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

APDC: Relevant conditions and scenarios that affects the eyes – Part 2

ICD-10-book-cover-for-APDC-series-labelAs I wrote some weeks ago in the post APDC: Relevant conditions and scenarios that affects the eyes – Part 1 (this link will open in a new tab of your current browser window), in this new instalment post of coding diseases of the eye and adnexa, I shall discuss about cataracts affecting the lens, conditions affecting the choroid and retina, on to glaucoma characterised by damage of the optic nerve, and to end this post with some conditions affecting the vitreous body and globe and their appropriate coding.

ICD 10 has one (1) block ranging from codes H25-H28 for all disorders of lens within the Chapter VII Diseases of the eye and adnexa (H00-H59). Within this block, a Health Information Management (HIM) / Medical Records (MR) practitioner  will find four (4) sub-divisions (subcategories) of three (3) category categories of codes. The first sub-division H25 is for the single condition affecting the older population group – the senile cataract, three-character categories which I believe have been selected or grouped because of their frequency, severity or susceptibility to public health intervention.  The second, third and fourth sub-divisions i.e H26, H27 and H28 are grouped among diseases with some common characteristic as well as allowing many different but rarer conditions. As always there is a provision for ‘other’ conditions to be classified. Do take note that H25 to H27 each has a category for ‘unspecified’ conditions.

The results from the last known national eye survey conducted in 1996 to determine the prevalence of blindness and low vision and their major causes among the Malaysian population of all ages, cataract was the leading cause of blindness (39%) followed by retinal diseases (24%) and another result finding showed that uncorrected refractive errors (48%) and cataract (36%) were the major causes of low vision.

When coding cataracts in the young population, cataracts present at birth takes it place among the codes in the Chapter XVII Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99). Code H26.0 is only for cataracts diagnosed until later in life of new-borns namely infantile cataracts present early in life, but are not present at birth. Also take note that the subcategory for infantile and juvenile cataracts includes the descriptor presenile.

Cataracts caused by an underlying inflammatory disorder example cataract in chronic iridocyclitis are included in the category “Complicated cataract (H26.2)”.  Remember the option to use additional external cause code (Chapter XX), if desired, to identify drug in the case for drug-induced cataract or if desired, to identify cause in the case for traumatic cataract.

Two codes are required  for diabetic cataract, a special coding condition, whereby the coder has to go elsewhere to find the code for the underlying generalised disease and also report the code H28.0 since diabetic cataract is indeed a manifestation in a particular organ or site, in this case the eye and specifically the lens. This is the principle of the dagger and asterisk system which provides alternative classifications. Always code the primary code for the underlying disease which will be marked with a dagger (†) and code the optional additional code for the manifestation to be marked with an asterisk (*), in this case H28.0 The eye specialties everywhere normally have a desire to see diabetic cataract classified to the Chapter VII for this manifestation when it was the reason for medical care.

Now, for example when the diabetes is not identified as type 2? How do you code?

Rationally, I would code to E11.3 as the dagger code because of the following connection which is (i) you are directed from H28.0* – diabetic cataract to go to the block E10-E14 with common fourth character .3+, (ii) then I look up the block diabetes mellitus (E10-E14) from the Chapter IV Endocrine, nutritional and metabolic diseases (E00-E90), I find first “With ophthalmic complications, Diabetic: .3+, cataract (H28.0*) as among a list of fourth-character subdivisions for use with categories E10-E14 and type II, a inclusion term is listed below E11, and finally, (iii) since the coder is required to “See before E10 for subdivisions”. In summary, the asterisk code H28.0* leads me to find E11.3 from the above mentioned connection.

The category H33 lists codes regarding retinal detachments, when the retina is pulled or lifted away from its normal position. When there is a retinal break, detachment may or may not happen. Horseshoe tear, a type of retinal detachment with no retinal break is quite commonly reported and is given the code H33.3

What if you are presented with the main term “congenital macular degeneration” as the diagnosis? How will you find the correct code? You could look at congenital first, and you will be directed to find the condition. The condition is macular degeneration. Finding macular, you will locate degeneration (H35.3), and then to find hereditary (H35.5) at the second level.  This is the way your find your way in the Alphabetic Index forest of codes.

Glaucoma is another serious condition of the eye, actually it is a group of diseases of the eyes characterised by damage of the optic nerve which can lead to permanent damage to the optic nerve, loss of peripheral vision, and eventually, blindness. You may encounter some that are chronic and some that are acute while coding glaucoma.

In ICD 10, glaucoma that is described as congenital glaucoma is reported with a code from glaucoma described as childhood, infantile, juvenile, or congenital are all reported as congenital glaucoma with a code from Chapter XVII Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) unlike in the past revision, ICD 9 when glaucoma that is described as childhood, infantile, or juvenile is reported with a code from the Chapter 6 – Nervous System and Sense Organ.

Glaucoma may be secondary to eye trauma,  eye inflammation, to other eye disorders and maybe even drugs. You may use the additional code, if desired, to identify cause or use the additional external cause code (Chapter XX), if desired, to identify drug.

You may not find any specific code for glaucoma associated with vascular disorders this time around in ICD 10, and the likely code to pick will be H40.8 Other glaucoma.

Endophthalmitis is to me the most common condition I had encountered for all conditions affecting the globe, affecting multiple structures of the eye, such as inflammation, degenerative conditions, and retained foreign bodies. Infact the inclusion clause “disorders affecting multiple structures of eye” included below H44 Disorders of globe already confirms this. By the way, endophthalmitis is an inflammatory condition within the intraocular cavities affecting the aqueous or vitreous humor. However, the ICD 10 does not differentiate between the terms acute, chronic, and unspecified endophthalmitis anymore but you can look up the Alphabetic Index and locate the qualifying terms like acute and subacute listed there under the lead term endophthalmitis, and the go find the appropriate code H44.0 Purulent endophthalmitis.

Coding vitreous haemorrhage in ICD 10 has changed, it now stands alone as H43.1, unlike in ICD 9.

Incidentally I have delayed writing this kind of posts as it required pulling together all my resources, understanding all the diseases and conditions in this Chapter, and finally a desirable post for the reader I wish to convince into reading a technical post like this one.

Readers, I think I have not more than three (3) more instalment posts on coding diseases of the eye and adnexa.

Happy coding!

References:

  1. Gerard, JT & Bryan, D 2012, Principles of Anatomy & Physiology, 13th edn, John Wiley & Sons, Inc, New Jersey, USA
  2. Michael, M & Valerie, OL 2012, Human anatomy, 3rd edn, The McGraw-Hill Companies, Inc., New York, USA
  3. Phillip, T 2012, Seeley’s principles of anatomy & physiology, 2nd edn, The McGraw-Hill Companies, Inc., New York, USA
  4. World Health Organization 2011, Volume 1 Tabular list, International Statistical Classification of Diseases and Related Health Problems 10th Revision, 2010 edn, Geneva, Switzerland
  5. Zainal, M, Ismail, SM, Ropilah, AR, Elias, H, Arumugam, G, Alias, G, Fathilah, J, Lim, TO, Ding, LM and Goh, PP 2002, Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1996, British Journal of Ophthalmology, September; 86(9): 951–956.viewed 27 Nov 2013, <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1771293/>

WHO-FIC Network Annual Meeting 2013 – Beijing, People’s Republic of China

A Health Information Management (HIM) / Medical Records (MR) practitioner reader of this website-blog will surely be familiar and knowledgeable of The International Classification of Diseases (ICD) that covers death and disease, two main parameters of health and the health system.

Perhaps many  HIM / MR practitioners may still not know that the ICD is one other reference classification which belongs to the World Health Organization Family of International Classifications (WHO-FIC)  Likewise, ICF (the International Classification of Functioning and Disability) and ICHI (International Classification of Health Interventions) are also reference classifications which belong to the WHO-FIC.

I think it is appropriate for any HIM / MR practitioner to be aware of developments of WHO classifications such as the ICD.  In this post, I like to share in this post of what is already available at the WHO website about the 2013 Annual Meeting of the International Network of WHO-FIC Collaborating Centres (WHO-FIC 2013) which will be held at the Empark Grand Hotel, in Beijing, China, from 12 to 18 October 2013. This year’s theme is: “Universal Health Coverage: Information and Innovation”. The reader can view detailed information about the meeting venue, accommodation and registration available on the meeting website at this link (this link will open in a new tab of your current browser window).

Since participation to this meeting is by invitation only, I like to suggest – since HIM / MR practitioner readers will already be familiar with ICD-10 but need to be aware of the ICD-11 revision, to focus and follow the progress and developments in ICD-10 and ICD-11 to be presented when the WHO-FIC Council meets in Beijing soon to review progress in relation to the strategic work plan of the WHO-FIC network and plan for the future. Please click on these links below (each of these links will open in a new tab of your current browser window) to know and learn the progress and developments in ICD-10 and ICD-11 :

progress and developments in ICD-10

progress and developments in ICD-11

References:

  1. WHO-FIC Network Annual Meeting 2013 – Beijing, People’s Republic of China, Classifications, The World Health Organisation (WHO), viewed 3 October 2013, <http://apps.who.int/classifications/network/meeting2013/en/>
  2. WHO-FIC Network Annual Meeting 2013, 2013 WHO-FIC Network, The World Health Organisation (WHO), viewed 3 October 2013, <http://www.whofic2013.org/register/toFrontPage.do>