Health Information Management

A little heat, please!

HIM-HIPAA Insider, January 26, 2015

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Every have one of those days when you feel like you’ll never be warm? I’m having one of those. One of the downsides to have a window cube is the cold seeps in with the sunshine. Or with the dreary gray day.

 
Why am I so cold? Maybe I am hypothermic. Hypothermia is a medical emergency that occurs when your body loses heat faster than it can produce it, causing a dangerously low body temperature. Okay, maybe not. Out of curiosity, how would we code hypothermia in ICD-10-CM?
 
Well, we need to know the age of the patient. ICD-10-CM includes a series of codes for hypothermia in a newborn (P80.-). For adult patients, we need to know the cause of the hypothermia:
  • Hypothermia due to illness (R68.0)
  • Hypothermia, not associated with low environmental temperature (R68.0)
  • Hypothermia NOS (accidental) (T68)
  • Hypothermia due to anesthesia (T88.51)
  • Hypothermia due to low environmental temperature (T68)
If I were in fact hypothermic, it would be because it’s cold out, so T68.XXXA for an initial encounter. Notice you need three placeholder Xs for this code so your seventh character for the encounter is in the seventh position.
 
Under T68, we also find a note to use an additional code to identify the source of exposure:
  • Exposure to excessive cold of man-made origin (W93)
  • Exposure to excessive cold of natural origin (X31)
T68 also has both an Excludes1 and Excludes2 note.
 
Excludes1 means the conditions are mutually exclusive, so you can’t have T68 with:
  • Hypothermia following anesthesia (T88.51)
  • Hypothermia not associated with low environmental temperature (R68.0)
  • Hypothermia of newborn (P80.-)
That makes sense, right? A patient’s hypothermia can’t be due to low environmental temperature and not due to low environmental temperature at the same time. Also if the hypothermia is due to anesthesia, it can’t also be due to low environmental temperature.
 
Excludes2 means the patient can have both conditions and when both are present, coders report both. In this case a patient can suffer from hypothermia and frostbite (T33-T34) at the same time. Again, that make sense.
 
None of this solves my chills, however. If my only symptom is chills and the physician can’t determine an actual medical diagnosis, we can code the symptom of chills. We have two code choices:
  • Chills with fever (R50.9)
  • Chills (without fever) (R68.83)
Again those conditions both have Excludes1 notes, telling you they are mutually exclusive.
 
Feeling cold all the time is one symptom of hypothyroidism (along with dry skin, thinning hair, and weight gain). To code hypothyroidism, we need to know the cause.
 
Is it congenital? We have two codes: one for with goiter (E03.0) and one for without goiter (E03.1).
 
Other choices include:
  • Iatrogenic NEC (E03.2)
  • Iodine-deficiency (acquired) (E01.8)
  • Subclinical (E02)
  • Postinfectious (E03.3)
  • Postirradiation (E89.0)
  • Postprocedural (E89.0)
  • Postsurgical (E89.0)
  • Specified NEC (E03.8)
It can also be due to:
  • Exogenous substance NEC (E03.2)
  • Iodine-deficiency, acquired (E01.8)
  • Subclinical (E02)
  • Irradiation therapy (E89.0)
  • Medicament NEC (E03.2)
  • P-aminosalicylic acid (PAS) (E03.2)
  • Phenylbutazone (E03.2)
  • Resorcinol (E03.2)
  • Sulfonamide (E03.2)
  • Surgery (E89.0)
  • Thiourea group drugs (E03.2)
Even though ICD-10-CM includes a lot of terms, most of them fall under just a few codes. If your physicians are not in the habit of specifying the cause of a patient’s hypothyroidism, start asking for it now. At the very least, show them the new codes and ask nicely if they can include that information going forward.
 
As interesting as this is, all of this coding is not making me warmer. Maybe it’s time for a coffee. Although I am a little jittery from the eight cups of coffee I’ve already had today. I’m also kind of dizzy and a little nauseous.
Oh, no, caffeine poisoning!
 
Off to the Table of Drugs and Chemicals. This will look very familiar. We have one in ICD-9-CM.
In the table, we’ll look up “caffeine” and see we have six possible codes:
  • Poisoning accidental
  • Poisoning, intentional self-harm
  • Poisoning, assault
  • Poisoning, undetermined
  • After effect
  • Underdosing
I’m not sure how you can underdose with caffeine, but maybe it happens.
 
In my case, it’s an accidental poisoning, so we would report T43.611.
 
I give up. I’m going in search of a space heater.
 
This article originally appeared on HCPro’s ICD-10 Trainer blog.



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