Part 5: Top 5 ICD-10-CM Chapters 2019

In 2019, HIA reviewed over 725,600 ICD-10-CM codes from many different facilities including reviews on our own coders. Yesterday we looked at the ICD-10-CM Chapter 9 and today we will focus on the fifth area with the most coding opportunities found during HIA reviews.

• Z00-Z99—Factors influencing health status and contact with health services
• A00-B99—Certain Infectious and Parasitic Diseases
• I00-I99—Disease of the Circulatory System
• J00-J99—Diseases of the Respiratory System
• E00-E89—Endocrine, Nutritional, and Metabolic Diseases

For Part 5 of this 5-part series, we will look at Chapter 4 within ICD-10-CM—E00-E89—Endocrine, Nutritional, and Metabolic Diseases. There is no possible way to include every guideline or coding reference for this chapter, but here are some of the most common issues.

Chapter 10: E00-E89—Endocrine, Nutritional, and Metabolic Diseases:

Chapter 4 in ICD-10-CM has 10 sections. In looking through the recommendations made, it looks like revisions and addition of the diagnoses are the most common recommendations. The “with” guideline is beginning to sink in with most coders but we still find recommendations due to this guideline.  This chapter covers malnutrition, obesity and diabetes as well as other endocrine, nutritional and metabolic diseases.  Below are a few areas where coding opportunities were identified during HIA client and internal quality reviews.

• Coders not using the “with” guideline when diabetes is documented with another condition that is presumed associated in ICD-10-CM (such as retinopathy, nephropathy, etc.).
• Sequencing of the appropriate diabetes code with manifestations when multiple manifestations are present
• Coding diabetes with unspecified complications or without complications in addition to a specified code for diabetes with a specific complication
• Only reporting dehydration when patient has hypernatremia or hyponatremia in addition. In ICD-10-CM, both may be reported
• Reporting unspecified obesity when documentation supported morbid obesity
• Reporting malnutrition without clinical indicators to support the diagnosis
• Missed query opportunities to clarify the specific malnutrition state
• Missed hyperlipidemia when patient is on long term medications
• Missed hypercholesterolemia when patient is on long term medications
• Missed further specificity on diagnoses that is available in the record
• Coding hypothyroidism in a patient s/p thyroidectomy to unspecified instead of postsurgical

In addition to the Official Coding Guidelines for ICD-10-CM for FY 2020, Pages 36-38 that address specific chapter guidelines to follow for reporting diseases of the respiratory system, there are multiple AHA Coding Clinics that discuss some of these in detail. Here are a few of these:

• ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2016 Pages: 9-14
• ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2013 Pages: 114-115
• ICD-10-CM/PCS Coding Clinic, Third Quarter 2013 Page: 20
• ICD-10-CM/PCS Coding Clinic, First Quarter 2016 Pages: 12-13
• ICD-10-CM/PCS Coding Clinic, Third Quarter 2018 Pages: 3-5
• ICD-10-CM/PCS Coding Clinic, Second Quarter 2016 Pages: 36-37
• ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2017 Pages: 7, 102, 108-109
• ICD-10-CM/PCS Coding Clinic, Third Quarter 2016 Page: 42
• ICD-10-CM/PCS Coding Clinic, Third Quarter 2017 Pages: 24-26
• ICD-10-CM/PCS Coding Clinic, Fourth Quarter 2018 Pages: 5-6, 79-80

Coding Tips for Chapter 4: E00-E89-Endocrine, Nutritional and Metabolic Diseases:

• Follow all instructional notes within ICD-10-CM for sequencing and to determine if additional codes would be reported
• Per coding guidelines, obesity is always considered to be clinically significant
• Per ICD-10-CM Official Guidelines for Coding and Reporting FY 2020 Pages 12 & 13, “The word “with” or “in” should be interpreted to mean “associated with” or “due to” when it appears in a code title, the Alphabetic Index (either under a main term or subterm), or an instructional note in the Tabular List. The classification presumes a causal relationship between the two conditions linked by these terms in the Alphabetic Index or Tabular List. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated or when another guideline exists that specifically requires a documented linkage between two conditions (e.g., sepsis guideline for “acute organ dysfunction that is not clearly associated with the sepsis”)…The word “with” in the Alphabetic Index is sequenced immediately following the main term or subterm, not in alphabetical order.”
• Diabetes is a significant complicating factor in pregnancy. A code from Chapter 15 (O00-O9A)—Pregnancy, Childbirth, and the Puerperium should be sequenced first followed by a code from Chapter 4 for the specific type of diabetes documented
• Review the entire medical record to look for specificity of any diagnoses
• Remember to code BMI when there is an associated condition documented by the provider
• Remember to report any long term use of medications the patient may be taking

Most of the tips above are for diabetes but there are many more diagnosis in this chapter of ICD-10-CM. Diabetes is just the most common reported code so there are more chances for errors. Following the instructional notes within ICD-10-CM is a must in this chapter.

Authored by Kim Boy, RHIT, CDIP, CCS, CCS-P

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.