Health Partners Plans ICD-10 Coding Guide

[Pages:25]Health Partners Plans ICD-10 Coding Guide

The codes listed are ICD-10 diagnosis codes that are most commonly used and billed for by providers but lack specificity. Use this guide to further specify the condition of the member. Medical record documentation should accurately match the diagnosis codes being billed for.

For more coding information, please contact Christina Rock, Supervisor, Clinical Education, at crock@.

Asthma

Intermittent, uncomplicated/ NOS J45.20

Mild

Persistent, uncomplicated/ NOS J45.30

Intermittent, with acute exacerbation J45.21

Persistent, with acute exacerbation J45.31

Intermittent, with status asthmatics J45.22

Persistent, with status asthmatics J45.32

Modereate

Persistent, uncomplicated/ NOS J45.40

Persistent, with acute exacerbation J45.41

Persistent, with status asthmatics J45.42

Severe

Persistent, uncomplicated/ NOS J45.50

Persistent, with acute exacerbation J45.51

Persistent, with status asthmatics J45.52

When documenting asthma, include the following:

1. Cause ? Exercise induced, cough variant, related to smoking, chemical or particulate cause, occupational

2. Severity ? Choose one of the three: mild, moderate or severe

3. Temporal Factors ? Acute, chronic, intermittent, persistent, status asthmatics, acute exacerbation

Type II Diabetes Mellitus E11

Type II with Kidney Complications E11.2

*Use additional code to identify stage of CKD

Type II with Ophthalmic Complications E11.3

NonProliferative Retinopathy

Proliferative Retinopathy

Type II diabetes mellitus with diabetic nephropathy E11.21

Type II diabetes mellitus with diabetic chronic kidney disease (CKD) E11.22

Mild NonProliferative Retinopathy E11.32

Moderate NonProliferative Retinopathy E11.33

Severe NonProliferative Retinopathy E11.34

Type II diabetes mellitus with proliferative diabetic retinopathy E11.35

Type II with Neurological Complications

E11.4

Type II diabetes mellitus with diabetic mononeuropathy E11.41

Type II diabetes mellitus with diabetic polyneuropathy E11.42

Type II diabetes mellitus with diabetic autonomic (poly) neuropathy E11.43

Add 4th ? 7th digits

? When documenting diabetes, include the following: 1. Type (e.g., Type I or Type II), drug or chemical induced, due to underlying condition 2. Complications (e.g., foot ulcers, retinopathy, neuropathy) 3. Treatment (e.g., insulin) ? U se Z13.1 for screening of diabetes mellitus or signs and symptoms codes until

diagnosis is confirmed

Chronic Kidney Disease (CKD)

Stage 1 Normal GFR ( 90 mL/min/1.73 m2 ) plus

either persistent albuminuria or known structural or hereditary renal disease

Stage 2 GFR 60 to 89 mL/min/1.73 m2

Stage 3 GFR 30 to 59 m./min/1.73m2

Stage 3a GFR 45 to 59 mL/min/1.73 m2

Stage 3b GFR 30 to 44 mL/min/1.73 m2

Stage 4 GFR 15 to 29 mL/min/1.73 m2

Stage 5 GFR < 15 mL/min/1.73 m2

End Stage Chronic kidney disease requiring chronic dialysis

When coding for CKD, code first any: ? Diabetic chronic kidney disease ? Hypertensive chronic kidney disease ? Use additional code to identify dialysis status Z99.2

N18.1

N18.2 N18.30 N18.31 N18.32 N18.4 N18.5 N18.6

Hypertension Diseases

? Essential (Primary) I10 ? Primary Pulmonary I27 ? Hypertensive Heart I11 ? Hypertensive Chronic Kidney Disease

? Hypertensive chronic kidney disease with stage 5 chronic kidney disease or endstage renal disease I12.0

? Hypertensive chronic kidney disease with stage 1?4 chronic kidney disease, or unspecified kidney disease I12.9

? Hypertensive Heart and Chronic Kidney Disease ? Hypertensive heart and chronic kidney disease with heart failure and stage 1?4 chronic kidney disease, or unspecified chronic kidney disease I13.0 ? Hypertensive heart and chronic kidney disease without heart failure with stage 1?4 chronic kidney disease I13.10 ? Hypertensive heart and chronic kidney disease without heart failure with stage 5 or end-stage renal disease I13.11 ? Hypertensive heart and chronic kidney disease with heart failure and with stage 5 or end-stage renal disease I13.2

Add 4th ? 7th digits 3 Digit Reportable

When documenting hypertension, include the following: 1. Type (e.g., essential, secondary) 2. Causal relationship (e.g., renal, pulmonary) 3. Use additional codes to identify:

a. Type of heart failure b. Stage of chronic kidney disease

Atrial Fibrillation

Persistent

Longstanding persistent atrial fibrillation I48.11

Other persistent atrial fibrillation I48.19

Chronic

Chronic atrial fibrillation, unspecified I48.20

Permanent atrial fibrillation I48.21

Other

Paroxysmal atrial fibrillation I48.0

Unspecified atrial fibrillation I48.91

When documenting atrial fibrillation, include the following:

? A trial fibrillation is still reported in patients that are not currently experiencing the erratic rhythm as long as the patient is requiring ongoing medication to help control the rate.

? A trial fibrillation is very common in postoperative patients and should be verified as a complication before coding as such.

? W hen multiple types of atrial fibrillation are documented in the record, select the most specific type.

Coronavirus Infection (COVID-19)

Confirmed diagnosis of COVID-19 Positive COVID-19 test or "presumptive"

positive COVID-19 test

Contact with and suspected exposure to COVID-19

Asymptomatic or symptomatic (code symptoms)

Suspected possible COVID-19 exposure ruled out

Code symptoms if patient symptomatic

Encounter for screening for COVID-19 During the COVID-19 pandemic, a screening code is generally not appropriate.

Personal history of COVID-19

Follow-up visit after COVID-19 infection resolved

U07.1 Z20.822 Z03.818

Z11.52 Z86.16

Z09

When coding for Covid-19: ? C ode U07.1 as principle dx when it meets criteria; code any associating

manifestations(e.g. pneumonia, ARDS).

? C ertain codes need to be sequenced first, such as obstetrics, sepsis, or transplant complications.

? C ode sign(s) and symptom(s) until definitive diagnosis(es) is confirmed.

? U07.2 is not a valid code for ICD-10-CM in the United States.

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