ICD 10 Official Guideline Tidbits
How many steps are there to correct ICD coding?
10 (answer on page xll of ICD (purple section)
A pregnant patient has a URI. Would ICD J06.9 be the First Listed Diagnosis?
No, It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy. Chapter 15 codes have sequencing priority over codes from other chapters.
Can ICD F07.81 be a primary ICD?
NO! NO! NO! A Thousand times No! Please make a note of it.
Should the provider be queried to laterality if they diagnose H81.10 (Benign paroxysmal vertigo, unspecified ear)?
No, laterality of paroxysmal vertigo can take a long process to establish. Per Dr. Currie, we should code R42 instead. (ICD tab – vertigo
How do you locate a code in ICD-10?
First locate the term in the alphabetic index and then verify the code in the tabular list. It is essential to use both the Alphabetic Index and Tabular List when locating and assigning a code. The Alphabetic index does not always provide the full code. Selection of the full code, including laterality and any applicable 7th character can only be done in the Tabular list. A dash (-) at the end of an Alphabetic Index entry indicates that additional characters are required. (Official guidelines, pg. 12)
What does it mean when ICD codes are labeled as “other”?
For use when the medical record provides detail for which a specific code does not exist.
Can ICD R65.20 be listed as a primary ICD?
No Code First: underlying infection, such as A41.9 Sepsis NOS
Can R06.02 be listed with J96?
No
Can J02.0 be coded with J36?
No, there is and excludes 1 rule J36 peritonsillar abscess.
Can N20.0 and N20.1 be coded together?
No, the combination code N20.2 should be used.
Does the ED and UC capture the Principal Diagnosis or First Listed Diagnosis?
In the outpatient setting, the term first-listed diagnosis is used in lieu of principal diagnosis. In determining the first-listed diagnosis the coding conventions of ICD-10-CM, as well as the general and disease specific guidelines take precedence over the outpatient guidelines. Diagnoses often are not established at the time of the initial encounter/visit. It may take two or more visits before the diagnosis is confirmed. The most critical rule involves beginning the search for the correct code assignment through the Alphabetic Index. Never begin searching initially in the Tabular List as this will lead to coding errors. List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided. MAKE SURE EACH CPT IS LINKED ONLY TO CORRECT ICD. DO NOT LINK ALL ICD TO ALL CPT.
There is a follow up note by a different EPPA provider, after a patient is discharged, which only indicates the test results show E Coli. How is this coded?
There was no face-to-face encounter (so no CPT) and ICD code assignment is based on the documentation by the patient's provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient's diagnosis). Test results listed by another provider not interpreted or treated by the patient’s provider are not coded.
True or false?
ICD Z00-Z99 would still be used when the patient has a symptom or illness or issue.
False-When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
Can adverse effect of Prednisone (T38.0X5A) be coded primary?
No, code first the nature of the adverse effect, such as: Adverse effect NOS (T88.7), aspirin gastritis (K29.-), contact dermatitis (L23-L25) (Tabular T38.0X5A).
Can N20.0 and N13.30 be coded together?
No, N20.0 has an Excludes1: that with hydronephrosis (N13.2).
Which 7th character is used in the ED?
7th character “A”, initial encounter is used while the patient is receiving active treatment for the condition. Examples are: surgical treatment, emergency department encounter. (Coding Specialist Training -Ch 5)
Can we code COVD from the lab results if the provider did not give it as a diagnosis?
No we do not code from lab results. Provider must document COVID as a diagnosis.
Can ICD T26.62XA be a primary ICD?
No, Code first-
Can laterality be pulled from nursing notes, radiology reports or other clinicians notes if the provider does not document laterality?
Yes, page 15 #13 in ICD 10, as long as it is part of the patients record for encounters for that day of service. If it is conflicting throughout the provider should be queried.
Can R03.0 be coded for a patient with a history of hypertension?
No, this category is to be used to record an episode of elevated blood pressure in a patient in whom no formal diagnosis of hypertension bas been made. Review the entire encounter to ensure the patient does not have a history of hypertension. (Tabular R03.0)
Which chapter has sequencing priority over other chapters?
Ch 15 Pregnancy, Childbirth, and the Puerperium. Additional codes from other chapters may be used to further specify conditions. It is the provider’s responsibility to state that the condition being treated is not affecting the pregnancy. (Ch 15 guidelines)
True or false
Z34 is used in conjunction with ICD codes from range O00-O9A
False Excludes1:any complication of pregnancy (O00-O9A) Its all complicated unless otherwise stated by the provider.
Should S00.03XA and S01.01XA be coded together?
No, according to ICD-10 guidelines, superficial injuries such as abrasions or contusions are not coded with more severe injuries.
What priority do superficial abrasions and contusion have when present with more serious injuries?
Do not code abrasions, contusions when there is a more severe injury to code. For example, when there is an open fracture, do not code the laceration. Meeting notes 1/28/25 Guidelines can be found in Find A Code on page 76 or under coding guidelines in the ICD-10 CM book.
Can a non-specific code such as T14.XXA or R58 be used?
No! This will cause a denial. Use the HPI, exam, and MDM to code injuries to the greatest possible specificity. Query the provider if necessary