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ICD-10 part three of six
- 1. ICD-10-CM Training Kimyatta Turner, MBA, RHIA LART Consulting Group, Inc. 1LART Consulting Group, Inc. 2015
- 2. Chapter 3 Session 3: Symbols, notes, acronyms, and conventions
- 3. Chapter 3 Symbols, notes, acronyms, and conventions Placeholder Character • Always the letter X • Two uses: 1. Fifth character for certain six character codes; X provides for future expansion Example: T37.0X1A, Poisoning by sulfonamides, accidental (unintentional), initial encounter LART Consulting Group, Inc. 2015 3
- 4. Placeholder Character (continued) 2. When a code has less than six characters and a seventh is required Assigned for all characters less than six Examples: W85.XXXA, Exposure to electric transmission lines, initial encounter S17. 0XXA, Crushing injury of larynx and trachea, initial encounter Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 4
- 5. Seventh Characters • Required in some categories • Further specificity Examples: O64.3XX1, Obstructed labor due to brow presentation, fetus 1 S02.110B, Type I occipital condyle fracture, initial encounter for open fracture Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 5
- 6. Activity – Placeholders and Seventh Characters Refer to the Tabular List, locate the following and determine the use of: • The seventh character for subcategory codes R40.21, R40.22, and R40.23 • The seventh character for category M80 • The X placeholder in subcategory O45.8 • The X placeholder in category X78 Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 6
- 7. Abbreviations • NEC (Not Elsewhere Classified) Example: ICD-10-CM ICD-9-CM H26.8 Other specified cataract 366.8 Other cataract I25.89 Other forms of chronic 414.8 Other specified forms ischemic heart disease of chronic ischemic heart disease Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 7
- 8. • NOS (Not Otherwise Specified) Example: ICD-10-CM ICD-9-CM H40.9 Unspecified glaucoma 365.9 Unspecified glaucoma J12.9 Viral pneumonia, unspecified 480.9 Viral pneumonia, unspecified Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 8
- 9. Punctuation ( ) Parentheses - Enclose supplementary words Examples: Alphabetic Index Anemia (essential) (general) (hemoglobin deficiency) (infantile) (primary) (profound) Diabetes, diabetic (mellitus) (sugar) Hemophilia (classical) (familial) (hereditary) Examples: Tabular List H44.611, Retained (old) magnetic foreign body in anterior chamber, right eye I10, Essential (primary) hypertension K51.011, Ulcerative (chronic) pancolitis with rectal bleeding Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 9
- 10. [ ] Brackets - Synonyms, explanatory phrases Examples: Tabular List B06, Rubella [German measles] J00, Acute nasopharyngitis [common cold] Examples: Alphabetic Index Disease, Alzheimer’s G30.9 [F02.80] Nephrosis, in amyloidosis E85.4 [N08] Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 10
- 11. : Colon – After an incomplete term Example: G73.7 Myopathy in diseases classified elsewhere Excludes1: myopathy in: rheumatoid arthritis (M05.32) sarcoidosis (D86.87) scleroderma (M34.82) sicca syndrome [Sjӧgren] (M35.03) systemic lupus erythematosus (M32.19) Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 11
- 12. Instructional notes • Inclusion Notes – Clarify Example: K25 Gastric Ulcer Includes: erosion (acute) of stomach pylorus ulcer (peptic) stomach ulcer (peptic) Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 12
- 13. Exclusion notes • Excludes1 – Pure “excludes” note Means “not coded here” • Two conditions cannot occur together – Congenital versus acquired Example: K51.4 Inflammatory polyps of colon Excludes1: adenomatous polyp of colon (D12.6) polyposis of colon (D12.6) polyps of colon NOS (K63.5) Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 13
- 14. • Excludes2 – Not included here Example: J37.1 Chronic laryngotracheitis Excludes2: acute laryngotracheitis (J04.2) acute tracheitis (J04.1) Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 14
- 15. • Code First and Use Additional Code – Underlying condition sequenced first – Followed by manifestation Example: G30 Alzheimer’s disease Use additional code to identify: dementia with behavioral disturbance (F02.81) dementia without behavioral disturbance (F02.80) Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 15
- 16. • Code first and use additional code (continued) Example: F02 Dementia in other diseases classified elsewhere Code first the underlying physiological condition, such as Alzheimer’s (G30.-) F02.80 Dementia in other diseases classified elsewhere, without behavioral disturbance F02.81 Dementia in other diseases classified elsewhere, with behavioral disturbance Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 16
- 17. • Cross Reference Notes – Look elsewhere before coding – see – see also – see condition Examples: Pyocele - mastoid – see Mastoiditis, acute - sinus (accessory) – see Sinusitis - Urethra (see also Urethritis) N34.0 Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 17
- 18. • Cross Reference Notes (continued) Examples: Mercurial – see condition Mercurialism – see subcategory T56.1 Labyrinthitis – (circumscribed) (destructive) (diffuse) (inner ear) (latent) (purulent) (suppurative) - see also subcategory H83.0 Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 18
- 19. • Relational Terms And – means and/or With – “associated with” or “due to” Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 19
- 20. • Find the note for C25.4, Malignant neoplasms of endocrine pancreas, and compare it to the note found under code 157.4 in ICD9CM • Locate the note for subcategory H62.4, Otitis externa in other diseases classified elsewhere, and review it against the note found under codes 380.13 and 380.15 in ICD9CM • Find the note for category J44, Other chronic obstructive pulmonary disease, and compare it to the note found under code 496 in ICD9CM Chapter 3 Symbols, notes, acronyms, and conventions LART Consulting Group, Inc. 2015 20
- 21. References American Medical Association (2012). American Health Information Management Association (2015). 2015 ICD-10-CM Coder training manual. Chicago, IL: AHIMA LART Consulting Group, Inc. 2015 21
Editor's Notes
- Hello and welcome to Session 3 ICD-10 training by LART Consulting Group. I am Kimyatta Vinson, a Registered Health Information Administrator and I will be your presenter throughout this training. These trainings are broken down into sessions that are easy to digest along with action steps for you to take in order to begin to master ICD-10-CM.
- Session 3 focuses on the symbols, notes, acronyms, and conventions used in ICD-10-CM.
- Correct assignment of ICD10CM diagnosis codes is dependent upon the individual understanding certain conventions used in the classification system. Similar to ICD9CM, abbreviations, punctuation, symbols, and notes are used as conventions and have special meanings that affect code assignment. ICD10CM utilizes a placeholder which is always the letter X and has two uses: As a fifth character for certain six character codes. The X provides for future expansion without disturbing the sixth character structure.
- When a code has less than 6 characters and a seventh is required, placeholder X is used. The X is assigned for all characters less than 6 in order to meet the requirement of coding to the highest level of specificity.
- Some ICD10CM categories require a seventh character to provide further specificity about the condition being coded. The seventh character may be a number or letter and must always be the seventh character.
- Here is an activity for you to gain a greater understanding of the purpose of the X placeholder and the seventh character
- Not elsewhere classified : ICD10CM, like its predecessors, contains codes to classify any and all conditions. A residual category, subdivision, or subclassification provides a location for “other” types of specified conditions that have not been classified anywhere else in the code set. These residual codes may also contain the term NEC as part of their descriptor. The Alphabetic Index uses NEC for a code description that will direct the coder to the Tabular List showing an Other Specified code description.
- Not Otherwise Specified: The unspecified or Not Otherwise Specified codes are available for use when the documentation of the condition identified by the provider is insufficient to assign a more specific code.
- Similar to ICD9CM, punctuation is used in both the alphabetic index and the tabular list. The types of punctuation included in ICD10CM are parentheses, brackets, and colons. Parentheses are used in both the alphabetic index and the tabular list to enclose supplementary words that may be present or absent in the statement of the disease without affecting the code number to which it is assigned. The terms within the parentheses are referred to as nonessential modifiers. The nonessential modifiers in the alphabetic index to diseases apply to subterms following a main term. However, when a nonessential modifier and a subentry are mutually exclusive, the subentry takes precedence. For example, in the ICD10CM alphabetic index under the main term Enteritis, “acute” is a nonessential modifier and “chronic” is a subentry. In this case, the nonessential modifier “acute” does not apply to the subentry chronic.
- The tabular list uses square brackets to enclose synonyms, alternative wordings, or explanatory phrases. Brackets are used in the alphabetic index to identify manifestation codes
- Colons are used in the tabular list after an incomplete term which needs one or more of the modifiers following the colon to make it assignable to a given category. The colon is used with both “includes” and “excludes” notes, in which the words that precede the colon are not considered complete terms and therefore must be appended by one of the modifiers indented under the statement before the condition can be assigned the correct code.
- Similar to ICD9CM a variety of notes appear in both the Alphabetic Index and Tabular List of ICD10CM. The various types of notes are includes and excludes notes, code first notes, use additional code notes, and cross reference notes. Includes notes are used as conventions in the ICD10CM tabular list to clarify the conditions included within a particular chapter, section, category, subcategory, or code. It is important to remember that the list of inclusions terms is not exhaustive and may include diagnoses not listed in the inclusion note. Inclusion notes are introduced by the word “includes” when appearing at the beginning of a chapter, section, or category. At the code level, the word “includes” does not precede the list of terms included in the code.
- ICD9CM contains a single type of excludes note which has two different meanings leaving it to the coding professional to determine the correct meaning of the excludes note. In ICD10CM there are two types of excludes notes designated either as Excludes1 or Excludes2 in their title. Either or both may appear under a category, subcategory, or code. The excludes1 note is a pure “excludes” note. It means not coded here. An excludes1 note indicates that the code excluded should never be used at the same as the code above the excludes1 note. This note is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- The excludes2 note means not included here. This type of excludes note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an excludes2 note appears under a note, it is acceptable to use both the code and the excluded code together if the patient has both conditions.
- Code first and use additional code notes are similar to their counterparts in ICD9CM. Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, IC10CM similar to ICD9CM, has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. The “use additional code” note appears at the etiology code and a “code first” note at the manifestation code.
- Cross reference notes are used in ICD10CM alphabetic index to advise the coding professional to look elsewhere before assigning a code. The three cross reference notes see, see also, and see condition are the same as those found in ICD9CM,
- The term and is interpreted to mean and/or when it appears in a code title within the ICD10CM tabular list. The word with should be interpreted to mean associated with or due to when it appears in a code title, the alphabetic index or an instructional note in the tabular list. The term with in the alphabetic index is sequenced immediately following the main term, not in alphabetic order.
- To gain skills in identifying the different types of notes, open the tabular list and review the following, comparing the ICD10CM entries to the ICD9CM entries for the same terms. Identify their similarities and differences.