ICD-10 codes must be used on all HIPAA transactions including outpatient claims with dates of service and inpatient claims with dates of discharge on and after October 1, 2013. Failure to do so can result in your claims and other transactions being rejected, and you will need to resubmit them with the ICD-10 codes.
ICD-10-PCS is replacement for the ICD-9-CM.

ICD-10-PCS coding is little tricky, as the ICD-10-PCS coders should have strong Anatomy and Physiology knowledge and understanding of various clinical and surgical procedures.

ICD-10-PCS codes are 7 digits, providing tremendous amounts of specificity. It uses seven characters, alpha or numeric, excluding the letters I and O to avoid confusion. Each of the seven characters of an ICD-10-PCS code has a standard meaning within each section, but may have a different meaning across sections.

Auto ICD-10-PCS Coder is an excellent tool for the hospital coders and billers to learn ICD-10-PCS Coding, features of which include auto generation of PCS code and prompts for the root operation and approaches.

Working Members of ICD-10 Coders Academy can access this tool at no additional cost. Please visit http://www.icd10codersacademy.com for Auto ICD-10-PCS demo. ICD-10 Training and free membership.
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Anatomy is a science that deals with the structures of the body and the relationship of various parts to each other. Knowledge of these structures is necessary to understand their functions.

The subject matter of Anatomy includes:

1. Cytology – Study of cells
2. Histology – Study of tissues also called as Microscopic anatomy
3. Osteology – Study of bones
4. Myology – Study of muscles
5. Arthrology – Study of joints
6. Splanchnology – Study of organs
7. Neurology – Study of the nervous system
8. Angiology – Study of blood vessels

Descriptive terms used in Anatomy:

The arrangement of various parts of the body may be:

1. Symmetric e.g. limbs, eyes, ears, and lungs. Their arrangement on the right side and left side are similar or mirror images of each other.

2. Asymmetric e.g. spleen, heart and liver. The spleen lies entirely in the left side. Liver lies mostly on the right side.

The study of human body is done in anatomical position. In this position, the body
is erect, the head facing forwards, arms by the sides and palms of the hand facing forward.

The following are a few important terms, which are used to describe the human body.
1. Median line (mid sagittal plane): The central plane, which divides the body into two halves i.e., right, and left.
2. Medial: Nearer to the median line
3. Lateral: Away from the median line
4. Superior: Nearer to the head
5. Inferior: Nearer to the foot
6. Anterior: Nearer to the front surface of the body also called as ventral
7. Posterior: Nearer to the back surface of the body also called as dorsal
8. Proximal: Nearer to the origin of the structure
9. Distal: Away from the origin of the structure
10. Superficial: Nearer to the skin surface
11. Deep: Deeper from the skin surface
Movements at joints:

The following are a few descriptive terms used to convey the movements, which occur at various joint:

1. Flexion: A movement where similar surfaces come nearer to each other. This reduces the angle between two bones e.g. bending the forearm at the elbow.

2. Extension: Movement where similar surfaces go apart. Here, the angle between two bones is increased. It is the opposite of flexion e.g. straightening of the bent forearm.

3. Adduction: A movement, which brings the limb towards midline.

4. Abduction: It is opposite of adduction where the limb is drawn away from the midline.

5. Rotation: A movement around a central axis involving 360°.

6. Medial rotation: A rotation towards medial direction.

7. Lateral rotation: A rotation towards lateral direction.

8. Circumduction: A movement involving flexion, abduction, extension and adduction, which occur in a sequence. This movement occurs in shoulder, hip etc.
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For learning medical coding three different manuals are used. They are
1. ICD
2. CPT
3. HCPCS
These manuals or books are updated every year with revised & new codes. The first manual ICD contains an extensive list of different codes given to different diseases. ICD stands for international classification of diseases. This manual consists of three sections or volumes in it. The volumes one & two are used for office visit coding & the volume III is used for hospital coding.
In the beginning of the manual there is guide to the 2009 ICD-9-CM updates which discusses about the new codes & deleted codes. After that from page number 1 up to page no 78 there is guidelines are provided regarding coding & reporting. From page no. 80 up to page no. 631 there is volume 2 alphabetical index appears first before the volume 1. The alphabetical index contains an extensive list of the names of different diseases & symptoms or signs. In this index with each name of disease or symptom or sign a number is assigned. With this number the coder has to search the exact code assigned for a particular condition in the volume 1. The volume one contains a tabular list arranged systematically for different diseases & conditions which affect body systems.
In short the alphabetical index of volume 2 guide us about the series in the table of volume 1 where we have to check the exact code of a disease or condition.
Anatomy of ICD-9 Code
Example 789.09 is ICD code for pain abdomen multiple sites.
Here,
789 the first three digits stand for the disease type or organ system affected.
0 the first digit after the decimal determines a sub classification of the main condition or disease state.
9 The second digit after the decimal in the code specifies the condition or diagnosis further. Pain in abdomen can be in different regions. The last digit specifies the exact region. In this case pain in multiple sites is coded by the last digit 9 which differentiate it from other codes.
Important Note:
Always try to code to the highest degree of specificity. Carry the numerical code to the 4th or 5th digit when necessary. Remember, there are only approximately 100 valid three digit codes; all other ICD-9 codes require additional digits four or five.

How to search a code for a disease in the ICD manual
Search first the name of the disease or sign or symptom in the alphabetical index of volume 2. Then look the number assign to it & then search that number in the tabular index of volume 1.
Example: 1
You want to search the code for typhoid fever.
Look for typhoid fever in the alphabetical index. It is given on the page number 253. The assigned code no. to typhoid fever is 002.0 in the alphabetical index.
Now search 002.0 in the tabular index for its precise code. The typhoid & paratyphoid fever are tabulated in the series 002 on Page no. 633 in volume one & the exact code for typhoid fever is 002.0

Example: 2
You want to search the code for night blindness.
Look for night blindness in the alphabetical index first. It is given on page no 133 & the assign code is 368.60. Search the code given to night blindness in the tabular index of volume 1. On the page no. 740 night blindness is listed in the category code of 365.6 series. In this series night blindness unspecified is given 368.60 as the exact code for it.
Note: While searching a condition in the alphabetical index of ICD manual always search for a condition associated with an anatomical site. Don’t search for the name of anatomical site.
Ex. If the word Chest pain is to be search, we should search for the word pain then in the word pain we should search chest. Similarly if we need to search pulmonary tuberculosis, then don’t search pulmonary because it is anatomical site i.e. lungs so search tuberculosis & in the list of various tuberculosis search for pulmonary.

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Code the E/M service of neonatologist.                                                                         (99468)

(a)    99468

(b)   99295

(c)    99477

(d)   99291

Rationale: Code 99468 is the correct code for initial inpatient neonatal critical care, per day, for the evaluation & management of a critically ill neonate, 28 days of age or less. Critical care management includes application of advanced technology equipments to stabilize deteriorating cardiovascular or respiratory functions (including ventilator or CPAP) if required, continuous monitoring & interpretation of vital signs, blood gasses & other biochemical parameters, frequent physician follow-up & constant observation by a health care team under direct supervision of a specialty physician. Code 99295 is deleted from CPT 2009. Code 99291 is for critical care but not for neonates. Code 99477 is the code for intensive care services but not for critical ill neonates.

Note:

• Remember that the expression “a high probably imminent or life threatening deterioration of the patient’s condition” should be part of the physician’s note to justify the condition of the patient as critical & require critical care level service.
• Intubation service & surfactant administration is bundled in the EM service, so not to be coded separately.

1. The same infant was extubated after 24 hours & placed on NCPAP. He was kept on IV fluids & trophic feeding to prevent from necrotizing enterocolitis. Code the EM service.

(99469)

(a)    99477

(b)   99468

(c)    99469

(d)   99471

Rationale: Code 99469 is the correct code for this service. It is the code for subsequent inpatient neonatal critical care, per day, for the evaluation & management of a critically ill neonate, 28 days of age or less. This service can’t be coded from continuing intensive care services codes. Because the infant is still on NCPAP, which can be considered for critical care codes if documentation supports the critical nature of the illness. Code 99471 is not the code for the baby of this age. Code 99477 can’t be used because the patient is still considered for critical care. Code 99468 is for the first day of neonatal critical care.

1. The same baby on 3^rd day of life is now kept in oxygen hood & continued on IV fluids & gradual increments in feeding are done. Weight of new born on 3^rd day is measured to be 1410gms.

(99478)

(a)    99468

(b)   99477

(c)    99478

(d)   99479

Rationale: 99478 is the correct code for this service. Codes 99478 – 99480 are the codes used to report subsequent day services provided by a physician directing the continuing intensive care of the low birth weight/normal birth weight neonates or infants who doesn’t need critical care but require intensive observations & frequent interventions (code 99478 for weight <1500gms, code 99479 for weight 1500-2500gms & code 99480 for normal birth weight babies of 2501-5000gms). Code 99477 is not used here since it is for initial intensive care, but the patient was already in critical care since two days before only subsequent intensive care codes are applied. Code 99468 is not applied for this case since the baby’s condition is now out of critical care requirements & the code 99479 is also wrong because this infant is still of <1500gms body weight.

1. 33 week gestation preterm newborn baby of weight 1870gms delivered through spontaneous vaginal delivery admitted to NICU for hypotonic appearance upon initial examination. It was treated with antibiotics to manage sepsis & IV fluids. Code the EM service.                          (99477)

(a)    99477

(b)   99468

(c)    99223

(d)   99295

Rationale: Code 99477 is the correct code for this service since the condition of child & the treatment provided doesn’t document critical care need so it is appropriate to code this from initial & continuing intensive care services. It is for initial hospital care, per day, for the evaluation & management of the neonate, 28 days of age or less, who requires intensive care observation, frequent interventions & other intensive care services. Code 99468 is not correct as it is for critical care. Code 99295 is deleted. Code 99223 is for adult patients not for pediatric.

Note:

• Infants or neonates who can be considered for coding from intensive care services are infants of any present body weight who are not critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring and constant observation by the health care team under direct physician supervision.  

1. Same baby monitored in the hospital remained on antibiotics through fourth day developed jaundice & the serum bilirubin was determined to be 15mg/dl. Code the EM service from day 2 to day 4.                                                                                                                           (99479X3)

(a)    99478

(b)   99479

(c)    99477

(d)   99479X3

Rationale: Code 99479X3 is the correct code for subsequent intensive care / day, for the evaluation & management of the recovering low birth weight infant (present birth weight of 1500 – 2500gms). Since the services are rendered for 3 subsequent days (2^nd, 3rd & 4^th) so the code 99479 is multiplied by 3. Code 99478 is inappropriate since it is for infants of below 1500gms. Code 99477 is used only for the first day of intensive care. This baby satisfies the criteria for intensive care services codes since medical record doesn’t document a critical care service.

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Adverse effect used from therapeutic use.

Use an additional code from E849 to indicate the place of occurrence for injuries and poisoning, and don’t code E849.9 if the place of occurrence not stated.

Rules For Poisoning Codes:-

1st list the poisoning code. 2nd code the condition. 3rd E-Code, how the poison occurred.

Rules For Adverse Effect Codes:-

1st code the condition. 2nd E-Code {adverse effect/ therapeutic use}, how the poison occurred.

E-Codes are listed in 5 Categories:

1. Accident:- Accidental overdose of drugs, wrong substances given or taken.

2. Therapeutic use/Adverse Effect:- A correct substance properly administered in therapeutic dosage as the external cause of adverse effect.{When the substance used as prescribed}

3. Suicide attempt: – Instances in which self-inflicted injuries or poisoning are involved.

4. Assault: – Injury or poisoning inflicted by another person with the intent to injure or kill.

5. Undetermined: – When the intent of the poisoning or injury can’t be determined whether it was intentional or accidental.

EXAMPLES:-

1. Supraventricular premature heartbeats secondary to use of digitalis{Drugs}

Codes:- Px: Supraventricular premature heart beats [condition]- 427.61

Sx: digitalis – E942.1 [Therapeutic use]

Px: Primary Sx: Secondary

2. Dry mouth due to taking Phenobarbital

Codes: – Px: Dry mouth- 527.7

Sx: Phenobarbital- E937.0 [Therapeutic use-adverse effect]

3. Parkinsonism due to use of haloperidol [drugs]

Codes: – Px: Parkinsonism – 332.1

Sx: Haloperidol- E939.2 [Therapeutic use]

4. Supraventricular tachycardia due to digoxin.

Codes: – Px: Supraventricular tachycardia- 427.0

Sx: digoxin – E942.1 [Therapeutic use]

5. convulsion due to darvon

Codes:- Px: Convulsion – 780.39

Sx: Darvon- E-935.8 [Therapeutic use]

ACCIDENT CASE:-

1. Convulsions due to accidental overdose of darvon

Codes:- 1st code the poisoning darvon- 965.8

Then code the condition Convulsions – 780.39

Then E-Code accidental overdose of darvon- E850.8

SUICIDE ATTEMPT:-

1. Cerebral anoxia due to barbiturate overdose suicide attempt.

Codes:- 1st code the poisoning barbiturate- 967.0

Then code the condition cerebral anoxia- 348.1

Then E-Code suicide attempt- E950.1

2. Coma due to overdose of Phenobarbital.

Codes:- 1st code the poisoning Phenobarbital- 967.0

Then code the condition coma- 780.01

Then E-Code [unidentified] – E980.1

Contact: Medical Coding and Billing training www.medicalcodingexperts.com www.medesun.com for details

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Group practice means a group of providers in a facility or clinic operating under the same tax ID.
3. E/M coding HPI calculation
For decision regarding the level of history component, individual elements (location, duration, severity, quality, timing, context, modifying factors & associated signs & symptoms) for history of present illness are to be counted accurately.
• If only three elements of history are present in the history then it is considered as brief history.
• History with more than three elements is considered as Extended HPI

4. Importance of ROS in E/M coding
ROS is an inventory of body systems done by physician during the process of recording the HPI. It helps define the problem, differential diagnosis, or identify needed testing etc. Importance of ROS can’t be ignored since it is also one factor which decides the level of history. It is not necessarily done by the physician. It can be recorded by other staff of physician’s office or by patient themselves on ROS questionnaire. However, the physician must review the information and comment on pertinent findings in the body of the note.

Note: The above information is for study purpose, the author doesn’t guarantee the validity and authentication of the subject, please refer to CPT Coding Guidelines
CPT is the registered Trademark of the American Medical Association.

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Author: Dr Yaseen, MD, CPC

Faculty Medical Coding

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BURNS:- A burn is a type of  injury that may be caused by heat, cold, electricity, chemicals, light, radiation or friction. Burns can be highly variable in terms of the tissue affected, the severity, and resultant complications. Muscle, bone, blood vessel, dermal and epidermal tissue can all be damaged with subsequent pain due to profound injury to nerves. Depending on the location affected and the degree of severity. The specific code assignment will depend

on the site and depth of the burn.

 CODING GUIDELINES FOR BURNS: –   Skin is made up of 3 layers.

 1^st Epidermis [outer most layer] – 1^st degree burn.

 2^nd Dermis [leather and thick layer] – 2^nd degree burn.

 3^rd Subcutaneous [fat/ full thickness] – 3^rd degree burn,

Here all layers of skin burn.

 First code the highest degree burn that is 3rd degree burn, then 2^nd degree burn precedence over 1^st degree burn.

 EXTENT OF BURN:-

 Code 948 classifies burns according to the extent of body surface involved.

 4^th digit indicates the total % of the body surface.

 5^th digit indicates % of 3^rd degree burns.

 Category 948 can be assigned as primary diagnosis when the site is mentioned, if the site is not mentioned, assign as secondary diagnosis.

 If the location is not mentioned, code the extent of the burn 948 series, if the location is mentioned code degree of burn and extent.

 Example:-

◦948.3 1      4^th digit   30°- 39°   The total body burn area

                    5^th digit 10°- 19°  The third degree burn.

 948.6 6    4^th digit 60°- 69°  The total body burn area.

                 5^th digit 60°-69°   The third degree burn.

 BURNS EXAMPLES:-

 1.  2^nd degree burn on the toes

 Code: 945.21

 2.  3^rd degree burn of the lower leg

 Code: 945.34

 3.  Sun burn of the face

 Code: 692.71

 1^st degree burn face and eyes

 Code: 941.12

 1^st degree burn 9%, 2^nd degree burn 18%m 3^rd degree burn 36%

 Code: 948.63 [extent codes only because it’s not mentioning any site of the organ]

 2^nd degree burn 30% and 3^rd degree burn 10%

 Code: 948.41

 3^rd degree burn of the thigh with 18%

 Code:       945.36   [3^rd degree burn of the thigh]

 948.11    [extent code]

 1^st degree burn foot 10%, 2^nd degree burn knee 10%, 3^rd degree burn wrist 10%

 Code:       944.37 [3^rd degree burn wrist]

                 945.25 [2^nd degree burn knee]

                 945.12 [1^st degree burn foot]

 Extent Code: 948.31

 3^rd degree burn of the leg and 2^nd degree burn of the forearm.

 Code: 945.30 [3rd degree burn leg]

943.21 [2nd degree burn forearm]

 There is no extent code because the percentage of the burn is not mentioned.

 10. Patient presented to the Emergency Department [ED] with the 3^rd degree burn palm 5%, 2^nd degree burn face 5%, and 1st degree burn foot 10%. Patient is also complaint of dehydration. Patient has allergy to penicillin.

 Code:       944.35 [3^rd degree burn palm]

                 941.20 [2^nd degree burn face]

                 945.12 [1^st degree burn foot]

 Extent Code: 948.20

 Dehydration ICD Coding:  276.51

 Allergy to penicillin: V14.0

 11.3^rd degree burn elbow 9%, 2^nd degree burn ankle 6%, 2^nd degree burn face 3%, 3^rd degree burn knee 6%, 2^nd degree burn on multiple side of the lower limb [leg] with loss of body[sever burn] due to 3^rd degree burn.

 Code: 943.32 [3^rd degree burn elbow]

                 945.23 [2^nd degree burn ankle]

                 941.20 [2^nd degree burn face]

                 945.35 [3^rd degree burn knee]

                 945.29 [2^nd degree burn lower limb-leg]

 Extent Code: 948.21

 Loss of body: 945.50

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BURNS:- A burn is a type of  injury that may be caused by heat, cold, electricity, chemicals, light, radiation or friction. Burns can be highly variable in terms of the tissue affected, the severity, and resultant complications. Muscle, bone, blood vessel, dermal and epidermal tissue can all be damaged with subsequent pain due to profound injury to nerves. Depending on the location affected and the degree of severity. The specific code assignment will depend

on the site and depth of the burn.

 CODING GUIDELINES FOR BURNS: –   Skin is made up of 3 layers.

 1^st Epidermis [outer most layer] – 1^st degree burn.

 2^nd Dermis [leather and thick layer] – 2^nd degree burn.

 3^rd Subcutaneous [fat/ full thickness] – 3^rd degree burn,

Here all layers of skin burn.

 First code the highest degree burn that is 3rd degree burn, then 2^nd degree burn precedence over 1^st degree burn.

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EXTENT OF BURN:-

 Code 948 classifies burns according to the extent of body surface involved.

 4^th digit indicates the total % of the body surface.

 5^th digit indicates % of 3^rd degree burns.

 Category 948 can be assigned as primary diagnosis when the site is mentioned, if the site is not mentioned, assign as secondary diagnosis.

If the location is not mentioned, code the extent of the burn 948 series, if the location is mentioned code degree of burn and extent.

Example:-

948.3 1            4^th digit   30°- 39°   The total body burn area

                         5^th digit 10°- 19°  The third degree burn.

 948.6 6           4^th digit 60°- 69°  The total body burn area.

                        5^th digit 60°-69°   The third degree burn.

 BURNS EXAMPLES:-

 2^nd degree burn on the toes

 Code: 945.21

 3^rd degree burn of the lower leg

 Code: 945.34

 Sun burn of the face

 Code: 692.71

 1^st degree burn face and eyes

 Code: 941.12

 1^st degree burn 9%, 2^nd degree burn 18%m 3^rd degree burn 36%

 Code: 948.63 [extent codes only because it’s not mentioning any site of the organ]

 2^nd degree burn 30% and 3^rd degree burn 10%

 Code: 948.41

 3^rd degree burn of the thigh with 18%

 Code:             945.36   [3^rd degree burn of the thigh]

 948.11          [extent code]

 1^st degree burn foot 10%, 2^nd degree burn knee 10%, 3^rd degree burn wrist 10%

 Code: 944.37 [3^rd degree burn wrist]

                        945.25 [2^nd degree burn knee]

                         945.12 [1^st degree burn foot]

 Extent Code: 948.31

 3^rd degree burn of the leg and 2^nd degree burn of the forearm.

 Code: 945.30 [3rd degree burn leg]

943.21 [2nd degree burn forearm]

 There is no extent code because the percentage of the burn is not mentioned.

 10. Patient presented to the Emergency Department [ED] with the 3^rd degree burn palm 5%, 2^nd degree burn face 5%, and 1st degree burn foot 10%. Patient is also complaint of dehydration. Patient has allergy to penicillin.

 Code:             944.35 [3^rd degree burn palm]

                         941.20 [2^nd degree burn face]

                         945.12 [1^st degree burn foot]

 Extent Code: 948.20

 Dehydration ICD Coding:  276.51

 Allergy to penicillin: V14.0

 3^rd degree burn elbow 9%, 2^nd degree burn ankle 6%, 2^nd degree burn face 3%, 3^rd degree burn knee 6%, 2^nd degree burn on multiple side of the lower limb [leg] with loss of body[sever burn] due to 3^rd degree burn.

 Code: 943.32 [3^rd degree burn elbow]

                         945.23 [2^nd degree burn ankle]

                         941.20 [2^nd degree burn face]

                         945.35 [3^rd degree burn knee]

                         945.29 [2^nd degree burn lower limb-leg]

 Extent Code: 948.21

 Loss of body: 945.50

 Dr Guptha, CPC,CPC-H,CPC-P,CHA,CMBS,CMRS,CHL7

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