Basic ICD10 CMPCS Coding 2013 Edition Chapter 4

Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of certain infectious and parasitic diseases? © 2013

ICD-10 -CM • Chapter 1, Certain Infections and Parasitic Diseases, A 00–B 99 • Chapter organized into blocks of codes of bacterial, viral and other types of infections, HIV disease, and parasitic infections © 2013

ICD-10 -CM • New block of codes exist for infections with predominantly sexual mode

ICD-10 -CM • Term “sepsis” has replaced “septicemia” as an equivalent term • Many codes expanded to reflect manifestations of the disease with the use of 4 th or 5 th characters allowing condition to be coded with one combination code instead of two codes © 2013

Coding Guidelines • Review ICD-10 -CM Official Guidelines for Coding and Reporting • Chapter-specific guidelines exist for coding of certain infectious and parasitic diseases (A 00–B 99). • Topics included in the guidelines are human immunodeficiency infections, infectious agents as the cause of disease, infections resistant to antibiotics, sepsis, severe sepsis, and septic shock, and MRSA conditions © 2013

ICD-10 -CM Guidelines • HIV infection o Code only confirmed cases, rules for sequencing • Infectious agents as the cause of diseases classified to other chapters o Use of categories B 95, B 96, and B 97 • Infections resistant to antibiotics o Use of category Z 16 • Sepsis, severe sepsis, and septic shock and sequencing © 2013

Includes and Excludes Notes • Notes appear at the beginning of ICD-10 -CM chapter • Includes: Diseases generally recognized as communicable or transmissible • Use additional code to identify resistance to antimicrobial drugs (Z 16. -) • Excludes 1 Note: Certain localized infections—see body systemrelated chapters. Infections and parasitic disease complicating pregnancy, childbirth and the puerperium (O 98 -). Influenza and other acute respiratory infections (J 00 -J 22) • Excludes 2 Note: Carrier or suspected carrier of infectious disease (Z 22. -). Infectious and parasitic diseases specific to the perinatal period (P 35–P 39) © 2013

Review of the Entire Record • To code these conditions, the entire health record must be reviewed to identify the following: o Body Site • for example, eye, intestine, or blood o Specific organism responsible • for example, bacteria, virus or fungus o Etiology of disease • for example, parasite or food poisoning o Severity of the disease • for example, acute of chronic © 2013

Combination Codes and Multiple Coding • Combination codes identify both the condition and the causative organism • Mandatory multiple coding is required to describe etiology and manifestation when infectious and parasitic diseases produce a manifestation within another body system • Alphabetic Index identifies two codes © 2013

Sepsis, Severe Sepsis and Septic Shock in ICD-10 -CM • Review definition of “sepsis” o Serious medical condition caused by the body’s immune response to an infection o Coder must review the physician’s documentation to determine if the causative organism is known o If only the term sepsis is documented, code A 41. 9, Sepsis, unspecified is the appropriate code © 2013

Sepsis, Severe Sepsis and Septic Shock in ICD-10 -CM • Review definition of “severe sepsis” o An infection associated acute organ dysfunction o May also be referred to as systemic inflammatory response syndrome due to an infectious process with acute organ dysfunction o Two codes are required to code severe sepsis © 2013

Sepsis, Severe Sepsis and Septic Shock in ICD-10 -CM • Review what is meant by septic shock • If septic shock is present, additional codes are required to identify the specific acute organ dysfunction, such as acute kidney failure (N 17. -) or acute respiratory failure (J 96. 0 -) • The Tabular List states that code R 65. 20 and R 65. 21 for severe sepsis without or with septic shock cannot be used as the principal, first-listed or the only code. • A “code first underlying infection” note appears to state to code first the particular infection that produced the severe sepsis. © 2013

HIV Disease in ICD-10 -CM • Review the facts about HIV infection and AIDS • The HIV classification includes categories and codes: o B 20 Human immunodeficiency virus [HIV] disease o Z 21 Asymptomatic human immunodeficiency virus [HIV] infection status o R 75 Inconclusive laboratory evidence of HIV © 2013

HIV Disease in ICD-10 -CM • Follow the coding guidelines for HIV disease • Only confirmed cases of HIV disease are coded • AIDS code B 20, followed by additional codes for all reported HIV-related conditions • Coding of pregnancy and HIV disease uses a code from the pregnancy chapter © 2013

HIV Disease in ICD-10 -CM • Patient with HIV disease but treated for an unrelated condition, such as a traumatic injury or a disease not caused by HIV disease. Code B 20 for HIV is additional diagnosis • Asymptomatic HIV infection status code Z 21 • Patients with inconclusive laboratory evidence of HIV code R 75 © 2013

HIV Disease in ICD-10 -CM • Testing for HIV • Z 22. 1, Encounter for screening for HIV • Additional codes may be applicable for high risk sexual behavior and for HIV counseling when provided during the screening encounter o Positive test results • Asymptomatic patient Z 21 • Symptomatic patient—code to the disease present © 2013

Sequelae of Infectious and Parasitic Diseases in ICD-10 -CM (B 90–B 94) • Certain infectious and parasitic diseases leave long-lasting effects after the infection is cured, which may be called a residual condition • Categories B 90–B 94 are used to identify the original infection that produces the problem or condition that patient has as a result of the infection. • Categories B 90–B 94 are not used if the original condition is still present or if the condition is identified as a chronic infection. • See “code first” note to code the condition the patient today first with an additional code to identify the sequelae fact © 2013

Bacterial and Viral Infectious Agents B 95–B 97 • Series of codes to identify the infective agents causing diseases • Used as additional diagnosis codes to identify the causative organism in diseases classified elsewhere o B 95. 0–B 95. 8: Streptococcus, staphylococcus, enterococcus • Example: Methicillin resistant Staphycoccus aureus o B 96. 0–B 96. 89: Other bacterial agents • Example: Escherichia coli (E. coli) o B 97. 0–B 9789: Viral agents • Example: Respiratory syncytial virus (RSV) © 2013

Bacterial and Viral Infectious Agents B 95–B 97 • Codes are identified in the Alphabetic Index under “infection” or the name of the organism, such as “Streptoccoccus” • Codes from B 95–B 97 will most likely be used with another code that identifies the site of an infection but does not include the causative organism • For example, the diagnosis of urinary tract infection due to E. coli would require two codes o N 39. 0 Urinary tract infection, site not specified o B 96. 20 Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere © 2013

Infection with Drug Resistant Microorganisms • Coding of bacterial infections that are resistant to current antibiotics • This specificity is necessary to identify all infections documented as antibiotic resistant • Code Z 16, Infections with drug resistant microorganisms, is assigned following the infection code for such cases © 2013

Methicillin Resistant Staphylococus Aureus (MRSA) • Coding of conditions due to MRSA bacteria are coded in one of two ways o A combination code that identifies the infection is due to MRSA o An additional code to identify the MRSA as the causative organism (B 95. 62) with a code for the site of the infection • Alphabetic Index entries main term of “infection” • Compare MRSA and MSSA—Methicillin susceptible Staphylococus aureus (B 95. 61) © 2013

ICD-10 -PCS Coding for Infectious and Parasitic Diseases • Infectious and parasitic diseases are not usually treated with surgical procedures. • However, the conditions are usually treated with medication therapy • Devices must be inserted in the patient for longterm intravenous infusions © 2013

ICD-10 -PCS Coding for Infectious and Parasitic Diseases • There are six root operations that always involve a device: insertion, replacement, supplement, change, removal and revision • The root operation of insertion is putting in a nonbiological device. Inserting a vascular access device (for the infusion) would be coded to the root operation of insertion. © 2013

ICD-10 -PCS Coding for Infectious and Parasitic Diseases • See Table 05 H—insertion of a device in an upper vein such as subclavian, brachial, basilic or cephalic • Approach is either open, percutaneous or percutaneous endoscopic • Device is an infusion device • There is no option for a qualifier so Z is used for the seventh character © 2013

ICD-10 -PCS Coding for Infectious and Parasitic Diseases • See Table 0 JH—insertion of a infusion device pump or reservoir or vascular access device as another option used for intravenous infusions • Approach is either open or percutaneous • Device character identifies is an infusion device • There is no option for a qualifier so Z is used for the seventh character © 2013

ICD-10 -PCS Coding for Infectious and Parasitic Diseases • When a device is no longer needed, the root operation Removal would be used • See Table 0 JP for the body part location, the approach and the device. There is no qualifier option. • Other Tables 05 P and 06 P may also be used for other removal procedures © 2013

ICD-10 -PCS Coding for Infectious and Parasitic Diseases • The patient may require invasive surgical procedures to treat the underlying condition that has caused the sepsis. • Repairing the intestine by excision, resection or a bypass procedure may also be coded for a patient with sepsis from a gastrointestinal source. © 2013