ICD-9-CM for Physicians – Volumes 1 & 2 2013 Expert International Classification of Diseases 9th Revision Clinical Modification Sixth Edition Edited by: Anita C. Hart, RHIA, CCS, CCS-P Melinda S. Stegman, MBA, CCS Beth Ford, RHIT, CCS OptumInsight is committed to providing you with the ICD-9-CM code update information you need to code accurately and to be in compliance with HIPAA regulations. In case of adoption of additional ICD-9-CM code changes effective April 1, 2013, OptumInsight will provide these code changes to you at no additional cost! Just check back at www.optumcoding.com/productalerts to review the latest information concerning any new code changes.
Codes Valid October 1, 2012, through September 30, 2013
Index to Diseases
2013 ICD-9-CM
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Revised Text
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2 Subterms under main terms may continue to next column or page Revised Code Volume 2 — 1
AAT — Abnormal, abnormality, abnormalities
S Additional Digit Required — Refer to the Tabular List for Digit Selection
Index
A AAT (alpha-1 antitrypsin) deficiency 273.4 AAV (disease) (illness) (infection) — see Human immunodeficiency virus (disease) (illness) (infection) Abactio — see Abortion, induced Abactus venter — see Abortion, induced Abarognosis 781.99 Abasia (-astasia) 307.9 atactica 781.3 choreic 781.3 hysterical 300.11 paroxysmal trepidant 781.3 spastic 781.3 trembling 781.3 trepidans 781.3 Abderhalden-Kaufmann-Lignac syndrome (cystinosis) 270.0 Abdomen, abdominal — see also condition accordion 306.4 acute 789.0 S angina 557.1 burst 868.00 convulsive equivalent (see also Epilepsy) 345.5 S heart 746.87 muscle deficiency syndrome 756.79 obstipum 756.79 Abdominalgia 789.0 S periodic 277.31 Abduction contracture, hip or other joint — see Contraction, joint Abercrombie’s syndrome (amyloid degeneration) 277.39 Aberrant (congenital) — see also Malposition, congenital adrenal gland 759.1 blood vessel NEC 747.60 arteriovenous NEC 747.60 cerebrovascular 747.81 gastrointestinal 747.61 lower limb 747.64 renal 747.62 spinal 747.82 upper limb 747.63 breast 757.6 endocrine gland NEC 759.2 gastrointestinal vessel (peripheral) 747.61 hepatic duct 751.69 lower limb vessel (peripheral) 747.64 pancreas 751.7 parathyroid gland 759.2 peripheral vascular vessel NEC 747.60 pituitary gland (pharyngeal) 759.2 renal blood vessel 747.62 sebaceous glands, mucous membrane, mouth 750.26 spinal vessel 747.82 spleen 759.0 testis (descent) 752.51 thymus gland 759.2 thyroid gland 759.2 upper limb vessel (peripheral) 747.63 Aberratio lactis 757.6 testis 752.51 Aberration — see also Anomaly chromosome — see Anomaly, chromosome(s) distantial 368.9 mental (see also Disorder, mental, nonpsychotic) 300.9 Abetalipoproteinemia 272.5 Abionarce 780.79 Abiotrophy 799.89 Ablatio placentae — see Placenta, ablatio retinae (see also Detachment, retina) 361.9 Ablation pituitary (gland) (with hypofunction) 253.7 placenta — see Placenta, ablatio uterus 621.8 Ablepharia, ablepharon, ablephary 743.62 Ablepsia — see Blindness Ablepsy — see Blindness
Abnormal, abnormality, abnormalities Abnormal, abnormality, abnormalities — Abnormal, abnormality, abnormalities — Ablutomania 300.3 see also Anomaly — continued see also Anomaly — continued Abnormal, abnormality, abnormalities — erythrocytes — continued hemoglobin (see also Disease, hemoglobin) see also Anomaly congenital, with perinatal jaundice 282.7 acid-base balance 276.4 282.9 [774.0] trait — see Trait, hemoglobin, abnormal fetus or newborn — see Distress, fetal Eustachian valve 746.9 hemorrhage, uterus — see Hemorrhage, adaptation curve, dark 368.63 excitability under minor stress 301.9 uterus alveolar ridge 525.9 fat distribution 782.9 histology NEC 795.4 amnion 658.9 S feces 787.7 increase affecting fetus or newborn 762.9 fetal heart rate — see Distress, fetal in anatomical relationship NEC 759.9 fetus NEC appetite 783.6 apertures, congenital, diaphragm 756.6 affecting management of pregnancy — development 783.9 auditory perception NEC 388.40 see Pregnancy, management afinvoluntary movement 781.0 autosomes NEC 758.5 fected by, fetal jaw closure 524.51 13 758.1 karyotype 795.2 causing disproportion 653.7 S 18 758.2 knee jerk 796.1 affecting fetus or newborn 763.1 21 or 22 758.0 labor NEC 661.9 S D1 758.1 causing obstructed labor 660.1 S affecting fetus or newborn 763.7 affecting fetus or newborn 763.1 E3 758.2 laboratory findings — see Findings, abnorfindings without manifest disease — see G 758.0 mal Findings, abnormal ballistocardiogram 794.39 length, organ or site, congenital — see Disfluid basal metabolic rate (BMR) 794.7 tortion amniotic 792.3 biosynthesis, testicular androgen 257.2 liver function test 790.6 cerebrospinal 792.0 blood level (of) loss of height 781.91 peritoneal 792.9 cobalt 790.6 loss of weight 783.21 pleural 792.9 copper 790.6 lung shadow 793.1 synovial 792.9 iron 790.6 mammogram 793.80 vaginal 792.9 lead 790.6 calcification 793.89 forces of labor NEC 661.9 S lithium 790.6 calculus 793.89 affecting fetus or newborn 763.7 magnesium 790.6 microcalcification 793.81 form, teeth 520.2 mineral 790.6 Mantoux test 795.5 function studies zinc 790.6 membranes (fetal) auditory 794.15 blood pressure affecting fetus or newborn 762.9 bladder 794.9 elevated (without diagnosis of hypertencomplicating pregnancy 658.8 S brain 794.00 sion) 796.2 menstruation — see Menstruation cardiovascular 794.30 low (see also Hypotension) 458.9 metabolism (see also condition) 783.9 endocrine NEC 794.6 reading (incidental) (isolated) (nonmovement 781.0 kidney 794.4 specific) 796.3 disorder NEC 333.90 liver 794.8 blood sugar 790.29 sleep related, unspecified 780.58 nervous system bowel sounds 787.5 specified NEC 333.99 central 794.00 breathing behavior — see Respiration head 781.0 peripheral 794.19 caloric test 794.19 involuntary 781.0 oculomotor 794.14 cervix (acquired) NEC 622.9 specified type NEC 333.99 pancreas 794.9 congenital 752.40 muscle contraction, localized 728.85 placenta 794.9 in pregnancy or childbirth 654.6 S myoglobin (Aberdeen) (Annapolis) 289.9 pulmonary 794.2 causing obstructed labor 660.2 S narrowness, eyelid 743.62 retina 794.11 affecting fetus or newborn 763.1 optokinetic response 379.57 special senses 794.19 chemistry, blood NEC 790.6 organs or tissues of pelvis NEC spleen 794.9 chest sounds 786.7 thyroid 794.5 in pregnancy or childbirth 654.9 S chorion 658.9 S vestibular 794.16 affecting fetus or newborn 763.89 affecting fetus or newborn 762.9 gait 781.2 causing obstructed labor 660.2 S chromosomal NEC 758.89 hysterical 300.11 affecting fetus or newborn 763.1 analysis, nonspecific result 795.2 gastrin secretion 251.5 origin — see Malposition, congenital autosomes (see also Abnormal, autoglobulin palmar creases 757.2 somes NEC) 758.5 cortisol-binding 255.8 Papanicolaou (smear) fetal, (suspected) affecting management thyroid-binding 246.8 anus 796.70 of pregnancy 655.1 S glucagon secretion 251.4 with sex 758.81 glucose 790.29 atypical squamous cells clinical findings NEC 796.4 in pregnancy, childbirth, or puerperium cannot exclude high grade communication — see Fistula 648.8 S squamous intraepitheconfiguration of pupils 379.49 fetus or newborn 775.0 lial lesion (ASC-H) coronary non-fasting 790.29 796.72 artery 746.85 gravitational (G) forces or states 994.9 of undetermined significance vein 746.9 hair NEC 704.2 (ASC-US) 796.71 cortisol-binding globulin 255.8 hard tissue formation in pulp 522.3 cytologic evidence of malignancy course, Eustachian tube 744.24 head movement 781.0 796.76 creatinine clearance 794.4 heart high grade squamous intraepithedentofacial NEC 524.9 rate lial lesion (HGSIL) 796.74 functional 524.50 fetus, affecting liveborn infant low grade squamous intraepithespecified type NEC 524.89 before the onset of labor 763.81 lial lesion (LGSIL) 796.73 development, developmental NEC 759.9 during labor 763.82 glandular 796.70 bone 756.9 unspecified as to time of onset specified finding NEC 796.79 central nervous system 742.9 763.83 cervix 795.00 direction, teeth 524.30 intrauterine with Dynia (see also Defect, coagulation) 286.9 before the onset of labor 763.81 atypical squamous cells Ebstein 746.2 during labor 763.82 cannot exclude high grade echocardiogram 793.2 unspecified as to time of onset squamous intraepitheechoencephalogram 794.01 763.83 lial lesion (ASC-H) echogram NEC — see Findings, abnormal, newborn 795.02 structure before the onset of labor 763.81 of undetermined significance electrocardiogram (ECG) (EKG) 794.31 during labor 763.82 (ASC-US) 795.01 electroencephalogram (EEG) 794.02 unspecified as to time of onset cytologic evidence of malignancy electromyogram (EMG) 794.17 763.83 795.06 ocular 794.14 shadow 793.2 high grade squamous intraepitheelectro-oculogram (EOG) 794.12 sounds NEC 785.3 lial lesion (HGSIL) 795.04 electroretinogram (ERG) 794.11 erythrocytes 289.9
Tabular List
Diseases of the Circulatory System
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414.11 Aneurysm of coronary vessels Aneurysm (arteriovenous) of coronary vessels
arteriosclerotic cardiovascular disease [ASCVD] (429.2) cardiovascular: arteriosclerosis or sclerosis (429.2) degeneration or disease (429.2)
DEF: Dilatation of all three-vessel wall layers forming a sac filled with blood. AHA: 2Q, ’10, 8-9; 3Q, ‘03, 10; 1Q, ‘99, 17
414.12 Dissection of coronary artery
c 414.0 Coronary atherosclerosis
DEF: A tear in the intimal arterial wall of a coronary artery resulting in the sudden intrusion of blood within the layers of the wall. AHA: w1Q, ’11, 3-4x
Arteriosclerotic heart disease Coronary (artery): [ASHD] arteritis or endarteritis Atherosclerotic heart disease atheroma Coronary (artery): sclerosis arteriosclerosis stricture Use additional code, if applicable, to identify chronic total occlusion of coronary artery (414.2) 2 embolism of graft (996.72) occlusion NOS of graft (996.72) thrombus of graft (996.72)
414.19 Other aneurysm of heart Arteriovenous fistula, acquired, of heart 414.2 Chronic total occlusion of coronary artery Complete occlusion of coronary artery Total occlusion of coronary artery Code first coronary atherosclerosis (414.00-414.07) 2 acute coronary occlusion with myo- cardial infarction (410.00-410.92) acute coronary occlusion without myocardial infarction (411.81)
DEF: A chronic condition marked by thickening and loss of elasticity of the coronary artery; caused by deposits of plaque containing cholesterol, lipoid material and lipophages. AHA: 2Q, ‘97, 13; 2Q, ‘95, 17; 4Q, ‘94, 49; 2Q, ‘94, 13; 1Q, ‘94, 6; 3Q, ‘90, 7
414.00 Of unspecified type of vessel, native or graft AHA: 1Q, ‘04, 24; 2Q, ‘03, 16; 3Q, ‘01, 15; 4Q, ‘99, 4; 3Q, ‘97, 15; 4Q, ‘96, 31
DEF: Complete blockage of coronary artery due to plaque accumulation over an extended period of time; results in substantial reduction of blood flow. AHA: 4Q, ’07, 82
y y
414.01 Of native coronary artery
DEF: Plaque deposits in natural heart vessels. AHA: 3Q, ’09, 9, 10; 3Q, ‘08, 10; 2Q, ‘08, 16; 3Q, ’06, 25; 4Q, ’05, 71; 2Q, ’04, 3; 4Q, ’03, 108; 3Q, ‘03, 9, 14; 3Q, ‘02, 4-9; 3Q, ‘01, 15; 2Q, ‘01, 8, 9; 3Q, ‘97, 15; 2Q, ‘96, 10; 4Q, ‘96, 31 TIP: Assign for documentation of CAD NOS in a patient with no history of coronary artery bypass procedure. I25.10 ASHD of native cor artery w/o angina pectoris I-10
414.02 Of autologous vein bypass graft AHA: 2Q, ’10, 8-9 DEF: Plaque deposit in grafted vein originating within patient.
414.03 Of nonautologous biological bypass graft
y
y
DEF: Plaque deposits in grafted vessel originating outside patient.
DEF: Plaque deposits in grafted artery originating within patient. AHA: 4Q, ‘96, 31
414.05 Of unspecified type of bypass graft Bypass graft NOS
AHA: 4Q, ‘08, 113 l
414.4 Coronary atherosclerosis due to calcified coronary y lesion Coronary atherosclerosis due to severely calcified coronary lesion Code first coronary atherosclerosis (414.00-414.07) 414.8 Other specified forms of chronic ischemic heart disease Chronic coronary insufficiency Ischemia, myocardial (chronic) Any condition classifiable to 410 specified as chronic, or presenting with symptoms after 8 weeks from date of infarction 2 coronary insufficiency (acute) (411.89) AHA: 3Q, ‘01, 15; 1Q, ‘92, 10; 3Q, ‘90, 7, 15; 2Q, ‘90, 19 I25.89 Other forms of chronic ischemic heart disease
y
AHA: 3Q, ‘97, 15; 4Q, ‘96, 31
Diseases of Pulmonary Circulation (415-417) b 415 Acute pulmonary heart disease 415.0 Acute cor pulmonale 2 cor pulmonale NOS (416.9)
AHA: 4Q, ’03, 60; 4Q, ‘02, 53
414.07 Of bypass graft (artery) (vein) of transplanted heart
c 414.1 Aneurysm and dissection of heart
DEF: A heart-lung disease marked by dilation and failure of the right side of heart; due to pulmonary embolism; ventilatory function is impaired and pulmonary hypertension results.
y
c 415.1 Pulmonary embolism and infarction
AHA: 4Q, ‘02, 54
Pulmonary (artery) (vein): Pulmonary (artery) (vein): apoplexy infarction (hemorrhagic) embolism thrombosis 2 chronic pulmonary embolism (416.2) personal history of pulmonary embolism w(V12.55)x that complicating: abortion (634-638 with .6, 639.6) ectopic or molar pregnancy (639.6) pregnancy, childbirth, or the puerperium (673.0-673.8)
414.10 Aneurysm of heart (wall) Aneurysm (arteriovenous): mural ventricular Arteries of the Heart
DEF: Embolism: Closure of the pulmonary artery or branch; due to thrombosis (blood clot). DEF: Infarction: Necrosis of lung tissue; due to obstructed arterial blood supply, most often by pulmonary embolism. AHA: 4Q, ‘90, 25
Left coronary artery Circumflex branch
Right coronary artery
415.11 Iatrogenic pulmonary embolism and infarction Use additional code for associated septic pulmonary embolism, if applicable, 415.12
Marginal branches
Descending branch (posterior interventricular artery)
b Additional Digit Required c 2013 ICD-9-C
Unspecified Code
I-10
414.9 Chronic ischemic heart disease, unspecified Ischemic heart disease NOS
414.06 Of native coronary artery of transplanted heart
Aortic valve
y
414.3 Coronary atherosclerosis due to lipid rich plaque Code first coronary atherosclerosis (414.00-414.07)
Descending branch (anterior interventricular artery)
Other Specified Code
AHA: 4Q, ‘95, 58 TIP: Do not report code 997.39 Other respiratory complications, with code 415.11.
Manifestation Code
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October 2012 • Volume 1 – 127
414–415.11
y
414.04 Of artery bypass graft Internal mammary artery
Diseases of the Circulatory System
b 414 Other forms of chronic ischemic heart disease
414–415.11
Diseases of the Circulatory System
415.12–420.99
Diseases of the Circulatory System Blood Flow
415.12 Septic pulmonary embolism Septic embolism NOS Code first underlying infection, such as: septicemia (038.0-038.9) 2 septic arterial embolism (449) AHA: 4Q, ‘07, 84-86
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415.13 Saddle embolus of pulmonary artery 415.19 Other AHA: 3Q, ’10, 10; 4Q, ’09, 86 I26.99 Other pulmonary embolism w/o acute cor pulmonale
I-10
b 416 Chronic pulmonary heart disease 416.0 Primary pulmonary hypertension Idiopathic pulmonary arteriosclerosis Pulmonary hypertension (essential) (idiopathic) (primary) 2 pulmonary hypertension NOS (416.8) secondary pulmonary hypertension (416.8)
Other Forms of Heart Disease (420-429)
DEF: A rare increase in pulmonary circulation, often resulting in right ventricular failure or fatal syncope. I-10 I27.0 Primary pulmonary hypertension
b 420 Acute pericarditis
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416.1 Kyphoscoliotic heart disease DEF: High blood pressure within the lungs as a result of curvature of the spine.
416.2 Chronic pulmonary embolism Use additional code, if applicable, for associated long-term (current) use of anticoagulants (V58.61) 2 personal history of pulmonary embolism w(V12.55)x DEF: A long-standing condition commonly associated with pulmonary hypertension in which small blood clots travel to the lungs repeatedly over many weeks, months, or years, requiring continuation of established anticoagulant or thrombolytic therapy. AHA: 4Q, ’09, 85-86
416.8 Other chronic pulmonary heart diseases Pulmonary hypertension NOS Pulmonary hypertension, secondary AHA: w1Q, ’11, 10;x 3Q, ‘10, 12; 2Q, ’10, 10 I27.89 Other specified pulmonary heart diseases
415.12–420.99
Tabular List
I-10
416.9 Chronic pulmonary heart disease, unspecified Chronic cardiopulmonary disease Cor pulmonale (chronic) NOS
b 417 Other diseases of pulmonary circulation 417.0 Arteriovenous fistula of pulmonary vessels 2 congenital arteriovenous fistula w(747.32)x
DEF: Abnormal communication between blood vessels within lung.
417.1 Aneurysm of pulmonary artery 2 congenital aneurysm w(747.39)x wcongenital arteriovenous aneurysm (747.32)x 417.8 Other specified diseases of pulmonary circulation Pulmonary: arteritis endarteritis Rupture of pulmonary vessel Stricture 417.9 Unspecified disease of pulmonary circulation Anatomy
Superior vena cava
Aorta
Aortic valve
Pulmonary artery Pulmonary vein
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acute: mediastinopericarditis myopericarditis pericardial effusion pleuropericarditis pneumopericarditis acute rheumatic pericarditis (391.0) postmyocardial infarction syndrome [Dressler's] (411.0)
DEF: Inflammation of the pericardium (heart sac); pericardial friction rub results from this inflammation and is heard as a scratchy or leathery sound.
420.0 Acute pericarditis in diseases classified elsewhere Code first underlying disease, as: actinomycosis (039.8) amebiasis (006.8) chronic uremia (585.9) nocardiosis (039.8) tuberculosis (017.9) uremia NOS (586) 2 pericarditis (acute) (in): Coxsackie (virus) (074.21) gonococcal (098.83) histoplasmosis (115.0-115.9 with fifth-digit 3) meningococcal infection (036.41) syphilitic (093.81)
c 420.9 Other and unspecified acute pericarditis 420.90 Acute pericarditis, unspecified Pericarditis (acute): Periocarditis (acute): NOS sicca infective NOS AHA: 2Q, ‘89, 12
420.91 Acute idiopathic pericarditis Pericarditis, acute: Periocarditis (acute): benign viral nonspecific 420.99 Other Pericarditis (acute): Pericarditis (acute): pneumococcal suppurative purulent Pneumopyopericardium staphylococcal Pyopericardium streptococcal 2 pericarditis in diseases classified elsewhere (420.0)
Pulmonary valve Left atrium Mitral valve
Right atrium Tricuspid valve Right ventricle Inferior vena cava
8 Newborn Age: 0
128 – Volume 1 • October 2012
Chorda tendinae Left ventricle
9 Pediatric Age: 0-17
x Maternity Age: 12-55
y Adult Age: 15-124
2013 ICD-9-CM
2012 ICD -9-CM Changes Physician.fm Page 1 Thursday,February 2,2012 2:15 PM
ICD-9-CM Changes 2013: An Insider’s View Volume 1—Tabular List of Diseases and Injuries Neoplasms (140–239) Chapter 1: Infectious and Parasitic Diseases (001–139)
Basal cell, squamous cell, other and unspecified malignant neoplasms of skin (173.00–173.99)
Escherichia coli infection (041.41–041.49)
New codes were created to identify and report basal cell carcinoma and squamous cell carcinoma, which are skin neoplasms that are not reportable to the cancer registry yet pose a significant health risk. Subcategories in the group identify site, and the subclassification codes identify the specific neoplasm type. Basal cell carcinoma is the most commonly occurring form of non-melanoma skin cancer and least likely to metastasize. Squamous cell carcinoma is the second most common skin neoplasm. Although both types of cancers are easily treated, basal cell lesions have a high recurrence rate. Both lesions can rapidly invade adjacent tissues and cause extensive damage if not removed. In general, causation includes a combination of genetic, environmental and other risk factors, although it has been noted that the lesions tend to develop due to long-term exposure to ultraviolet (UV) radiation from sunlight. Basal cells are the regenerative cells at the bottom layer of the epidermis. A history of basal cell carcinoma may increase the risk for developing other skin cancers, including squamous cell carcinoma. The appearance of basal skin lesions varies in color and characteristics; from colorless or white, waxy bumps or crusty, scar-like lesions to flesh-colored or darkened, brown or black patches. Some lesions contain visible blood vessels at the site of a non-healing wound-like lesion that may bleed or ooze. These lesions may be easily confused with an ordinary non-healing sore or scar and can grow rapidly in diameter. Squamous cells are flat, brick-like cells just above the basal cell layer. The UV radiation is thought to damage the DNA within the skin, disrupting the normal cellular regeneration process and causing cells to grow abnormally, thereby forming a cancerous tumor. Squamous cell skin lesions also vary in appearance—from white to reddened lesions that may present as firm nodules or scaly, flat crusted lesions or ulcerations. Treatment options vary in intensity and technique, from topical ointments to electrodessication, laser or surgical excision, cryosurgery and Mohs micrographic surgery, which removes the tumor layer by layer to decrease the chance of recurrence.
041.41 041.42
Shiga toxin-producing Escherichia coli [E. coli] Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC) l 041.43 Shiga toxin-producing Escherichia coli [E. coli] (STEC), unspecified l 041.19 Other and unspecified Escherichia coli [E. coli] Escherichia coli (E. coli) are a large and diverse group of bacteria, which range from the relatively harmless to those that cause serious, life-threatening gastrointestinal illness. Many serogroups of E. coli can produce Shiga toxin. In the United States, Shiga toxin-producing Escherichia coli (STEC), including the strain E. coli O157:H7, are a leading cause of bacterial enteric infections. The 0157:H7 E. coli strain is a devastating infection to the pediatric population, differing from regular E. coli infection in that it is much more virulent and likely to lead to permanent renal damage including hemolytic uremic syndrome. STEC produces toxin known as Shiga toxin, verotoxin, or verocytotoxin (VTEC), which causes enterohemorrhagic conditions. These toxins may be identified by either culture or non-culture laboratory tests to detect the presence Shiga toxin or Shiga toxin genes (e.g., O157:H7 antigen). However, when the specific H antigen is not positive for H7, certain serogroup O157 E. coli strains require non-culture confirmation to be identified as STEC infections. STEC transmission can occur by the consumption of contaminated food (e.g., unpasteurized juice, raw milk, raw produce) or by direct contact contaminated animals or surfaces. Known routes of direct contamination include contact with an asymptomatic animal carrier or contaminated surfaces in an animal care environment or from hand-to-hand transmission of fecal contaminants. l l
Coding Tips The potentially virulent Shiga-toxin producing E. coli is classified by certain serological subtypes. Report new codes 041.41 for O157 serotypes, 04.42 for non-O157, or code 041.43 for other Shiga-toxin producing subspecies. New code 041.19 reports unspecified or not otherwise specified non-Shiga-toxin producing E. coli infection previously classified to code 041.4.
Coding Scenario A 9-year-old female presents to the hospital with onset of profuse watery, bloody diarrhea with severe, cramping abdominal pain. The patient was admitted and placed on IV hydration. Laboratory tests revealed significant leukocytosis, and positive for a markedly elevated blood urea nitrogen (BUN)/creatinine, and a microangiopathic hemolytic anemia (Hgb >8 g/dL) consistent with hemolytic-uremic syndrome. Stool culture was positive for E. coli serotype O157:H7. History is remarkable for exposure to livestock approximately one week ago, during the county fair, where she assisted in the livestock exhibits, primarily handling and showing swine. Diagnosis: Hemorrhagic E. coli serotype O157:H7 colitis with hemolytic-uremic syndrome.
Code assignment: 008.04 041.41 283.11
Enterohemorrhagic E. coli Shiga toxin-producing Escherichia coli [E. coli] Hemolytic-uremic syndrome
Coding Tips With the addition of the new codes to identify basal and squamous cell carcinoma, the most common malignant skin neoplasms are classified by type and site. There are separate classifications for Merkel cell carcinoma of the skin (209.31–209.39), Kaposi’s sarcoma of the skin (176.0), malignant melanoma (172), and basal cell and squamous cell carcinoma (173.00–173.99).
Scenario A 38-year-old male with short, fair-hair presents with three crusty, scaling skin lesions of the ear and scalp. He is an avid golfer, with chronic exposure to ultraviolet radiation. He admits to inconsistent, if negligible, use of sun protection other than a hat that leaves his ears exposed. Physical exam reveals three flesh-toned, scar-like, scaling skin lesions. Two small lesions are noted on the upper aspect of the pinna, which crust and occasionally bleed. The remaining lesion is posterior to the ear on the occipital portion of the scalp. Shave biopsies revealed basal cell carcinoma in all 3 lesions. The lesions were removed by electrodessication and curettage without incident.
Code assignment: 173.21 173.41 86.11
2013 ICD-9-CM
Basal cell carcinoma of skin of ear and external auditory canal Basal cell carcinoma of scalp and skin of neck Closed biopsy of skin and subcutaneous tissue
ICD-9-CM Changes 2013– 1
