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ICD-9-CM Chapter 6

Chapter 1 Infectious and Parasitic Diseases
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Infectious Diseases
Pathogen invades body
Parasitic Diseases
Parasite invades body and harms host (body)
Code Range for Infectious Diseases & Parasitic Diseases
001-139
* Organized by Organism Type & Body Site
4 Classifications of Organisms
1. Bacteria
2. Funci
3. Parasites
4. Viruses
Bacteria
- One Celled Organisms - named by shape & arrangements
Common Sites for Bacterial Infection
- Bloodstream
- Skin
- Gastrointestinal, respiratory, and urinary tracts
**Specific organism can cause disease in different body sites... coder must note the type of organism and body site when coding.
Culture and Sensitivity Tes (C&S)
- Ordered by physician to diagnose specific bacterial organism causing bacterial infection
- Identifies antibiotic to use to treat
Bacteria are named by:
Shape and arrangement
- Cocci = round
- Bacilli = straight rod
- Sprilla = Sprial, corkscrew, curved
- Diplo = Pairs
- Strepto = chains
- Staphylo = clusters
Fungi
microscopic plant life that lack chlorophyll and must have a source of matter for nutrition because they cant manufacture their own food. Two common forms that affect Humans:
1. Molds
2. Yeast
Yeast Infections
Caused by an unicellular fungi that reproduce by budding
Molds
cause by long filament-shaped fungi.
Opportunistic Parasites
Fungi, (yeasts and molds) that affect human tissues
Opportunistic Infections
Opportunistic parasites attack weakened immune systems and cause Opportunistic Infections in their host.
Opportunistic Infections most commonly occur in:
- Pts. w/ chronic conditions like AIDS, diabetes, cancer
- Infants & newborns
- Patients who are postsurgery
- Steroid users
Common yeasts and molds affecting humans
Athlete's foot (tinea pdis)
Thrush (candida albicans) mouth
Ringworm (tinea capitis)
Chicago disease (blastomyces dermatitidis)
Parasites
one celled organisms that live on living matter and are classified by the way they move... Parasitic Infections found in:
- intestinal tract, bloodstream, lymph nodes, central nervous sytem, & skin.
Helminths
Organisms that include flatworms, roundworms and flukes
Arthropods
organisms that include insects, ticks, spiders and mites.
Parasitic Infections
found in intestinal tract, bloodstream lymph nodes, central nervous system.
- Tapeworm - attach to body & cause disorders... uses hooks & suckers to attach to intestinal wall of its host.
- Malarial Parasites - in red blood cells
Viruses
smallest of infectious pathogens
- penetrate cells and release their DNA or RNA into the nucleus of a cell, causing damage to the human cell.
Common Viral Diseases
- Shingles (herpes zoster)
- Chickenpox (varicella)
- AIDS (Human immunodeficiency Virus)
- Genital herpes (herpes simplex)
- German Measles ( RNA virus)
- West Nile Fever ( Flavivirus)
Coding of Parasitic Diseases in ICD-9-CM
Coded in 1 of 3 ways:
1. Single Code Assignment
2. Combination Code Assignment
3. Dual Code Assignment
Single Code Assignment
Only 1 code needed to code diagnostic statement
Combination Code Assignment
Used when a single code is used to identify organism AND condition caused by organism.
- 1st reference term in Alpha Index
- 2nd Verify in Tabular list
i.e. Herpes Simplex w/ Manifestation meningitis 054.79
Dual Code Assignment
2 codes needed to code a diagnostic statement - in Alpha Index 2 codes listed, 1 in brackets indicating it should be listed as 2nd code... List as: Etiology 1st and then Manifestation 2nd in brackets
Conditions with both an underlying etiology and multiple body system manifestation due to the underlying etiology.
For such conditions it's required the underlying condition be sequenced first, followed by the manifestation.... wherever this exists there is a "use additional code" note at etiology code and "Code first" note at the manifestation code.
Intestinal Infectious Diseases (Category Codes 001-009)
This range of codes includes infections that occur in the stomach, intestines, and colon. The codes are organized according to the type of organisms causing the infection and the site of the infection.
Intestinal Infectious Diseases w/ codes are:
- Cholera (001.0-001.9
- Typhoid & paratyphoid fevers (002.0-002.9)
- Salmonella infections (003-003.9)
Shingellosis (004.0-004.9)
- Bacteria food poisoning (005.0-005.9)
- Ambebiasis (006.0- 006.9)
- Intestinal infections d/t other organisms (008.0-008.9)
**Above display many of same symptoms regardless of type of disao
Signs & Symptoms of Infectious Intestinal Diseases
Nausea, vomiting, Anorixia, Abdominal pain, Fever, Muscular aches, malaise
Clinical Tests for Infectious Intestinal diseases
Blood & stool cultures to identify the type of infectious organisms
Treatment for infectious intestinal diseases
- Antiemetric drug to reduce vomiting
- Antimotility drug to relieve the abdominal pan
- Hydrate orally
- Hydrate thru IV
Tuberculosis (Category Codes 010 - 018)
Tuberculosis is an infection caused by Mycobacterium Tuberculosis that spreads through the body via lymph and blood vessels and most commonly localizes in the lungs.
*** EXCLUDES states Congenital tuberculosis (771.2) and late effects of TB (137.0-137.4) are excluded
Tuberculosis Symptoms
fatigue, weakness, loss of appetitie annd weight, coughing, hemotysis, night sweats, and increased temperature later in the day and evening.
Clinical Tests used to diagnose TB
Chest Xrays
Mantous skin test
Sputem Culter
All codes for Tuberculosis have FIVE digits... fifth digits used are:
0 Unspecified
1 Bacteriological or histological exam not d
2. Bacteriological or histological exam unknown
3 Tubercle bacilli found in sputum by microscopy
4 Tubercle bacilli found by bacterial culture
5 Tubercle bacilli not found, but TB confirmed histologically
6. Tubercle bacilli confirmed by other methods
Zoonotic Bacterial Diseases
(Category Codes 020-027)
bacterial diseases that are transmittedd to humans by contact w/ infected animals, insects, fleas, ticks, or their discharges or products.
Common Zoonotic Bacterial Disease Symptoms
fever
chills,
headache, sweating
body aches
weakness
fatigue
***Blood specimens used for diagnosis
Common Zoonotic Bacterial Diseases:
- Anthrax
- Bubonic Plague
- Listeriosis Meningitis
- Mediterranean Fever
Other Bacterial Diseases
category Codes 030-041) classifies a wide range of bacterial diseases. One of most common is Streptococcal sore throat 034.0
Septiciemia
generally refers to a systemic disease associated w/ the presence of pathological microorganisms or toxins in the blood, which can include bacteria, viruses, fungi or other organisms.
Systemic Inflammatory Response Syndrome (SIRS)
Generally refers to the systemic response to infection, trauma/burns, or other insult (such as cancer), with symptoms including fever, tachycardia, tachypnea, and leukocytosis
Sepsis
Generally refers to SIRS due to infection
Severe Sepsis
Generally refers to sepsis with associated acute organ dysfunctions
Septicemia
Category 038
- subdivides into fourth digits that identify specific bacteria
SIRS
Classified into subcategory code 995.9
- fifth digits to identify specifics
SIRS, unspecified
995.90
Sepsis
995.91
Severe Sepsis
995.92
SIRS due to noninfectious process without acute organ dysfunction
995.93
SIRS due to noninfectious process with acute organ dysfunction
995.94
Septic Shock d/t Severe Sepsis is coded as:
995.92, 785.52
*For all cases of Septic Shock the code for the systemic infection should be sequenced first, followed by codes 995.92 and 785.52.
Any additional codes should also be assigned.
Septic Shock without documentation of severe sepsis
Septich shock indicates the presence of severe sepsis... Severe sepsis code 995.92, MUST be assigned with code 785.52, Septic Shock!
Toxic Shock Syndrome
Code 040.82
an acute infection, caused by staphylococcus or streptococcus bacteria, with an abrupt onset of symptoms... high fever, rash diarrha, vomiting, and myalgia, possible organ failure, hypotension, shock.
Human Immunodeficiency Virus/ HIV Disease
Code 042
* Code only confirmed cases of HIV
a. patient admitted ofr HIV-related condition - Code 042
b. Pt. w/ HIV disease admitted for unrelated condition - Code unrelated condition as primary and HIV as secondary
c. Whether pt. is newly diagnosed... Encounter for HIV conditions is errelevant to the sequencing decision
d. Asymptomatic HIV - Code V08
e. Pts. w/ inconclusive HIV serology but no definitive dx or manifestations of the illness... may be assigned code 795.71... inconclusive serologic test for HIV
f. Previousely diagnosed HIV-related illness - Code with042.
Encounters for Testing HIV
When coding testing for HIV Coder may use: V73.89
Viral Diseases Generally Accompanied by Exanthem (rash) (Category Codes 050-059)
Common diseases coded to this range include smallpox, chickenpox, herpes zoster, herpes simplex, congenital herpes, measles and rubella. **** When coding in this section coder NEEDS to note any complications so it can be reflected in the code.
Other Diseases d/t Viruses and Chlamydiae (Category Code 979-079)
Category Codes 070-079
- Codes in this section use 4th & 5th digits to identify the organism and manifestations or complications of the disease.
(Viral hepatitis, Rabies, Mumps, Hand, foot and mouth disease, infectious mononucleosis, Viral warts)
Infection Mononucleosis
Signs and Symptoms
Enlarged lymph nods, Fever, Sore Throat, Maliase, Anorexia, Myalgia, Splenomegaly...
Clinical Testing: Elevated WBC & atypical lymphocytes, liver function tests abnormal
Treatment: Steroid therapy; Symptomatic treatment includes OTC pain relievers & warm gargle.
Viral Hepatitis
Hepatitis A (HAV) 070-070.1
Hepatitis B (HBV) 070.2 and 070.3
Hepatitis C (HCV) 070.4
Disease highlight - Viral Hepatitis
Category Code 070
Syphyllis and other Venereal Diseases
Category Codes 090-099
Include bacterial and unspecified venereal diseases that are transmitted sexually or transplacentally to a fetus from an infected pregnant woman.
Mycosis (Category Codes 110-118)
This section includes fungal infections that affect various body sites. Instructional note at beginning of section directs coders to use additional codes to identify associated manifestations.
Candidiasis or Moniliasis infections... Category code 112
Fungal infections caused by the fungus Candida which can affect various sites.... ICD-9-CM uses 4th & 5th digits to identify the vaious sites affected by Candida.
Common Candida sites:
Mouth = Thrush 112.0
Vulva and Vagina - Candial or Monilial Vulvovaginitis = 112.1
Skin and Nails - called Candidal onychia = code 112.3
Opportunistic Mycotic Infections... Coded to 118
These infections include a wide variety of fungal infections that occur in a compromised host, typically a patient who has a chronic disease or weakened immune system.
Late Effects of Infectious and Parasitic Diseases (Category Codes 137-139)
Late Effects are used to code residual conditions due to a previous disease or injury.
- Code 137 - Late Effects of Tuberculosis
- Code 138 - Late Effects of acute poliomyelitis
- Code 139 - Late Effects of other infectious and parsitic diseases
*** used when a patient has previously had an infection and now has a residual condition due to the infection. Code for the residual is listed FIRST, and the late effect code is listed second.
i.e. Constrictive Pericarditis as residual condition...History of Tuberculosis.... code 423.2 for constrictive pericarditis first...