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Review ICD-10-CM coding for common diagnoses in primary care settings

Physician Practice Insider, May 5, 2015

For coders of certain specialties, the transition from ICD-9-CM to ICD-10-CM may only require learning a handful of new concepts and terms. However, coders for primary care physicians will likely need to use codes from a variety of sections and learn multiple new concepts in ICD-10-CM due to the diverse diagnoses encountered in those settings.

Let's look at three specific conditions that primary care physicians commonly treat and the new concepts and terms associated with them.

Reporting common hypertensive diseases

Hypertensive diseases are located from I10-I15 in ICD-10-CM. The first thing coders may see in this section is a note to use an additional code to identify:

Exposure to environmental tobacco smoke (Z77.22)
History of tobacco use (Z87.891)
Occupational exposure to environmental tobacco smoke (Z57.31)
Tobacco dependence (F17.-)
Tobacco use (Z72.0)

"You will notice as a constant recurrent theme in ICD-10, if there's any exposure to tobacco—whether it's in the cardiovascular system, respiratory system, or during pregnancy [codes]—you're going find these notes," said Annie Boynton, BS, RHIT, CPCO, CCS, CPC, CCS-P, COC, CPC-P, CPC-I, director of provider regulatory compliance (ICD-10) communication, adoption, and training for UnitedHealth Group of Boston. Boynton spoke at AAPC's 2015 HealthCon in Las Vegas March 29–April 1.

ICD-10-CM does not use terms such as "controlled" or "uncontrolled" to describe hypertension, but coders should look in documentation for terms such as "transient hypertension," Boynton said.

Transient hypertension is reported when a provider records an episode of elevated blood pressure in a patient without a formal diagnosis of hypertension. Report transient hypertension with code R03.0 (elevated blood-pressure reading, without diagnosis of hypertension).

Hypertensive heart disease (I11) has two available options:

I11.0, hypertensive heart disease with heart failure
I11.9, hypertensive heart disease without heart failure

For example, a patient visits his family physician for his three-month follow-up visit. He is being treated for hypertensive heart disease with benign hypertension.

Coders should report I11.9 (hypertensive heart disease without heart failure), Boynton said.

When reporting I11.0, the ICD-10-CM Manual instructs coders to use an additional code to identify the type of heart failure (I50.-).

Reporting respiratory diseases

Respiratory diseases are located in Chapter 10 (J00–J99) of ICD-10-CM, and can include many common illnesses diagnosed by providers that may lead to more serious conditions. Coders will note that this section includes the instructions to report additional tobacco use codes, as Boynton previously noted.

Bronchitis is an inflammation of the bronchial tube lining, according to the Mayo Clinic. Symptoms can include coughing and production of thickened mucus. Acute bronchitis is a common condition that can develop from a cold or other respiratory disease, according to the Mayo Clinic, while chronic bronchitis is a constant irritation or inflammation of these tubes.

In ICD-10-CM, codes for bronchitis are separated by acute (J20) and chronic (J40) diagnoses, Boynton said. Acute bronchitis codes are further specified by the causal organism, such as J20.3 (acute bronchitis due to coxsackievirus). Coders can report J20.9 (acute bronchitis, unspecified) if the provider does not know the causative organism.