Coding for Chapter 1 of the ICD-10-CM

Overview

When coding for Infectious and Parasitic diseases (A00-B99), you will be using combination codes and multiple codes to describe their diagnoses. Conditions in this category have many different variations based on the severity and how far in the disease process the infection is.??

Goals

1. Know how to code A and B codes (A00-B99)
2. Know how to code sepsis, severe sepsis, and septic shock
3. Know how to code for COVID-19 infections

A and B codes (A00-B99)

Chapter 1 classifies diseases according to the etiology (cause) of the disease. These conditions can affect multiple organ systems, which is why there are so many variations of codes to describe more specifically. When coding an infection that is resistant to antibiotics, report the infection first, followed by Z16- (infection with drug-resistant microorganisms).?

Sepsis, Severe Sepsis, and Septic Shock

Sepsis

Sepsis is an inflammatory condition in response to microorganisms in the tissue of the body. This condition is characterized by systemic inflammatory response syndrome (SIRS). A condition that is confirmed with two or more of the following symptoms: hypothermia, tachycardia, increased respiratory rate, and increased or decreased white blood cell count.

To report sepsis, assign the code for the underlying infection (sepsis) first, then the causal organism code. If the causal organism is not known, code A41.9 (sepsis, unspecified organism).

Example:

Initial encounter for a patient with sepsis due to a blood transfusion. He has hemophilia.?

Code: T80.29XA (Sepsis, following, infusion, therapeutic injection), A41.9 (sepsis, generalized), D66 (hemophilia)

Since this sepsis was caused by therapeutic injection, that must be coded first, then the generalized sepsis, followed by the hemophilia that may affect the patient’s treatment.?

Severe Sepsis

To code for severe sepsis, an acute organ dysfunction must be related to the condition of sepsis, or the physician describes severe sepsis in the SOAP notes. Severe sepsis (R65.2) can never be used as the first-listed diagnosis.?

Example: Acute renal failure and acute respiratory failure due to sepsis.

Code: A41.9 (sepsis, generalized), R65.20 (sepsis, severe), N17.9 (Failure, renal, acute), J96.00 (failure, respiration, respiratory, acute)

It requires at least three codes to diagnose severe sepsis: a code for the underlying systemic infection related to sepsis, the code for severe sepsis (R65.2), and the codes for the organ dysfunction.?

Septic Shock

This is a circulatory failure that is a specific type of organ dysfunction. Like other variations of sepsis, you must code the underlying infection first, followed by severe sepsis with septic shock (R65.21), then the codes for the organ dysfunction.?

COVID-19 Infections

1. Confirmed Cases

Code only confirmed cases that are either documented by a provider or by a positive COVID-19 test. If the provider documents “suspected’, “probable,” or “inconclusive,” do not assign COVID-19 (U07.1).?

2. Sequencing of codes

When COVID-19 meets the requirements for principal diagnosis, code U07.1 is first followed by associated manifestations unless other guidelines require precedence, such as sepsis, obstetrics, or transplant complications.

3. Exposure to COVID-19

For asymptomatic patients that may have been exposed to COVID-19, assign code Z20.822 (contact with and suspected exposure to COVID-19).?

4. Screening for COVID-19

During a pandemic, a screening code is not necessary; instead, code Z20.822 (suspected exposure). At all other times, code Z11.52 (encounter for screening for COVID-19).

5. Asymptomatic Individuals who test positive for COVID-19

If the patient is positive for COVID-19 but shows no signs of it, code as positive for COVID-19.

For more information related to using the ICD-10-CM, contact Sosa Practice Partners. We have 20 years of experience with medical billing and practice management.