Rheumatic heart disease
______?_____ occurs as a result of an infection with group A hemolytic Streptococcus.
Example: Mitral valve stenosis and insufficiency listed together is assumed to be rheumatic.
(mitral valve insufficiency alone is not rheumatic. But because it is listed with the stenosis, which IS considered to be rheumatic, the entire condition isassumed to be rheumatic).
When there is more than one condition affecting the mitral valves & one is presumed to be rheumatic in origin the condition is classified as _________?
1 & 3 Mitral valve stenosis, Mitral valve stenosis and insufficiency
Which of the following are assumed to be rheumatic in origin?
1.) Mitral valve stenosis
2.) Mitral valve insufficiency
3.) Mitral valve stenosis and insufficiency
1.) Only when specified as such in the medical record.
2.) Presumed to be rheumatic in origin.
1.) Aortic conditions alone are considered rheumatic when______?
2.) A disorder affecting both the mitral and aortic valves is _________?
2 - mitral valve insufficiency with aortic valve insufficiency.
4 - rheumatic aortic stenosis, &
5 - Mitral stenosis and aortic stenosis
Which of the following conditions can be cassified as rheumatic?
1.) Aortic valve insufficiency
2.) mitral valve insufficiency with aortic valve insufficiency.
3.) Aortic valve stenosis
4.) rheumatic aortic stenosis
5.) Mitral stenosis and aortic stenosis
Rheumatic heart failure - 398.91
Unless the physician specifies a different cause, heart failure in a patient who has rheumatic heart disease is classified as___________?
False - Do not assume this relationship unless a link between CHF and rheumatic heart disease is established in the diagnostic statement.
True/False - Congestive heart failure can be assumed to be rheumatic without a physician's statement linking rheumatic heart disease and the CHF.
Ischemic heart disease - categories 410 - 414
The general term for a number of disorders caused by a decrease in blood supply to the heart due to coronary insufficiency. Other common terms include: arteriosclerotic heart disease (ASHD), coronary ischemia, coronary artery disease, and coronary arteriosclerosis (atherosclerosis)
410, Acute myocardial infarction. 4th digit indicates the wall involved.
A Myocardial infarction described as acute or with a duration of 8 weeks or less is classified in category_______________?
Acute myocardial infarction (category 410)
An acute ischemic condition that ordinarily appears following prolonged myocardial ischemia & usually precipitated by an occlusive coronary thrombosis at the site of an existing arteriosclerotic stenosis.
electrocardiographic report. (A code from subcategory 410.9, Myocardial infarction, unspecified site, should not be assigned unless no information regarding the site is documented in the medical record.)
Diagnostic statements do not always mention the affected wall, but this information can almost always be found in the ____________?
ST-segment elevation (codes 410.0-410.6 and 410.8) or non-ST-segment elevation (code 410.7).
(Be careful to note that these codes are used for documented acute myocardial infarctions and should not be confused with abnormal findings on electrocardiograms of ST-segment elevation.)
Myocardial infarctions are also classified according to whether there is a _________ or ____________?_
If a myocardial infarction is documented as nontransmural or subendocardial, but the site is provided, it is still coded as a____________?
1.) If a non-ST elevation myocardial infarction (NSTEMI) evolves to ST-elevation myocardial infarction (STEMI), assign the code for _________?.
2.) If STEMI converts to NSTEMI due to thrombolytic therapy, assign the code for _________?
Whether the current admission is the initial episode of care or a subsequent one for the same infarction.
A fifth-digit subclassification is provided for category 410 to indicate ____________?
The history makes no mention of a previous infarction.
Although physicians do not ordinarily use the terms "initial" or "subsequent" in the diagnostic statement, it is safe to consider an admission for infarction as the initial episode of care when ____________?
The first hospital to which a patient is admitted as well as to any other acute care facility to which the patient is transferred without an intervening discharge. E.g., pt. is admitted to Hospital A for an initial episode of care for an acute anteroseptal myocardial infarction, transferred to Hospital B for diagnostic workup or therapy, and then transferred back to Hospital A without being discharged from acute care, code 410.11, (Acute myocardial infarction, of other anterior wall, initial episode of care) is assigned for all three admissions.
For MI (category 410), Fifth digit 1 indicating the initial (first) episode of care for an infarction is assigned for_________?
The patient is admitted for further care of a cardiac condition any time during the first eight weeks after the infarction occurred.
For MI (category 410), Fifth digit 2, (subsequent episode of care), is assigned as principle when ________?
MI with a fifth digit of 2 for "subsequent admission" is added as an addional diagnosis with the cardio conditon that occasioned the admit listed as the principle diagnosis. If admit is for symptoms i.e "chest/pain" MI would be listed as principle diagnosis. as it is assumed to be associated with the initial MI.
If pt. had an MI in the past 8 weeks and is readmitted prior to the end of the 8 weeks for other conditions, _______ is always added as an additional diagnosis?
414.8, Other specified forms of chronic ischemic heart disease.
Myocardial infarction described as chronic or with a duration of more than eight weeks is classified as _______?
Both infarctions are coded according to the sites involved.
Patients sometimes experience a second infarction involving another wall during a hospital admission for an acute myocardial infarction. Ho should this situation be coded?
Diastolic heart failure
occurs when the heart has a problem relaxing between contractions to allow enough blood into the ventricles
Systolic heart failure
occurs when the ability of the heart to contract decreases
Thrombophlebitis of a vein
a condition indicated by a clot that has become inflamed
Thrombosis of a vein
a condition indicated by the forming of a clot
code for MI is sequenced first, +
additional code of 458.8, (Other specified hypotension).
Sequence the following:
postinfarction hypotension experienced by patients with acute myocardial infarction
Myocardia infarction (MI) +
additional code for the congestive heart failure (CHF). Additional codes are also assigned for any mention of cardiogenic shock, ventricular arrhythmia, and fibrillation.
An evolving myocardial infarction sometimes precipitates right ventricular failure that progresses to congestive heart failure. The patient may then be admitted because of this precursor condition, which then progresses to an acute myocardial infarction. After study, the principal diagnosis in this situation is____________?
MI (410.01) +
CHF (428.0) +
Congestive heart failure with acute myocardial infarction of anterolateral wall with ventricular fibrillation
1.) Code 412, (Old myocardial infarction)
2.) current ischemic heart disease is present
3.) has some significance for the current episode of care.
1.) A diagnosis of ________________? is usually made on the basis of electrocardiographic findings or some other investigation in a patient who is not experiencing symptoms & is essentially a history code, even though it is not included in the V-code chapter of ICD-9-CM.
2.) It should not be assigned when __________?
3.) it should be assigned as an additional code only when it_____?
Code 411.1, (Intermediate coronary syndrome)
Code________? includes conditions described as unstable angina, crescendo angina, preinfarction angina, accelerated angina, and impending myocardial infarction. These conditions occur after less exertion than angina pectoris; the pain is more severe and is less easily relieved by nitroglycerin. Without treatment, it often progresses to acute myocardial infarction.
1.) the underlying condition is not identified and there is no surgical intervention.
2.) coronary arteriosclerosis (414.0x) is the principal diagnosis, + additional code (411.1) for the unstable angina.
1.) Code 411.1 is designated as the principal diagnosis only when ___________?
Patients with severe coronary arteriosclerosis and unstable angina may be admitted for cardiac bypass surgery or a percutaneous coronary angioplasty to prevent further progression to infarction. In such cases, the correct code assignment is_____?
1.) For this admission, the coronary arteriosclerosis (414.0x) is the principal diagnosis, +
additional code (411.1) for the unstable angina.
2.) unstable angina (411.1) is the principal diagnosis.
Code the following:
1.) Pt admitted with unstable angina and underwent right and left heart catheterization, which showed coronary arteriosclerosis. A coronary bypass procedure was recommended, but the pt. needed some time to think it over and to discuss it with his family.
2.) Pt. admitted with unstable angina and a history of myocardial infarction five years ago. She was treated with IV nitroglycerin, and the angina subsided by the end of the first hospital day. No other complications were noted, and no additional diagnostic studies were carried out.
False - A diagnosis of acute ischemic heart disease or acute myocardial ischemia does not always indicate an infarction. It is often possible to prevent infarction by means of surgery and/or the use of thrombolytic agents if the patient is treated promptly.
T/F? A diagnosis of acute ischemic heart disease or acute myocardial ischemia always indicates an infarction.
1.) There is occlusion or thrombosis of the artery without infarction.
2.) coronary insufficiency and subendocardial ischemia.
1.) Code 411.81, (Acute coronary occlusion without myocardial infarction), is assigned when_________?
2.) Code 411.89, (Other acute and subacute forms of ischemic heart disease), includes ______&______?
False. Dx. of coronary artery disease or coronary heart disease without any further qualification is too vague to be coded accurately; the physician should be asked to provide a more specific diagnosis. Code 414.9, (Unspecified chronic ischemic heart disease), should rarely be assigned in an acute care hospital setting.
True/False? Diagnoses of coronary artery disease or coronary heart disease without any further qualification can be adequately coded to 414.9, (Unspecified chronic ischemic heart disease).
The medical record makes it clear that there has been no previous bypass surgery. (If there is a history of previous bypass, code 414.02, 414.03, or 414.04 should be assigned when information re. the material used in the bypass is available).
414.01, Coronary atherosclerosis of native coronary arteries, can be assigned when_________?
Code for chronic total occlusion of a coronary artery. (414.2) should be used as an additional code following the atherosclerosis (414.00-414.07) code.
If coronary atherosclerosis (414.00-414.07) is present with a chronic total occlusion of a coronary artery what should also be assigned?.
The patient is diagnosed with acute coronary occlusion with or without myocardial infarction.
Code for chronic total occlusion of a coronary artery (414.2) should not be assigned if ___________?
False. All codes for heart failure include any associated pulmonary edema; therefore, no additional code is assigned.
True/False? Heart failure with associated pulmonary edema requires an assignment of two codes.
systolic (428.2x) and diastolic (428.3x).
Fifth digits further specify whether the heart failure is unspecified, acute, chronic, or acute on chronic.
Two main categories of heart failure?
Heart failure that occurs when the ability of the heart to contract decreases?
Heart failure that occurs when the heart has a problem relaxing between contractions to allow enough blood to enter the ventricles?
Two codes are required. Congestive heart failure is not an inherent component of systolic or diastolic heart failure.
What is the appropriate code assignment when the diagnostic statement lists congestive heart failure along with either systolic or diastolic heart failure?
Coded as acute systolic heart failure with congestive heart failure. Code:
Systolic heart failure, Acute on chronic (428.23) +
Congestive heart failure, unspecified (428.0)
(An acute exacerbation of a chronic condition e.g. heart failure - is coded as acute on chronic. Code acute condition, systolic failure, 1st )
Assign codes for the following:
A patient is documented as having systolic dysfunction with acute exacerbation of congestive heart failure (CHF)
2 codes required. code systolic (or diastolic) first. E.g. systolic heart failure, acute on chronic (428.23) + CHF (428.0) as an additional code.
CHF and systolic heart failure, acute on chronic
False. This condition is indexed to 429.9, (Heart disease, unspecified). It is not appropriate for the coder to assume that a patient is in heart failure when only "diastolic dysfunction" or "systolic dysfunction" is documented.
True/False? Diastolic or systolic dysfunction without mention of heart failure is presumed to be heart failure?
Whether the right or left ventricle is primarily affected.
Heart failure is differentiated clinically by ___________? Code
1.) Left-sided heart failure (428.1) (left ventricular failure).
2.) False. These associated conditions are included in the code. No additional codes are assigned.
1.) _______ is due to the accumulation of excess fluid behind the left ventricle.
2.) True/False? Conditions such as dyspnea, orthopnea, bronchospasm, and acute pulmonary edema; if present should also be coded.
Right-sided failure (CHF) (428.0).
This type of heart failure ordinarily follows left-sided failure and is classified in ICD-9-CM as congestive heart failure
The term "congestive heart failure" (428.0) is often mistakenly used interchangeably with "heart failure." Congestion, pulmonary or systemic fluid build-up, is one feature of heart failure, but it does not occur in all patients.
No.The code for right sided failure (CHF) includes any left-sided failure that is present; therefore, codes 428.0 and 428.1 are not assigned for the same episode of care; code 428.0 takes precedence.
For a diagnosis of CHF or right-sided failure, with left ventricuar failure, should two codes be assigned?
1.)HTN (category 402) + CHF (428.0) assigned as an additional diagnosis.
2.) HTNsive renal (category 403) +
code from 585.1-585.6, 585.9 to identify the stage of chronic kidney disease is assigned as an additional diagnosis.
3.) category 404 + CHF (428.0) + code from 585.1-585.9. (Fifth digits for category 404 indicate with or without heart failure and/or the stage of the chronic kidney disease.)
1.) Hypertensive heart failure with congestive failure?
2.) Same condition as above with chronic kidney disease or renal sclerosis (including atrophy of kidney, contracted kidney, renal cirrhosis, or renal fibrosis) present,
3.) Hypertensive heart disease, congestive heart failure, and chronic kidney disease or renal sclerosis ?
1.) Cardiac tamponade
2.) 1st code for underlying condition + Cardiac tamponade (423.3)
1.) The compression of the heart caused by the accumulation of fluid inside the pericardium. is often associated with viral or bacterial pericarditis
2.) Code sequencing?
1.) Cardiomyopathy (425.x)
2.) As an additional code with the underlying disease sequenced 1st.
1.) _______? presents a clinical picture of a dilated heart, flabby heart muscles, and normal coronary arteries.
Common types incude those due to the long-term consumption of alcohol and those described as congestive or constrictive.
2.) How is this condition coded?
1.) Amyloidosis, unspecified (277.30,), +
Nutritional and metabolic cardiomyopathy. (425.7)
2.) Hypertensive heart disease (Category 402) + Cardiomyopathy in other diseases classified elsewhere (425.8).
Sequence the following:
1.) cardiomyopathy due to amyloidosis?
2.) Hypertensive cardiomyopathy ?
True. The coder should never assume that infarction has occurred.
True/False? For category 433, (Occlusion and stenosis of precerebral arteries, and category 434, (Occlusion of cerebral arteries), The a fifth-digit 1, indicating the presence of cerebral infarction, is not assigned unless cerebral infarction is clearly documented in the medical record and the physician has indicated a relationship between cerebral artery stenosis or occlusion and the infarction.
433.10, (Occlusion and stenosis of precerebral arteries, carotid artery, without mention of cerebral infarction), to describe carotid artery stenosis without cerebral infarction. +
433.30, (Occlusion and stenosis of precerebral arteries, multiple and bilateral, without mention of cerebral infarction) to describe the laterality. Using two codes will capture both the specific artery involved and the laterality.
Code assignment for biateral corotid artery stenosis?
434.91, (Cerebral artery occlusion, unspecified, with cerebral infarction), is assigned for the diagnosis of stroke or CVA.
When the diagnosis is stated as cerebrovascular accident, CVA, or stroke without any further qualification, & no further information after review the medical record or consult with the physician is available?
Code 434.91, (Cerebral artery occlusion, unspecified, with cerebral infarction) +
V45.88 (tPA in past 24 hrs. different facility)
(Pt actually suffered a cerebral infarction. Brain damage may not show on CT scan, but would be visible microscopically).
Aborted CVA when there is no further specification as to the type of CVA. Patients who present with symptoms of an acute cerebrovascular infarction and treated with tissue plasminogen activator (tPA) in a different facility in the last 24 hours?
431, Intracerebral hemorrhage
When a hemorrhage occurs in the brain--in the space where there is tissue death (infarction) either due to the thrombolytic therapy (tPA) or spontaneously after the original infarct (hemorrhagic conversion), _________ is assigned as an additional code?
Assign 434.91, (Cerebral artery occlusion, unspecified, with cerebral infarction), +
431, (Intracerebral hemorrhage).
A patient sustained a left frontal cerebral infarction with hemorrhagic conversion. The provider documented that the patient had an acute cerebral infarct and later developed hemorrhagic conversion of the infarct. The provider stated that the hemorrhagic conversion had occurred spontaneously.
Principal dx. = 434.91, (Cerebral artery occlusion, unspecified, with cerebral infarction), . +
997.02, (Iatrogenic cerebrovascular infarction or hemorrhage), +
431,(Intracerebral hemorrhage), for the cerebral hemorrhagic conversion due to the thrombolytic tx. (997.02 is assigned b/c the hemorrhage resulted from tx. with the thrombolytic) Also assign:
784.3, Aphasia, +
E934.4, Drugs, adverse effects +
99.10, Injection or infusion of thrombolytic agent.
Pt. admitted with expressive aphasia due to acute cerebral infarction. The patient was given intravenous (IV) tissue plasminogen activator (tPA) within 4.5 hours of the onset of symptoms, with significant improvement of aphasia. A brain MRI showed acute left temporoparietal infarct with asymptomatic hemorrhagic conversion. The provider stated that the hemorrhagic conversion was caused by the tPA therapy.
997.02, (Iatrogenic cerebrovascular infarction or hemorrhage). + additional code to identify the specific type of stroke/CVA. (The general rule for postoperative complications is that when the complication code does not specifically identify the condition, an additional code should be assigned to more fully explain it).
1.) Assigned only when it is significant for the current episode of care.
2.) V12.54, (Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits).
1.) Category 438.xx (Late effect of cerebrovascular disease) are only assigned when?
2.) ________? should be assigned rather than a code from category 438 when the patient has a history of a cerebrovascular infarction (CVA) with no residual conditions, a history of TIA, or a history of prolonged reversible ischemic neurological deficit (PRIND).
1.) Can be assigned as the principal diagnosis when the purpose of the admission is to deal with the late effect.
2.) Can be assigned as additional codes when a new CVA is present and deficits from an earlier episode remain.
Codes from category 438 differ from other late effect codes in two ways?
A code from category V57 is assigned as the principal diagnosis with an additional code from category 438.
If the admission is for the purpose of rehabilitation to deal with late effects of a CVA?
The underlying cause is sequenced first, followed by the code for the hypertension. For example:
Hypertension due to systemic lupus erythematosus = 710.0 + 405.99
Acromegaly with secondary hypertension =
253.0 + 405.99
Coding rue for secondary hypertension (405) - the result of some other primary disease?
Usually refers to an existing hypertension that is under control by means of continuing therapy. If the hypertension is still under treatment, a HTN code from categories 401 through 405 should be assigned.
Hypertension described as "controlled" or "history of" hypertension?
When a causal relationship is stated (due to hypertension) or implied (hypertensive). A cause-and-effect relationship between hypertension and heart disease cannot be assumed. When the diagnostic statement mentions both conditions but does not indicate a causal relationship between them, separate codes are assigned.
Category 402, (Hypertensive heart disease) is assigned when________?
Category 402 with a fifth-digit to indicates heart failure + additional code to to specify the type of heart failure (428.0-428.43), if known:
Congestive heart failure due to hypertension 402.91 + 428.0
Hypertensive heart disease with congestive heart failure 402.91 + 428.0
Category 402, (Hypertensive heart disease) with heart failure?
True. ICD-9-CM usually assumes that there is a cause-and-effect relationship. Use category 403 (HTNsive CKD) + additional code (585.1-585.6, 585.9) to identify the specific stage of chronic kidney disease.
True/False? When the diagnostic statement includes both hypertension and chronic kidney disease or renal sclerosis, a causal relationship is assumed.
Category 404, (Hypertensive heart and chronic kidney disease) with fifth digits indicating presence/absence of heart failure, and stage of the chronic kidney disease + additional code (585.1-585.6, 585.9) to identify the specific stage of chronic kidney disease.
When a heart condition ordinarily coded to category 402 and a kidney condition coded to category 403 both exist?
Code for each condition must be assigned to fully describe the condition. Condition + HTN code. For example:
Atherosclerosis of aorta with benign essential hypertension 440.0 + 401.1
Coronary atherosclerosis and systemic benign hypertension 414.00 + 401.1
HTN associated with other conditions?
True/False? The axis for coding aortocoronary bypass grafts is the number of coronary arteries involved in the bypass.The graft material used in an aortocoronary bypass does not affect code assignment.
Whether one or both internal mammary arteries are used, regardless of the number of coronary arteries involved:
The axis for coding internal mammary-coronary artery bypass grafts is ______________?
1.) hypothermia, 2.) cardioplegia, 3.) intraoperative pacing, and 4.) chest tube insertions
Procedures such as 1.)_____,2.)________3.)________, and 4.)________ are considered to be integral to bypass surgery; no separate codes are assigned
1.) any use of extracorporeal circulation (39.61)
2.) pressurized treatment of venous bypass graft with pharmaceutical substance (00.16).
When coding a CABG procedure, additional codes should also be assigned for 1.) __________? or 2.)__________?
This procedure involved only the aorta and the coronary arteries. Because four coronary arteries were bypassed, 36.14, (Aorto)coronary bypass of four or more coronary arteries, is assigned.
Coronary artery vascularization was carried out with four grafts: the aorta to the diagonal branch of the left coronary and in sequential fashion to the obtuse marginal branch of the circumflex, the right coronary artery, and the left anterior descending coronary artery?
All four grafts brought blood from the aorta to the coronary arteries. Sections of both the saphenous vein and the internal mammary artery were used for this purpose, but the materials used for the graft do not affect the code. Because four arteries (LAD, diagonal, obtuse marginal, and posterior descending) were bypassed, code 36.14, (Aorto)coronary bypass of four or more coronary arteries, is assigned.
Grafts from the aorta to the coronary arteries were carried out by grafting the bifurcated left anterior descending system with a 1.5-millimeter section of the left internal mammary artery. The first diagonal was then grafted side-to-side with a 4-millimeter section of the saphenous vein. The obtuse marginal was then grafted with a 4-millimeter section of the saphenous vein. The posterior descending was diffusely diseased and was grafted with a 4-millimeter section of the saphenous vein?
In this case, a single internal mammary-coronary artery bypass and three aortocoronary bypass grafts were placed (OM, diagonal, PDA). The codes assigned are 36.15, Single internal mammary-coronary artery bypass, and 36.13, (Aorto)coronary artery bypass of three coronary arteries. The sequence of the codes is optional.
Bypass grafts were performed by bringing the left internal mammary artery to the left anterior ascending; a saphenous vein graft was then used to bring blood from the aorta to the obtuse marginal branch of the circumflex artery, to the diagonal artery, and to the proximal PDA?
In this case, three coronary arteries were bypassed, one by an internal mammary-coronary artery bypass and two by aortocoronary bypasses. The codes assigned are 36.15, Single internal mammary-coronary artery bypass, and 36.12, (Aorto)coronary artery bypass.
The left internal mammary artery was loosened and used to bypass the left anterior descending artery; grafts of the saphenous vein were bypassed to the posterior descending artery and to the obtuse marginal branch of the circumflex.
True. Code only the pacemaker insertion for temporary or intraoperative pacemakers.
True/False? No codes are assigned for insertion of the leads or for removal of a temporary or intraoperative pacemaker.
Two codes. One code indicates the type of device, commonly called a pulse generator (37.81-37.83); the other indicates the insertion of the leads (37.71-37.74). Assign also code 17.81, Insertion of antimicrobial envelope, with the permanent pacemaker codes (37.71-37.73 and 37.81-37.83) to provide additional information about devices used as part of the primary procedure.
______? codes are required for the initial insertion of a permanent pacemaker.
38.97, (Central venous catheter placement with guidance).
Central venous line inserted using electrocardiographic guidance.
1.) direct extension, metastisis
2.) direct extension
1.) A solid malignant neoplasm spreads form its site of origin by either_____ or ______?
2.) spread to adjacent site?
3.) spread to distant site?
site mentioned is secondary (use additional code for primary neoplasm if present or V10 (hx. of malignant neoplasm) if primary has been eradicated)
site mentioned is primary (use additional code for secondary CA or199.1 if site unknown)
unknown primary or secondary site.
code 199.1 is used to indicate___?
CA described as "carcinomatosis", "CA is everywhere", "disseminated", "generalized"
code 199.0 is used to indicate ______?
primary site is kidney, secondary is the lung
Designate "primary" & "secondary" in single metastatic site with morphology type mentioned. E.g. "metastatic renal cell carcinoma of the lung".
bone, brain, diaphragm, heart, liver, lymph nodes, mediastinum, meninges, peritoneum, pleura, retroperitoneum, spinal cord, & sites classifiable to 195.
When only one site is described as metastatic and the morphology type is is not stated the site should be designated as "primary" except for the following___?___(13 sites), which should be designated as "secondary".
secondary (additional code should be assigned for primary site if known or 199.1 if primary site is unknown)
Multiple metastatic sites or two or more sites described as "metastatic" should be coded as _____?
1st.= neoplasm +
2nd =. dysfunction
Code sequence for endocrine dysfunction due to neoplasm?
1st = secondary site +
2nd = primary maignancy
Admission for tx. directed at secondary site?
1st = V58.0/V58.11/V58.12 (Encounter for x) +
2nd = neoplasm
Admission for chemo, Immunotherapy, or rad. tx?
1st = anemia/antineoplastic induced anemia/dehydration/pancytopenia etc. +
2nd = neoplasm
Admission for anemia, pancytopenia, dehydration associated with malignancy or chemotherapy, radiation therapy, or immunotherapy?
1st = primary neoplasm +
2nd = secondary neoplasm
Pt. admitted because of a primary neoplasm with metastasis and treatment is directed equally at both primary and secondary sites?
1st = V58.0/V58.11/V58.12 +
2nd = codes for compications
Admission for chemo, Immunotherapy, or rad. tx. and develops complications such as nausea, vomiting, or dehydration?
1.) Principle dx = code for the malignancy NOT V58.11
2.) Principle dx = V58.11
1.) Admission for insertion of port only for later chemo?
2.) Admission port insertion followed by chemo on the same visit?
1st = malignant neoplasm
2nd = pleural effusion/ascites
Malignant pleural effusion/malignant ascites
Malignancy has been completely eradicated and is no longer under treatment.
Codes form category V10 (hx. of malignant neoplasm can only be used when________?
fracture. Do not code the disocation.
Fracture with dislocation in the same bone is coded as?
Open. Open fx takes precedence in this situation.
When the diagnostic statement contains terms that relate to both open and closed fractures for the same fracture it is coded as_________?
"compound", "infected", "missile", "puncture", and "with foreign body" all refer to_____?
"comminuted", "depressed", "elevated", "greenstick", "spiral", and "simple" all refer to________?
any fracture not specified as open defaults to_______? in the ICD-9.
For cerebral laceration, contusion, subdural/subarachnid/intercranial hemorrhage or any condition codable to categories 851-854, a code for ________ is not assigned.
True/False? Although the ICD-9 does not allow dual coding for the diagnosis of bilateral fractures of the same site, bilateral procedures on fractures should be coded twice.
False. Only code the repair of skull fracture as debridement in this case is considered part of this procedure.
True/False? Debridement associated with repair of an open skull fracture should be assigned as an additional code.
1.)Physician should be queried to see if it shoud be assigned as acute.
2.) trauma or disease (pathalogical)
1.) Normally, pathologic fractures are not classified as acute. If a pathological fracture involves some type of trauma, then ________?
2.) Compression fractures can be either due to _____ or ____?
open or closed
Manipulation or reduction of a fracture is coded as either_____ or ______?
True. However, this assignment is not necessary for skull fractures as the debridement is included in those codes.
True/False? Debridement associated with open reduction of bones of upper or lower extremities should be assigned an additional code.
1st = reduction of fracture +
2nd = application of external fixator device
3rd = type of device (if known)
Codes assigned for external fixation?
True/False? - not taking enough of a required/prescribed medication is considered poisoning in ICD-9.
Adverse effect (condition) code + E code for drug
Basic coding sequence for adverse effects of medication taken theraputically?
Poisoning code (960 - 979 located in drug table) + manifestation/condition +
E code for drug/substance
Basic coding sequence for poisoning?
Same basic sequence as poisoning:
Toxic effect code (980 - 989) +
E code for external cause (i.e. accidental exposure, intentional self-harm, assault, undetermined)
Basic coding sequence for toxic effects?
False. This should be coded as an adverse effect unless misused/abused, in which case it would be coded as poisoning.
True/False? "toxicity" from medicines is coded as a toxic effect.
Errors in dosage or admisnistration of theraputic drugs are classified as _________?
still poisoning code (960 - 979)
If apt. is being treated for an overdose/poisoning and tranfered to another facility, the principle dx. at the new facility is_____?
Classified as poisoning. Sequence as poisoning & use two poisoning codes & 2 E codes (accidental):
980.0 (alcohol poisoning) +
969.4 (Valium poisoning) +
780.01 (coma) +
E860.0 (accidental poisoning alcohol) +
E853.2 (accidental poisoning Valium)
Interaction of theraputic drug used correctly? Example: coma due to alcohol with valium?
Classified as a poisoning, additional code following the manifestatio (condition) code for the dependence or abuse. Example:
965.01 (poisoning) +
518.4 (edema) +
304.00 (dependence code) +
E850.0 (accidental poisoning, heroin)
Acute condition due to a reaction resulting from the interaction of alcohol or drugs in abuse or dependence? For example: Acute pulmonary edema due to accidental heroin overdose in a patient who is heroin dependent?
True/False? Use of subcategory 995.2, (Other and unspecified adverse effect of drug, medicinal and biological substance) may be used in the outpatient setting, but their use for inpatient reporting is inappropriate.
True/False? Nonhealing burns and necrosis of burned skin are coded as acute current burns.
Late effects (906.5-906.9)
Sequelae (such as scarring or contracture) that remain after a burn has healed are classified as ___________?
1.) each burn site
2.) location of burns is not documented.
1.) When coding burns, separate codes are used for ______?
2.) Category 946 (multiple sites) should only be used if ____?
True. Different burn types heal at different rates a pt. may have both healed and unhealed burns.
True/False? Both current (acute) burns and late effects of burns can be present on the same admission record.
The highest degree recorded in the diagnostic statement.
Burns of the same local site at the three-digit category level but of different degrees are classified as _______?
1.) Burn of the highest degree (most severe) with additional codes for the burns of other sites.
945.34 Third-degree burn of leg +
943.21 Second-degree burn of forearm
1.)When coding multiple burns, sequence first the __________?
2.) For example, a patient is admitted with third-degree burns of the lower leg and first-degree and second-degree burns of the forearm?
Code for the burn +
958.3 (posttraumatic wound infection)
A code from category 948 as an additional code.
When more than 20 percent of the body surface is involved in third-degree burns, it is advisable to assign
condition resulting from the treatment of another condition
False. "Complication" as used in ICD-9-CM does not imply that improper or inadequate care is responsible for the problem.
True/False? The term "complication" as used in ICD-9-CM does implies that improper or inadequate care is responsible for the problem.
1.) The complication is assigned as an additional code.
2.) It is designated as the principal diagnosis.
Code Sequencing for complications?
1.) When it occurs during the episode in which the operation or other care was given?
2.) When it develops later and is the reason for the hospital admission?
1st - Refer to the main term for the condition and look for a subterm indicating a postoperative or other iatrogenic condition. For example:
Adhesion(s) . . .
postoperative (gastrointestinal tract) . . . 568.0
eyelid 997.9 . . .
2nd - When entry can be found under the main term, the coder should refer to the main term "Complications" and look for an appropriate subterm.
Two steps for locating complications in the al phabetical index?
False. These are generally not considered complications as they are common postoperative conditions. They should not be assigned as postoperative complications unless the physician clearly documents them as such.
True/False? postoperative conditions such as pain and anemia are usually complications and can be coded as such.
Additional codes for the specific infection, such as cystitis or sepsis, and for the responsible organism if that information is available:
E. coli infection due to peritoneal dialysis catheter 996.68 + 041.4
Chronic interstitial cystitis due to indwelling catheter 996.64 + 595.
996.64, Infection or inflammation due to indwelling urinary catheter? Fifth digits indicate the site and/or type of complication. For example:
E. coli infection due to peritoneal dialysis catheter?
Chronic interstitial cystitis due to indwelling catheter?
Two codes are required to fully describe a transplant complication: the appropriate code from subcategory 996.8 and a secondary code that identifies the complication. For example:
Acute graft-versus-host disease resulting from complications of bone marrow transplant 996.85 + 279.51
996.8, Complications of transplanted organ?
1st - code from categories (480-484) pneumonias +
2nd - VAP (997.31)
Admit for one type of pneumonia, pt. develops ventilator associated pneumnia (VAP)?
Subcategory 997.6 with fifth digit indicating the type of complication. + a code from (V49.6 - V49.7) to indicate the site of the amputation.
Complications of an amputated stump?
SURGICAL OR MEDICAL CARE AS EXTERNAL CAUSE
1.) E870 - E876
2.) E878 - E879
SURGICAL OR MEDICAL CARE AS EXTERNAL CAUSE
1.) Only used when the condition is stated to be due to a misadventure of medical or surgical care?
2.) Are used when the condition is described as due to medical or surgical care but without mention of misadventure.