Combination Codes

HS317b – Coding & Classification of Health Data

Combination Codes

Dagger/Asterisk Dual Combination Combination Code Two codes to explain disease process

Diagnosis Type 3

Possible combinations

Infections Pneumonia Septicemia HIV Musculoskeletal

Infection Dual Combination

Identify infectious organism & manifestation in a local system chapter. Both must be used together Example: Ms. B was diagnosed with a candidial

infection of the vulva and vagina B37.3† Candidiasis of vulva and vagina (N77.1*) N77.1* Vaginitis, vulvitis and vulvovaginitis in infectious and

parasitic diseases classified elsewhere

Infection Combination Code

One code will indicate manifestation and organism

Example:Patient was diagnosed with streptococcal

pharyngitis J02.0 Streptococal pharyngitis

Infection – Two Codes

Use two codes to identify disease and infectious organism

Example: patient was confirmed to have acute cystitis caused by E.ColiN30.0 Acute CystitisB96.2(3) Escherichia coli

(any Dx between B95-B97 = Dx Type 3)

Human Immunodeficiency Virus

MRDx must be B24 HIV disease Manifestation that is being treated will be

sequenced immediately following B24B24 HIVF02.4* Dementia in human

immunodeficiency virus [HIV] disease

HIV Mutually Exclusive

B24 Human immunodeficiency virus [HIV] disease (never use Dx Type 2)

Z21 asymptomatic human immunodeficiency virus [HIV] infection status

R75 nonconclusive serologic evidence of HIV

Anemia & Neoplasms

D63.0* Anaemia in neoplastic disease (C00-D48†)Use only if anemia is unspecified.

Pneumonia & COPD

Combination Code Patient comes into hospital with COPD

and pneumonia (or any other acute lower respiratory tract infection) J44.0Chronic obstructive pulmonary disease

with acute lower respiratory infection

FYI - COPD

J44.0Chronic obstructive pulmonary disease with acute lower respiratory infection

J44.1Chronic obstructive pulmonary disease with acute exacerbation, unspecified

J44.8Other specified chronic obstructive pulmonary disease

J44.9Chronic obstructive pulmonary disease, unspecified

Pneumonia & COPD

When infection is a significant condition in its own right an additional code must be used to specify the type of infection for epidemiological purposes. The condition must be assigned to a diagnosis type 1

J18.9 (1) Pneumonia, unspecified

Example

A 68 year old man with severe COPD contracted the common cold. His condition worsened and he was admitted. Chest X-ray revealed pneumonia. He was subsequently admitted for COPD exacerbation and pneumonia.

Example

M - J44.0 Chronic obstructive pulmonary disease with acute lower respiratory infection

1 - J18.9 Pneumonia, unspecified

Sepsis & Pneumonia

Patient was being treated in ICU for pneumonia and staphylococcus aureus septicemia

Folio lookup – pneumonia – septicemia-septicemia A41 J17.0* (note: even though

A41 does not have a dagger it is considered a dagger/asterisk relationship)

Lobar Pneumonia

Lobar pneumonia = when pneumonia is documented as complete consolidation of an entire lobe. Apical, basilar and massive

J18.1 Lobar pneumonia, unspecified when organism is unknown. If organism identified code to pneumonia with

organism Combination Code, i.e. J13 Pneumonia due to

Streptococcus pneumonia

Bronchopneumonia

When inflammation is scattered here and there throughout the lungs, often with bilateral involvement.

Terms: catarrhal, confluent, diffuse, disseminated (focal), lobular (segmental) and patchy

J18.0 Bronchopneumonia, unspecified

ARDS & Respiratory Failure

Acute respiratory failure (J96.0) is an inherent part of the J80 Adult respiratory distress syndrome.Syndrome: can include sepsis, systemic

inflammatory response syndrome One code J80 needs to be coded

Mechanical Ventilation

Mandatory to code if duration is > 96 hours.

Indicate through procedure code with attribute ‘extended’ for > 96 hours1.GZ.31.CA-ND – - EX

Bleeding Esophageal Varices

Patient with known alcoholic cirrhosis of the liver admitted with bleeding esophageal varices

Bleeding Esophageal Varices

Varix esophagus (ulcerated) I85.9 – – bleeding I85.0 – – congenital Q27.8 – – in (due to) – – – alcoholic liver disease K70† I98.2* – – – cirrhosis of liver K74† I98.2* – – – schistosomiasis B65 I98.2* – – – toxic liver disease K71† I98.2*

K70.3 Alcoholic cirrhosis of liver I98.2* Oesophageal varices in

diseases classified elsewhere K92.0 Haematemesis

Gastrointestinal Bleeding

Look for combination codes If no combination, code disease and add

as Diagnosis type 3: K92.0 Haematemesis K92.1 Melena K92.2 Gastrointestinal haemorrhage,

unspecified

Pathological Fractures

No known traumatic injury Documented as a result of an underlying

disease (neoplasm, osteoporosis, Paget’s disease or an endocrine disorder)

Fracture bone T14.2 – – in (due to) neoplastic disease NEC

(see also Neoplasm) (8000/1) D48.0† M90.7*M90.7* Fracture of bone in neoplastic

disease (C00-D48†)

Spinal disease & myopathy

Displacement

-vertebra – – lumbar, lumbosacral (with) M51.2 – – – myelopathy M51.0† G99.2* – – – neuritis, radiculitis, radiculopathy or

sciatica M51.1† G55.1*

Sandwiching Codes

Peritonitis due to peritoneal dialysis catheter exit site infection. The physician ordered skin and peritoneal fluid cultures (positive for staphylococcus) to confirm the cause of the peritonitis

Codes

T85.7 Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts

K65.9 Peritonitis, unspecified B95.3 Streptococcus pneumoniae as

the cause of diseases classified to other chapters

Y84.1 Kidney dialysis

Classification based on MRDx

MCC 4 Diseases and Disorder of the Respiratory System

MCC 16 Blood and blood forming organs and Immunological Disorders

MCC 18 Multisystemic or unspecified site infections

MCC 24 HIV Infections (AIDS)No complexity assigned

MCC 4 Respiratory System

Factors that can influence CMG assignmentTuberculosis, Respiratory Failure or

respiratory infections and inflammations associated with Cystic Fibrosis (Dagger/asterisk codes) (CMG 487 CF)

CMG 135 Tracheostomy

MCC HIV

Assignment of CMG based on manifestation diagnosisRespiratory Disorders will assign case to

CMG 860 Respiratory Tract Disorders with HIV

No complexity level assigned