Basic ICD10 CM and ICD10 PCS Coding 2016
Basic ICD-10 -CM and ICD-10 -PCS Coding 2016 Edition Chapter 6: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders (E 00 -E 89) © 2016
Learning Objectives • Review the chapter’s learning objectives • Review the chapter’s key terms • At the conclusion of this chapter, what must you know about the coding of endocrine, nutritional and metabolic diseases and immunity disorders? © 2016
ICD-10 -CM Chapter 4: Endocrine, Nutritional and Metabolic Diseases • Includes common disorders of thyroid gland, obesity, dehydration, and diabetes mellitus • Other conditions coded to chapter 4 include intraoperative complications of endocrine system, malnutrition, metabolic disorders, and postprocedural endocrine and metabolic complications, not elsewhere classified © 2016
Coding Guidelines and Instructional Notes for ICD-10 -CM Chapter 4 • Chapter specific guidelines – Diabetes mellitus codes are combination codes that include the type of diabetes, the body system affected and the complication affecting that body system – Assign as many codes from categories E 08 -E 13 as needed to identify all of the associated conditions that the patient had © 2016
Coding Guidelines and Instructional Notes for ICD-10 -CM Chapter 4 • Chapter specific guidelines • Notes appear under Diabetes categories – E 08 Diabetes mellitus due to underlying condition • Code first the underlying condition • Use additional code to identify any insulin use – E 09 Drug or chemical induced diabetes mellitus • Code first poisoning due to drug or toxin if applicable • Use additional code for adverse effect to identify drug • Use additional code to identify any insulin use © 2016
Disorders of Thyroid Gland (E 00 E 07) • Review Figure 7. 1 for organs within the endocrine system • Thyroid gland located in the neck in front of the trachea • Produces two hormones, T 4 and T 3, that regulate metabolic functions • Four parathyroid glands located to the dorsal area of the thyroid lobes © 2016
Disorders of Thyroid Gland (E 00 E 07) • Hypothyroidism is decreased production of the thyroid hormones – Congenital, acquired, autoimmune forms • Goiter is an enlargement of the thyroid gland – Cystic or fibrous with single or multiple lobes – Toxic goiter has numerous nodules and excessive thyroid hormone production © 2016
Disorders of Thyroid Gland (E 00 E 07) • Thyrotoxicosis is excess thyroid hormone present – Produces accelerated metabolic processes – Not the same as hyperthyroidism that is excessive thyroid function – Treated with antithyroid drugs • Thyroiditis – Inflammation of the thyroid gland – May be caused by viral or bacterial infection, certain medications, genetics, or autoimmune disease © 2016
Diabetes Mellitus (E 08 -E 13) • Five categories for diabetes mellitus • Diabetes is a metabolic disease in which the pancreas does not produce insulin normally • Combination codes identify manifestations and complications of diabetes by using 4 th or 5 th characters • Report uncontrolled diabetes status by using code for diabetes mellitus, by type, with hyperglycemia © 2016
Diabetes Mellitus (E 08 -E 13) • Diabetes is a metabolic disease in which the pancreas does not produce insulin normally • Causes may be both hereditary and non-hereditary • Glucose is not broken down to be used and stored and sugar accumulates in the blood and spills into the urine • Treatment consists of insulin regulation with insulin injections or oral antidiabetic agents • Over time, high blood sugar can lead to diseases of the heart, eyes, kidneys, nerves, gums, and teeth © 2016
Five Categories for Diabetes Mellitus • E 08, Diabetes mellitus due to underlying condition • E 09, Drug or chemical induced diabetes mellitus • E 10, Type 1 diabetes mellitus • E 11, Type 2 diabetes mellitus • E 13, Other specified diabetes mellitus © 2016
Diabetes Type 1 (E 10) • Usually diagnosed in children and young adults • Previously known as juvenile diabetes • Body does not produce insulin • Only 5 percent of people who have diabetes have this form of the disease © 2016
Diabetes Type 2 (E 11) • Most common type of diabetes • Body does not produce enough insulin, the cells ignore the insulin or use insulin well • Patients are usually older, obese, or have family history of diabetes • May have frequent infections, blurred vision, cuts, and bruises that are slow to heal and tingling or numbness in hands and feet © 2016
Diabetes due to Underlying Condition (E 08) • Code first number appears under category E 08, such as: – Congenital rubella – Cushing’s syndrome – Cystic fibrosis – Malignant neoplasm – Malnutrition – Pancreatitis and other diseases of pancreas © 2016
Drug or Chemical-Induced Diabetes Mellitus (E 09) • Code first number appears under category E 08, such as: – Congenital rubella – Cushing’s syndrome – Cystic fibrosis – Malignant neoplasm – Malnutrition – Pancreatitis and other diseases of pancreas © 2016
Other Specified Diabetes Mellitus (E 13) • Includes note under category E 13 states this is diabetes mellitus due to – genetic defects of beta-cell function – diabetes mellitus due to genetic defects in insulin action – Postpancreatectomy diabetes mellitus – Postprocedural diabetes mellitus – Secondary diabetes mellitus NEC © 2016
Other Specified Diabetes Mellitus • Other forms of diabetes are coded elsewhere in ICD-10 -CM – Gestational diabetes (O 24. 4 -) – Neonatal diabetes mellitus (P 70. 2) © 2016
Coding Overview for Diabetes • Coder may assign as many codes from categories E 08 -E 13 as needed to identify all the associated conditions that a patient may have treated • Additional code (Z 79. 4) is available to indicate the use of insulin, except with Type 1 diabetes © 2016
Other Disorders of Glucose Regulation and Pancreatic Internal Secretion (E 15 E 16) • E 15. 0 Nondiabetic hypoglycemia coma • E 16. 0 Drug-induced hypoglycemia without coma – Use additional code for adverse effect, if applicable • E 16. 1 and E 16. 2, Other and unspecified hypoglycemia • Hypoglycemia is usually a side effect of diabetes but it can occur in patients without diabetes – To find the cause, laboratory tests are performed to measure blood glucose, insulin, and other chemicals © 2016
Other Disorders of Glucose Regulation and Pancreatic Internal Secretion (E 15 -E 16) • Review Figure 7. 2 to see the organs affected by Zollinger-Ellison syndrome • One or more gastrinomas develop in the pancreas and duodenum and release abnormally large amounts of gastrin hormone that causes the stomach to produce excessive amounts of acid • Can produce severe peptic ulcerations in the duodenum or other parts of the upper intestine such as the stomach © 2016
Disorders of Other Endocrine Glands (E 20 -E 35) • Eight major endocrine glands: pituitary, pineal, thyroid, thymus, adrenal, pancreas, testes, ovaries • For conditions related to the use of medications, notes are included to “use additional code” for adverse effect to identify the drug or drugs that are responsible for the gland’s dysfunction © 2016
Disorders of Other Endocrine Glands (E 20 -E 35) • Cushing’s syndrome results from the excessive production or exposure to the hormone cortisol • Cortisol is produced by the adrenal gland • Most common cause is a pituitary tumor • May be produced by taking a synthetic hormone drug to treat another condition • Treatment is medications to lower the cortisol level or surgery to remove pituitary gland © 2016
Disorders of Other Endocrine Glands (E 20 -E 35) • Addison’s disease is also known as primary adrenocortical insufficiency • Adrenal gland does not produce enough of hormones cortisol androgens • Cause may be autoimmune where the body’s immune system attacks its own tissue • Treatment includes replacement therapy with glucocorticoid and mineral corticoid drugs and careful regulation of fluids and diet intake © 2016
Disorders of Other Endocrine Glands (E 20 -E 35) • Polycystic ovarian syndrome or disease • Characterized by anovulation, amenorrhea, hirsutism, and infertility • Cause is unknown but suspected to be multifactoral • Produces endometrial hyperplasia that is a risk factor for endometrial cancer • Medications used to treat are combined hormonal birth control pill with estrogen and progestin or insulin-sensitizing drugs © 2016
Malnutrition (E 40 -E 46) • Caused by inadequate or unbalanced diet, problems with digestion or absorption, and certain medical conditions • Varies from very mild to severe • Kwashiorkor is very rare in the U. S. and is more likely to occur in very poor countries with lack of food • Marasmus is severe deficiency of calories and protein that produces weight loss and dehydration • Documentation must describe the type of malnutrition including the degree and type of protein-calorie or proteinenergy malnutrition © 2016
Overweight, Obesity, and Other Hyperalimentation (E 65 -E 68) • Person’s weight is greater than what is considered healthy for their height • Related to genetic composition, overeating, not being physically active • Body Mass Index (BMI) is weight in kilograms divided by the square of height in meters • BMI ranges indicate underweight, normal weight, overweight, and obese status • See coding guideline 1. B. 14 addresses documentation requirements in order to code © 2016
Metabolic Disorders (E 70 -E 88) • Volume depletion may refer to depletion of total body water (dehydration) or depletion of blood volume (hypovolemia) • Dehydration (E 86. 0) can be caused by vomiting, excessive heat and sweating, diarrhea, or lack of food or fluid intake • Hypovolemia (E 86. 1) is abnormally low circulating blood volume and may be caused by internal bleeding, external bleeding from trauma or due to loss of body volume and fluid from diarrhea, vomiting, dehydration, or burns – Usually requires emergency medical treatment – Can produce hypovolemic shock © 2016
Metabolic Disorders (E 70 -E 88) • Cystic fibrosis is inherited disease of exocrine glands that affects the gastrointestinal and respiratory systems • Category E 84 describes complications that occur with cystic fibrosis in the different body systems • Characterized by chronic obstructive pulmonary disease, pancreatic insufficiency, and abnormally high sweat electrolytes • The degree of pulmonary involvement usually determines the course of the disease • Respiratory failure and cor pulmonale can be life threatening © 2016
Postprocedural Endocrine and Metabolic Complications, NEC (E 89) • • • Postprocedural hypothyroidism Hypoinsulinemia Hypoparathyroidism Hypopituitarism Postprocedural ovarian failure Postprocedural hemorrhage and hematoma of an endocrine system organ © 2016
ICD-10 -PCS Procedures for the Endocrine, Nutritional and Metabolic Disorders • Review Table 7. l for root operations likely to be used on body parts within the endocrine system – – – © 2016 Change – Destruction - Division Drainage – Excision – Extirpation Insertion – Inspection – Reattachment Release – Removal – Repair Reposition – Resection - Revision
ICD-10 -PCS Procedures for the Endocrine, Nutritional and Metabolic Disorders • Review Table 7. 2 for body parts involved in procedures performed within the endocrine system – Pituitary – Pineal – Adrenal – Carotid body – Paraaortic – Coccygeal glomus – Glomus jugulare – Aortic body – Paraganglion extremity – Thyroid gland – Superior parathyroid gland – inferior parathyroid gland – Parathyroid glands – Endocrine gland © 2016
ICD-10 -PCS Procedures for the Endocrine, Nutritional and Metabolic Disorders • Review Table 7. 3 for the approaches involved in procedures performed within the endocrine system – Open – Percutaneous endoscopic © 2016
ICD-10 -PCS Procedures for the Endocrine, Nutritional and Metabolic Disorders • Review Table 7. 4 for the devices involved in procedures performed within the endocrine system – – – © 2016 Drainage device Monitoring device Infusion device Other device No device
ICD-10 -PCS Procedures for the Endocrine, Nutritional and Metabolic Disorders • Review Table 7. 5 for the qualifier that may be used with procedures performed within the endocrine system – Diagnostic – No qualifier © 2016
ICD-10 -PCS Procedures for the Endocrine, Nutritional and Metabolic Disorders • Most common procedures on the endocrine glands are – Excision – Resection – Destruction • Biopsy procedures may be done by excision or by fine needle aspiration that could either be an excision of tissue or drainage of fluids or gases • Laterality is important to identify body parts • ICD-10 -PCS guidelines for B 3. 4 a should be reviewed for biopsy procedures © 2016
ICD-10 -PCS Procedures for the Endocrine, Nutritional and Metabolic Disorders • Stereotactic radiosurgery using gamma beam, particulate type, or other photo radiosurgery is available to destroy lesions on endocrine glands such as the – – – Pituitary gland Pineal gland Adrenal glands Parathyroid glands Thyroid • Coded in the radiation therapy section of ICD-10 -PCS © 2016
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