ICD Coding advice from the WHO for the 2019 novel coronavirus (COVID-19)

The purpose of this post is to share the World Health Organization [WHO] official diagnosis coding guidance update for health care encounters and deaths related to the 2019 novel coronavirus (COVID-19) previously named 2019-nCoV.

Screenshot image from ICD-10

ICD-10 Chapter XXII: Codes for special purposes has a special sub-category called U07 Emergency use of U07. WHO’s recent creation of an emergency ICD-10 code U07.1, is assigned to the disease diagnosis of 2019-nCoV acute respiratory disease. See my screenshot image from ICD-10 to the left.

 

The title of U07 will be changed back to ‘codes for emergency use’.

It is to be noted that the name ‘2019-nCoV’ is temporary and is likely to change (to be independent of date and virus family, and for consistency with international virus taxonomy).

For ICD-11, the code for the illness would be RA01.0

A new and final ICD-10-CM code title for the COVID-19 diagnosis code is now [March 17–18, 2020] been established, and will be implemented effective October 1, 2020, by the Centers for Disease Control and Prevention’s (CDC), USA and the National Center for Health Statistics (NCHS), USA.

References:

  1. Emergency use ICD codes for COVID-19 disease outbreak, Classifications, WHO, <http://www9.who.int/classifications/icd/covid19/en/>
  2. Organizations Developing New Codes for COVID-19, and a Primer on the Virus, Under the Dome, Journal of AHIMA, <https://journal.ahima.org/new-icd-10-cm-code-for-covid-19-becomes-effective-october-1/>

8 strange ICD codes

Sometimes we encounter morbidity and mortality conditions that are amusingly unconventional and idiosyncratic to apply the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code or the 2015 American International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes.

Let’s delve into the infographic below (click on the infographic to view a larger image in a new tab of your current window) from Healthcare IT News  (a publication of  HIMSS Media which is a media organisation serving today’s healthcare industry, including all major healthcare organisations), and hope to find appropriate ICD-10 codes for them.

On verifying the codes given in the infographic, I found them to have similar variations in ICD-10 when compared to the ICD-10-CM codes. Let’s look in detail each of these 8 zaniest codes using the ICD-10-CM and how the differ when using ICD-10.

The first code from the infographic is Z63.1

It was not quiet easy to find an equivalent code for Z63.1 in ICD-10. In ICD-10 there is Z63 but you will need to cross reference with other codes to find hints for lead terms found among other codes belonging under a three-digit category. For example, Z63.1 is one of the several four-digit categories belonging under the three-digit category Z63.

Since “Family discord NOS” is classified to “Other specified problems related to primary support group” with code Z63.8; but when a family discord in relation to or with parents and in-laws is the situation with a presenting patient, then Z63.1 is the appropriate code.

Another example would be when the patient is a “Dependent relative needing care at home”. If the dependent relative is a parent and in-law(s), then code Z63.1 is the appropriate code since this code qualifies with specificity who the dependent relative is, since the parent or the in-law would be an elder or aged. So rather than using code Z63.6 which is for “Dependent relative needing care at home”, use Z63.1 when the dependent relative is a parent or an in-law.

Asphyxiation due to being trapped in a (discarded) refrigerator, accidental has the ICD-10-CM Diagnosis Code T71.231D, which differs from ICD-10.

ICD-10 differs from ICD-10-CM when two codes for asphyxiation due to being trapped in a refrigerator which may be accidental, one from Chapter IX Injury, poisoning and certain other consequences of external causes  and the other from the Chapter XX External causes of morbidity and mortality.

The ICD-10 code T71 from Chapter IX is used for the asphyxiation from systemic oxygen deficiency due to low oxygen content in ambient air. The ICD-10 code W81 from Chapter XX  is used fo describe the circumstances when the patient was found confined to or trapped in a low-oxygen environment including accidentally shut in or trapped in refrigerator. No mention of “discarded” is found for the ICD-10 code W81 if the refrigerator was indeed discarded.

ICD-10 code V97.3 only specifies if the person on ground injured in air transport got sucked into jet unlike ICD-10-CM which has a unique code when person sucked into jet engine with code V97.33XD, “engine” as the addition qualifying term used here.

The exclusion note for “Falls“ includes falls into water (with drowning or submersion) in ICD-10 is classifiable to codes ranging from W65 to W74 which are conditions due to accidental drowning and submersion. There is no code found for accidental drowning and submersion from a fall into a bucket under codes W65 to W74. So we are left only with using the code W74 “Unspecified drowning and submersion” which includes “fall into water NOS”.

This differs greatly from the ICD-10-CM code W16.221 which is for “Fall in (into) bucket of water causing drowning and submersion”, which could happen if the patient was a toddler.

V91.7 applying the fourth-character subdivision “.7” is the most likely ICD-10 code to use for an accident to watercraft for example a burn to water-skis (which is a watercraft) causing other injury (in this case a burn), when compared to ICD-10-CM V91.07XD for a burn due to water-skis on fire.

Walking into a stationary object is to say “striking against or struck by other objects” describing the ICD-10 code W22. From the infographic, the stationary object is a lamp post. ICD-10-CM uses the code W22.02XD in this instance.

Hair causing external constriction is the cause when an item like hair is causing the external constriction. The ICD-10-CM code W49.01XD is for a subsequent encounter when hair is causing an external constriction. In ICD-10, the equivalent would be to use the code W49 for “Exposure to other and unspecified inanimate mechanical forces”. Here the inanimate mechanical force (the constriction) is from the hair.

Animal-rider injured in collision with streetcar or trolley uses the ICD-10-CM code V80.730A for an initial encounter. I think the ICD-10 code V80 Animal-rider or occupant of animal-drawn vehicle injured in transport accident best describes a similar accident. You will also need to find a ICD-10 code for the injury as a consequence of the external cause.

8 Strange-Codes

Infographic credit: http://himt.wisconsin.edu/blog/6-health-information-technology-infographics-need-see-right-now/

Now we have seen how weird some 8 conditions can be, and how we will know exactly which ICD-10 or ICD-10-CM code to use.

References:

  1. World Health Organization 2011, Volume 1 Tabular list, International Statistical Classification of Diseases and Related Health Problems 10th Revision, 2010 edn, Geneva, Switzerland
  2. 8 zaniest ICD-10 codes, 25 July 2013, Healthcare IT news, viewed 28 February 2015, <http://www.healthcareitnews.com/infographic/infographic-top-zaniest-icd-10-codes>

Tracking the Ebola outbreak (if any) in Malaysia

Ebola virus disease (EVD) – formerly known as Ebola haemorrhagic fever, its outbreak in West Africa with the first case notified in March 2014, and its effects around the world, continues to get news coverage.

As I write this article, the World Health Organisation (WHO) is investigating reports according to three media outlets that an undisclosed number of Islamic State of Iraq and Syria (ISIS) militants displaying signs of Ebola have been showing up at an Iraqi hospital in the ISIS-held city of Mosul, 250 miles north of Baghdad. Thus, Malaysians who are fighting there alongside other ISIS militants – and when they return, are likely to pose a real danger of exposing the Malaysian public with Ebola. Fortunately, the Ministry of Health Malaysia has in place a comprehensive “Guideline on Ebola Viral Disease (EVD) Management In Malaysia” which includes guidelines for healthcare providers to stay alert for and evaluate any probable case,  for example known persons who are returning from ISIS controlled regions. The guidelines ensures screening of an such an individual as a Person Under Investigation (PUI) since he or she was a contact of an EVD case with either a high or low risk.

The World Health Organisation (WHO) warns that the Ebola virus causes an acute, serious illness which is often fatal if untreated. EVD first appeared in 1976 in two African states, and takes its name when the second case occurred in a village near the Ebola River, in the Democratic Republic of Congo.

The International Classification of Diseases (ICD) Ninth Revision i.e. ICD-9 for morbidity and mortality coding was adopted by Malaysia by 1978. Since the Ebola virus was first discovered in 1976, Health Information Management (HIM) / Medical Records (MR) practitioners in Malaysia who had just started morbidity and mortality coding using ICD-9, would have coded any probable case of Ebola as “078.89, other specified diseases due to viruses”.

As the Ebola outbreak heightened after the West African outbreak in 2014, any eventuality of an outbreak in Malaysia will not impede our ability to track and respond to the virus within its own borders and makes it easier to share information with the rest of the world. Malaysia’s ability to immediately track and respond to the Ebola outbreak from a public health perspective will be possible with the specificity in patient data morbidity and mortality coding for EVD using the Tenth Revision of ICD i.e. ICD 10, as Malaysia would be able to use the ICD-10 code for the Ebola virus – A98.4 to assess the efficacy of treatment and outcomes. Malaysia adopted ICD-10 by 1 January 1999 in our morbidity and mortality reporting systems.

The infographic by the Coalition for ICD-10 below (click to enlarge the infographic which will open in a new tab of your current browser window), presents the public health benefits of using ICD-10 in the fight against Ebola.

EVD Infographic

References :

  1. Ebola virus disease, Fact sheet N°103 Updated September 2014, World Health Organisation (WHO),viewed 3 January 2015, ,< http://www.who.int/mediacentre/factsheets/fs103/en/ >
  2. Guidelines On Ebola, Ministry of Health Malaysia, viewed 3 January 2015, ,< http://www.moh.gov.my/english.php/pages/view/606 >
  3. ICD-10: A Common Language for Public Health, The Coalition for ICD-10,viewed 3 January 2015, ,< http://coalitionforicd10.org/2014/09/04/icd-10-a-common-language-for-public-health/ >
  4. ISIS fighters ‘have contracted Ebola’: World Health Organisation investigating reports militants showed up at Iraqi hospital with lethal disease, Mail Online, Saturday, Jan 3rd 2015, viewed 3 January 2015, < http://www.dailymail.co.uk/news/article-2894154/ISIS-fighters-contracted-Ebola-World-Health-Organisation-investigating-reports-Islamist-militants-disease-showed-Iraqi-hospital.html >

APDC: Relevant conditions and scenarios that affects the eyes – Part 3

ICD-10-book-cover-for-APDC-series-labelAs always when I present any coding lecture, I will stick to my style in this post as well firstly to describe (i) the basic anatomy of the visual system and its connections, (ii) explain how this “machinery” functions to produce vision. (iii) what happens when this “machinery” malfunctions and (iv) end with the appropriate International Statistical Classification of Diseases and Related Health Problems, 10th Revision, 2010 edition,  (ICD-10) codes to apply along with any peculiarities and nuances, if any. However, I will be brief as possible with (i), (ii) and (iii) for posts like this one so as not to be too lengthy and burdensome to the reader passing through this website-blog.

My plan is to discuss conditions affecting the ocular muscles, disorders of refraction and accommodation, visual disturbances  and cover visual impairment and blindness in this post.

We normally gaze with each eye coming to the same point in space, that is to say that the eyes are aligned in the same direction. This is called binocular vision.  Coordinated eye movements also allows us the ability to see in 3-D. All this is possible with the aid of the extraocular muscles  around the eyes.

Problems arise when there is lack of coordination between eyes where the eyes are not parallel and not aligned with one another. They then prevent the gaze of each eye to enable binocular vision and affecting depth perception (3-D vision). One or both eyes may turn inward, and the patient is cross-eyed. He or she will have double vision and/or there is visual loss in one eye without the ability to see in 3-D. One or both eyes may also turn out, especially seen in paediatric cases.

Conditions affecting the ocular muscles affecting binocular movement include strabismus. Forms of strabismus include esotropia characterised by a turning inward of one or both eyes and exotropia when the eye is turned out.

Strabismus in ICD-10 is part of the disorders of ocular muscles affecting binocular movement. It is grouped under the ICD-10 codes block of H49 to H52. However, the classification of strabismus in ICD-10 is differentiated by the category H50 for all conditions that involves lack of coordination between the extraocular muscles affecting binocular movement and another category H40 which is for conditions caused by the paralysis of the lateral rectus muscle. Within the category H50, ICD-10 provides codes for the different types of esotropia and exotropia, i.e monocular, alternating and intermittent. H51 is the third category for all other disorders of binocular movement.

Myopia, also called nearsightedness and hypermetropia, also called farsightedness are common disorders of refraction and accommodation. Disorders of refraction and accommodation would not be complete if I do not mention here about astigmatism and presbyopia. The category H52 includes myopia, hypermetropia, astigmatism and presbyopia among others.

Many conditions listed under visual disturbances in ICD-10 can be symptoms of another condition, for example vascular disease, diabetes and congenital conditions.

Amblyopia (also known as ‘lazy eye’, is loss of vision in an eye which is otherwise healthy), blurred vision (patient suffers a loss of sharpness of vision and the inability to see small details), diplopia (double vision) causing a patient to see two objects instead of one and scotomas (blind spots) are areas in the field of vision that have been partially altered resulting in an area of partially diminished or entirely deteriorated visual acuity, surrounded by a normal field of vision.

Blurred vision is reported under code H53.8 Other visual disturbances, unlike all the other specified visual disturbances each with a separate ICD-10 code.

Do take note that the code for scintillating scotoma is not found under the subcategory H53.4 Visual field defects along with other types of scotomas, but you will find it is listed under subjective visual disturbances with the ICD-10 code H53.1

Before I go on to relate ICD-10 codes relevant to visual Impairment and blindness, I think it is worthwhile to understand the word perception in relation to the eye.

Martin (2008, p.180) explains that perception “is an internal representation of our external environment.” When a person becomes aware of, knows, or identifies an object by means of the senses (in this case the eyes), this act or faculty of perceiving, or apprehending by means of the senses or of the mind, cognition, and understanding is said to be visual perception. One hypothesis according to Martin (2008) is called ‘what’ vs. ‘how’ which postulates  that the visual system is divided into two or more streams of information. The ‘what’ pathway mediates the conscious recognition of objects and scenes. The ‘how’ pathway provides visuospatial information (ability to process and interpret visual information about where objects are in space) directly into the motor systems (the part of the central nervous system that is involved with movement) to guide our actions. Thus, different aspects of visual perceptions such as movement, depth, colour and shape are processed separately.

When a patient lacks in visual perception due to physiological or neurological factors, they are considered to have a form of visual impairment or blindness . Visual impairment is a chronic visual deficit situation when a patient complains that every day functioning is impaired. Eyeglasses or contact lenses cannot correct this impairment.

Total blindness is the other situation when there is a complete lack of form and there is no visual light perception.

Visual impairment including blindness in ICD-10 is classified to H54. A table below H54 gives a classification of severity of visual impairment. The definitions of codes, for example “Visual impairment category 5” is the definition for the code H54.0 Blindness, binocular is referred from this table. From the table, total blindness must be coded to H54.0 since the patient’s vision is deficit due to no visual light perception and because the definition of code H54.0 is “Visual impairment category 5”

In the next post, let’s examine (i) the two categories in the other disorders block of codes, nystagmus and other irregular eye movements and intraoperative and postoperative complications, (ii) conditions affecting the eyes that originate during the perinatal period, and (iii) traumatic injuries of the eye and ocular adnexa.

References:

  1. Gerard, JT & Bryan, D 2012, Principles of Anatomy & Physiology, 13th edn, John Wiley & Sons, Inc, New Jersey, USA
  2. Martin, JT 2008, An Introduction to the Visual System,  2nd edn, Cambridge University Press, Cambridge, UK
  3. Michael, M & Valerie, OL 2012, Human anatomy, 3rd edn, The McGraw-Hill Companies, Inc., New York, USA
  4. Phillip, T 2012, Seeley’s principles of anatomy & physiology, 2nd edn, The McGraw-Hill Companies, Inc., New York, USA
  5. World Health Organization 2011, Volume 1 Tabular list, International Statistical Classification of Diseases and Related Health Problems 10th Revision, 2010 edn, Geneva, Switzerland