibrillator generator only
Insertion of defibrillator generator into chest subcutaneous tissue and fascia, open
0JH608Z,
approach
Replacement of defibrillator lead only
Removal of cardiac rhythm related device from trunk subcutaneous tissue and
0JPT0PZ,
fascia, open approach

Insertion of cardiac rhythm related device into chest subcutaneous tissue and
0JH60PZ,
fascia, open approach
Replacement of defibrillator generator only
Removal of cardiac rhythm related device from trunk subcutaneous tissue and
0JPT0PZ,
fascia, open approach

Insertion of defibrillator generator into chest subcutaneous tissue and fascia, open
0JH608Z,
approach
Revision of lead only
Revision of cardiac rhythm related device in trunk subcutaneous tissue and fascia,
0JWT0PZ,
open approach
Revision of generator only
Revision of cardiac rhythm related device in trunk subcutaneous tissue and fascia,
0JWT0PZ,
open approach
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Resection of rib w/ reconstruction of anterior chest wall
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages: 101-102 Effective with
discharges: October 1, 2012
Related Information
Question:
Patient is a 72-year-old gentleman with right anterior fourth rib low grade chondrosarcoma who
underwent resection of a 9 cm. segment of the right fourth rib and reconstruction of anterior
chest wall using methylmethacrylate Marlex overlay plate sutured into the third and fifth ribs for
stabilization. How should the surgical procedure be coded? Should this be coded to the root
operations excision and supplement, or the root operation replacement?
Answer:
Assign code 0PB10ZZ, Excision of right rib, open approach, for removal of the rib. In addition,
assign code 0WU80JZ, Supplement chest wall with synthetic substitute, open approach, for the
insertion of the Marlex and methylmethacrylate composite plate. Even though the physician
referred to the procedure as "resection," the root operation "excision" should be selected.
The ICD-10-PCS definition of "resection" is the "cutting out or off, without replacement, all of a
body part," but in this instance a segment of the rib was removed, rather than the entire rib. The
Marlex and methylmethacrylate composite plate was used to reinforce the chest wall and
therefore the root operation "supplement" was selected. The root operation "replacement" is not
appropriate because the objective of the procedure was not to physically take the place and/or
function of all or a portion of a body part.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Sequencing of acute and subsequent myocardial infarctions
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages: 102-103 Effective with
discharges: October 1, 2012
Question:
A 66-year-old male patient was discharged from the hospital after being hospitalized for a week
for treatment of an acute transmural myocardial infarction of the anterior wall. A week after his
discharge, he was brought back in the emergency department for chest pain and was admitted for
treatment of a subsequent acute transmural myocardial infarction of the inferior wall. How
should the second admission be coded?
Answer:
The sequencing of the I22 and I21 codes depends on the circumstances of the encounter. Since
the reason for the admission was the subsequent MI, assign code I22.1, Subsequent ST elevation
(STEMI) myocardial infarction of inferior wall, as the principal diagnosis. Assign code I21.09,
ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall, as
a secondary diagnosis. An I21 code must accompany an I22 code to identify the site of the initial
acute myocardial infarction (AMI), and to indicate that the patient is still within the 4 week time
frame of healing from the initial AMI.

© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Sequencing of myocardial infarction codes
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Page: 102 Effective with discharges:
October 1, 2012
Question:
A 59-year-old male patient was admitted to the hospital due to an acute transmural myocardial
infarction of the anterior wall. A week after admission, while the patient was still in the hospital,
he patient suffered another acute myocardial infarction (AMI), this time, a transmural infarction
of the inferior wall. How should this encounter be coded?
Answer:
Assign code I21.09, ST elevation (STEMI) myocardial infarction involving other coronary artery
of anterior wall, as the principal diagnosis. Assign code I22.1, Subsequent ST elevation (STEMI)
myocardial infarction of inferior wall, as a secondary diagnosis.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Seventh character for fetus identification
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages: 107-108 Effective with
discharges: October 1, 2012
Question:
Physicians often document twins as fetus A and fetus B. However, the fetal extensions in chapter
15, Pregnancy, childbirth and the puerperium, for codes related to complications of multiple
gestation (e.g., O31, O32, etc.) refer to fetus 1, fetus 2, and so on. For the purposes of selecting
the seventh character for these codes, is it appropriate to assume that fetus A is fetus 1 and B is 2,
etc.?
Answer:
Yes, some providers prefer to refer to each fetus in multiple gestation cases by alphabetical
characters, such as fetus A, fetus B, etc., rather than numbers (fetus 1, fetus 2, etc.). In such
cases, fetus A should be equated with fetus 1, fetus B should be equated with fetus 2, and so on.
There is no expectation that the same fetus number or alphabetical character be consistently
carried over from one admission to another. Identification of the fetus, whether by number or
alphabetical character, is based on the provider documentation.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Coding Clinic for ICD-10-CM introduction
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Page: 90 Effective with discharges:
October 1, 2012
Introduction
Although ICD-10-CM and ICD-10-PCS have not been implemented yet, in response to requests
from the coding community, the AHA Central Office announced last November that interested
parties may start sending ICD-10- CM/PCS questions to the AHA Central Office. However, just
as with ICD- 9-CM, inquirers must have a working knowledge of ICD-10-CM and ICD- 10-PCS
coding when submitting a question. The service is limited to providing coding advice and not
advice on the General Equivalence Mappings (GEMs) or implementation issues. Please refer to
the AHA's website for information on submission of requests for coding advice:
www.ahacentraloffice.org
The following ICD-10-CM and ICD-10-PCS coding questions have been reviewed and approved
through the same process used for all Coding Clinic issues. Future issues of Coding Clinic will
continue to include ICD-10-CM/ PCS issues as approved by the Editorial Advisory Board.
© Copyright 1984-2016, American Hospital Association ("AHA"), Chicago, Illinois.
Reproduced with permission. No portion of this publication may be copied without the
express, written consent of AHA.

Long term care coding issues for ICD-10-CM
ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2012 Pages: 90-98 Effective with discharges:
October 1, 2012
Related Information
Long Term Care Coding Issues for ICD-10-CM
Coding guidelines and examples were provided in Coding Clinic for ICD-9- CM, Fourth Quarter
1999 with regards to the application of coding guidelines for long term care (LTC). Similarly,
inquiries have been received regarding how coders should sequence the principal diagnosis when
coding in the long term care (LTC) setting. The following have been developed and approved by
the Cooperating Parties in conjunction with the Editorial Advisory Board of Coding Clinic, to
standardize the process of data collection for LTC and to assist the coder in coding and reporting
these cases using ICD-10-CM.
The diagnostic listing in long term care (LTC) is dynamic and dependent on many factors and
has a longer time frame than an acute care stay. ICD-10- CM codes are assigned upon admission,
concurrently as diagnoses arise, at the time of discharge, transfer, or expiration of the resident.
The UHDDS definition of principal diagnosis (that condition established after study to be chiefly
responsible for occasioning the admission of the patient to the hospital for care) has been
expanded since its initial development and now includes all non-outpatient settings (acute care,
short term, long term care and psychiatric hospitals; home health agencies; rehab facilities;
nursing homes, etc). Other diagnoses present (e.g., chronic conditions) which affect the resident's
continued care should also be coded. The listing of diagnoses in the long-term care setting, may
vary depending on the point in time when coding is being done.
The "first listed diagnosis" is the diagnosis which is chiefly responsible for the admission to, or
continued residence in the nursing facility and should be sequenced first. For example, when
coding an admission to the facility, the "first listed diagnosis" is the condition chiefly responsible
for the admission to the facility. If coding diagnoses during the resident's stay, it is the condition
chiefly responsible for the continued stay in the facility.
Question: