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May 19, 2015 Medtronic Cardiac Rhythm and Heart Failure ICD-10 Coding for Hospitals
May 19, 2015
Medtronic Cardiac Rhythm and Heart Failure
ICD-10 Coding for Hospitals
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DisclaimerThis presentation is intended for educational use. Any duplication is prohibited without written consent of Medtronic’s Economics and Health Policy department. This information does not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for their interpretation of the appropriate codes to use for specific procedures.
Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service.
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ICD-10-PCS Procedure Codes
ICD-10-CM Diagnosis Codes
Background and Framework
Topics
Appendix : Key Resources
DRG Impact
Attachment : Diagnosis Code Crosswalks
Questions
Background and Framework
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Effective Date
ICD-10 goes into effect October 1, 2015.
ICD-10-CM for diagnosis codes and ICD-10-PCS for procedure codes go into effect together on the same date.
ICD-10 is effective by date of discharge, not by date of admission.
Use of ICD-10 in the United States was formally proposed in August 2008 and finalized in January 2009.
Implementation of ICD-10 was initially scheduled for October 2013 and has been postponed twice since then.
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Who Uses What
Provider Setting Diagnoses Procedures
Hospitals Inpatient ICD-10-CM ICD-10-PCS
Hospitals Outpatient ICD-10-CM CPT
Physicians Facility/Office ICD-10-CM CPT
ASCs Outpatient ICD-10-CM CPT
Hospitals, physicians and all other providers must use ICD-10 diagnosis codes.
Hospitals must also use ICD-10-PCS procedure codes for inpatient cases.
Implementation of ICD-10 does not affect use of CPT®.
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ICD-10 Coding Guidelines
Guidelines for use of ICD-10 are available from multiple credible sources.
The ICD-10 Official Guidelines for Coding and Reporting
Instructions within the ICD-10 codebook itself
Coding Clinic and AHA Coding Clinic Advisor
Minutes from meetings of the ICD-10 Coordination and Maintenance Committee
AHA ICD-10-CM and ICD-10-PCS Coding Handbook
AHIMA ICD-10-PCS: An Applied Approach
ICD-10-PCS Reference Manual
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General Equivalence MappingsGeneral Equivalence Mappings (GEMs) are a useful tool for going back-and-forth between ICD-9 and ICD-10 codes, for both diagnoses and procedures.
Forward GEMs go from ICD-9 to ICD-10; Backward GEMs go from ICD-10 to ICD-9.
The GEMs can be found at: http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105
The GEMs can be a good starting place. But NCHS and CMS strongly recommend coding directly from the ICD-10 codebooks, as studies have consistently indicated that this is most accurate.
http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html
ICD-10-CM Diagnosis Codes
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Codes are organized by chapter, mostly by body system. The chapters are virtually identical to those in ICD-9-CM.
Codes are alpha-numeric and can be 3 to 7 digits long.
Diagnosis Code Structure
Talpha
8number
2alpha or number
2 0 A
Category Details Extension
1T82.120ADisplacement of cardiac electrode, initial encounter
R 5 5 R55Syncope
I 5 0
2I50.23Acute on chronic systolic heart failure
3
Decimal
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Volume of Diagnosis CodesICD-9-CM
14,567 codesICD-10-CM
69,823 codes
ICD-10-CM has far more diagnosis codes than ICD-9-CM and provides a greater level of specificity.
ICD-9-CM ICD-10-CM
427.31 Atrial fibrillation
I48.0 Paroxysmal atrial fibrillationI48.1 Persistent atrial fibrillationI48.2 Chronic atrial fibrillation
I48.91 Unspecified atrial fibrillation
427.32 Atrial flutterI48.3 Typical atrial flutter (type I)I48.4 Atypical atrial flutter (type II)
I48.92 Unspecified atrial flutter
Example: Atrial fibrillation and atrial flutter
But some unnecessary distinctions have been removed. Example: Second degree atrioventricular block
ICD-9-CM ICD-10-CM 426.12 AV block, Mobitz II I44.1 Atrioventricular block, second degree426.13 AV block, other second degree
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Heart Failure
ICD-9-CM ICD-10-CM 428.0 Congestive heart failure, unspecified I50.9 Heart failure, unspecified 428.1 Left heart failure I50.1 Left ventricular failure 428.20 Systolic heart failure, unspecified I50.20 Unspecified systolic (congestive) heart failure428.21 Acute systolic heart failure I50.21 Acute systolic (congestive) heart failure428.22 Chronic systolic heart failure I50.22 Chronic systolic (congestive) heart failure428.23 Acute on chronic systolic heart failure I50.23 Acute on chronic systolic (congestive) heart failure428.30 Unspecified diastolic heart failure I50.30 Unspecified diastolic (congestive) heart failure428.31 Acute diastolic heart failure I50.31 Acute diastolic (congestive) heart failure428.32 Chronic diastolic heart failure I50.32 Chronic diastolic (congestive) heart failure428.33 Acute on chronic diastolic heart failure I50.33 Acute on chronic diastolic (congestive) heart failure
428.40 Unspecified combined systolic and diastolic heart failure I50.40 Unspecified combined systolic (congestive) and diastolic
(congestive) heart failure
428.41 Acute combined systolic and diastolic heart failure I50.41 Acute combined systolic (congestive) and diastolic
(congestive) heart failure
428.42 Chronic combined systolic and diastolic heart failure I50.42 Chronic combined systolic (congestive) and diastolic
(congestive) heart failure
428.43 Acute on chronic combined systolic and diastolic heart failure I50.43 Acute on chronic combined systolic (congestive) and
diastolic (congestive) heart failure428.9 Unspecified heart failure I50.9 Heart failure, unspecified
Heart failure works the same way in ICD-10-CM as it does in ICD-9-CM.
“Congestive” heart failure does not have its own code.A code from I50 is assigned separately to identify the type of heart failure with hypertensive heart disease with heart failure.
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ICD-9-CM410.0x Acute myocardial infarction, of anterolateral wall 410.1x Acute myocardial infarction, of other anterior wall 410.2x Acute myocardial infarction, of inferolateral wall410.3x Acute myocardial infarction, of inferoposterior wall410.4x Acute myocardial infarction, of other inferior wall 410.5x Acute myocardial infarction, of other lateral wall410.6x Acute myocardial infarction, true posterior wall 410.7x Acute myocardial infarction, subendocardial (NSTEMI)410.8x Acute myocardial infarction, of other specified sites 410.9x Acute myocardial infarction, unspecified site
Acute Myocardial Infarction
AMI: ICD-9-CM
AMI: ICD-10-CM
Episode of care is not identified per se. AMI is differentiated between initial AMI (I21) and subsequent AMI (I22) The AMI site identifies the specific coronary artery involved (“culprit lesion”).
ICD-10-CM handles acute myocardial infarction differently from ICD-9-CM.
5th digit
0 – unspecified episode of care
1 – initial episode of care
2 – subsequent episode of care
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Initial AMI (I21)
Acute Myocardial Infarction
ICD-10-CMI21.01 ST elevation (STEMI) myocardial infarction involving left main coronary arteryI21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary arteryI21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary arteryI21.19 ST elevation (STEMI) myocardial infarction involving other coronary arteryI21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary arteryI21.29 ST elevation (STEMI) myocardial infarction involving other sitesI21.3 ST elevation (STEMI) myocardial infarction of unspecified site I21.4 Non-ST elevation (NSTEMI) myocardial infarction
Initial AMI codes I21 continue to be assigned to encounters for continued care, including transfer to another hospital or post-acute setting, while the AMI is within 28 days of onset.1
If the AMI is documented as NSTEMI (subendocardial, non-transmural) and a site is provided, it is still coded as NSTEMI.2
1. ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(1 )2. ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(3 )
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Crosswalk: Acute Myocardial Infarction
ICD-10-CMI22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wallI22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wallI22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarctionI22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sitesI22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
Subsequent AMI (I22)
A subsequent AMI is a new AMI that occurs within 28 days of a previous AMI, regardless of site.3
Codes from I22 cannot be assigned alone. They must always be assigned with a code from I21. Sequencing of the codes depends on the circumstances of the encounter.3
3. ICD-10-PCS Official Guidelines for Coding and Reporting (Diagnosis), FY 2015, Section I, C9.e(4 )
Old MI
ICD-9-CM ICD-10-CM 412 Old myocardial infarction I25.2 Old myocardial infarction
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Bradycardia and TachycardiaTachycardia
ICD-9-CM ICD-10-CM
427.0 Paroxysmal supraventricular tachycardia I47.1 Supraventricular tachycardia (includes AVNRT)I49.2 Junctional premature depolarization
427.1 Paroxysmal ventricular tachycardia I47.0 Re-entry ventricular arrhythmia I47.2 Ventricular tachycardia
427.2 Paroxysmal tachycardia, unspecified I47.9 Paroxysmal tachycardia, unspecified 785.0 Tachycardia, unspecified R00.0 Tachycardia, unspecified
“Paroxysmal” does not need to be documented for SVT and VT.
But tachycardia that’s unspecified is assigned to symptom code R00.0.
BradycardiaICD-9-CM ICD-10-CM
427.81 Sinoatrial node dysfunction (SSS) I49.5 Sick sinus syndrome (tachy-brady syndrome)— R00.1 Bradycardia, unspecified
Bradycardia that’s unspecified or documented only as “sinoatrial” or “sinus” bradycardia is assigned to symptom code R00.1.
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Device Complications
For other (non-mechanical) complications, ICD-10-CM also differentiates the type of complication but not the type of device.
Proposals have already been made to ICD-10 C&M Committee to create new codes to provide more detail on the specific device.
Mechanical complication is defined the same way in ICD-10-CM as it is in ICD-9-CM.
For mechanical complication, ICD-10-CM differentiates the type of complication and the component but not the device.
ICD-9-CM ICD-10-CM
996.01
996.04
Mechanical complication due to cardiac pacemaker
Mechanical complication due to implantable defibrillator
T82.110A Breakdown (mechanical) of cardiac electrode, initial encounterT82.111A Breakdown (mechanical) of cardiac pulse generator, initial encounterT82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounterT82.120A Displacement of cardiac electrode, initial encounterT82.121A Displacement of cardiac pulse generator, initial encounterT82.128A Displacement of other cardiac electronic device, initial encounterT82.190A Other mechanical complication of cardiac electrode, initial encounterT82.191A Other mechanical complication of cardiac pulse generator, initial encounterT82.198A Other mechanical complication of other cardiac electronic device, initial encounter
ICD-10-PCSProcedure Codes
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ICD-10-PCS Format and Structure Codes are alpha-numeric and are always 7 digits long.
Each position in an ICD-10-PCS procedure code represents a distinct element.
1 2 3 4 5 6 7
sectionbody system
root operation approach qualifierbody part device
There is no decimal point. There are virtually no unspecified or default codes.
In ICD-10-PCS, codes are not assigned per se. They are constructed, character by character, from code tables.
ICD-10-PCS contains no instructional notes. Standardized terms and definitions are used throughout.
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Volume of Procedure Codes
ICD-10-PCS has far more procedure codes than ICD-9-CM and provides much greater specificity.
ICD-9-CM3,882 codesICD-10-PCS71,962 codes
Use of ICD-10-PCS requires in-depth clinical and technical coding knowledge:
Relevant clinical anatomy Procedural components Exact nature of devices used Standard terms, particularly Root Operation Procedure coding guidelines and precedents
Full system CRT-D
ICD-9-CM 1 code ICD-10-PCS 4 codes
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Root Operations for Devices Six root operations always involve implanted devices where the
sole objective is do something with the device. Three of the six root operations are relevant for cardiac rhythm
and heart failure devices.
There are two scenarios for replacing a device:5
H-Insertion of the new device and P-Removal of the old device R-Replacement of the body part with a new device and P-Removal
of the old device 4. ICD-10-PCS Reference Manual 2015, p.675. ICD-10-PCS Reference Manual 2015, p.69; see also AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.416, 418, 302
Root Operation Objective4 ExampleH-Insertion Putting in a non-biological device Implanting a pulse generatorP-Removal Taking out a device Removing a leadW-Revision Correcting a malfunctioning or displaced device Repositioning a lead R-Replacement Putting in a device that replaces a body part Replacing a hip or heart valve
U-Supplement Putting in a device that reinforces or augments a body part Laying mesh in a hernia repair
2-Change Exchanging a device without cutting or puncture Exchanging a tracheostomy tube
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Cardiac Rhythm and HF Procedures
PPM, ICD, CRT-P, CRT-D
Diagnostic Electrophysiologic Studies (EPS)
Implanted Loop Recorder (Cardiac Event Monitor)
Ablation for Arrhythmia
Cardioversion
Electrophysiologic (EP) Mapping
Antibacterial Envelope
Device Evaluation
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PPM, ICD, CRT-P, CRT-D
Conventional pacemakers are placed for bradycardia and heart block.
Conventional defibrillators are placed for ventricular tachycardia or ventricular fibrillation, or for primary prevention indications such as cardiomyopathy.
Typical Indications
CRT-P (biventricular pacemakers) are placed for heart failure, with or without bradycardia or heart block.
CRT-D (biventricular defibrillators) are placed for heart failure with either ventricular tachycardia or primary prevention indications.
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PPM, ICD, CRT-P, CRT-D
4-Pacemaker, Single Chamber5-Pacemaker, Single Chamber RR6-Pacemaker, Dual Chamber
8-Defibrillator Generator
7-Cardiac Resynchronization Pacemaker Pulse Generator
9-Cardiac Resynchronization Defibrillator Pulse Generator
Adapta Sensia Advisa Versa
Evera SecuraProtecta DR/VR
Viva Consulta Syncra
Viva Quad, XT, S Protecta
The model name may be insufficient to assign the device value.
Device Values and Models
The model numbers differentiate and can be found at:http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/documents/documents/medicare-c-code-list-color.pdf (see p. 6-7)
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Generator PlacementRoot Operation H – Insertion
Examples of Generator Insertion
0JH608Z Insertion of defibrillator generator into chest subcutaneous tissue and fascia, open approach
Coding Guidelines Creation of the pocket is not coded separately6
6. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.419
0JH609Z Insertion of cardiac resynchronization defibrillator pulse generator into chest subcutaneous tissue and fascia, open approach
Body System J – Subcutaneous Tissue and Fascia
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Generator RemovalRoot Operation P – Removal
Example of Generator Removal
0JPT0PZ Removal of cardiac rhythm related device from trunk subcutaneous tissue and fascia, open approach
Device Value
7. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.418
P – Cardiac Rhythm Related Device
For P-Removal, the same device value and same code are used regardless of whether the generator is a PPM, ICD, CRT-P, or CRT-D.7
Coding Guideline
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Generator RevisionRoot Operation W – Revision
Example of Generator Revision
0JWT0PZ Revision of cardiac rhythm related device from trunk subcutaneous tissue and fascia, open approach
Device Value P – Cardiac Rhythm Related Device
For W-Revision, the same device value and same code are used regardless of whether the generator is a PPM, ICD, CRT-P, or CRT-D.
Coding Guideline
This can be used for revising or relocating the device pocket8, or re-opening the pocket to correct a flipped generator.
8. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.416, 417
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Lead PlacementRoot Operation H – Insertion
Coding Guidelines Placement of each lead is coded separately.
Body System 2 – Heart and Great Vessels
Transcatheter placement of a “left ventricular” lead via the coronary vein is apparently assigned to Body Part 4-Coronary Vein.
Body Parts 6 and 7 for Atrium, Right and Left and K and L for Ventricle, Right and Left are apparently assigned for transcatheter placement of a lead into the chamber.
Body Part N-Pericardium is apparently assigned for placement of an epicardial lead (patch).
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Lead PlacementExamples of Lead Insertion
02H63KZ Insertion of defibrillator lead into right atrium, percutaneous approach
Transvenous placement of CRT-D leads into right atrium and right ventricle with transvenous left ventricular lead via coronary sinus
02HK3KZ Insertion of defibrillator lead into right ventricle, perc approach02H43KZ Insertion of defibrillator lead into coronary vein, perc approach
02HN0KZ Insertion of defibrillator lead into pericardium, open approach Epicardial placement of CRT-D left ventricular lead by thoracotomy
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Lead RemovalRoot Operation P – Removal
Example of Lead Removal
02PA3MZ Removal of cardiac lead from heart, percutaneous approach
Device Value M – Cardiac Lead
For P-Removal, the same device value and same code are used regardless of whether the lead is for a PPM, ICD, CRT-P, or CRT-D.
Coding Guideline
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Lead RevisionRoot Operation W – Revision
Example of Lead Revision
02WA3MZ Revision of cardiac lead in heart, percutaneous approach
Device Value
For W-Revision, the same device value and same code are used regardless of whether the lead is for a PPM, ICD, CRT-P, or CRT-D.
Coding Guideline
This can be used for repositioning a displaced lead.9
9. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.419, see also ICD-10-PCS Reference Manual 2015, p.74-75
M – Cardiac Lead
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Subcutaneous Defibrillator Lead
0JH60PZ Insertion of cardiac rhythm related device into chest subcutaneous tissue and fascia, open approach
10. Coding Clinic, 4th Q 2012
The lead is tunneled subcutaneously and positioned in the left chest to achieve reliable defibrillation. The electrical impulse generated travels through the tissues to the heart.
Body System J – Subcutaneous Tissue and Fascia
Device Value P – Cardiac Rhythm Related Device10
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Antimicrobial EnvelopeAntimicrobial envelopes are coated with antibiotics. They hold PPM, ICD, CRT-P or CRT-P generators and are implanted with the generator. The intent is to reduce infection and also stabilize the devices.
There’s a separate code for placement of an antimicrobial envelope; it is assigned in addition to the generator insertion code.
3E0102A Introduction of anti-infective envelope into subcutaneous tissue, open approach
Device: AIGISRx envelope (also called TYRX)
Example of Envelope Placement
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Implanted Loop RecorderILRs (implanted cardiac event recorders, implanted cardiac monitors) are placed in subcutaneous tissue for long-term recording and monitoring of heart rhythms.
Devices 2 – Monitoring Device : Reveal XT, Reveal LINQ
Approach 0 – Open
placement of Reveal XT 3 – Percutaneous
placement of Reveal LINQ
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Loop Recorder
0JH632Z Insertion of monitoring device into chest subcutaneous tissue and fascia, percutaneous approach
Example of Loop Recorder Placement
Example of Loop Recorder Removal
0JPT32Z Removal of monitoring device from trunk subcutaneous tissue and fascia, percutaneous approach
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Ablation for Arrhythmia Transvenous ablation is performed to disrupt aberrant electrical conduction pathways within the heart and restore normal rhythm.
Root Operation 5 – Destruction 8 – Conduction Mechanism11
Body Part
Example of Ablation for Arrhythmia A single code is apparently used for all ablations of all arrhythmias
because the target is always the aberrant conduction pathway.11
11. Coding Clinic, 4th Q 2014
02583ZZ Destruction of conduction mechanism, percutaneous approach
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Diagnostic Electrophysiologic StudiesIn a diagnostic EP study, catheters are threaded through the vena cava and into the heart, usually at the high right atrium, bundle of HIS, and right ventricle.
For diagnosis, the catheters are used to perform pacing and recording as well as induction of arrhythmia. The patients may go on to receive an therapeutic ablation.
There’s just one code for a diagnostic EP study12
4A023FZ Measurement of cardiac rhythm, percutaneous approach12. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.415
Example of EP Study
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Electrophysiologic MappingMapping is often performed together with diagnostic EP studies and also with therapeutic ablations.
02K83ZZ Map conduction mechanism, percutaneous approach
Special mapping catheters within the heart precisely identify the arrhythmia origin or path, and create 3D maps to guide the physician.
This is a separate step and is coded separately from the EP study or ablation.
Example of Cardiac EP Mapping
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Device Evaluation: Interrogation Pacemakers and defibrillators, both conventional and biventricular, need to be checked periodically. This can be done by interrogation or by non-invasive programmed stimulation (NIPS).
Both evaluations are non-invasive. The difference is that for an interrogation, an arrhythmia is not induced but for NIPs, it is.
Example of Interrogation13
4B02XSZ Measurement of cardiac pacemaker, external approach4B02XTZ Measurement of cardiac defibrillator, external approach
The approach is X-External by its nature.
13. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.416
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Device Evaluation: NIPS
Coding Guidelines
4A02X4Z Measurement of cardiac electrical activity, external approach
Do not code NIPS for device testing at the time of defibrillator implantation. This is considered integral and is not coded at all.14
14. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.415
NIPS tests the device to ensure it can deliver the appropriate shock as needed. This requires inducing a potentially lethal arrhythmia.
Do not code a diagnosis of ventricular fibrillation when NIPS is performed. Inducing this arrhythmia is the point.14
The approach is X-External by its nature. Example of NIPS
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CardioversionCardioversion applies electrical shock to convert an arrhythmia to normal rhythm.
5A2204Z Restoration of cardiac rhythm, single
This code is used only for external cardioversion.
Coding Guidelines15
The code is still assigned regardless of whether cardioversion was successful in converting the rhythm.
15. AHA ICD-10-CM and ICD-10-PCS Coding Handbook 2015, p.112
There’s just one code for external cardioversion.Example of Cardioversion
DRG Impact
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ICD-10 DRG ConversionThe conversion of the DRG Grouper is about coding, not about grouping.
The same DRG will be assigned regardless of whether the case is coded in ICD-9 or ICD-10.
CMS has repeatedly stated its goal in the DRG conversion:
The conversion process has involved only replacing the ICD-9-CM codes with the equivalent ICD-10 codes.
DRG titles and underlying DRG logic has not changed, but some minor DRG variations are unavoidable. In a study of 10 million FY 2013 MedPAR records, CMS found a
DRG shift of 1.07%, with reimbursement change of -0.04%15
15. Estimating the Impact of the Transition to ICD-10 on Medicare Inpatient Hospital Paymentshttp://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/Downloads/2015-03-18-Impact-ICD10-Transition.pdf
If the same DRG is not assigned, recheck the codes
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Sample CCs
Code DescriptionE44.0-E46 other malnutrition
E87.0 hypernatremiaE87.1 hyponatremia I31.4 cardiac tamponade
I42.0, I42.5, I42.8-I42.9
cardiomyopathy (non-ischemic) (dilated, congestive, constrictive, restrictive)
I44.2 AV block, complete I45.2 bifascicular block I45.3 trifascicular block
I45.89 other conduction disorder I47.2 ventricular tachycardiaI50.1 left ventricular failure
I50.20 systolic heart failure, unspecifiedI50.22 systolic heart failure, chronic I50.30 diastolic heart failure, unspecifiedI50.32 diastolic heart failure, chronic
I50.40 combined diastolic/systolic heart failure, unspecified
I50.42 combined diastolic/systolic heart failure, chronic
Code Description
I82.409-I82.891 venous thrombosis and embolism
J44.1 acute exacerbation of COPD
J80 acute respiratory distress syndrome (adult, child)
J90, J94.2, J94.8 pleural effusion, hemothorax, hydrothorax (non-traumatic)
J95.811-J95.812 iatrogenic pneumothorax, air leakJ96.10-J96.12 respiratory failure, chronicJ98.11-J98.19 atelectasis, pulmonary collapse
K56.0,K56.60-K56.7 bowel obstruction, ileus
N17.8-N17.9 acute renal failure, other and unspecified
N18.4 CKD, stage IV N18.5 CKD, stage V N39.0 urinary tract infection
R65.10 SIRSR78.81 bacteremia Z68.1 BMI less than 19, adult
Z68.41-Z68.45 BMI 40 and over, adult
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Sample MCCs
Code DescriptionA40.0-A40.9, A41.01-A41.9 septicemia, sepsis
E41-E43 severe malnutritionI21.01-I21.4, I22.0-I22.9 acute myocardial infarction
I26.01-I26.99 pulmonary embolismI50.21 systolic heart failure, acuteI50.23 systolic heart failure, acute on chronicI50.31 diastolic heart failure, acuteI50.33 diastolic heart failure, acute on chronicI50.41 combined diastolic/systolic heart failure, acuteI50.43 combined diastolic/systolic heart failure, acute on chronic
J12.0-J18.9 pneumoniaJ69.0 aspiration pneumoniaJ81.0 acute pulmonary edema
J96.00-J96.02 respiratory failure, acuteJ96.20-J96.22 respiratory failure, acute on chronic N17.0-N17.2 acute renal failure, specified lesion
N18.6 ESRDR65.20-R65.21 severe sepsis
Appendix: Key Resources
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Key Websites NCHS and CMS have a wealth of ICD-10 resources and educational materials available on-line.NCHS http://www.cdc.gov/nchs/icd/icd10cm.htm#icd2105
• ICD-10-CM Tabular and Index • Diagnosis code GEMS• Official ICD-10-CM guidelines (diagnoses)
• ICD-10-PCS Code Tables and Index• Official ICD-10-CM guidelines (procedures)
CMS http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html
• Procedure code GEMs
Procedures: http://www.cms.gov/Medicare/Coding/ICD9ProviderDiagnosticCodes/ICD-9-CM-C-and-M-Meeting-Materials.html
ICD-10 Coordination and Maintenance Committee
• Code proposals, presentation slides, videos, summaries
Diagnoses: http://www.cdc.gov/nchs/icd/icd9cm_maintenance.htm
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Medtronic Contacts Medtronic is available to assist with your ICD-10 questions and issues.
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Email us:[email protected]
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