INTRODUCTION TO ICD-10-CM CODES: PART 3 CHAPTER-SPECIFIC GUIDELINES CHAPTERS 16-21 2012 Official Guidelines for Coding and Reporting COURSE DESCRIPTION This CE course is the third of three courses that introduces basic information on ICD-10-CM codes. This course identifies diseases and injuries in Chapters 16-21of the ICD-10-CM Tabular List, including examples of codes found in each chapter. Also included are chapter-specific coding guidelines and attachments of the Tabular List, Alphabetic Index, and Table of Drugs. Rev 4.0 ©May 2014 1 COURSE TITLE: Introduction to ICD-10-CM: Part 3 Author: Steve M. Verno, CMBSI, CMSCS, CEMCS, CPM-MCS Billing and Coding Consultant Heal Your Practice Lucia Johnson, M.A. Ed, MT(ASCP)SBB Vice President, Recertification NCCT Number of Clock Hours Credit: 6.0 Course # 1221412 P.A.C.E. ® Approved: __ Yes X_ No OBJECTIVES Upon completion of this continuing education course, the professional should be able to: 1. Identify diseases and injuries located in Chapters 16-21 of the ICD10-CM Tabular List. 2. List examples of codes found in Chapters 16-21 of the ICD-10-CM Tabular List. 3. Identify chapter-specific coding guidelines in Chapters 16-21 based on the 2012 ICD-10-CM Official Guidelines for Coding and Reporting. 4. Using the examples of the Tabular List, Alphabetic Index, and Table of Drugs provided, locate codes for specific diseases and injuries. Disclaimer The writers for NCCT continuing education courses attempt to provide factual information based on literature review and current professional practice. However, NCCT does not guarantee that the information contained in the continuing education courses is free from all errors and omissions. 2 INTRODUCTION Chapters 16-21 of the ICD-10-CM codes (2012 version) will be reviewed in this last of three introductory courses which discusses the new diagnosis codes that will be implemented on October 1, 2014*. *NOTE: On 3/27/2014, Congress voted to delay implementation of ICD-10 code sets until October 1, 2015. The NCCT CE courses Introduction to ICD-10-CM Codes: Part 1 and Introduction to ICD-10-CM Codes: Part 2 should be completed before this course. The Part 1 introduction course reviews the structure and conventions of ICD-10-CM codes which assists with the understanding of the content presented in this course. The Part 2 introduction course provides information on Chapters 1-15 of the ICD-10-CM Tabular List. CHAPTER REVIEW The following table identifies diseases and injuries found in Chapters 16-21 of the ICD10-CM Tabular List. Associated codes and examples of codes are included. The examples of codes should be reviewed with attention placed on code structure and increased specificity. As discussed in CE course Introduction to ICD-10-CM: Part 1, ICD-10-CM codes are structured as follows. Combination of letters and numbers that can go to as many as 7 characters  Characters 1-3: Category o First character is alpha o Characters 2 and 3 are numeric  Characters 4-6: Etiology, anatomic site, severity, or other clinical detail such as laterality o Can be alpha or numeric  Character 7: Extension (initial encounter, subsequent encounter, sequela, etc.) o Can be alpha or numeric ICD-10-CM CHAPTER NUMBER 16 CHAPTER TITLE/ASSOCIATED CODES Certain Conditions Originating in the Newborn (perinatal period)            Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery: P00 – P04 Disorders related to length of gestation and fetal growth: P05 – P08 Abnormal findings on neonatal screening: P09 Birth trauma: P10 – P15 Respiratory and cardiovascular disorders specific to the perinatal period: P10 – P29 Hemorrhagic and hematological disorders of newborn: P50 – P61 Transitory endocrine and metabolic disorders specific to newborn: P70 – P74 Digestive system disorders of newborn: P76 – P78 Conditions involving the integument and temperature regulation of newborn: P80 – P83 Other problems with newborn: P84 Other disorders originating in the perinatal period: P90 – P96 Examples from the Tabular List  P00.4 Newborn (suspected to be) affected by maternal nutritional disorders 3                       17 P01.01 P02.4 P03.2 P04.2 P05.18 P07.33 P08.2 P09 P10.4 P12.3 P24.00 P28.3 P35.1 P39.3 P51.9 P52.6 P55.1 P58.41 P61.3 P70.2 P74.1 P92.6 Newborn (suspected to be) affected by premature rupture of membranes Newborn (suspected to be) affected by prolapsed cord Newborn (suspected to be) affected by forceps delivery Newborn (suspected to be) affected by maternal use of tobacco Newborn small for gestational age, 2000-2499 grams Preterm newborn, gestational age 30 completed weeks Post-term newborn Abnormal findings on neonatal screening Tentorial tear due to birth injury Bruising of scalp due to birth injury Meconium aspiration without respiratory symptoms Primary sleep apnea of newborn Congenital cytomegalovirus infection Neonatal urinary tract infection Umbilical hemorrhage of newborn Cerebellar (nontraumatic) and posterior fossa hemorrhage of newborn ABO isoimmunization of newborn Neonatal jaundice due to drugs or toxins transmitted from mother Congenital anemia from fetal blood loss Neonatal diabetes mellitus Dehydration of newborn Failure to thrive in newborn Congenital Malformations, Deformations, and Chromosomal Abnormalities            Congenital malformations of the nervous system: Q00 – Q07 Congenital malformations of the eye, ear, face, and neck: Q10 – Q18 Congenital malformations of the circulatory system: Q20 – Q28 Congenital malformations of the respiratory system: Q30 – Q34 Cleft lip and cleft palate: Q35 – Q37 Other congenital malformations of the digestive system: Q38 – Q45 Congenital malformations of the genital organs: Q50 – Q56 Congenital malformations of the urinary system: Q60 – Q64 Congenital malformations and deformations of the musculoskeletal system: Q65 – Q79 Other congenital malformations: Q80 – Q89 Chromosomal abnormalities, not elsewhere classified: Q90 – Q99 Examples from the Tabular List  Q00.0 Anencephaly  Q01.2 Occipital encephalocele  Q04.5 Megalencephaly  Q05.0 Cervical spina bifida with hydrocephalus  Q07.03 Arnold-Chiari syndrome with spina bifida and hydrocephalus  Q10.2 Congenital entropion  Q13.3 Congenital corneal opacity  Q16.0 Congenital absence of (ear) auricle  Q18.3 Webbing of neck  Q21.3 Tetralogy of Fallot  Q22.4 Congenital tricuspid stenosis  Q25.0 Patent ductus arteriosus  Q27.32 Arteriovenous malformation of renal vessel  Q30.3 Congenital perforated nasal septum  Q35.1 Cleft hard palate  Q37.2 Cleft soft palate with bilateral cleft lip  Q39.6 Congenital diverticulum of esophagus  Q43.1 Hirschsprung’s disease  Q44.6 Cystic disease of liver  Q50.01 Congenital absence of ovary, unilateral  Q52.11 Transverse vaginal septum  Q53.02 Ectopic testis, unilateral  Q55.5 Congenital absence and aplasia of penis  Q61.01 Congenital single renal cyst  Q64.5 Congenital absence of bladder and urethra 4            18 Q66.2 Q70.02 Q72.31 Q74.1 Q76.427 Q77.4 Q79.6 Q85.1 Q09.2 Q96.0 Q98.0 Congenital metatarsus (primus) varus Fused fingers, left hand Congenital absence of right foot and toe(s) Congenital malformation of knee Congenital lordosis, lumbosacral region Acondroplasia Ehlers-Danlos syndrome Tuberous sclerosis Trisomy 21, translocation Karyotype 45, X Klinefelter syndrome karyotype 47, XXY Symptoms, Signs, and Abnormal Clinical and Laboratory Findings               Symptoms and signs involving the circulatory and respiratory systems: R00 – R09 Symptoms and signs involving the digestive system and abdomen: R10 – R19 Symptoms and signs involving the skin and subcutaneous tissue: R20 – R23 Symptoms and signs involving the nervous and musculoskeletal systems: R25 – R29 Symptoms and signs involving the genitourinary system: R30 – R39 Symptoms and signs involving cognition, perception, emotional state, and behavior: R40 – R46 Symptoms and signs involving speech and voice: R47 – R49 General symptoms and signs: R50 – R69 Abnormal findings on examination of blood, without diagnosis: R70 – R79 Abnormal findings on examination of urine, without diagnosis: R80 – R82 Abnormal findings on examination of other body fluids, substances, and tissues, without diagnosis: R83 – R89 Abnormal findings on diagnostic imaging and in function studies, without diagnosis: R90 – R94 Abnormal tumor markers: R97 Ill-defined and unknown cause of mortality: R99 Examples from the Tabular List  R00.0 Tachycardia, unspecified  R00.2 Palpitations  R03.0 Elevated blood-pressure reading, without diagnosis of hypertension  R04.0 Epistaxis  R04.4 Hemoptysis  R06.02 Shortness of breath  R07.1 Chest pain on breathing  R09.1 Pleurisy  R09.81 Nasal congestion  R10.11 Right upper quadrant pain  R11.1 Vomiting  R14.3 Flatulence  R19.06 Epigastric swelling, mass or lump  R20.3 Hyperesthesia  R23.3 Spontaneous ecchymosis  R29.4 Clicking hip  R35.1 Nocturia  R36.0 Urethral discharge without blood  R40.0 Somnolence  R41.81 Age-related cognitive decline  R45.1 Restlessness and agitation  R45.86 Emotional lability  R47.81 Slurred speech  R50.83 Postvaccination fever  R56.00 Simple febrile convulsions  R60.0 Localized edema  R63.1 Polydipsia  R68.11 Excessive crying of infant (baby)  R70.0 Elevated erythrocyte sedimentation rate  R73.01 Impaired fasting glucose  R78.79 Finding of abnormal level of heavy metals in blood  R82.3 Hemoglobinuria 5     19 R87.5 R92.2 R94.31 R97.2 Abnormal microbiological findings in specimens from female genital organs Inconclusive mammogram Abnormal electrocardiogram [ECG] [EKG] Elevated prostate specific antigen [PSA] Injury, Poisoning, and Certain Other External Consequences of External Causes                       Injuries to the head: S00 – S09 Injuries to the neck: S10 – S19 Injuries to the thorax: S20 – S29 Injuries to the abdomen, lower back, lumbar spine, pelvis, and external genitals: S30 – S39 Injuries to the shoulder and upper arm: S40 – S49 Injuries to the elbow and forearm: S50 – S59 Injuries to the wrist, hand, and fingers: S60 – S69 Injuries to the hip and thigh: S70 – S79 Injuries to the knee and lower leg: S80 – S89 Injuries to the ankle and foot: S90 – S99 Unspecified multiple injuries: T07 Injury of unspecified body region: T14 Effects of foreign body entering through natural orifice: T15 – T19 Burns and corrosions of external body surface, specified by site: T20 – T25 Burns and corrosions confined to eye and internal organs: T26 – T28 Burns and corrosions of multiple and unspecified body regions: T30 – T32 Frostbite: T33 – T34 Poisoning by, adverse effects of, and underdosing of drugs, medicaments, and biological substances: T36 – T50 Toxic effects of substances chiefly nonmedical as to source: T51 – T65 Other and unspecified effects of external causes: T66 – T78 Certain early complications of trauma: T79 Complications of surgical and medical care, not elsewhere classified: T80 – T88 Examples from the Tabular List  S00.03 Contusion of scalp  S00.12 Contusion of left eyelid and periocular area  S00.451 Superficial foreign body of right ear  S00.561 Insect bite (nonvenomous) of lip  S01.24 Puncture wound with foreign body of nose  S01.451 Laceration of lip and oral cavity without foreign body  S02.2 Fracture of nasal bones  S03.2 Dislocation of tooth  S04.51 Injury of facial nerve, right side  S05.72 Avulsion of left eye  S06.2X4 Diffuse traumatic brain injury with loss of consciousness of 6 hours to 24 hours  S06.320 Contusion and laceration of left cerebrum without loss of consciousness  S06.825 Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level  S08.122 Partial traumatic amputation of left ear  S13.130 Subluxation of C2/C3 cervical vertebrae  S15.011 Minor laceration of right carotid artery  S21.052 Open bite of left breast  S22.070 Wedge compression fracture of T9/T10 vertebra  S25.511 Laceration of intercostal blood vessels, right side  S31.824 Puncture wound with foreign body of left buttock  S32.2 Fracture of coccyx  S32.482 Displaced dome fracture of left acetabulum  S33.6 Sprain of sacroiliac joint  S36.031 Moderate laceration of spleen  S37.522 Contusion of fallopian tube, bilateral  S42.242 4-part fracture of surgical neck of left humerus  S44.22 Injury of radial nerve a upper arm level, left arm  S46.392 Other injury of muscle, fascia, and tendon of triceps, left arm  S48.021 Partial traumatic amputation at right shoulder joint  S52.122 Displaced fracture of head of left radius 6                                                      20 S53.401 Unspecified sprain of right elbow S57.82 Crushing injury of left forearm S60.111 Contusion of right thumb with damage to nail S60.322 Blister (nonthermal) of left thumb S61.324 Laceration with foreign body of right ring finger with damage to nail S62.211 Bennett’s fracture, right hand S62.645 Nondisplaced fracture of proximal phalanx of left ring finger S63.410 Traumatic rupture of collateral ligament of right index finger at metacarpophalangeal and interphalangeal joint S65.412 Laceration of blood vessel of left thumb S66.319 Strain of extensor muscle, fascia and tendon of unspecified finger at wrist and hand level S70.01 Contusion of right hip S72.432 Displaced fracture of medial condyle of left femur S76.321 Laceration of muscle, fascia and tendon of the posterior muscle group at thigh level, right thigh S82.045 Nondisplaced comminuted fracture of left patella S83.512 Sprain of anterior cruciate ligament of left knee S90.111 Contusion of right great toe without damage to nail S91.351 Open bite, right foot S96.022 Laceration of muscle and tendon of long flexor muscle of toe at ankle and foot level, left foot T15.11 Foreign body in conjunctival sac, right eye T20.26 Burn of second degree of forehead and cheek T21.75 Corrosion of third degree of buttock T23.251 Burn of second degree of right palm T26.02 Burn of left eyelid and periocular area T32.98 Corrosions involving 90% or more of body surface with 80-89% third degree corrosion T33.532 Superficial frostbite of left finger(s) T36.4X2 Poisoning by tetracyclines, intentional self-harm T37.5X5 Adverse effect of antiviral drugs T41.1X5 Adverse effect of intravenous anesthetics T42.4X6 Underdosing of benzodiazepines T43.621 Poisoning by amphetamines, accidental (unintentional) T45.515 Adverse effect of anticoagulants T47.2X5 Adverse effect of stimulant laxatives T50.5X3 Poisoning by appetite depressants, assault T52.8X1 Toxic effect of other organic solvents, accidental (unintentional) T58.02 Toxic effect of carbon monoxide from motor vehicle exhaust, intentional self-harm T62.0X1 Toxic effect of ingested mushrooms, accidental (unintentional) T63.331 Toxic effect of venom of brown recluse spider, accidental (unintentional) T67.3 Heat exhaustion, anhidrotic T71.113 Asphyxiation due to smothering under pillow, assault T74.12 Child physical abuse, confirmed T75.01 Shock due to being struck by lightning T75.3 Motion sickness T76.21 Adult sexual abuse, suspected T78.01 Anaphylactic reaction due to peanuts T79.4 Traumatic shock T80.212 Local infection due to central venous catheter T80.310 ABO incompatibility with acute hemolytic transfusion reaction T81.500 Unspecified complication of foreign body accidentally left in body following surgical operation T82.03 Leakage of heart valve prosthesis T83.32 Displacement of intrauterine contraceptive device T84.033 Mechanical loosening of internal left knee prosthetic joint T86.841 Corneal transplant failure T88.0 Infection following immunization External Causes of Morbidity       Pedestrian injured in transport accident: V00 – V09 Pedal cycle rider injured in transport accident: V10 – V19 Motorcycle rider injured in transport accident: V20 – V29 Occupant of 3-wheeled motor vehicle injured in transport accident: V30 – V39 Car occupant injured in transport accident: V40 – V49 Occupant of pick-up truck or van injured in transport accident: V50 – V59 7                        Occupant of heavy transport vehicle injured in transport accident: V60 – V69 Bus occupant injured in transport accident: V70 – V79 Other land transport accidents: V80 – V89 Water transport accidents: V90 – V94 Air and space transport accidents: V95-V97 Other and unspecified transport accidents: V98 – V99 Slipping, tripping, stumbling, and falls: W00 – W19 Exposure to inanimate mechanical forces: W20 – W49 Exposure to animate mechanical forces: W50 – W64 Accidental non-transport drowning and submersion: W65 – W74 Exposure to electric current, radiation, and extreme ambient air temperature and pressure: W85 – W99 Exposure to smoke, fire, and flames: X00 – X08 Contact with heat and hot substances: X10 – X19 Exposure to forces of nature: X30 – X39 Accidental exposure to other specified factors: X52 – X58 Intentional self-harm: X71 – X83 Assault: X92 – Y09 Event of undetermined intent: Y21 – Y33 Legal intervention, operations of war, military operations, and terrorism: Y35 – Y38 Misadventures to patients during surgical and medical care: Y62 – Y69 Medical devices associated with adverse incidents in diagnostic and therapeutic use: Y70 – Y82 Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure: Y83 – Y84 Supplementary factors related to causes of morbidity classified elsewhere: Y90 – Y99 Examples from the Tabular List  V00.01 Pedestrian on foot injured in collision with roller-skater  V00.132 Skateboarder colliding with stationary object  V00.811 Fall from moving wheelchair (powered)  V09.21 Pedestrian injured in traffic accident involving military vehicle  V26.4 Motorcycle driver injured in collision with other nonmotor vehicle in traffic accident  V37.1 Passenger in three-wheeled motor vehicle injured in collision with fixed or stationary object in nontraffic accident  V45.6 Car passenger injured in collision with railway train or railway vehicle in traffic accident  V64.4 Person boarding or alighting a heavy transport vehicle injured in noncollision transport accident  V80.010 Animal-rider injured by fall from or being thrown from horse in noncollision accident  V86.11 Passenger of ambulance or fire engine injured in traffic accident  V90.15 Drowning and submersion due to canoe or kayak sinking  V91.04 Burn due to sailboat on fire  V93.62 Machinery accident on board fishing boat  V95.41 Spacecraft crash injuring occupant  W10.1 Fall (on) (from) sidewalk curb  W16.012 Fall into swimming pool striking water surface causing other injury  W18.42 Slipping, tripping and stumbling without falling due to stepping into hole or opening  W21.02 Struck by soccer ball  W22.11 Striking against or struck by driver side automobile airbag  W21.0 Contact with powered kitchen appliance  W33.12 Accidental malfunction of hunting rifle  W46.1 Contact with contaminated hypodermic needle  W54.0 Bitten by dog  W56.41 Bitten by shark  W61.11 Bitten by macaw  W88.1 Exposure to radioactive isotopes  W93.2 Prolonged exposure in deep freeze unit or refrigerator  X00.3 Fall from burning building or structure in uncontrolled fire  X11.0 Contact with hot water in bath or tub  X17 Contact with hot engines, machinery and tools  X34 Earthquake  X73.0 Intentional self-harm by shotgun discharge  Y02.0 Assault by pushing or placing victim in front of motor vehicle  V07.420 Foster father, perpetrator of maltreatment and neglect  Y35.001 Legal intervention involving unspecified firearm discharge, law enforcement official injured  Y36.270 War operations involving fragments from weapons, military personnel 8               21 Y36.6X1 Y37.92 Y38.3X2 Y38.811 Y62.0 Y63.3 Y65.53 Y76.0 Y84.1 War operation involving biological weapons, civilian Military operations involving friendly fire Terrorism involving fires, conflagration and hot substances, civilian injured Terrorism involving suicide bomber, public safety official injured Failure of sterile precautions during surgical operation Inadvertent exposure of patient to radiation during medical care Performance of correct procedure (operation) on wrong side or body part Diagnostic and monitoring obstetric and gynecological devices associated with adverse incidents Kidney dialysis as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure Y90.5 Blood alcohol level of 100-119 mg/100 mL Y92.017 Garden or yard in single-family (private) house as the place of occurrence of the external cause Y92.221 Middle school as the place of occurrence of the external cause Y93.75 Activity, martial arts Y93.K1 Activity, walking an animal Factors Influencing Health Status and Contact with Health Services               Persons encountering health services for examination: Z00 – Z13 Genetic carrier and genetic susceptibility to disease: Z14 – Z15 Infection and drug-resistant microorganisms: Z16 Estrogen receptor status: Z17 Retained foreign body fragments: Z18 Persons with potential health hazards related to communicable diseases: Z20 – Z28 Persons encountering health services in circumstances related to reproduction: Z30 – Z39 Persons encountering health services for specific procedures and health care: Z40 – Z53 Persons with potential health hazards related to socioeconomic and psychosocial circumstances: Z55 – Z65 Do not resuscitate (DNR) status: Z66 Blood type: Z67 Body mass index (BMI): Z68 Persons encountering health services in other circumstances: Z69 – Z76 Persons with potential health hazards related to family and personal history and certain conditions influencing health status: Z77 – Z99 Examples from the Tabular List  Z00.111 Health examination for newborn 8 to 28 days old  Z00.3 Encounter for examination for adolescent development state  Z01.110 Encounter for hearing examination following failed hearing screening  Z01.83 Encounter for blood typing  Z02.1 Encounter for pre-employment examination  Z02.83 Encounter for blood-alcohol and blood-drug test  Z12.31 Encounter for screening mammogram for malignant neoplasm of breast  Z15.02 Genetic susceptibility to malignant neoplasm of ovary  Z16.21 Resistance to vancomycin  Z22.51 Carrier of viral hepatitis B  Z28.01 Immunization not carried out because of acute illness of patient  Z31.41 Encounter for fertility testing  Z34.02 Encounter for supervision of normal first pregnancy, second trimester  Z43.2 Encounter for attention to ileostomy  Z45.010 Encounter for checking and testing of cardiac pacemaker pulse generator [battery]  Z48.811 Encounter for surgical aftercare following surgery on the nervous system  Z52.4 Kidney donor  Z55.3 Underachievement in school  Z56.82 Military employment status  Z59.0 Homelessness  Z62.22 Institutional upbringing  Z63.0 Problems in relationship with spouse or partner  Z65.2 Problems related to release from prison  Z65.4 Victim of crime and terrorism  Z67.21 Type B blood, Rh negative  Z68.37 Body mass index (BMI) 37.0 – 37.9, adult  Z69.010 Encounter for mental health services for victim of parental child abuse  Z71.6 Tobacco abuse counseling 9                  Z76.82 Z77.21 Z79.52 Z80.42 Z82.41 Z84.81 Z85.6 Z86.14 Z87.312 Z88.2 Z89.212 Z91.010 Z91.11 Z94.7 Z95.810 Z97.2 Z99.81 Awaiting organ transplant status Contact with and (suspected) exposure to potentially hazardous body fluids Long term (current) use of systemic steroids Family history of malignant neoplasm of prostate Family history of sudden cardiac death Family history of carrier of genetic disease Personal history of leukemia Personal history of Methicillin resistant Staphylococcus aureus infection Personal history of (healed) stress fracture Allergy status to sulfonamides status Acquired absence of left upper limb below elbow Allergy to peanuts Patient’s noncompliance with dietary regimen Corneal transplant status Presence of automatic (implantable) cardiac defibrillator Presence of dental prosthetic device (complete) (partial) Dependence on supplemental oxygen CODING GUIDELINES: CHAPTERS 16-21 The following are coding guidelines for ICD-10-CM that come from the Centers for Medicare and Medicaid Services (CMS). This information is from the CMS website (www.cms.gov) and it is in the public domain, available for downloading and use without copyright infringement. 10 ICD-10-CM Official Guidelines for Coding and Reporting 2012 Narrative changes appear in bold text Items underlined have been moved within the guidelines since the 2011 version Italics are used to indicate revisions to heading changes The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines should be used as a companion document to the official version of the ICD-10CM as published on the NCHS website. The ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings. The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO). These guidelines have been approved by the four organizations that make up t he Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. The instructions and conventions of the classification take precedence over guidelines. These guidelines are based on t he coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses and procedures that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. W ithout such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated. The term encounter is used for all settings, including hospital admissions. In the context of these guidelines, the term provider is used throughout the guidelines to mean physician or any qualified health care practitioner who is legally accountable for establishing the patient’s diagnosis. Only this set of guidelines, approved by the Cooperating Parties, is official. The guidelines are organized into sections. Section I includes the structure and conventions of the classification and general guidelines that apply to the entire classification, and chapterspecific guidelines that correspond to the chapters as they are arranged in the classification. Section II includes guidelines for selection of principal diagnosis for non-outpatient settings. Section III includes guidelines for reporting additional diagnoses in non-outpatient settings. Section IV is for outpatient coding and reporting. It is necessary to review all sections of the guidelines to fully understand all of the rules and instructions needed to code properly. 16. Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96) For coding and reporting purposes the perinatal period is defined as before birth through the 28th day following birth. The following guidelines are provided for reporting purposes a. General Perinatal Rules 1) Use of Chapter 16 Codes Codes in this chapter are never for use on the maternal record. Codes from Chapter 15, the obstetric chapter, are never permitted on the newborn record. Chapter 16 codes may be used throughout the life of the patient if the condition is still present. 2) Principal Diagnosis for Birth Record When coding the birth episode in a newborn record, assign a code from category Z38, Liveborn infants according to place of birth and type of delivery, as the principal diagnosis. A code from category Z38 is assigned only once, to a newborn at the time of birth. If a newborn is transferred to another institution, a code from category Z38 should not be used at the receiving hospital. A code from category Z38 is used only on the newborn record, not on the mother’s record. 3) Use of Codes from other Chapters with Codes from ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 59 of 113 Chapter 16 Codes from other chapters may be used with codes from chapter 16 if the codes from the other chapters provide more specific detail. Codes for signs and symptoms may be assigned when a definitive diagnosis has not been established. If the reason for the encounter is a perinatal condition, the code from chapter 16 should be sequenced first. 4) Use of Chapter 16 Codes after the Perinatal Period Should a condition originate in the perinatal period, and continue throughout the life of the patient, the perinatal code should continue to be used regardless of the patient’s age. 5) Birth process or community acquired conditions If a newborn has a condition that may be either due to the birth process or community acquired and the documentation does not indicate which it is, the default is due to the birth process and the code from Chapter 16 should be used. If the condition is community-acquired, a code from Chapter 16 should not be assigned. 6) Code all clinically significant conditions All clinically significant conditions noted on routine newborn examination should be coded. A condition is clinically significant if it requires:  clinical evaluation; or  therapeutic treatment; or  diagnostic procedures; or  extended length of hospital stay; or  increased nursing care and/or monitoring; or  has implications for future health care needs Note: The perinatal guidelines listed above are the same as the general coding guidelines for “additional diagnoses”, except for the final point regarding implications for future health care needs. Codes should be assigned for conditions that have been specified by the provider as having implications for future health care needs. b. Observation and Evaluation of Newborns for Suspected Conditions not Found Assign a code from categories P00-P04 to identify those instances when a healthy newborn is evaluated for a suspected condition that is determined after study not to be present. Do not use a code from ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 60 of 113 categories P00-P04 when the patient has identified signs or symptoms of a suspected problem; in such cases, code the sign or symptom. c. Coding Additional Perinatal Diagnoses 1) Assigning codes for conditions that require treatment Assign codes for conditions that require treatment or further investigation, prolong the length of stay, or require resource utilization. 2) Codes for conditions specified as having implications for future health care needs Assign codes for conditions that have been specified by the provider as having implications for future health care needs. Note: This guideline should not be used for adult patients. d. Prematurity and Fetal Growth Retardation Providers utilize different criteria in determining prematurity. A code for prematurity should not be assigned unless it is documented. Assignment of codes in categories P05, Disorders of newborn related to slow fetal growth and fetal malnutrition, and P07, Disorders of newborn related to short gestation and low birth weight, not elsewhere classified, should be based on the recorded birth weight and estimated gestational age. Codes from category P05 should not be assigned with codes from category P07. When both birth weight and gestational age are available, two codes from category P07 should be assigned, with the code for birth weight sequenced before the code for gestational age. A code from P05 and codes from P07.2 and P07.3 may be used to specify weeks of gestation as documented by the provider in the record. e. Low birth weight and immaturity status Codes from category P07, Disorders of newborn related to short gestation and low birth weight, not elsewhere classified, are for use for a child or adult who was premature or had a low birth weight as a newborn and this is affecting the patient’s current health status. See Section I.C.21. Factors influencing health status and contact with health services, Status. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 61 of 113 f. Bacterial Sepsis of Newborn Category P36, Bacterial sepsis of newborn, includes congenital sepsis. If a perinate is documented as having sepsis without documentation of congenital or community acquired, the default is congenital and a code from category P36 should be assigned. If the P36 code includes the causal organism, an additional code from category B95, Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere, or B96, Other bacterial agents as the cause of diseases classified elsewhere, should not be assigned. If the P36 code does not include the causal organism, assign an additional code from category B96. If applicable, use additional codes to identify severe sepsis (R65.2-) and any associated acute organ dysfunction. g. Stillbirth Code P95, Stillbirth, is only for use in institutions that maintain separate records for stillbirths. No other code should be used with P95. Code P95 should not be used on the mother’s record. 17. Chapter 17: Congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99) Assign an appropriate code(s) from categories Q00-Q99, Congenital malformations, deformations, and chromosomal abnormalities when a malformation/deformation or chromosomal abnormality is documented. A malformation/deformation/or chromosomal abnormality may be the principal/first-listed diagnosis on a record or a secondary diagnosis. When a malformation/deformation/or chromosomal abnormality does not have a unique code assignment, assign additional code(s) for any manifestations that may be present. When the code assignment specifically identifies the malformation/deformation/or chromosomal abnormality, manifestations that are an inherent component of the anomaly should not be coded separately. Additional codes should be assigned for manifestations that are not an inherent component. Codes from Chapter 17 may be used throughout the life of the patient. If a congenital malformation or deformity has been corrected, a personal history code should be used to identify the history of the malformation or deformity. Although present at birth, malformation/deformation/or chromosomal abnormality may not be identified until later in life. Whenever the condition is diagnosed by the physician, it is appropriate to assign a code from codes Q00-Q99.For the birth admission, the appropriate code from category Z38, Liveborn infants, according to place of birth and type of delivery, should be sequenced as the principal diagnosis, followed by any congenital anomaly codes, Q00- Q99. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 62 of 113 18. Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Chapter 18 includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded. Signs and symptoms that point to a specific diagnosis have been assigned to a category in other chapters of the classification. a. Use of symptom codes Codes that describe symptoms and signs are acceptable for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider. b. Use of a symptom code with a definitive diagnosis code Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code. Signs or symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification. c. Combination codes that include symptoms ICD-10-CM contains a number of combination codes that identify both the definitive diagnosis and common symptoms of that diagnosis. When using one of these combination codes, an additional code should not be assigned for the symptom. d. Repeated falls Code R29.6, Repeated falls, is for use for encounters when a patient has recently fallen and the reason for the fall is being investigated. Code Z91.81, History of falling, is for use when a patient has fallen in the past and is at risk for future falls. When appropriate, both codes R29.6 and Z91.81 may be assigned together. e. Coma scale The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 63 of 113 information is collected. The coma scale codes should be sequenced after the diagnosis code(s). These codes, one from each subcategory, are needed to complete the scale. The 7th character indicates when the scale was recorded. The 7th character should match for all three codes. At a minimum, report the initial score documented on presentation at your facility. This may be a score from the emergency medicine technician (EMT) or in the emergency department. If desired, a facility may choose to capture multiple coma scale scores. Assign code R40.24, Glasgow coma scale, total score, when only the total score is documented in the medical record and not the individual score(s). f. Functional quadriplegia Functional quadriplegia (code R53.2) is the lack of ability to use one’s limbs or to ambulate due to extreme debility. It is not associated with neurologic deficit or injury, and code R53.2 should not be used for cases of neurologic quadriplegia. It should only be assigned if functional quadriplegia is specifically documented in the medical record. g. SIRS due to Non-Infectious Process The systemic inflammatory response syndrome (SIRS) can develop as a result of certain non-infectious disease processes, such as trauma, malignant neoplasm, or pancreatitis. When SIRS is documented with a noninfectious condition, and no subsequent infection is documented, the code for the underlying condition, such as an injury, should be assigned, followed by code R65.10, Systemic inflammatory response syndrome (SIRS) of non-infectious origin without acute organ dysfunction, or code R65.11, Systemic inflammatory response syndrome (SIRS) of non-infectious origin with acute organ dysfunction. If an associated acute organ dysfunction is documented, the appropriate code(s) for the specific type of organ dysfunction(s) should be assigned in addition to code R65.11. If acute organ dysfunction is documented, but it cannot be determined if the acute organ dysfunction is associated with SIRS or due to another condition (e.g., directly due to the trauma), the provider should be queried. h. Death NOS Code R99, Ill-defined and unknown cause of mortality, is only for use in the very limited circumstance when a patient who has already died is brought into an emergency department or other healthcare facility ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 64 of 113 and is pronounced dead upon arrival. It does not represent the discharge disposition of death. 19. Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88) a. Application of 7th Characters in Chapter 19 Most categories in chapter 19 have a 7th character requirement for each applicable code. Most categories in this chapter have three 7th character values (with the exception of fractures): A, initial encounter, D, subsequent encounter and S, sequela. Categories for traumatic fractures have additional 7th character values. 7th character “A”, initial encounter is used while the patient is receiving active treatment for the condition. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician. 7th character “D” subsequent encounter is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external or internal fixation device, medication adjustment, other aftercare and follow up visits following treatment of the injury or condition. The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the 7th character “D” (subsequent encounter). 7th character “S”, sequela, is for use for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn. The scars are sequelae of the burn. When using 7th character “S”, it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself. The “S” is added only to the injury code, not the sequela code. The 7th character “S” identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code. b. Coding of Injuries When coding injuries, assign separate codes for each injury unless a combination code is provided, in which case the combination code is assigned. Code T07, Unspecified multiple injuries should not be assigned in the inpatient setting unless information for a more ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 65 of 113 specific code is not available. Traumatic injury codes (S00-T14.9) are not to be used for normal, healing surgical wounds or to identify complications of surgical wounds. The code for the most serious injury, as determined by the provider and the focus of treatment, is sequenced first. 1) Superficial injuries Superficial injuries such as abrasions or contusions are not coded when associated with more severe injuries of the same site. 2) Primary injury with damage to nerves/blood vessels When a primary injury results in minor damage to peripheral nerves or blood vessels, the primary injury is sequenced first with additional code(s) for injuries to nerves and spinal cord (such as category S04), and/or injury to blood vessels (such as category S15). When the primary injury is to the blood vessels or nerves, that injury should be sequenced first. c. Coding of Traumatic Fractures The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site in accordance with both the provisions within categories S02, S12, S22, S32, S42, S49, S52, S59, S62, S72, S79, S82, S89, S92 and the level of detail furnished by medical record content. A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced. More specific guidelines are as follows: 1) Initial vs. Subsequent Encounter for Fractures Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) while the patient is receiving active treatment for the fracture. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion. Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 66 of 113 the fracture during the healing or recovery phase. Examples of fracture aftercare are: cast change or removal, removal of external or internal fixation device, medication adjustment, and follow-up visits following fracture treatment. Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes. Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R). A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone. See Section I.C.13. Osteoporosis. The aftercare Z codes should not be used for aftercare for traumatic fractures. For aftercare of a traumatic fracture, assign the acute fracture code with the appropriate 7th character. 2) Multiple fractures sequencing Multiple fractures are sequenced in accordance with the severity of the fracture. d. Coding of Burns and Corrosions The ICD-10-CM makes a distinction between burns and corrosions. The burn codes are for thermal burns, except sunburns, that come from a heat source, such as a fire or hot appliance. The burn codes are also for burns resulting from electricity and radiation. Corrosions are burns due to chemicals. The guidelines are the same for burns and corrosions. Current burns (T20-T25) are classified by depth, extent and by agent (X code). Burns are classified by depth as first degree (erythema), second degree (blistering), and third degree (full-thickness involvement). Burns of the eye and internal organs (T26-T28) are classified by site, but not by degree. 1) Sequencing of burn and related condition codes Sequence first the code that reflects the highest degree of burn when more than one burn is present. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 67 of 113 a. When the reason for the admission or encounter is for treatment of external multiple burns, sequence first the code that reflects the burn of the highest degree. b. When a patient has both internal and external burns, the circumstances of admission govern the selection of the principal diagnosis or first-listed diagnosis. c. When a patient is admitted for burn injuries and other related conditions such as smoke inhalation and/or respiratory failure, the circumstances of admission govern the selection of the principal or first-listed diagnosis. 2) Burns of the same local site Classify burns of the same local site (three-character category level, T20-T28) but of different degrees to the subcategory identifying the highest degree recorded in the diagnosis. 3) Non-healing burns Non-healing burns are coded as acute burns. Necrosis of burned skin should be coded as a non-healed burn. 4) Infected Burn For any documented infected burn site, use an additional code for the infection. 5) Assign separate codes for each burn site When coding burns, assign separate codes for each burn site. Category T30, Burn and corrosion, body region unspecified is extremely vague and should rarely be used. 6) Burns and Corrosions Classified According to Extent of Body Surface Involved Assign codes from category T31, Burns classified according to extent of body surface involved, or T32, Corrosions classified according to extent of body surface involved, when the site of the burn is not specified or when there is a need for additional data. It is advisable to use category T31 as additional coding when needed to provide data for evaluating burn mortality, such as that needed by burn units. It is also advisable to use category T31 as an additional code for reporting purposes when there is mention of a third-degree burn involving 20 percent or more of the body surface. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 68 of 113 Categories T31 and T32 are based on the classic “rule of nines” in estimating body surface involved: head and neck are assigned nine percent, each arm nine percent, each leg 18 percent, the anterior trunk 18 percent, posterior trunk 18 percent, and genitalia one percent. Providers may change these percentage assignments where necessary to accommodate infants and children who have proportionately larger heads than adults, and patients who have large buttocks, thighs, or abdomen that involve burns. 7) Encounters for treatment of sequela of burns Encounters for the treatment of the late effects of burns or corrosions (i.e., scars or joint contractures) should be coded with a burn or corrosion code with the 7th character “S” for sequela. 8) Sequelae with a late effect code and current burn When appropriate, both a code for a current burn or corrosion with 7th character “A” or “D” and a burn or corrosion code with 7th character “S” may be assigned on the same record (when both a current burn and sequelae of an old burn exist). Burns and corrosions do not heal at the same rate and a current healing wound may still exist with sequela of a healed burn or corrosion. 9) Use of an external cause code with burns and corrosions An external cause code should be used with burns and corrosions to identify the source and intent of the burn, as well as the place where it occurred. e. Adverse Effects, Poisoning, Underdosing and Toxic Effects Codes in categories T36-T65 are combination codes that include the substance that was taken as well as the intent. No additional external cause code is required for poisonings, toxic effects, adverse effects and underdosing codes. 1) Do not code directly from the Table of Drugs Do not code directly from the Table of Drugs and Chemicals. Always refer back to the Tabular List. 2) Use as many codes as necessary to describe Use as many codes as necessary to describe completely all drugs, medicinal or biological substances. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 69 of 113 3) If the same code would describe the causative agent If the same code would describe the causative agent for more than one adverse reaction, poisoning, toxic effect or underdosing, assign the code only once. 4) If two or more drugs, medicinal or biological substances If two or more drugs, medicinal or biological substances are reported, code each individually unless a combination code is listed in the Table of Drugs and Chemicals. 5) The occurrence of drug toxicity is classified in ICD-10CM as follows: (a) Adverse Effect When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug (T36-T50). The code for the drug should have a 5th or 6th character “5” (for example T36.0X5-) Examples of the nature of an adverse effect are tachycardia, delirium, gastrointestinal hemorrhaging, vomiting, hypokalemia, hepatitis, renal failure, or respiratory failure. (b) Poisoning When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional selfharm, assault and undetermined. Use additional code(s) for all manifestations of poisonings. If there is also a diagnosis of abuse or dependence of the substance, the abuse or dependence is assigned as an additional code. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 70 of 113 Examples of poisoning include: (i) Error was made in drug prescription Errors made in drug prescription or in the administration of the drug by provider, nurse, patient, or other person. (ii) Overdose of a drug intentionally taken If an overdose of a drug was intentionally taken or administered and resulted in drug toxicity, it would be coded as a poisoning. (iii) Nonprescribed drug taken with correctly prescribed and properly administered drug If a nonprescribed drug or medicinal agent was taken in combination with a correctly prescribed and properly administered drug, any drug toxicity or other reaction resulting from the interaction of the two drugs would be classified as a poisoning. (iv) Interaction of drug(s) and alcohol When a reaction results from the interaction of a drug(s) and alcohol, this would be classified as poisoning. See Section I.C.4. if poisoning is the result of insulin pump malfunctions. (c) Underdosing Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer’s instruction. For underdosing, assign the code from categories T36-T50 (fifth or sixth character “6”). Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded. Noncompliance (Z91.12-, Z91.13-) or complication of care (Y63.8-Y63.9) codes are to be used with an underdosing code to indicate intent, if known. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 71 of 113 (d) Toxic Effects When a harmful substance is ingested or comes in contact with a person, this is classified as a toxic effect. The toxic effect codes are in categories T51-T65. Toxic effect codes have an associated intent: accidental, intentional self-harm, assault and undetermined. f. Adult and child abuse, neglect and other maltreatment Sequence first the appropriate code from categories T74.- (Adult and child abuse, neglect and other maltreatment, confirmed) or T76.(Adult and child abuse, neglect and other maltreatment, suspected) for abuse, neglect and other maltreatment, followed by any accompanying mental health or injury code(s). If the documentation in the medical record states abuse or neglect it is coded as confirmed (T74.-). It is coded as suspected if it is documented as suspected (T76.-). For cases of confirmed abuse or neglect an external cause code from the assault section (X92-Y08) should be added to identify the cause of any physical injuries. A perpetrator code (Y07) should be added when the perpetrator of the abuse is known. For suspected cases of abuse or neglect, do not report external cause or perpetrator code. If a suspected case of abuse, neglect or mistreatment is ruled out during an encounter code Z04.71, Encounter for examination and observation following alleged physical adult abuse, ruled out, or code Z04.72, Encounter for examination and observation following alleged child physical abuse, ruled out, should be used, not a code from T76. If a suspected case of alleged rape or sexual abuse is ruled out during an encounter code Z04.41, Encounter for examination and observation following alleged physical adult abuse, ruled out, or code Z04.42, Encounter for examination and observation following alleged rape or sexual abuse, ruled out, should be used, not a code from T76. See Section I.C.15. Abuse in a pregnant patient. g. Complications of care 1) General guidelines for complications of care (a) Documentation of complications of care ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 72 of 113 See Section I.B.16. for information on documentation of complications of care. 2) Pain due to medical devices Pain associated with devices, implants or grafts left in a surgical site (for example painful hip prosthesis) is assigned to the appropriate code(s) found in Chapter 19, Injury, poisoning, and certain other consequences of external causes. Specific codes for pain due to medical devices are found in the T code section of the ICD-10-CM. Use additional code(s) from category G89 to identify acute or chronic pain due to presence of the device, implant or graft (G89.18 or G89.28). 3) Transplant complications (a) Transplant complications other than kidney Codes under category T86, Complications of transplanted organs and tissues, are for use for both complications and rejection of transplanted organs. A transplant complication code is only assigned if the complication affects the function of the transplanted organ. Two codes are required to fully describe a transplant complication: the appropriate code from category T86 and a secondary code that identifies the complication. Pre-existing conditions or conditions that develop after the transplant are not coded as complications unless they affect the function of the transplanted organs. See I.C.21. for transplant organ removal status See I.C.2. for malignant neoplasm associated with transplanted organ. (b) Kidney transplant complications Patients who have undergone kidney transplant may still have some form of chronic kidney disease (CKD) because the kidney transplant may not fully restore kidney function. Code T86.1- should be assigned for documented complications of a kidney transplant, such as transplant failure or rejection or other transplant complication. Code T86.1- should not be assigned for post kidney transplant patients who have chronic kidney (CKD) unless a transplant complication such as transplant failure or rejection is documented. If the ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 73 of 113 documentation is unclear as to whether the patient has a complication of the transplant, query the provider. Conditions that affect the function of the transplanted kidney, other than CKD, should be assigned a code from subcategory T86.1, Complications of transplanted organ, Kidney, and a secondary code that identifies the complication. For patients with CKD following a kidney transplant, but who do not have a complication such as failure or rejection, see section I.C.14. Chronic kidney disease and kidney transplant status. 4) Complication codes that include the external cause As with certain other T codes, some of the complications of care codes have the external cause included in the code. The code includes the nature of the complication as well as the type of procedure that caused the complication. No external cause code indicating the type of procedure is necessary for these codes. 5) Complications of care codes within the body system chapters Intraoperative and postprocedural complication codes are found within the body system chapters with codes specific to the organs and structures of that body system. These codes should be sequenced first, followed by a code(s) for the specific complication, if applicable. 20. Chapter 20: External Causes of Morbidity (V01-Y99) Introduction: These guidelines are provided for the reporting of external causes of morbidity codes in order that there will be standardization in the process. These codes are secondary codes for use in any health care setting. External cause codes are intended to provide data for injury research and evaluation of injury prevention strategies. These codes capture how the injury or health condition happened (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault), the place where the event occurred the activity of the patient at the time of the event, and the person’s status (e.g., civilian, military). a. General External Cause Coding Guidelines 1) Used with any code in the range of A00.0-T88.9, Z00-Z99 ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 74 of 113 An external cause code may be used with any code in the range of A00.0-T88.9, Z00-Z99, classification that is a health condition due to an external cause. Though they are most applicable to injuries, they are also valid for use with such things as infections or diseases due to an external source, and other health conditions, such as a heart attack that occurs during strenuous physical activity. 2) External cause code used for length of treatment Assign the external cause code, with the appropriate 7th character (initial encounter, subsequent encounter or sequela) for each encounter for which the injury or condition is being treated. 3) Use the full range of external cause codes Use the full range of external cause codes to completely describe the cause, the intent, the place of occurrence, and if applicable, the activity of the patient at the time of the event, and the patient’s status, for all injuries, and other health conditions due to an external cause. 4) Assign as many external cause codes as necessary Assign as many external cause codes as necessary to fully explain each cause. If only one external code can be recorded, assign the code most related to the principal diagnosis. 5) The selection of the appropriate external cause code The selection of the appropriate external cause code is guided by the Alphabetic Index of External Causes and by Inclusion and Exclusion notes in the Tabular List. 6) External cause code can never be a principal diagnosis An external cause code can never be a principal (first-listed) diagnosis. 7) Combination external cause codes Certain of the external cause codes are combination codes that identify sequential events that result in an injury, such as a fall which results in striking against an object. The injury may be due to either event or both. The combination external cause code used should correspond to the sequence of events regardless of which caused the most serious injury. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 75 of 113 8) No external cause code needed in certain circumstances No external cause code from Chapter 20 is needed if the external cause and intent are included in a code from another chapter (e.g. T36.0X1- Poisoning by penicillins, accidental (unintentional)). b. Place of Occurrence Guideline Codes from category Y92, Place of occurrence of the external cause, are secondary codes for use after other external cause codes to identify the location of the patient at the time of injury or other condition. A place of occurrence code is used only once, at the initial encounter for treatment. No 7th characters are used for Y92. Only one code from Y92 should be recorded on a medical record. A place of occurrence code should be used in conjunction with an activity code, Y93. Do not use place of occurrence code Y92.9 if the place is not stated or is not applicable. c. Activity Code Assign a code from category Y93, Activity code, to describe the activity of the patient at the time the injury or other health condition occurred. An activity code is used only once, at the initial encounter for treatment. Only one code from Y93 should be recorded on a medical record. An activity code should be used in conjunction with a place of occurrence code, Y92. The activity codes are not applicable to poisonings, adverse effects, misadventures or sequela . Do not assign Y93.9, Unspecified activity, if the activity is not stated. A code from category Y93 is appropriate for use with external cause and intent codes if identifying the activity provides additional information about the event. d. Place of Occurrence, Activity, and Status Codes Used with other External Cause Code When applicable, place of occurrence, activity, and external cause status codes are sequenced after the main external cause code(s). Regardless of the number of external cause codes assigned, there ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 76 of 113 should be only one place of occurrence code, one activity code, and one external cause status code assigned to an encounter. e. If the Reporting Format Limits the Number of External Cause Codes If the reporting format limits the number of external cause codes that can be used in reporting clinical data, report the code for the cause/intent most related to the principal diagnosis. If the format permits capture of additional external cause codes, the cause/intent, including medical misadventures, of the additional events should be reported rather than the codes for place, activity, or external status. f. Multiple External Cause Coding Guidelines More than one external cause code is required to fully describe the external cause of an illness or injury. The assignment of external cause codes should be sequenced in the following priority: If two or more events cause separate injuries, an external cause code should be assigned for each cause. The first-listed external cause code will be selected in the following order: External codes for child and adult abuse take priority over all other external cause codes. See Section I.C.19., Child and Adult abuse guidelines. External cause codes for terrorism events take priority over all other external cause codes except child and adult abuse. External cause codes for cataclysmic events take priority over all other external cause codes except child and adult abuse and terrorism. External cause codes for transport accidents take priority over all other external cause codes except cataclysmic events, child and adult abuse and terrorism. Activity and external cause status codes are assigned following all causal (intent) external cause codes. The first-listed external cause code should correspond to the cause of the most serious diagnosis due to an assault, accident, or self-harm, following the order of hierarchy listed above. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 77 of 113 g. Child and Adult Abuse Guideline Adult and child abuse, neglect and maltreatment are classified as assault. Any of the assault codes may be used to indicate the external cause of any injury resulting from the confirmed abuse. For confirmed cases of abuse, neglect and maltreatment, when the perpetrator is known, a code from Y07, Perpetrator of maltreatment and neglect, should accompany any other assault codes. See Section I.C.19. Adult and child abuse, neglect and other maltreatment h. Unknown or Undetermined Intent Guideline If the intent (accident, self-harm, assault) of the cause of an injury or other condition is unknown or unspecified, code the intent as accidental intent. All transport accident categories assume accidental intent. 1) Use of undetermined intent External cause codes for events of undetermined intent are only for use if the documentation in the record specifies that the intent cannot be determined. i. Sequelae (Late Effects) of External Cause Guidelines 1) Sequelae external cause codes Sequela are reported using the external cause code with the 7th character “S” for sequela. These codes should be used with any report of a late effect or sequela resulting from a previous injury. 2) Sequela external cause code with a related current injury A sequela external cause code should never be used with a related current nature of injury code. 3) Use of sequela external cause codes for subsequent visits Use a late effect external cause code for subsequent visits when a late effect of the initial injury is being treated. Do not use a late effect external cause code for subsequent visits for followup care (e.g., to assess healing, to receive rehabilitative therapy) of the injury when no late effect of the injury has been documented. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 78 of 113 j. Terrorism Guidelines 1) Cause of injury identified by the Federal Government (FBI) as terrorism When the cause of an injury is identified by the Federal Government (FBI) as terrorism, the first-listed external cause code should be a code from category Y38, Terrorism. The definition of terrorism employed by the FBI is found at the inclusion note at the beginning of category Y38. Use additional code for place of occurrence (Y92.-). More than one Y38 code may be assigned if the injury is the result of more than one mechanism of terrorism. 2) Cause of an injury is suspected to be the result of terrorism When the cause of an injury is suspected to be the result of terrorism a code from category Y38 should not be assigned. Suspected cases should be classified as assault. 3) Code Y38.9, Terrorism, secondary effects Assign code Y38.9, Terrorism, secondary effects, for conditions occurring subsequent to the terrorist event. This code should not be assigned for conditions that are due to the initial terrorist act. It is acceptable to assign code Y38.9 with another code from Y38 if there is an injury due to the initial terrorist event and an injury that is a subsequent result of the terrorist event. k. External cause status A code from category Y99, External cause status, should be assigned whenever any other external cause code is assigned for an encounter, including an Activity code, except for the events noted below. Assign a code from category Y99, External cause status, to indicate the work status of the person at the time the event occurred. The status code indicates whether the event occurred during military activity, whether a non-military person was at work, whether an individual including a student or volunteer was involved in a non-work activity at the time of the causal event. A code from Y99, External cause status, should be assigned, when applicable, with other external cause codes, such as transport accidents and falls. The external cause status codes are not applicable to poisonings, adverse effects, misadventures or late effects. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 79 of 113 Do not assign a code from category Y99 if no other external cause codes (cause, activity) are applicable for the encounter. An external cause status code is used only once, at the initial encounter for treatment. Only one code from Y99 should be recorded on a medical record. Do not assign code Y99.9, Unspecified external cause status, if the status is not stated. 21. Chapter 21: Factors influencing health status and contact with health services (Z00-Z99) Note: The chapter specific guidelines provide additional information about the use of Z codes for specified encounters. a. Use of Z codes in any healthcare setting Z codes are for use in any healthcare setting. Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter. Certain Z codes may only be used as first-listed or principal diagnosis. b. Z Codes indicate a reason for an encounter Z codes are not procedure codes. A corresponding procedure code must accompany a Z code to describe any procedure performed. c. Categories of Z Codes 1) Contact/Exposure Category Z20 indicates contact with, and suspected exposure to, communicable diseases. These codes are for patients who do not show any sign or symptom of a disease but are suspected to have been exposed to it by close personal contact with an infected individual or are in an area where a disease is epidemic. Category Z77, indicates contact with and suspected exposures hazardous to health. Contact/exposure codes may be used as a first-listed code to explain an encounter for testing, or, more commonly, as a secondary code to identify a potential risk. 2) Inoculations and vaccinations Code Z23 is for encounters for inoculations and vaccinations. It indicates that a patient is being seen to receive a prophylactic ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 80 of 113 inoculation against a disease. Procedure codes are required to identify the actual administration of the injection and the type(s) of immunizations given. Code Z23 may be used as a secondary code if the inoculation is given as a routine part of preventive health care, such as a well-baby visit. 3) Status Status codes indicate that a patient is either a carrier of a disease or has the sequelae or residual of a past disease or condition. This includes such things as the presence of prosthetic or mechanical devices resulting from past treatment. A status code is informative, because the status may affect the course of treatment and its outcome. A status code is distinct from a history code. The history code indicates that the patient no longer has the condition. A status code should not be used with a diagnosis code from one of the body system chapters, if the diagnosis code includes the information provided by the status code. For example, code Z94.1, Heart transplant status, should not be used with a code from subcategory T86.2, Complications of heart transplant. The status code does not provide additional information. The complication code indicates that the patient is a heart transplant patient. For encounters for weaning from a mechanical ventilator, assign a code from subcategory J96.1, Chronic respiratory failure, followed by code Z99.11, Dependence on respirator [ventilator] status. The status Z codes/categories are: Z14 Genetic carrier Genetic carrier status indicates that a person carries a gene, associated with a particular disease, which may be passed to offspring who may develop that disease. The person does not have the disease and is not at risk of developing the disease. Z15 Genetic susceptibility to disease Genetic susceptibility indicates that a person has a gene that increases the risk of that person developing the disease. Codes from category Z15 should not be used as principal or first-listed codes. If the patient has the condition to which he/she is susceptible, and that condition is the reason for the encounter, the code for the current condition should be sequenced first. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 81 of 113 Z16 Z17 Z18 Z21 Z22 Z28.3 Z33.1 Z66 Z67 Z68 Z74.01 Z76.82 Z78 If the patient is being seen for follow-up after completed treatment for this condition, and the condition no longer exists, a follow-up code should be sequenced first, followed by the appropriate personal history and genetic susceptibility codes. If the purpose of the encounter is genetic counseling associated with procreative management, code Z31.5, Encounter for genetic counseling, should be assigned as the first-listed code, followed by a code from category Z15. Additional codes should be assigned for any applicable family or personal history. Resistance to antimicrobial drugs This code indicates that a patient has a condition that is resistant to antimicrobial drug treatment. Sequence the infection code first. Estrogen receptor status Retained foreign body fragments Asymptomatic HIV infection status This code indicates that a patient has tested positive for HIV but has manifested no signs or symptoms of the disease. Carrier of infectious disease Carrier status indicates that a person harbors the specific organisms of a disease without manifest symptoms and is capable of transmitting the infection. Underimmunization status Pregnant state, incidental This code is a secondary code only for use when the pregnancy is in no way complicating the reason for visit. Otherwise, a code from the obstetric chapter is required. Do not resuscitate This code may be used when it is documented by the provider that a patient is on do not resuscitate status at any time during the stay. Blood type Body mass index (BMI) Bed confinement status Awaiting organ transplant status Other specified health status Code Z78.1, Physical restraint status, may be used when it is documented by the provider that a patient has been put in restraints during the current encounter. Please note that this code should not be reported when it is documented by the provider that ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 82 of 113 Z79 Z88 Z89 Z90 Z91.0Z92.82 a patient is temporarily restrained during a procedure. Long-term (current) drug therapy Codes from this category indicate a patient’s continuous use of a prescribed drug (including such things as aspirin therapy) for the long-term treatment of a condition or for prophylactic use. It is not for use for patients who have addictions to drugs. This subcategory is not for use of medications for detoxification or maintenance programs to prevent withdrawal symptoms in patients with drug dependence (e.g., methadone maintenance for opiate dependence). Assign the appropriate code for the drug dependence instead. Assign a code from Z79 if the patient is receiving a medication for an extended period as a prophylactic measure (such as for the prevention of deep vein thrombosis) or as treatment of a chronic condition (such as arthritis) or a disease requiring a lengthy course of treatment (such as cancer). Do not assign a code from category Z79 for medication being administered for a brief period of time to treat an acute illness or injury (such as a course of antibiotics to treat acute bronchitis). Allergy status to drugs, medicaments and biological substances Except: Z88.9, Allergy status to unspecified drugs, medicaments and biological substances status Acquired absence of limb Acquired absence of organs, not elsewhere classified Allergy status, other than to drugs and biological substances Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to a current facility Assign code Z92.82, Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility, as a secondary diagnosis when a patient is received by transfer into a facility and documentation indicates they were administered tissue plasminogen activator (tPA) within the last 24 hours prior to admission to the current facility. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 83 of 113 This guideline applies even if the patient is still receiving the tPA at the time they are received into the current facility. The appropriate code for the condition for which the tPA was administered (such as cerebrovascular disease or myocardial infarction) should be assigned first. Z93 Z94 Z95 Z96 Z97 Z98 Code Z92.82 is only applicable to the receiving facility record and not to the transferring facility record. Artificial opening status Transplanted organ and tissue status Presence of cardiac and vascular implants and grafts Presence of other functional implants Presence of other devices Other postprocedural states Assign code Z98.85, Transplanted organ removal status, to indicate that a transplanted organ has been previously removed. This code should not be assigned for the encounter in which the transplanted organ is removed. The complication necessitating removal of the transplant organ should be assigned for that encounter. See section I.C19. for information on the coding of organ transplant complications. Z99 4) Dependence on enabling machines and devices, not elsewhere classified Note: Categories Z89-Z90 and Z93-Z99 are for use only if there are no complications or malfunctions of the organ or tissue replaced, the amputation site or the equipment on which the patient is dependent. History (of) There are two types of history Z codes, personal and family. Personal history codes explain a patient’s past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring. Family history codes are for use when a patient has a family member(s) who has had a particular disease that causes the patient to be at higher risk of also contracting the disease. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 84 of 113 Personal history codes may be used in conjunction with followup codes and family history codes may be used in conjunction with screening codes to explain the need for a test or procedure. History codes are also acceptable on any medical record regardless of the reason for visit. A history of an illness, even if no longer present, is important information that may alter the type of treatment ordered. The history Z code categories are: Z80 Family history of primary malignant neoplasm Z81 Family history of mental and behavioral disorders Z82 Family history of certain disabilities and chronic diseases (leading to disablement) Z83 Family history of other specific disorders Z84 Family history of other conditions Z85 Personal history of malignant neoplasm Z86 Personal history of certain other diseases Z87 Personal history of other diseases and conditions Z91.4Personal history of psychological trauma, not elsewhere classified Z91.5 Personal history of self-harm Z91.8Other specified personal risk factors, not elsewhere classified Exception: Z91.83, Wandering in diseases classified elsewhere Z92 Personal history of medical treatment Except: Z92.0, Personal history of contraception Except: Z92.82, Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to a current facility 5) Screening Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease (e.g., screening mammogram). The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test. A screening code may be a first-listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an office visit for other health problems. A screening code is not necessary if ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 85 of 113 the screening is inherent to a routine examination, such as a pap smear done during a routine pelvic examination. Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis. The Z code indicates that a screening exam is planned. A procedure code is required to confirm that the screening was performed. The screening Z codes/categories: Z11 Encounter for screening for infectious and parasitic diseases Z12 Encounter for screening for malignant neoplasms Z13 Encounter for screening for other diseases and disorders Except: Z13.9, Encounter for screening, unspecified Z36 Encounter for antenatal screening for mother 6) Observation There are two observation Z code categories. They are for use in very limited circumstances when a person is being observed for a suspected condition that is ruled out. The observation codes are not for use if an injury or illness or any signs or symptoms related to the suspected condition are present. In such cases the diagnosis/symptom code is used with the corresponding external cause code. The observation codes are to be used as principal diagnosis only. Additional codes may be used in addition to the observation code but only if they are unrelated to the suspected condition being observed. Codes from subcategory Z03.7, Encounter for suspected maternal and fetal conditions ruled out, may either be used as a first-listed or as an additional code assignment depending on the case. They are for use in very limited circumstances on a maternal record when an encounter is for a suspected maternal or fetal condition that is ruled out during that encounter (for example, a maternal or fetal condition may be suspected due to an abnormal test result). These codes should not be used when the condition is confirmed. In those cases, the confirmed condition should be coded. In addition, these codes are not for use if an illness or any signs or symptoms related to the suspected condition or problem are present. In such cases the diagnosis/symptom code is used. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 86 of 113 Additional codes may be used in addition to the code from subcategory Z03.7, but only if they are unrelated to the suspected condition being evaluated. Codes from subcategory Z03.7 may not be used for encounters for antenatal screening of mother. See Section I.C.21. Screening. For encounters for suspected fetal condition that are inconclusive following testing and evaluation, assign the appropriate code from category O35, O36, O40 or O41. The observation Z code categories: Z03 Encounter for medical observation for suspected diseases and conditions ruled out Z04 Encounter for examination and observation for other reasons Except: Z04.9, Encounter for examination and observation for unspecified reason 7) Aftercare Aftercare visit codes cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare Z code should not be used if treatment is directed at a current, acute disease. The diagnosis code is to be used in these cases. Exceptions to this rule are codes Z51.0, Encounter for antineoplastic radiation therapy, and codes from subcategory Z51.1, Encounter for antineoplastic chemotherapy and immunotherapy. These codes are to be first-listed, followed by the diagnosis code when a patient’s encounter is solely to receive radiation therapy, chemotherapy, or immunotherapy for the treatment of a neoplasm. If the reason for the encounter is more than one type of antineoplastic therapy, code Z51.0 and a code from subcategory Z51.1 may be assigned together, in which case one of these codes would be reported as a secondary diagnosis. The aftercare Z codes should also not be used for aftercare for injuries. For aftercare of an injury, assign the acute injury code with the appropriate 7th character (for subsequent encounter). The aftercare codes are generally first-listed to explain the specific reason for the encounter. An aftercare code may be used as an additional code when some type of aftercare is provided in addition to the reason for admission and no ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 87 of 113 diagnosis code is applicable. An example of this would be the closure of a colostomy during an encounter for treatment of another condition. Aftercare codes should be used in conjunction with other aftercare codes or diagnosis codes to provide better detail on the specifics of an aftercare encounter visit, unless otherwise directed by the classification. Should a patient receive multiple types of antineoplastic therapy during the same encounter, code Z51.0, Encounter for antineoplastic radiation therapy, and codes from subcategory Z51.1, Encounter for antineoplastic chemotherapy and immunotherapy, may be used together on a record. The sequencing of multiple aftercare codes depends on the circumstances of the encounter. Certain aftercare Z code categories need a secondary diagnosis code to describe the resolving condition or sequelae. For others, the condition is included in the code title. Additional Z code aftercare category terms include fitting and adjustment, and attention to artificial openings. Status Z codes may be used with aftercare Z codes to indicate the nature of the aftercare. For example code Z95.1, Presence of aortocoronary bypass graft, may be used with code Z48.812, Encounter for surgical aftercare following surgery on the circulatory system, to indicate the surgery for which the aftercare is being performed. A status code should not be used when the aftercare code indicates the type of status, such as using Z43.0, Encounter for attention to tracheostomy, with Z93.0, Tracheostomy status. The aftercare Z category/codes: Z42 Encounter for plastic and reconstructive surgery following medical procedure or healed injury Z43 Encounter for attention to artificial openings Z44 Encounter for fitting and adjustment of external prosthetic device Z45 Encounter for adjustment and management of implanted device Z46 Encounter for fitting and adjustment of other devices Z47 Orthopedic aftercare Z48 Encounter for other postprocedural aftercare Z49 Encounter for care involving renal dialysis Z51 Encounter for other aftercare ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 88 of 113 8) Follow-up The follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists. They should not be confused with aftercare codes, or injury codes with a 7th character for subsequent encounter, that explain ongoing care of a healing condition or its sequelae. Follow-up codes may be used in conjunction with history codes to provide the full picture of the healed condition and its treatment. The follow-up code is sequenced first, followed by the history code. A follow-up code may be used to explain multiple visits. Should a condition be found to have recurred on the follow-up visit, then the diagnosis code for the condition should be assigned in place of the follow-up code. The follow-up Z code categories: Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm Z39 Encounter for maternal postpartum care and examination 9) Donor Codes in category Z52, Donors of organs and tissues, are used for living individuals who are donating blood or other body tissue. These codes are only for individuals donating for others, not for self-donations. They are not used to identify cadaveric donations. 10) Counseling Counseling Z codes are used when a patient or family member receives assistance in the aftermath of an illness or injury, or when support is required in coping with family or social problems. They are not used in conjunction with a diagnosis code when the counseling component of care is considered integral to standard treatment. The counseling Z codes/categories: Z30.0Encounter for general counseling and advice on contraception Z31.5 Encounter for genetic counseling ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 89 of 113 Z31.6Z32.2 Z32.3 Z69 Z70 Z71 Z76.81 11) Encounter for general counseling and advice on procreation Encounter for childbirth instruction Encounter for childcare instruction Encounter for mental health services for victim and perpetrator of abuse Counseling related to sexual attitude, behavior and orientation Persons encountering health services for other counseling and medical advice, not elsewhere classified Expectant mother prebirth pediatrician visit Encounters for Obstetrical and Reproductive Services See Section I.C.15. Pregnancy, Childbirth, and the Puerperium, for further instruction on the use of these codes. Z codes for pregnancy are for use in those circumstances when none of the problems or complications included in the codes from the Obstetrics chapter exist (a routine prenatal visit or postpartum care). Codes in category Z34, Encounter for supervision of normal pregnancy, are always first-listed and are not to be used with any other code from the OB chapter. Codes in category Z3A, Weeks of gestation, may be assigned to provide additional information about the pregnancy. The outcome of delivery, category Z37, should be included on all maternal delivery records. It is always a secondary code. Codes in category Z37 should not be used on the newborn record. Z codes for family planning (contraceptive) or procreative management and counseling should be included on an obstetric record either during the pregnancy or the postpartum stage, if applicable. Z codes/categories for obstetrical and reproductive services: Z30 Encounter for contraceptive management Z31 Encounter for procreative management Z32.2 Encounter for childbirth instruction Z32.3 Encounter for childcare instruction Z33 Pregnant state Z34 Encounter for supervision of normal pregnancy Z36 Encounter for antenatal screening of mother Z3A Weeks of gestation Z37 Outcome of delivery ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 90 of 113 Z39 Z76.81 12) Encounter for maternal postpartum care and examination Expectant mother prebirth pediatrician visit Newborns and Infants See Section I.C.16. Newborn (Perinatal) Guidelines, for further instruction on the use of these codes. Newborn Z codes/categories: Z76.1 Encounter for health supervision and care of foundling Z00.1Encounter for routine child health examination Z38 Liveborn infants according to place of birth and type of delivery 13) Routine and administrative examinations The Z codes allow for the description of encounters for routine examinations, such as, a general check-up, or, examinations for administrative purposes, such as, a pre-employment physical. The codes are not to be used if the examination is for diagnosis of a suspected condition or for treatment purposes. In such cases the diagnosis code is used. During a routine exam, should a diagnosis or condition be discovered, it should be coded as an additional code. Pre-existing and chronic conditions and history codes may also be included as additional codes as long as the examination is for administrative purposes and not focused on any particular condition. Some of the codes for routine health examinations distinguish between “with” and “without” abnormal findings. Code assignment depends on the information that is known at the time the encounter is being coded. For example, if no abnormal findings were found during the examination, but the encounter is being coded before test results are back, it is acceptable to assign the code for “without abnormal findings.” When assigning a code for “with abnormal findings,” additional code(s) should be assigned to identify the specific abnormal finding(s). Pre-operative examination and pre-procedural laboratory examination Z codes are for use only in those situations when a patient is being cleared for a procedure or surgery and no treatment is given. The Z codes/categories for routine and administrative examinations: ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 91 of 113 Z00 Z01 Z02 Z32.0- 14) Encounter for general examination without complaint, suspected or reported diagnosis Encounter for other special examination without complaint, suspected or reported diagnosis Encounter for administrative examination Except: Z02.9, Encounter for administrative examinations, unspecified Encounter for pregnancy test Miscellaneous Z codes The miscellaneous Z codes capture a number of other health care encounters that do not fall into one of the other categories. Certain of these codes identify the reason for the encounter; others are for use as additional codes that provide useful information on circumstances that may affect a patient’s care and treatment. Prophylactic Organ Removal For encounters specifically for prophylactic removal of an organ (such as prophylactic removal of breasts due to a genetic susceptibility to cancer or a family history of cancer), the principal or first-listed code should be a code from category Z40, Encounter for prophylactic surgery, followed by the appropriate codes to identify the associated risk factor (such as genetic susceptibility or family history). If the patient has a malignancy of one site and is having prophylactic removal at another site to prevent either a new primary malignancy or metastatic disease, a code for the malignancy should also be assigned in addition to a code from subcategory Z40.0, Encounter for prophylactic surgery for risk factors related to malignant neoplasms. A Z40.0 code should not be assigned if the patient is having organ removal for treatment of a malignancy, such as the removal of the testes for the treatment of prostate cancer. Miscellaneous Z codes/categories: Z28 Immunization not carried out Except: Z28.3, Underimmunization status Z40 Encounter for prophylactic surgery Z41 Encounter for procedures for purposes other than remedying health state Except: Z41.9, Encounter for procedure for purposes other than remedying health state, unspecified ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 92 of 113 Z53 Z55 Z56 Z57 Z58 Z59 Z60 Z62 Z63 Z64 Z65 Z72 Z73 Z74 Z75 Z76.0 Z76.3 Z76.4 Z76.5 Z91.1Z91.83 Z91.89 15) Persons encountering health services for specific procedures and treatment, not carried out Problems related to education and literacy Problems related to employment and unemployment Occupational exposure to risk factors Problems related to physical environment Problems related to housing and economic circumstances Problems related to social environment Problems related to upbringing Other problems related to primary support group, including family circumstances Problems related to certain psychosocial circumstances Problems related to other psychosocial circumstances Problems related to lifestyle Problems related to life management difficulty Problems related to care provider dependency Except: Z74.01, Bed confinement status Problems related to medical facilities and other health care Encounter for issue of repeat prescription Healthy person accompanying sick person Other boarder to healthcare facility Malingerer [conscious simulation] Patient’s noncompliance with medical treatment and regimen Wandering in diseases classified elsewhere Other specified personal risk factors, not elsewhere classified Nonspecific Z codes Certain Z codes are so non-specific, or potentially redundant with other codes in the classification, that there can be little justification for their use in the inpatient setting. Their use in the outpatient setting should be limited to those instances when there is no further documentation to permit more precise coding. Otherwise, any sign or symptom or any other reason for visit that is captured in another code should be used. Nonspecific Z codes/categories: Z02.9 Encounter for administrative examinations, unspecified Z04.9 Encounter for examination and observation for unspecified reason Z13.9 Encounter for screening, unspecified ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 93 of 113 Z41.9 Z52.9 Z86.59 Z92.0 16) Encounter for procedure for purposes other than remedying health state, unspecified Donor of unspecified organ or tissue Personal history of other mental and behavioral disordersZ88.9 Allergy status to unspecified drugs, medicaments and biological substances status Personal history of contraception Z Codes That May Only be Principal/First-Listed Diagnosis The following Z codes/categories may only be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined: Z00 Encounter for general examination without complaint, suspected or reported diagnosis Z01 Encounter for other special examination without complaint, suspected or reported diagnosis Z02 Encounter for administrative examination Z03 Encounter for medical observation for suspected diseases and conditions ruled out Z04 Encounter for examination and observation for other reasons Z33.2 Encounter for elective termination of pregnancy Z31.81 Encounter for male factor infertility in female patient Z31.82 Encounter for Rh incompatibility status Z31.83 Encounter for assisted reproductive fertility procedure cycle Z31.84 Encounter for fertility preservation procedure Z34 Encounter for supervision of normal pregnancy Z39 Encounter for maternal postpartum care and examination Z38 Liveborn infants according to place of birth and type of delivery Z42 Encounter for plastic and reconstructive surgery following medical procedure or healed injury Z51.0 Encounter for antineoplastic radiation therapy Z51.1Encounter for antineoplastic chemotherapy and immunotherapy Z52 Donors of organs and tissues Except: Z52.9, Donor of unspecified organ or tissue Z76.1 Encounter for health supervision and care of foundling ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 94 of 113 Z76.2 Z99.12 Encounter for health supervision and care of other healthy infant and child Encounter for respirator [ventilator] dependence during power failure ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 95 of 113 workup and/or therapy provided, and the Alphabetic Index, Tabular List, or another coding guidelines does not provide sequencing direction, any one of the diagnoses may be sequenced first. D. Two or more comparative or contrasting conditions. In those rare instances when two or more contrasting or comparative diagnoses are documented as “either/or” (or similar terminology), they are coded as if the diagnoses were confirmed and the diagnoses are sequenced according to the circumstances of the admission. If no further determination can be made as to which diagnosis should be principal, either diagnosis may be sequenced first. E. A symptom(s) followed by contrasting/comparative diagnoses When a symptom(s) is followed by contrasting/comparative diagnoses, the symptom code is sequenced first. All the contrasting/comparative diagnoses should be coded as additional diagnoses. F. Original treatment plan not carried out Sequence as the principal diagnosis the condition, which after study occasioned the admission to the hospital, even though treatment may not have been carried out due to unforeseen circumstances. G. Complications of surgery and other medical care When the admission is for treatment of a complication resulting from surgery or other medical care, the complication code is sequenced as the principal diagnosis. If the complication is classified to the T80-T88 series and the code lacks the necessary specificity in describing the complication, an additional code for the specific complication should be assigned. H. Uncertain Diagnosis If the diagnosis documented at the time of discharge is qualified as “probable”, “suspected”, “likely”, “questionable”, “possible”, or “still to be ruled out”, or other similar terms indicating uncertainty, code the condition as if it existed or was established. The bases for these guidelines are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis. Note: This guideline is applicable only to inpatient admissions to short-term, acute, long-term care and psychiatric hospitals. I. Admission from Observation Unit 1. Admission Following Medical Observation When a patient is admitted to an observation unit for a medical condition, which either worsens or does not improve, and is subsequently admitted as an ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 96 of 113 inpatient of the same hospital for this same medical condition, the principal diagnosis would be the medical condition which led to the hospital admission. 2. Admission Following Post-Operative Observation When a patient is admitted to an observation unit to monitor a condition (or complication) that develops following outpatient surgery, and then is subsequently admitted as an inpatient of the same hospital, hospitals should apply the Uniform Hospital Discharge Data Set (UHDDS) definition of principal diagnosis as "that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care." J. Admission from Outpatient Surgery When a patient receives surgery in the hospital's outpatient surgery department and is subsequently admitted for continuing inpatient care at the same hospital, the following guidelines should be followed in selecting the principal diagnosis for the inpatient admission: • • • If the reason for the inpatient admission is a complication, assign the complication as the principal diagnosis. If no complication, or other condition, is documented as the reason for the inpatient admission, assign the reason for the outpatient surgery as the principal diagnosis. If the reason for the inpatient admission is another condition unrelated to the surgery, assign the unrelated condition as the principal diagnosis. ICD-10-CM Official Guidelines for Coding and Reporting 2012 Page 97 of 113 CONCLUSION This CE course has reviewed Chapters 16-21 of the ICD-10-CM coding guidelines. Included in the review are diseases and injuries classified by chapter, examples of codes found in each chapter, and examples of codes from the Tabular List, Alphabetic Index, and Table of Drugs. At the completion of this course, the professional should be familiar with ICD-10-CM code structure, detail, and location of codes for diseases and injuries found in Chapters 16-21. REFERENCES Grider, Deborah J. Principles of ICD-10-CM Coding. The American Medical Association. 2012. The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). ICD-10-CM Official Guidelines for Coding and Reporting 2012. www.cms.gov. Accessed 1 May 2012. ABOUT THE AUTHOR Steve Verno is a Certified Medical Billing Specialist Instructor, a Certified Emergency Medical Coding Specialist, a Certified Multispecialty Coding Specialist, and a Certified Practice Manager-Medical Coding Specialist. He is a retired American Red Cross Health and Safety Instructor Trainer, a retired American Red Cross Disaster Action Team Captain, a graduate of the American Red Cross College. He is a coding and billing consultant and instructor for Heal Your Practice, The Coding Institute, Lake Sumter Medical Society, Physician Office Managers Association of America, the Professional Association of Healthcare Coding Specialists and he is a member of the Medical Economics Committee with the Florida College of Emergency Physicians and a coding/billing consultant to the Federal Trade Commission. He is an Editorial Board Member of the Medical Association of Billers, Billing-Coding Advantage, Physician Office Managers Association of America and the Professional Association of Healthcare Coding Specialists. Steve’s specialties are Emergency Medicine, Family Practice, Urgent care, Internal Medicine, Pediatrics, ERISA, ICD-10, Appeals, AR Recovery, Fraud and Abuse, Health Insurance Contracts, and Compliance. Steve with Don Self is a co-author of the Layperson’s Guide to the Employment Retirement Income Security Act (ERISA). For the last ten years, Steve has been a moderator of the Medical Association of Billers On-Line Medical Billing forum, providing almost 10,000 responses to visitor questions on coding, medical billing, fraud and abuse and compliance. He has had more than 40 articles on coding and billing published in the Billing-Coding Advantage magazine, the Medical Association of Billers, Codetrends Newsletter, and the Professional Association of Healthcare Coding Specialists coding newsletter. He was a contributing editor for the Insurance Handbook for the Medical Office, written by Marilyn Fordney and published by Elsevier Science. He has also developed guidebooks on ERISA, Appeals, and specialty ICD-10-CM training for emergency medicine, family practice, cardiology, general surgery, radiation oncology, sports medicine, and preparing for ICD-10-CM. Steve is also an Adjunct Professor of the Health and Safety Department at Everest University and is presently on medical leave. 11 ATTACHMENT A: ICD-10-CM 2012 TABULAR LIST- Examples Note: This handout is to be used for the ICD-10-CM CE test only. This handout is NOT to be used for actual coding. PO5 Disorders of newborn related to slow fetal growth and fetal malnutrition P05.1 Newborn small for gestational age Newborn small-and-light-for-dates Newborn small-for-dates P05.10 P05.11 P05.12 P05.13 P05.14 P05.15 P05.16 P05.17 P05.18 P35 Newborn small for gestational age, unspecified weight Newborn small for gestational age, less than 500 grams Newborn small for gestational age, 500-749 grams Newborn small for gestational age, 750-999 grams Newborn small for gestational age, 1000-1249 grams Newborn small for gestational age, 1250-1499 grams Newborn small for gestational age, 1500-1749 grams Newborn small for gestational age, 1750-1999 grams Newborn small for gestational age, 2000-2499 grams Congenital viral diseases Includes: infections acquired in utero or during birth P35.0 P35.1 P35.2 P35.3 P35.8 P35.9 Congenital rubella syndrome Congenital rubella pneumonitis Congenital cytomegalovirus infection Congenital herpesviral [herpes simplex] infection Congenital viral hepatitis Other congenital viral diseases Congenital varicella [chickenpox] Congenital viral disease, unspecified P55 Hemolytic disease of newborn P55.0 Rh isoimmunization of newborn P55.1 ABO isoimmunization of newborn P55.8 Other hemolytic diseases of newborn P55.9 Hemolytic disease of newborn, unspecified P56 Hydrops fetalis due to hemolytic disease Excludes1: hydrops fetalis NOS (P83.2) P56.0 Hydrops fetalis due to isoimmunization P56.9 Hydrops fetalis due to other and unspecified hemolytic disease P56.90 Hydrops fetalis due to unspecified hemolytic disease P56.99 Hydrops fetalis due to other hemolytic disease P57 Kernicterus P57.0 Kernicterus due to isoimmunization P57.8 Other specified kernicterus Excludes1: Crigler-Najjar syndrome (E80.5) P57.9 Kernicterus, unspecified P58 Neonatal jaundice due to other excessive hemolysis Excludes1: jaundice due to isoimmunization (P55-P57) P58.0 Neonatal jaundice due to bruising 12 P58.1 P58.2 P58.3 P58.4 Neonatal jaundice due to bleeding Neonatal jaundice due to infection Neonatal jaundice due to polycythemia Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn Code first poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4 or 6) Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) P58.41 Neonatal jaundice due to drugs or toxins transmitted from mother P58.42 Neonatal jaundice due to drugs or toxins given to newborn P58.5 Neonatal jaundice due to swallowed maternal blood P58.8 Neonatal jaundice due to other specified excessive hemolysis P58.9 Neonatal jaundice due to excessive hemolysis, unspecified P59 Neonatal jaundice from other and unspecified causes Excludes1: jaundice due to inborn errors of metabolism (E70-E88) kernicterus (P57.-) P59.0 Neonatal jaundice associated with preterm delivery Hyperbilirubinemia of prematurity Jaundice due to delayed conjugation associated with preterm delivery P59.1 Inspissated bile syndrome P59.2 Neonatal jaundice from other and unspecified hepatocellular damage Excludes1: congenital viral hepatitis (P35.3) P59.20 Neonatal jaundice from unspecified hepatocellular damage P59.29 Neonatal jaundice from other hepatocellular damage Neonatal giant cell hepatitis Neonatal (idiopathic) hepatitis P59.3 Neonatal jaundice from breast milk inhibitor P59.8 Neonatal jaundice from other specified causes P59.9 Neonatal jaundice, unspecified Neonatal physiological jaundice (intense)(prolonged) NOS P92 Feeding problems of newborn Excludes1: feeding problems in child over 28 days old (R63.3) P92.0 Vomiting of newborn Excludes1: vomiting of child over 28 days old (R11.-) P92.01 Bilious vomiting of newborn Excludes1: bilious vomiting in child over 28 days old (R11.4) P92.09 Other vomiting of newborn Excludes1: regurgitation of food in newborn (P92.1) P92.1 Regurgitation and rumination of newborn P92.2 Slow feeding of newborn P92.3 Underfeeding of newborn P92.4 Overfeeding of newborn P92.5 Neonatal difficulty in feeding at breast P92.6 Failure to thrive in newborn Excludes1: failure to thrive in child over 28 days old (R62.51) P92.8 Other feeding problems of newborn P92.9 Feeding problem of newborn, unspecified Q05 Spina bifida Includes: hydromeningocele (spinal) meningocele (spinal) meningomyelocele myelocele myelomeningocele rachischisis 13 spina bifida (aperta)(cystica) syringomyelocele Use additional code for any associated paraplegia (paraparesis) (G82.2-) Excludes1: Arnold-Chiari syndrome, type II (Q07.0-) spina bifida occulta (Q76.0) Q05.0 Cervical spina bifida with hydrocephalus Q05.1 Thoracic spina bifida with hydrocephalus Dorsal spina bifida with hydrocephalus Thoracolumbar spina bifida with hydrocephalus Q05.2 Lumbar spina bifida with hydrocephalus Lumbosacral spina bifida with hydrocephalus Q05.3 Sacral spina bifida with hydrocephalus Q05.4 Unspecified spina bifida with hydrocephalus Q05.5 Cervical spina bifida without hydrocephalus Q05.6 Thoracic spina bifida without hydrocephalus Dorsal spina bifida NOS Thoracolumbar spina bifida NOS Q05.7 Lumbar spina bifida without hydrocephalus Lumbosacral spina bifida NOS Q05.8 Sacral spina bifida without hydrocephalus Q05.9 Spina bifida, unspecified Q35 Cleft palate Includes: fissure of palate palatoschisis Excludes1: cleft palate with cleft lip (Q37.-) Q35.1 Q35.3 Q35.5 Q35.7 Q35.9 Q36 Cleft hard palate Cleft soft palate Cleft hard palate with cleft soft palate Cleft uvula Cleft palate, unspecified Cleft palate NOS Cleft lip Includes: cheiloschisis congenital fissure of lip harelip labium leporinum Excludes1: cleft lip with cleft palate (Q37.-) Q36.0 Cleft lip, bilateral Q36.1 Cleft lip, median Q36.9 Cleft lip, unilateral Cleft lip NOS Q37 Cleft palate with cleft lip Includes: cheilopalatoschisis Q37.0 Cleft hard palate with bilateral cleft lip Q37.1 Cleft hard palate with unilateral cleft lip Cleft hard palate with cleft lip NOS Q37.2 Cleft soft palate with bilateral cleft lip Q37.3 Cleft soft palate with unilateral cleft lip Cleft soft palate with cleft lip NOS Q37.4 Cleft hard and soft palate with bilateral cleft lip Q37.5 Cleft hard and soft palate with unilateral cleft lip Cleft hard and soft palate with cleft lip NOS 14 Q37.8 Unspecified cleft palate with bilateral cleft lip Q37.9 Unspecified cleft palate with unilateral cleft lip Cleft palate with cleft lip NOS Q90 Down syndrome Use additional code(s) to identify any associated physical conditions and degree of intellectual disabilities (F70-F79) Q90.0 Q90.1 Q90.2 Q90.9 Q91 Trisomy 18 and Trisomy 13 Q91.0 Q91.1 Q91.2 Q91.3 Q91.4 Q91.5 Q91.6 Q91.7 Q92 Trisomy 21, nonmosaicism (meiotic nondisjunction) Trisomy 21, mosaicism (mitotic nondisjunction) Trisomy 21, translocation Down syndrome, unspecified Trisomy 21 NOS Trisomy 18, nonmosaicism (meiotic nondisjunction) Trisomy 18, mosaicism (mitotic nondisjunction) Trisomy 18, translocation Trisomy 18, unspecified Trisomy 13, nonmosaicism (meiotic nondisjunction) Trisomy 13, mosaicism (mitotic nondisjunction) Trisomy 13, translocation Trisomy 13, unspecified Other trisomies and partial trisomies of the autosomes, not elsewhere classified Includes: unbalanced translocations and insertions Excludes1: trisomies of chromosomes 13, 18, 21 (Q90-Q91) Q92.0 Whole chromosome trisomy, nonmosaicism (meiotic nondisjunction) Q92.1 Whole chromosome trisomy, mosaicism (mitotic nondisjunction) Q92.2 Partial trisomy Less than whole arm duplicated Whole arm or more duplicated Excludes1: partial trisomy due to unbalanced translocation (Q92.5) Q92.5 Duplications with other complex rearrangements Partial trisomy due to unbalanced translocations Code also any associated deletions due to unbalanced translocations, inversions and insertions (Q93.7) Q92.6 Marker chromosomes Trisomies due to dicentrics Trisomies due to extra rings Trisomies due to isochromosomes Individual with marker heterochromatin Q92.61 Marker chromosomes in normal individual Q92.62 Marker chromosomes in abnormal individual Q92.7 Triploidy and polyploidy Q92.8 Other specified trisomies and partial trisomies of autosomes Duplications identified by fluorescence in situ hybridization (FISH) Duplications identified by in situ hybridization (ISH) Duplications seen only at prometaphase Q92.9 Trisomy and partial trisomy of autosomes, unspecified R00 Abnormalities of heart beat Excludes1: abnormalities originating in the perinatal period (P29.1-) specified arrhythmias (I47-I49) R00.0 Tachycardia, unspecified Rapid heart beat Sinoauricular tachycardia NOS 15 R00.1 R00.2 R00.8 R00.9 R01 Sinus [sinusal] tachycardia NOS Excludes1: neonatal tachycardia (P29.11) paroxysmal tachycardia (I47.-) Bradycardia, unspecified Sinoatrial bradycardia Sinus bradycardia Slow heart beat Vagal bradycardia Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) Excludes1: neonatal bradycardia (P29.12) Palpitations Awareness of heart beat Other abnormalities of heart beat Unspecified abnormalities of heart beat Cardiac murmurs and other cardiac sounds Excludes1: cardiac murmurs and sounds originating in the perinatal period (P29.8) R01.0 Benign and innocent cardiac murmurs Functional cardiac murmur R01.1 Cardiac murmur, unspecified Cardiac bruit NOS Heart murmur NOS R01.2 Other cardiac sounds Cardiac dullness, increased or decreased Precordial friction R03 Abnormal blood-pressure reading, without diagnosis R03.0 Elevated blood-pressure reading, without diagnosis of hypertension Note: This category is to be used to record an episode of elevated blood pressure in a patient in whom no formal diagnosis of hypertension has been made, or as an isolated incidental finding. R03.1 Nonspecific low blood-pressure reading Excludes1: hypotension (I95.-) maternal hypotension syndrome (O26.5-) neurogenic orthostatic hypotension (G90.3) R05 Cough Excludes1: cough with hemorrhage (R04.2) smoker's cough (J41.0) R06 Abnormalities of breathing Excludes1: acute respiratory distress syndrome (J80) respiratory arrest (R09.2) respiratory arrest of newborn (P28.81) respiratory distress syndrome of newborn (P22.-) respiratory failure (J96.-) respiratory failure of newborn (P28.5) R06.0 Dyspnea Excludes1: tachypnea NOS (R06.82) transient tachypnea of newborn (P22.1) R06.00 Dyspnea, unspecified R06.01 Orthopnea R06.02 Shortness of breath R06.09 Other forms of dyspnea 16 R06.1 Stridor Excludes1: congenital laryngeal stridor (P28.89) laryngismus (stridulus) (J38.5) R06.2 Wheezing Excludes1: Asthma (J45.-) R06.3 Periodic breathing Cheyne-Stokes breathing R06.4 Hyperventilation Excludes1: psychogenic hyperventilation (F45.8) R06.5 Mouth breathing Excludes2: dry mouth NOS (R68.2) R06.6 Hiccough Excludes1: psychogenic hiccough (F45.8) R06.7 Sneezing R06.8 Other abnormalities of breathing R06.81 Apnea, not elsewhere classified Apnea NOS Excludes1: apnea (of) newborn (P28.4) sleep apnea (G47.3-) sleep apnea of newborn (primary) (P28.3) R06.82 Tachypnea, not elsewhere classified Tachypnea NOS Excludes1: transitory tachypnea of newborn (P22.1) R06.83 Snoring R06.89 Other abnormalities of breathing Breath-holding (spells) Sighing R06.9 Unspecified abnormalities of breathing R11 Nausea and vomiting Excludes1: cyclical vomiting associated with migraine (G43.A-) excessive vomiting in pregnancy (O21.-) hematemesis (K92.0) neonatal hematemesis (P54.0) newborn vomiting (P92.0-) psychogenic vomiting (F50.8) vomiting associated with bulimia nervosa (F50.2) vomiting following gastrointestinal surgery (K91.0) R11.0 Nausea Nausea NOS Nausea without vomiting R11.1 Vomiting R11.10 Vomiting, unspecified Vomiting NOS R11.11 Vomiting without nausea R11.12 Projectile vomiting R11.13 Vomiting of fecal matter R11.14 Bilious vomiting Bilious emesis R11.2 Nausea with vomiting, unspecified Persistent nausea with vomiting NOS R12 Heartburn Excludes1: dyspepsia NOS (R10.13) functional dyspepsia (K30) R30 Pain associated with micturition Excludes1: psychogenic pain associated with micturition (F45.8) 17 R30.0 Dysuria Strangury R30.1 Vesical tenesmus R30.9 Micturition, unspecified Painful urination NOS R31 Hematuria Excludes1: hematuria included with underlying conditions, such as: acute cystitis with hematuria (N30.01) acute prostatitis with hematuria (N41.01) recurrent and persistent hematuria in glomerular diseases (N02.-) R31.0 R31.1 R31.2 R31.9 Gross hematuria Benign essential microscopic hematuria Other microscopic hematuria Hematuria, unspecified R32 Unspecified urinary incontinence Enuresis NOS Excludes1: functional urinary incontinence (R39.81) nonorganic enuresis (F98.0) stress incontinence and other specified urinary incontinence (N39.3-N39.4-) urinary incontinence associated with cognitive impairment (R39.81) R33 Retention of urine Excludes1: psychogenic retention of urine (F45.8) R33.0 Drug induced retention of urine Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) R33.8 Other retention of urine Code first, if applicable, any causal condition, such as: enlarged prostate (N40.1) R33.9 Retention of urine, unspecified R34 Anuria and oliguria Excludes1: anuria and oliguria complicating abortion or ectopic or molar pregnancy (O00-O07, O08.4) anuria and oliguria complicating pregnancy (O26.83-) anuria and oliguria complicating the puerperium (O90.4) R35 Polyuria Code first, if applicable, any causal condition, such as: enlarged prostate (N40.1) Excludes1: psychogenic polyuria (F45.8) R35.0 Frequency of micturition R35.1 Nocturia R35.8 Other polyuria Polyuria NOS R45 Symptoms and signs involving emotional state R45.0 Nervousness Nervous tension R45.1 Restlessness and agitation R45.2 Unhappiness R45.3 Demoralization and apathy Excludes1: anhedonia (R45.84) R45.4 Irritability and anger R45.5 Hostility R45.6 Violent behavior 18 R45.7 State of emotional shock and stress, unspecified R45.8 Other symptoms and signs involving emotional state R45.81 Low self-esteem R45.82 Worries R45.83 Excessive crying of child, adolescent or adult Excludes1: excessive crying of infant (baby) R68.11 R45.84 Anhedonia R45.85 Homicidal and suicidal ideations Excludes1: suicide attempt (T14.91) R45.850 Homicidal ideations R45.851 Suicidal ideations R45.86 Emotional lability R45.87 Impulsiveness R45.89 Other symptoms and signs involving emotional state R46 Symptoms and signs involving appearance and behavior Excludes1: appearance and behavior in schizophrenia, schizotypal and delusional disorders (F20-F29) mental and behavioral disorders (F01-F99) R46.0 R46.1 R46.2 R46.3 R46.4 R46.5 R46.6 R46.7 R46.8 R59 Very low level of personal hygiene Bizarre personal appearance Strange and inexplicable behavior Overactivity Slowness and poor responsiveness Excludes1: stupor (R40.1) Suspiciousness and marked evasiveness Undue concern and preoccupation with stressful events Verbosity and circumstantial detail obscuring reason for contact Other symptoms and signs involving appearance and behavior R46.81 Obsessive-compulsive behavior Excludes1: obsessive-compulsive disorder (F42) R46.89 Other symptoms and signs involving appearance and behavior Enlarged lymph nodes Includes: swollen glands Excludes1: lymphadenitis NOS (I88.9) acute lymphadenitis (L04.-) chronic lymphadenitis (I88.1) mesenteric (acute) (chronic) lymphadenitis (I88.0) R59.0 Localized enlarged lymph nodes R59.1 Generalized enlarged lymph nodes Lymphadenopathy NOS R59.9 Enlarged lymph nodes, unspecified R60 Edema, not elsewhere classified Excludes1: angioneurotic edema (T78.3) ascites (R18.-) cerebral edema (G93.6) cerebral edema due to birth injury (P11.0) edema of larynx (J38.4) edema of nasopharynx (J39.2) edema of pharynx (J39.2) gestational edema (O12.0-) hereditary edema (Q82.0) hydrops fetalis NOS (P83.2) hydrothorax (J94.8) nutritional edema (E40-E46) hydrops fetalis NOS (P83.2) 19 newborn edema (P83.3) pulmonary edema (J81.-) R60.0 Localized edema R60.1 Generalized edema R60.9 Edema, unspecified Abnormal findings on examination of urine, without diagnosis (R80-R82) Excludes1: abnormal findings on antenatal screening of mother (O28.-) diagnostic abnormal findings classified elsewhere - see Alphabetical Index specific findings indicating disorder of: amino-acid metabolism (E70-E72) carbohydrate metabolism (E73-E74) R80 Proteinuria Excludes1: gestational proteinuria (O12.1-) R80.0 Isolated proteinuria Idiopathic proteinuria Excludes1: isolated proteinuria with specific morphological lesion (N06.-) R80.1 Persistent proteinuria, unspecified R80.2 Orthostatic proteinuria, unspecified Postural proteinuria R80.3 Bence Jones proteinuria R80.8 Other proteinuria R80.9 Proteinuria, unspecified Albuminuria NOS R81 Glycosuria Excludes1: renal glycosuria (E74.8) R82 Other and unspecified abnormal findings in urine Includes: chromoabnormalities in urine Use additional code to identify any retained foreign body, if applicable (Z18.-) Excludes2: hematuria (R31.-) R82.0 Chyluria Excludes1: filarial chyluria (B74.-) R82.1 Myoglobinuria R82.2 Biliuria R82.3 Hemoglobinuria Excludes1: hemoglobinuria due to hemolysis from external causes NEC (D59.6) hemoglobinuria due to paroxysmal nocturnal [Marchiafava-Micheli] (D59.5) R82.4 Acetonuria Ketonuria R82.5 Elevated urine levels of drugs, medicaments and biological substances Elevated urine levels of catecholamines Elevated urine levels of indoleacetic acid Elevated urine levels of 17-ketosteroids Elevated urine levels of steroids R82.6 Abnormal urine levels of substances chiefly nonmedicinal as to source Abnormal urine level of heavy metals R82.7 Abnormal findings on microbiological examination of urine Positive culture findings of urine 20 Excludes1: colonization status (Z22.-) R82.8 Abnormal findings on cytological and histological examination of urine R82.9 Other and unspecified abnormal findings in urine R82.90 Unspecified abnormal findings in urine R82.91 Other chromoabnormalities of urine Chromoconversion (dipstick) Idiopathic dipstick converts positive for blood with no cellular forms in sediment Excludes1: hemoglobinuria (R82.3) myoglobinuria (R82.1) R82.99 Other abnormal findings in urine Cells and casts in urine Crystalluria Melanuria R94 Abnormal results of function studies Includes: abnormal results of radionuclide [radioisotope] uptake studies abnormal results of scintigraphy R94.0 Abnormal results of function studies of central nervous system R94.01 Abnormal electroencephalogram [EEG] R94.02 Abnormal brain scan R94.09 Abnormal results of other function studies of central nervous system R94.1 Abnormal results of function studies of peripheral nervous system and special senses R94.11 Abnormal results of function studies of eye R94.110 Abnormal electro-oculogram [EOG] R94.111 Abnormal electroretinogram [ERG] Abnormal retinal function study R94.112 Abnormal visually evoked potential [VEP] R94.113 Abnormal oculomotor study R94.118 Abnormal results of other function studies of eye R94.12 Abnormal results of function studies of ear and other special senses R94.120 Abnormal auditory function study R94.121 Abnormal vestibular function study R94.128 Abnormal results of other function studies of ear and other special senses R94.13 Abnormal results of function studies of peripheral nervous system R94.130 Abnormal response to nerve stimulation, unspecified R94.131 Abnormal electromyogram [EMG] Excludes1: electromyogram of eye (R94.113) R94.138 Abnormal results of other function studies of peripheral nervous system R94.2 Abnormal results of pulmonary function studies Reduced ventilatory capacity Reduced vital capacity R94.3 Abnormal results of cardiovascular function studies R94.30 Abnormal result of cardiovascular function study, unspecified R94.31 Abnormal electrocardiogram [ECG] [EKG] Excludes1: long QT syndrome (I45.81) R94.39 Abnormal result of other cardiovascular function study Abnormal electrophysiological intracardiac studies Abnormal phonocardiogram Abnormal vectorcardiogram S00 Superficial injury of head Excludes1: diffuse cerebral contusion (S06.2-) focal cerebral contusion (S06.3-) injury of eye and orbit (S05.-) open wound of head (S01.-) 21 The appropriate 7th character is to be added to each code from category S00 A - initial encounter D - subsequent encounter S - sequela S00.0 Superficial injury of scalp S00.00 Unspecified superficial injury of scalp S00.01 Abrasion of scalp S00.02 Blister (nonthermal) of scalp S00.03 Contusion of scalp Bruise of scalp Hematoma of scalp S00.04 External constriction of part of scalp S00.05 Superficial foreign body of scalp Splinter in the scalp S00.06 Insect bite (nonvenomous) of scalp S00.07 Other superficial bite of scalp Excludes1: open bite of scalp (S01.05) S00.1 Contusion of eyelid and periocular area Black eye Excludes2: contusion of eyeball and orbital tissues (S05.1) S00.10 Contusion of unspecified eyelid and periocular area S00.11 Contusion of right eyelid and periocular area S00.12 Contusion of left eyelid and periocular area S00.2 Other and unspecified superficial injuries of eyelid and periocular area Excludes2: superficial injury of conjunctiva and cornea (S05.0-) S00.20 Unspecified superficial injury of eyelid and periocular area S00.201 Unspecified superficial injury of right eyelid and periocular area S00.202 Unspecified superficial injury of left eyelid and periocular area S00.209 Unspecified superficial injury of unspecified eyelid and periocular area S00.21 Abrasion of eyelid and periocular area S00.211 Abrasion of right eyelid and periocular area S00.212 Abrasion of left eyelid and periocular area S00.219 Abrasion of unspecified eyelid and periocular area S00.22 Blister (nonthermal) of eyelid and periocular area S00.221 Blister (nonthermal) of right eyelid and periocular area S00.222 Blister (nonthermal) of left eyelid and periocular area S00.229 Blister (nonthermal) of unspecified eyelid and periocular area S00.24 External constriction of eyelid and periocular area S00.241 External constriction of right eyelid and periocular area S00.242 External constriction of left eyelid and periocular area S00.249 External constriction of unspecified eyelid and periocular area S00.25 Superficial foreign body of eyelid and periocular area Splinter of eyelid and periocular area Excludes2: retained foreign body in eyelid (H02.81-) S00.251 Superficial foreign body of right eyelid and periocular area S00.252 Superficial foreign body of left eyelid and periocular area S00.259 Superficial foreign body of unspecified eyelid and periocular area S00.26 Insect bite (nonvenomous) of eyelid and periocular area S00.261 Insect bite (nonvenomous) of right eyelid and periocular area S00.262 Insect bite (nonvenomous) of left eyelid and periocular area S00.269 Insect bite (nonvenomous) of unspecified eyelid and periocular area S00.27 Other superficial bite of eyelid and periocular area Excludes1: open bite of eyelid and periocular area (S01.15) S00.271 Other superficial bite of right eyelid and periocular area S00.272 Other superficial bite of left eyelid and periocular area S00.279 Other superficial bite of unspecified eyelid and periocular area S00.3 Superficial injury of nose S00.30 Unspecified superficial injury of nose S00.31 Abrasion of nose 22 S00.32 Blister (nonthermal) of nose S00.33 Contusion of nose Bruise of nose Hematoma of nose S00.34 External constriction of nose S00.35 Superficial foreign body of nose Splinter in the nose S00.36 Insect bite (nonvenomous) of nose S00.37 Other superficial bite of nose Excludes1: open bite of nose (S01.25) S52 Fracture of forearm Note: A fracture not indicated as displaced or nondisplaced should be coded to displaced A fracture not indicated as open or closed should be coded to closed The open fracture designations are based on the Gustilo open fracture classification Excludes1: traumatic amputation of forearm (S58.-) Excludes2: fracture at wrist and hand level (S62.-) The appropriate 7th character is to be added to all codes from category S52 A - initial encounter for closed fracture B - initial encounter for open fracture type I or II initial encounter for open fracture NOS C - initial encounter for open fracture type IIIA, IIIB, or IIIC D - subsequent encounter for closed fracture with routine healing E - subsequent encounter for open fracture type I or II with routine healing F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing G - subsequent encounter for closed fracture with delayed healing H - subsequent encounter for open fracture type I or II with delayed healing J - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing K - subsequent encounter for closed fracture with nonunion M - subsequent encounter for open fracture type I or II with nonunion N - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion P - subsequent encounter for closed fracture with malunion Q - subsequent encounter for open fracture type I or II with malunion R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - sequela S52.0 Fracture of upper end of ulna Fracture of proximal end of ulna Excludes2: fracture of elbow NOS (S42.40-) fractures of shaft of ulna (S52.2-) S52.00 Unspecified fracture of upper end of ulna S52.001 Unspecified fracture of upper end of right ulna S52.002 Unspecified fracture of upper end of left ulna S52.009 Unspecified fracture of upper end of unspecified ulna S52.01 Torus fracture of upper end of ulna The appropriate 7th character is to be added to all codes in subcategory A - initial encounter for closed fracture D - subsequent encounter for fracture with routine healing G - subsequent encounter for fracture with delayed healing K - subsequent encounter for fracture with nonunion P - subsequent encounter for fracture with malunion S - sequela S52.011 Torus fracture of upper end of right ulna S52.012 Torus fracture of upper end of left ulna S52.019 Torus fracture of upper end of unspecified ulna 23 S52.02 Fracture of olecranon process without intraarticular extension of ulna S52.021 Displaced fracture of olecranon process without intraarticular extension of right ulna S52.022 Displaced fracture of olecranon process without intraarticular extension of left ulna S52.023 Displaced fracture of olecranon process without intraarticular extension of unspecified ulna S52.024 Nondisplaced fracture of olecranon process without intraarticular extension of right ulna S52.025 Nondisplaced fracture of olecranon process without intraarticular extension of left ulna S52.026 Nondisplaced fracture of olecranon process without intraarticular extension of unspecified ulna S52.03 Fracture of olecranon process with intraarticular extension of ulna S52.031 Displaced fracture of olecranon process with intraarticular extension of right ulna S52.032 Displaced fracture of olecranon process with intraarticular extension of left ulna S52.033 Displaced fracture of olecranon process with intraarticular extension of unspecified ulna S52.034 Nondisplaced fracture of olecranon process with intraarticular extension of right ulna S52.035 Nondisplaced fracture of olecranon process with intraarticular extension of left ulna S52.036 Nondisplaced fracture of olecranon process with intraarticular extension of unspecified ulna S52.04 Fracture of coronoid process of ulna S52.041 Displaced fracture of coronoid process of right ulna S52.042 Displaced fracture of coronoid process of left ulna S52.043 Displaced fracture of coronoid process of unspecified ulna S52.044 Nondisplaced fracture of coronoid process of right ulna S52.045 Nondisplaced fracture of coronoid process of left ulna S52.046 Nondisplaced fracture of coronoid process of unspecified ulna S52.09 Other fracture of upper end of ulna S52.091 Other fracture of upper end of right ulna S52.092 Other fracture of upper end of left ulna S52.099 Other fracture of upper end of unspecified ulna S60 Superficial injury of wrist, hand and fingers The appropriate 7th character is to be added to each code from category S60 A - initial encounter D - subsequent encounter S - sequela S60.0 Contusion of finger without damage to nail Excludes1: contusion involving nail (matrix) (S60.1) S60.00 Contusion of unspecified finger without damage to nail Contusion of finger(s) NOS S60.01 Contusion of thumb without damage to nail S60.011 Contusion of right thumb without damage to nail S60.012 Contusion of left thumb without damage to nail S60.019 Contusion of unspecified thumb without damage to nail S60.02 Contusion of index finger without damage to nail S60.021 Contusion of right index finger without damage to nail S60.022 Contusion of left index finger without damage to nail S60.029 Contusion of unspecified index finger without damage to nail S60.03 Contusion of middle finger without damage to nail S60.031 Contusion of right middle finger without damage to nail S60.032 Contusion of left middle finger without damage to nail 24 S60.039 Contusion of unspecified middle finger without damage to nail S60.04 Contusion of ring finger without damage to nail S60.041 Contusion of right ring finger without damage to nail S60.042 Contusion of left ring finger without damage to nail S60.049 Contusion of unspecified ring finger without damage to nail S60.05 Contusion of little finger without damage to nail S60.051 Contusion of right little finger without damage to nail S60.052 Contusion of left little finger without damage to nail S60.059 Contusion of unspecified little finger without damage to nail S60.1 Contusion of finger with damage to nail S60.10 Contusion of unspecified finger with damage to nail S60.11 Contusion of thumb with damage to nail S60.111 Contusion of right thumb with damage to nail S60.112 Contusion of left thumb with damage to nail S60.119 Contusion of unspecified thumb with damage to nail S60.12 Contusion of index finger with damage to nail S60.121 Contusion of right index finger with damage to nail S60.122 Contusion of left index finger with damage to nail S60.129 Contusion of unspecified index finger with damage to nail S60.13 Contusion of middle finger with damage to nail S60.131 Contusion of right middle finger with damage to nail S60.132 Contusion of left middle finger with damage to nail S60.139 Contusion of unspecified middle finger with damage to nail S60.14 Contusion of ring finger with damage to nail S60.141 Contusion of right ring finger with damage to nail S60.142 Contusion of left ring finger with damage to nail S60.149 Contusion of unspecified ring finger with damage to nail S60.15 Contusion of little finger with damage to nail S60.151 Contusion of right little finger with damage to nail S60.152 Contusion of left little finger with damage to nail S60.159 Contusion of unspecified little finger with damage to nail T16 Foreign body in ear Includes: foreign body in auditory canal The appropriate 7th character is to be added to each code from category T16 A - initial encounter D - subsequent encounter S - sequela T16.1 T16.2 T16.9 T17 Foreign body in right ear Foreign body in left ear Foreign body in ear, unspecified ear Foreign body in respiratory tract The appropriate 7th character is to be added to each code from category T17 A - initial encounter D - subsequent encounter S - sequela T17.0 T17.1 T17.2 Foreign body in nasal sinus Foreign body in nostril Foreign body in nose NOS Foreign body in pharynx Foreign body in nasopharynx Foreign body in throat NOS T17.20 Unspecified foreign body in pharynx T17.200 Unspecified foreign body in pharynx causing asphyxiation T17.208 Unspecified foreign body in pharynx causing other injury 25 T17.21 Gastric contents in pharynx Aspiration of gastric contents into pharynx Vomitus in pharynx T17.210 Gastric contents in pharynx causing asphyxiation T17.218 Gastric contents in pharynx causing other injury T17.22 Food in pharynx Bones in pharynx Seeds in pharynx T17.220 Food in pharynx causing asphyxiation T17.228 Food in pharynx causing other injury T17.29 Other foreign object in pharynx T17.290 Other foreign object in pharynx causing asphyxiation T58 Toxic effect of carbon monoxide Includes: asphyxiation from carbon monoxide toxic effect of carbon monoxide from all sources The appropriate 7th character is to be added to each code from category T58 A - initial encounter D - subsequent encounter S - sequela T58.0 T58.1 T58.2 Toxic effect of carbon monoxide from motor vehicle exhaust Toxic effect of exhaust gas from gas engine Toxic effect of exhaust gas from motor pump T58.01 Toxic effect of carbon monoxide from motor vehicle exhaust, accidental (unintentional) T58.02 Toxic effect of carbon monoxide from motor vehicle exhaust, intentional selfharm T58.03 Toxic effect of carbon monoxide from motor vehicle exhaust, assault T58.04 Toxic effect of carbon monoxide from motor vehicle exhaust, undetermined Toxic effect of carbon monoxide from utility gas Toxic effect of acetylene Toxic effect of gas NOS used for lighting, heating, cooking Toxic effect of water gas T58.11 Toxic effect of carbon monoxide from utility gas, accidental (unintentional) T58.12 Toxic effect of carbon monoxide from utility gas, intentional self-harm T58.13 Toxic effect of carbon monoxide from utility gas, assault T58.14 Toxic effect of carbon monoxide from utility gas, undetermined Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels Toxic effect of carbon monoxide from incomplete combustion of coal, coke, kerosene, wood T58.2X Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels T58.2X1 Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, accidental (unintentional) T58.2X2 Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, intentional self-harm T58.2X3 Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, assault T58.2X4 Toxic effect of carbon monoxide from incomplete combustion of other domestic fuels, undetermined T58.8 Toxic effect of carbon monoxide from other source Toxic effect of carbon monoxide from blast furnace gas Toxic effect of carbon monoxide from fuels in industrial use Toxic effect of carbon monoxide from kiln vapor T58.8X Toxic effect of carbon monoxide from other source T58.8X1 Toxic effect of carbon monoxide from other source, accidental (unintentional) 26 T58.9 T67 T58.8X2 Toxic effect of carbon monoxide from other source, intentional self-harm T58.8X3 Toxic effect of carbon monoxide from other source, assault T58.8X4 Toxic effect of carbon monoxide from other source, undetermined Toxic effect of carbon monoxide from unspecified source T58.91 Toxic effect of carbon monoxide from unspecified source, accidental (unintentional) T58.92 Toxic effect of carbon monoxide from unspecified source, intentional selfharm T58.93 Toxic effect of carbon monoxide from unspecified source, assault T58.94 Toxic effect of carbon monoxide from unspecified source, undetermined Effects of heat and light Excludes1: erythema [dermatitis] ab igne (L59.0) malignant hyperpyrexia due to anesthesia (T88.3) radiation-related disorders of the skin and subcutaneous tissue (L55-L59) Excludes2: burns (T20-T31) sunburn (L55.-) sweat disorder due to heat (L74-L75) The appropriate 7th character is to be added to each code from category T67 A - initial encounter D - subsequent encounter S - sequela T67.0 T67.1 T67.2 T67.3 T67.4 T67.5 T67.6 T67.7 T67.8 T67.9 T76 Heatstroke and sunstroke Heat apoplexy Heat pyrexia Siriasis Thermoplegia Use additional code(s) to identify any associated complications of heatstroke, such as: coma and stupor (R40.-) systemic inflammatory response syndrome (R65.1-) Heat syncope Heat collapse Heat cramp Heat exhaustion, anhydrotic Heat prostration due to water depletion Excludes1: heat exhaustion due to salt depletion (T67.4) Heat exhaustion due to salt depletion Heat prostration due to salt (and water) depletion Heat exhaustion, unspecified Heat prostration NOS Heat fatigue, transient Heat edema Other effects of heat and light Effect of heat and light, unspecified Adult and child abuse, neglect and other maltreatment, suspected Use additional code, if applicable, to identify any associated current injury Excludes1: adult and child maltreatment, confirmed (T74.-) suspected abuse and maltreatment in pregnancy (O9A.3-, O9A.4-, O9A.5-) suspected adult physical and sexual abuse, ruled out (Z04.71) suspected child physical and sexual abuse, ruled out (Z04.72) The appropriate 7th character is to be added to each code from category T76 A - initial encounter D - subsequent encounter S - sequela 27 T76.0 T76.1 T76.2 T76.3 T76.9 T84 Neglect or abandonment, suspected T76.01 Adult neglect or abandonment, suspected T76.02 Child neglect or abandonment, suspected Physical abuse, suspected T76.11 Adult physical abuse, suspected T76.12 Child physical abuse, suspected Sexual abuse, suspected Rape, suspected Sexual abuse, suspected Excludes1: alleged abuse, ruled out (Z04.7) T76.21 Adult sexual abuse, suspected T76.22 Child sexual abuse, suspected Psychological abuse, suspected T76.31 Adult psychological abuse, suspected T76.32 Child psychological abuse, suspected Unspecified maltreatment, suspected T76.91 Unspecified adult maltreatment, suspected T76.92 Unspecified child maltreatment, suspected Complications of internal orthopedic prosthetic devices, implants and grafts Excludes2: failure and rejection of transplanted organs and tissues (T86.-) fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6) The appropriate 7th character is to be added to each code from category T84 A - initial encounter D - subsequent encounter S - sequela T84.0 Mechanical complication of internal joint prosthesis T84.01 Broken internal joint prosthesis Breakage (fracture) of prosthetic joint Broken prosthetic joint implant Excludes1: periprosthetic joint implant fracture (T84.04) T84.010 Broken internal right hip prosthesis T84.011 Broken internal left hip prosthesis T84.012 Broken internal right knee prosthesis T84.013 Broken internal left knee prosthesis T84.018 Broken internal joint prosthesis, other site Use additional code to identify the joint (Z96.6-) T84.019 Broken internal joint prosthesis, unspecified site T84.02 Dislocation of internal joint prosthesis Instability of internal joint prosthesis Subluxation of internal joint prosthesis T84.020 Dislocation of internal right hip prosthesis T84.021 Dislocation of internal left hip prosthesis T84.022 Instability of internal right knee prosthesis T84.023 Instability of internal left knee prosthesis T84.028 Dislocation of other internal joint prosthesis Use additional code to identify the joint (Z96.6-) T84.029 Dislocation of unspecified internal joint prosthesis T84.03 Mechanical loosening of internal prosthetic joint Aseptic loosening of prosthetic joint T84.030 Mechanical loosening of internal right hip prosthetic joint T84.031 Mechanical loosening of internal left hip prosthetic joint T84.032 Mechanical loosening of internal right knee prosthetic joint T84.033 Mechanical loosening of internal left knee prosthetic joint T84.038 Mechanical loosening of other internal prosthetic joint Use additional code to identify the joint (Z96.6-) 28 T84.039 Mechanical loosening of unspecified internal prosthetic joint T84.04 Periprosthetic fracture around internal prosthetic joint Excludes2: breakage (fracture) of prosthetic joint (T84.01) T84.040 Periprosthetic fracture around internal prosthetic right hip joint T84.041 Periprosthetic fracture around internal prosthetic left hip joint T84.042 Periprosthetic fracture around internal prosthetic right knee joint T84.043 Periprosthetic fracture around internal prosthetic left knee joint T84.048 Periprosthetic fracture around other internal prosthetic joint Use additional code to identify the joint (Z96.6-) Accidents (V00-X58) Transport accidents (V00-V99) Note: This section is structured in 12 groups. Those relating to land transport accidents (V01- V89) reflect the victim's mode of transport and are subdivided to identify the victim's 'counterpart' or the type of event. The vehicle of which the injured person is an occupant is identified in the first two characters since it is seen as the most important factor to identify for prevention purposes. A transport accident is one in which the vehicle involved must be moving or running or in use for transport purposes at the time of the accident. Use additional code to identify: Airbag injury (W22.1) Type of street or road (Y92.4-) Use of cellular telephone and other electronic equipment at the time of the transport accident (Y93.C-) Excludes1: agricultural vehicles in stationary use or maintenance (W31.-) assault by crashing of motor vehicle (Y03.-) automobile or motor cycle in stationary use or maintenance- code to type of accident crashing of motor vehicle, undetermined intent (Y32) intentional self-harm by crashing of motor vehicle (X82) Excludes2: transport accidents due to cataclysm (X34-X38) Note: Definitions of transport vehicles: (a) A transport accident is any accident involving a device designed primarily for, or used at the time primarily for, conveying persons or good from one place to another. (b) A public highway [traffic way] or street is the entire width between property lines (or other boundary lines) of land open to the public as a matter of right or custom for purposes of moving persons or property from one place to another. A roadway is that part of the public highway designed, improved and customarily used for vehicular traffic. (c) A traffic accident is any vehicle accident occurring on the public highway [i.e. originating on, terminating on, or involving a vehicle partially on the highway]. A vehicle accident is assumed to have occurred on the public highway unless another place is specified, except in the case of accidents involving only off-road motor vehicles, which are classified as nontraffic accidents unless the contrary is stated. (d) A nontraffic accident is any vehicle accident that occurs entirely in any place other than a public highway. (e) A pedestrian is any person involved in an accident who was not at the time of the accident riding in or on a motor vehicle, railway train, streetcar or animal-drawn or other vehicle, or on a pedal cycle or animal. This includes, a person changing a tire or working on a parked car. It also includes the use of a pedestrian conveyance such as a baby carriage, ice-skates, roller skates, a skateboard, nonmotorized or motorized wheelchair, motorized mobility scooter, or nonmotorized scooter. (f) A driver is an occupant of a transport vehicle who is operating or intending to operate it. (g) A passenger is any occupant of a transport vehicle other than the driver, except a person traveling on the outside of the vehicle. (h) A person on the outside of a vehicle is any person being transported by a vehicle but not occupying the space normally reserved for the driver or passengers, or the space intended for 29 the transport of property. This includes the body, bumper, fender, roof, running board or step of a vehicle. (i) A pedal cycle is any land transport vehicle operated solely by nonmotorized pedals including a bicycle or tricycle. (j) A pedal cyclist is any person riding a pedal cycle or in a sidecar or trailer attached to a pedal cycle. (k) A motorcycle is a two-wheeled motor vehicle with one or two riding saddles and sometimes with a third wheel for the support of a sidecar. The sidecar is considered part of the motorcycle. (l) A motorcycle rider is any person riding a motorcycle or in a sidecar or trailer attached to the motorcycle. (m) A three-wheeled motor vehicle is a motorized tricycle designed primarily for on-road use. This includes a motor-driven tricycle, a motorized rickshaw, or a three-wheeled motor car. (n) A car [automobile] is a four-wheeled motor vehicle designed primarily for carrying up to 7 persons. A trailer being towed by the car is considered part of the car. (o) A pick-up truck or van is a four or six-wheeled motor vehicle designed for carrying passengers as well as property or cargo weighing less than the local limit for classification as a heavy goods vehicle, and not requiring a special driver's license. This includes a minivan and a sport-utility vehicle (SUV). (p) A heavy transport vehicle is a motor vehicle designed primarily for carrying property, meeting local criteria for classification as a heavy goods vehicle in terms of weight and requiring a special driver's license. (q) A bus (coach) is a motor vehicle designed or adapted primarily for carrying more than 10 passengers, and requiring a special driver's license. (r) A railway train or railway vehicle is any device, with or without freight or passenger cars couple to it, designed for traffic on a railway track. This includes subterranean (subways) or elevated trains. (s) A streetcar is a device designed and used primarily for transporting passengers within a municipality, running on rails, usually subject to normal traffic control signals, and operated principally on a right-of-way that forms part of the roadway. This includes a tram or trolley that runs on rails. A trailer being towed by a streetcar is considered part of the streetcar. (t) A special vehicle mainly used on industrial premises is a motor vehicle designed primarily for use within the buildings and premises of industrial or commercial establishments. This includes battery-powered trucks, forklifts, coal-cars in a coal mine, logging cars and trucks used in mines or quarries. (u) A special vehicle mainly used in agriculture is a motor vehicle designed specifically for use in farming and agriculture (horticulture), to work the land, tend and harvest crops and transport materials on the farm. This includes harvesters, farm machinery and tractor and trailers. (v) A special construction vehicle is a motor vehicle designed specifically for use on construction and demolition sites. This includes bulldozers, diggers, earth levellers, dump trucks. backhoes, front-end loaders, pavers, and mechanical shovels. (w) A special all-terrain vehicle is a motor vehicle of special design to enable it to negotiate over rough or soft terrain, snow or sand. This includes snow mobiles, All-terrain vehicles (ATV), and dune buggies. It does not include passenger vehicle designated as Sport Utility Vehicles (SUV). (w) A watercraft is any device designed for transporting passengers or goods on water. This includes motor or sailboats, ships, and hovercraft. (x) An aircraft is any device for transporting passengers or goods in the air. This includes hot-air balloons, gliders, helicopters and airplanes. (y) A military vehicle is any motorized vehicle operating on a public roadway owned by the military and being operated by a member of the military. Pedestrian injured in transport accident (V00-V09) Includes: person changing tire on transport vehicle person examining engine of vehicle broken down in (on side of) road Excludes1: fall due to non-transport collision with other person (W03) pedestrian on foot falling (slipping) on ice and snow (W00.-) struck or bumped by another person (W51) 30 V00 Pedestrian conveyance accident Use additional place of occurrence and activity external cause codes, if known (Y92.-, Y93.) Excludes1: collision with another person without fall (W51) fall due to person on foot colliding with another person on foot (W03) fall from non-moving wheelchair, nonmotorized scooter and motorized mobility scooter without collision(W05.-) pedestrian (conveyance) collision with other land transport vehicle (V01-V09) pedestrian on foot falling (slipping) on ice and snow (W00.-) The appropriate 7th character is to be added to each code from category V00 A - initial encounter D - subsequent encounter S - sequela V00.0 Pedestrian on foot injured in collision with pedestrian conveyance V00.01 Pedestrian on foot injured in collision with roller-skater V00.02 Pedestrian on foot injured in collision with skateboarder V00.09 Pedestrian on foot injured in collision with other pedestrian conveyance V00.1 Rolling-type pedestrian conveyance accident Excludes1: accident with babystroller (V00.82-) accident with wheelchair (powered) (V00.81-) accident with motorized mobility scooter (V00.83-) V00.11 In-line roller-skate accident V00.111 Fall from in-line roller-skates V00.112 In-line roller-skater colliding with stationary object V00.118 Other in-line roller-skate accident Excludes1: roller-skater collision with other land transport vehicle (V01V09 with 5thcharacter 1) V00.12 Non-in- line roller-skate accident V00.121 Fall from non-in-line roller-skates V00.122 Non-in-line roller-skater colliding with stationary object V00.128 Other non-in-line roller-skating accident Excludes1: roller-skater collision with other land transport vehicle (V01th V09 with 5 character 1) V00.13 Skateboard accident V00.131 Fall from skateboard V00.132 Skateboarder colliding with stationary object V00.138 Other skateboard accident Excludes1: skateboarder collision with other land transport vehicle th (V01-V09 with 5 character 2) V00.14 Scooter (nonmotorized) accident Excludes1: Motor scooter accident (V20-V29) V00.141 Fall from scooter (nonmotorized) V00.142 Scooter (nonmotorized) colliding with stationary object V00.148 Other scooter (nonmotorized) accident Excludes1: scooter (nonmotorized) collision with other land transport th vehicle (V01-V09 with 5 character 9) V00.15 Heelies accident Rolling shoe Wheeled shoe Wheelies accident V00.151 Fall from heelies V00.152 Heelies colliding with stationary object V00.158 Other heelies accident V00.18 Accident on other rolling-type pedestrian conveyance V00.181 Fall from other rolling-type pedestrian conveyance V00.182 Pedestrian on other rolling-type pedestrian conveyance colliding with stationary object V00.188 Other accident on other rolling-type pedestrian conveyance 31 V00.2 Gliding-type pedestrian conveyance accident V00.21 Ice-skates accident V00.211 Fall from ice-skates V00.212 Ice-skater colliding with stationary object V00.218 Other ice-skates accident Excludes1: ice-skater collision with other land transport vehicle (V01th V09 with 5 digit 9) V00.22 Sled accident V00.221 Fall from sled V00.222 Sledder colliding with stationary object V00.228 Other sled accident Excludes1: sled collision with other land transport vehicle (V01-V09 th with 5 digit 9) V00.28 Other gliding-type pedestrian conveyance accident V00.281 Fall from other gliding-type pedestrian conveyance V00.282 Pedestrian on other gliding-type pedestrian conveyance colliding with stationary object V00.288 Other accident on other gliding-type pedestrian conveyance Excludes1: gliding-type pedestrian conveyance collision with other th land transport vehicle (V01-V09 with 5 digit 9) W00 Fall due to ice and snow Includes: pedestrian on foot falling (slipping) on ice and snow Excludes1: fall on (from) ice and snow involving pedestrian conveyance (V00.-) fall from stairs and steps not due to ice and snow (W10.-) The appropriate 7th character is to be added to each code from category W00 A - initial encounter D - subsequent encounter S - sequela W00.0 W00.1 W00.2 W00.9 W01 Fall on same level due to ice and snow Fall from stairs and steps due to ice and snow Other fall from one level to another due to ice and snow Unspecified fall due to ice and snow Fall on same level from slipping, tripping and stumbling Includes: fall on moving sidewalk Excludes1: fall due to bumping (striking) against object (W18.0-) fall in shower or bathtub (W18.2-) fall on same level NOS (W18.30) fall on same level from slipping, tripping and stumbling due to ice or snow (W00.0) fall off or from toilet (W18.1-) slipping, tripping and stumbling NOS (W18.40) slipping, tripping and stumbling without falling (W18.4-) The appropriate 7th character is to be added to each code from category W01 A - initial encounter D - subsequent encounter S - sequela W01.0 Fall on same level from slipping, tripping and stumbling without subsequent striking against object Falling over animal 32 W01.1 Fall on same level from slipping, tripping and stumbling with subsequent striking against object W01.10 Fall on same level from slipping, tripping and stumbling with subsequent striking against unspecified object W01.11 Fall on same level from slipping, tripping and stumbling with subsequent striking against sharp object W01.110 Fall on same level from slipping, tripping and stumbling with subsequent striking against sharp glass W01.111 Fall on same level from slipping, tripping and stumbling with subsequent striking against power tool or machine W01.118 Fall on same level from slipping, tripping and stumbling with subsequent striking against other sharp object W01.119 Fall on same level from slipping, tripping and stumbling with subsequent striking against unspecified sharp object W01.19 Fall on same level from slipping, tripping and stumbling with subsequent striking against other object W01.190 Fall on same level from slipping, tripping and stumbling with subsequent striking against furniture W01.198 Fall on same level from slipping, tripping and stumbling with subsequent striking against other object X11 Contact with hot tap-water Includes: contact with boiling tap-water contact with boiling water NOS Excludes1: contact with water heated on stove (X12) The appropriate 7th character is to be added to each code from category X11 A - initial encounter D - subsequent encounter S - sequela X11.0 Contact with hot water in bath or tub Excludes1: contact with running hot water in bath or tub (X11.1) X11.1 Contact with running hot water Contact with hot water running out of hose Contact with hot water running out of tap X11.8 Contact with other hot tap-water Contact with hot water in bucket Contact with hot tap-water NOS X37 Cataclysmic storm The appropriate 7th character is to be added to each code from category X37 A - initial encounter D - subsequent encounter S - sequela X37.0 Hurricane Storm surge Typhoon X37.1 Tornado Cyclone Twister X37.2 Blizzard (snow)(ice) X37.3 Dust storm X37.4 Tidalwave X37.41 Tidal wave due to earthquake or volcanic eruption Tidal wave NOS Tsunami 33 X37.42 Tidal wave due to storm X37.43 Tidal wave due to landslide X37.8 Other cataclysmic storms Cloudburst Torrential rain Excludes2: flood (X38) X37.9 Unspecified cataclysmic storm Storm NOS Excludes1: collapse of dam or man-made structure causing earth movement (X39.0) X38 Flood Flood arising from remote storm Flood of cataclysmic nature arising from melting snow Flood resulting directly from storm Excludes1: collapse of dam or man-made structure causing earth movement (X39.0) tidal wave NOS (X37.41) tidal wave caused by storm (X37.2) The appropriate 7th character is to be added to code X38 A - initial encounter D - subsequent encounter S – sequela X78 Intentional self-harm by sharp object The appropriate 7th character is to be added to each code from category X78 A - initial encounter D - subsequent encounter S - sequela X78.0 X78.1 X78.2 X78.8 X78.9 Y04 Intentional self-harm by sharp glass Intentional self-harm by knife Intentional self-harm by sword or dagger Intentional self-harm by other sharp object Intentional self-harm by unspecified sharp object Assault by bodily force Excludes1: assault by: submersion (X92.-) use of weapon (X93-X95, X99, Y00) The appropriate 7th character is to be added to each code from category Y04 A - initial encounter D - subsequent encounter S - sequela Y04.0 Y04.1 Y04.2 Y04.8 Y36 Assault by unarmed brawl or fight Assault by human bite Assault by strike against or bumped into by another person Assault by other bodily force Assault by bodily force NOS Operations of war Includes: injuries to military personnel and civilians caused by war, civil insurrection, and peacekeeping missions Excludes1: injury to military personnel occurring during peacetime military operations (Y37.-) military vehicles involved in transport accidents with non-military vehicle during peacetime (V09.01,V09.21, V19.81, V29.81, V39.81, V49.81, V59.81, V69.81, V79.81) 34 The appropriate 7th character is to be added to each code from category Y36 A - initial encounter D - subsequent encounter S - sequela Y36.3 War operations involving fires, conflagrations and hot substances War operations involving smoke, fumes, and heat from fires, conflagrations and hot substances Excludes1: war operations involving fires and conflagrations aboard military aircraft (Y36.1-) war operations involving fires and conflagrations aboard military watercraft (Y36.0-) war operations involving fires and conflagrations caused indirectly by conventional weapons(Y36.2-) war operations involving fires and thermal effects of nuclear weapons (Y36.53-) Y36.30 War operations involving unspecified fire, conflagration and hot substance Y36.300 War operations involving unspecified fire, conflagration and hot substance, military personnel Y36.301 War operations involving unspecified fire, conflagration and hot substance, civilian Y36.31 War operations involving gasoline bomb War operations involving incendiary bomb War operations involving petrol bomb Y36.310 War operations involving gasoline bomb, military personnel Y36.311 War operations involving gasoline bomb, civilian Y36.32 War operations involving incendiary bullet Y36.320 War operations involving incendiary bullet, military personnel Y36.321 War operations involving incendiary bullet, civilian Y36.33 War operations involving flamethrower Y36.330 War operations involving flamethrower, military personnel Y36.331 War operations involving flamethrower, civilian Y36.39 War operations involving other fires, conflagrations and hot substances Y36.390 War operations involving other fires, conflagrations and hot substances, military personnel Y36.391 War operations involving other fires, conflagrations and hot substances, civilian Y38 Terrorism These codes are for use to identify injuries resulting from the unlawful use of force or violence against persons or property to intimidate or coerce a Government, the civilian population, or any segment thereof, in furtherance of political or social objective Use additional code for place of occurrence (Y92.-) The appropriate 7th character is to be added to each code from category Y38 A - initial encounter D - subsequent encounter S - sequela Y38.6 Terrorism involving biological weapons Terrorism involving anthrax Terrorism involving cholera Terrorism involving smallpox Y38.6X Terrorism involving biological weapons Y38.6X1 Terrorism involving biological weapons, public safety official injured Y38.6X2 Terrorism involving biological weapons, civilian injured Y38.6X3 Terrorism involving biological weapons, terrorist injured 35 Complications of medical and surgical care (Y62-Y84) Includes: complications of medical devices surgical and medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure Misadventures to patients during surgical and medical care (Y62-Y69) Excludes2: breakdown or malfunctioning of medical device (during procedure) (after implantation) (ongoing use) (Y70-Y82) surgical and medical procedures as the cause of abnormal reaction of the patient, without mention of misadventure at the time of the procedure (Y83-Y84) Y62 Failure of sterile precautions during surgical and medical care Y62.0 Y62.1 Y62.2 Y62.3 Y62.4 Y62.5 Y62.6 Y62.8 Y62.9 Y76 Failure of sterile precautions during surgical operation Failure of sterile precautions during infusion or transfusion Failure of sterile precautions during kidney dialysis and other perfusion Failure of sterile precautions during injection or immunization Failure of sterile precautions during endoscopic examination Failure of sterile precautions during heart catheterization Failure of sterile precautions during aspiration, puncture and other catheterization Failure of sterile precautions during other surgical and medical care Failure of sterile precautions during unspecified surgical and medical care Obstetric and gynecological devices associated with adverse incidents Y76.0 Diagnostic and monitoring obstetric and gynecological devices associated with adverse incidents Y76.1 Therapeutic (nonsurgical) and rehabilitative obstetric and gynecological devices associated with adverse incidents Y76.2 Prosthetic and other implants, materials and accessory obstetric and gynecological devices associated with adverse incidents Y76.3 Surgical instruments, materials and obstetric and gynecological devices (including sutures) associated with adverse incidents Y76.8 Miscellaneous obstetric and gynecological devices associated with adverse incidents, not elsewhere classified Supplementary factors related to causes of morbidity classified elsewhere (Y90-Y99) Note: These categories may be used to provide supplementary information concerning causes of morbidity. They are not to be used for single-condition coding. Y92 Place of occurrence of the external cause The following category is for use, when relevant, to identify the place of occurrence of the external cause. Use in conjunction with an activity code. Place of occurrence should be recorded only at the initial encounter for treatment Y92.1 Institutional (nonprivate) residence as the place of occurrence of the external cause Y92.12 Nursing home as the place of occurrence of the external cause Home for the sick as the place of occurrence of the external cause Hospice as the place of occurrence of the external cause Y92.120 Kitchen in nursing home as the place of occurrence of the external cause Y92.121 Bathroom in nursing home as the place of occurrence of the external cause 36 Y92.122 Bedroom in nursing home as the place of occurrence of the external cause Y92.123 Driveway of nursing home as the place of occurrence of the external cause Y92.124 Garage of nursing home as the place of occurrence of the external cause Y92.125 Swimming-pool of nursing home as the place of occurrence of the external cause Y92.126 Garden or yard of nursing home as the place of occurrence of the external cause Y92.128 Other place in nursing home as the place of occurrence of the external cause Y92.129 Unspecified place in nursing home as the place of occurrence of the external cause Y92.3 Sports and athletics area as the place of occurrence of the external cause Y92.31 Athletic court as the place of occurrence of the external cause Excludes1: tennis court in private home or garden (Y92.09) Y92.310 Basketball court as the place of occurrence of the external cause Y92.311 Squash court as the place of occurrence of the external cause Y92.312 Tennis court as the place of occurrence of the external cause Y92.318 Other athletic court as the place of occurrence of the external cause Y92.32 Athletic field as the place of occurrence of the external cause Y92.320 Baseball field as the place of occurrence of the external cause Y92.321 Football field as the place of occurrence of the external cause Y92.322 Soccer field as the place of occurrence of the external cause Y92.328 Other athletic field as the place of occurrence of the external cause Cricket field as the place of occurrence of the external cause Hockey field as the place of occurrence of the external cause Y92.33 Skating rink as the place of occurrence of the external cause Y92.330 Ice skating rink (indoor) (outdoor) as the place of occurrence of the external cause Y92.331 Roller skating rink as the place of occurrence of the external cause Y92.34 Swimming pool (public) as the place of occurrence of the external cause Excludes1: swimming pool in private home or garden (Y92.016) Y92.39 Other specified sports and athletic area as the place of occurrence of the external cause Golf-course as the place of occurrence of the external cause Gymnasium as the place of occurrence of the external cause Riding-school as the place of occurrence of the external cause Stadium as the place of occurrence of the external cause Y93 Activity codes Note: Category Y93 is provided for use to indicate the activity of the person seeking healthcare for an injury or health condition, such as a heart attack while shoveling snow, which resulted from, or was contributed to, by the activity. These codes are appropriate for use for both acute injuries, such as those from chapter 19, and conditions that are due to the long-term, cumulative effects of an activity, such as those from chapter 13. They are also appropriate for use with external cause codes for cause and intent if identifying the activity provides additional information on the event. These codes should be used in conjunction with codes for external cause status (Y99) and place of occurrence (Y92). Y93.0 Activities involving walking and running Excludes1: activity, walking an animal (Y93.K1) activity, walking or running on a treadmill (Y93.A1) Y93.01 Activity, walking, marching and hiking Activity, walking, marching and hiking on level or elevated terrain Excludes1: activity, mountain climbing (Y93.31) Y93.02 Activity, running 37 Y93.H Activities involving exterior property and land maintenance, building and construction Y93.H1 Activity, digging, shoveling and raking Activity, dirt digging Activity, raking leaves Activity, snow shoveling Y93.H2 Activity, gardening and landscaping Activity, pruning, trimming shrubs, weeding Y93.H3 Activity, building and construction Y93.H9 Activity, other involving exterior property and land maintenance, building and construction Z00 Encounter for general examination without complaint, suspected or reported diagnosis Excludes1: encounter for examination for administrative purposes (Z02.-) Excludes2: encounter for pre-procedural examinations (Z01.81-) special screening examinations (Z11-Z13) Z00.0 Encounter for general adult medical examination Encounter for adult periodic examination (annual) (physical) and any associated laboratory and radiologic examinations Excludes1: encounter for examination of sign or symptom- code to sign or symptom general health check-up of infant or child (Z00.12.-) Z00.1 Z00.00 Encounter for general adult medical examination without abnormal findings Encounter for adult health check-up NOS Z00.01 Encounter for general adult medical examination with abnormal findings Use additional code to identify abnormal findings Encounter for newborn, infant and child health examinations Z00.11 Newborn health examination Health check for child under 29 days old Use additional code to identify any abnormal findings Excludes1: health check for child over 28 days old (Z00.12-) Z00.110 Health examination for newborn under 8 days old Health check for newborn under 8 days old Z00.111 Health examination for newborn 8 to 28 days old Health check for newborn 8 to 28 days old Newborn weight check Z00.12 Encounter for routine child health examination Encounter for development testing of infant or child Health check (routine) for child over 28 days old Excludes1: health check for child under 29 days old (Z0.11-) health supervision of foundling or other healthy infant or child (Z76.1-Z76.2) newborn health examination (Z00.11-) Z00.121 Encounter for routine child health examination with abnormal findings Use additional code to identify abnormal findings Z00.129 Encounter for routine child health examination without abnormal findings Encounter for routine child health examination NOS Estrogen receptor status (Z17) Z17 Estrogen receptor status Code first malignant neoplasm of breast (C50.-) Z17.0 Z17.1 Estrogen receptor positive status [ER+] Estrogen receptor negative status [ER-] 38 Persons with potential health hazards related to communicable diseases (Z20-Z28) Z20 Contact with and (suspected) exposure to communicable diseases Excludes1: carrier of infectious disease (Z22.-) diagnosed current infectious or parasitic disease -see Alphabetic Index Excludes2: personal history of infectious and parasitic diseases (Z86.1-) Z20.0 Z20.1 Z20.2 Z20.3 Z20.4 Z20.5 Z20.6 Z32 Encounter for pregnancy test and childbirth and childcare instruction Z32.0 Z32.2 Z32.3 Z43 Contact with and (suspected) exposure to intestinal infectious diseases Z20.01 Contact with and (suspected) exposure to intestinal infectious diseases due to Escherichia coli (E. coli) Z20.09 Contact with and (suspected) exposure to other intestinal infectious diseases Contact with and (suspected) exposure to tuberculosis Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission Contact with and (suspected) exposure to rabies Contact with and (suspected) exposure to rubella Contact with and (suspected) exposure to viral hepatitis Contact with and (suspected) exposure to human immunodeficiency virus [HIV] Excludes1: asymptomatic human immunodeficiency virus [HIV] HIV infection status (Z21) Encounter for pregnancy test Z32.00 Encounter for pregnancy test, result unknown Encounter for pregnancy test NOS Z32.01 Encounter for pregnancy test, result positive Z32.02 Encounter for pregnancy test, result negative Encounter for childbirth instruction Encounter for childcare instruction Encounter for prenatal or postpartum childcare instruction Encounter for attention to artificial openings Includes: closure of artificial openings passage of sounds or bougies through artificial openings reforming artificial openings removal of catheter from artificial openings toilet or cleansing of artificial openings Excludes1: artificial opening status only, without need for care (Z93.-) complications of external stoma (J95.0-, K94.-, N99.5-) Excludes2: fitting and adjustment of prosthetic and other devices (Z44-Z46) Z43.0 Z43.1 Z43.2 Z43.3 Z43.4 Z43.5 Z43.6 Z43.7 Z43.8 Z43.9 Encounter for attention to tracheostomy Encounter for attention to gastrostomy Encounter for attention to ileostomy Encounter for attention to colostomy Encounter for attention to other artificial openings of digestive tract Encounter for attention to cystostomy Encounter for attention to other artificial openings of urinary tract Encounter for attention to nephrostomy Encounter for attention to ureterostomy Encounter for attention to urethrostomy Encounter for attention to artificial vagina Encounter for attention to other artificial openings Encounter for attention to unspecified artificial opening 39 Z48 Encounter for other postprocedural aftercare Excludes1: encounter for follow-up examination after completed treatment (Z08-Z09) Excludes2: encounter for attention to artificial openings (Z43.-) encounter for fitting and adjustment of prosthetic and other devices (Z44-Z46) Z48.0 Z72 Encounter for attention to dressings, sutures and drains Excludes1: encounter for planned postprocedural wound closure (Z48.1) Z48.00 Encounter for change or removal of nonsurgical wound dressing Encounter for change or removal of wound dressing NOS Z48.01 Encounter for change or removal of surgical wound dressing Z48.02 Encounter for removal of sutures Encounter for removal of staples Z48.03 Encounter for change or removal of drains Problems related to lifestyle Excludes2: problems related to life-management difficulty (Z73.-) problems related to socioeconomic and psychosocial circumstances (Z55-Z65) Z72.0 Z72.3 Z72.4 Z72.5 Z72.6 Z72.8 Tobacco use Tobacco use NOS Excludes1: history of tobacco dependence (Z87.891) nicotine dependence (F17.2-) tobacco dependence (F17.2-) tobacco use during pregnancy (O99.33-) Lack of physical exercise Inappropriate diet and eating habits Excludes1: behavioral eating disorders of infancy or childhood (F98.2.- F98.3) eating disorders (F50.-) lack of adequate food (Z59.4) malnutrition and other nutritional deficiencies (E40-E64) High risk sexual behavior Promiscuity Excludes1: paraphilias (F65) Z72.51 High risk heterosexual behavior Z72.52 High risk homosexual behavior Z72.53 High risk bisexual behavior Gambling and betting Excludes1: compulsive or pathological gambling (F63.0) Other problems related to lifestyle Z72.81 Antisocial behavior Excludes1: conduct disorders (F91.-) Z72.810 Child and adolescent antisocial behavior Antisocial behavior (child) (adolescent) without manifest psychiatric disorder Delinquency NOS Group delinquency Offenses in the context of gang membership Stealing in company with others Truancy from school Z72.811 Adult antisocial behavior Adult antisocial behavior without manifest psychiatric disorder Z72.82 Problems related to sleep Z72.820 Sleep deprivation Lack of adequate sleep Excludes1: insomnia (G47.0-) Z72.821 Inadequate sleep hygiene Bad sleep habits Irregular sleep habits 40 Z72.9 Z88 Unhealthy sleep wake schedule Excludes1: insomnia (F51.0-, G47.0-) Z72.89 Other problems related to lifestyle Self-damaging behavior Problem related to lifestyle, unspecified Allergy status to drugs, medicaments and biological substances Excludes2: Allergy status, other than to drugs and biological substances (Z91.0-) Z88.0 Z88.1 Z88.2 Z88.3 Z88.4 Z88.5 Z88.6 Z88.7 Z88.8 Z88.9 Z98 Allergy status to penicillin Allergy status to other antibiotic agents status Allergy status to sulfonamides status Allergy status to other anti-infective agents status Allergy status to anesthetic agent status Allergy status to narcotic agent status Allergy status to analgesic agent status Allergy status to serum and vaccine status Allergy status to other drugs, medicaments and biological substances status Allergy status to unspecified drugs, medicaments and biological substances status Other postprocedural states Excludes2: aftercare (Z43-Z49, Z51) follow-up medical care (Z08-Z09) postprocedural complication - see Alphabetical Index Z98.5 Sterilization status Excludes1: female infertility (N97.-) male infertility (N46.-) Z98.51 Tubal ligation status Z98.52 Vasectomy status 41 ATTACHMENT B: ICD-10-CM ALPHABETIC INDEX TO DISEASES and INJURIESExamples Note: This handout is to be used for the ICD-10-CM CE test only. This handout is NOT to be used for actual coding. Abuse adult - see Maltreatment, adult as reason for couple seeking advice(including offender) Z63.0 Aftercare - see also Care Z51.89 involving removal of drains Z48.03 dressings(nonsurgical) Z48.00 staples Z48.02 surgical dressings Z48.01 sutures Z48.02 Allergy, allergic (reaction) (to) T78.40 air-borne substance NEC(rhinitis) J30.89 anaphylactic reaction or shock T78.2 angioneurotic edema T78.3 animal(dander) (epidermal) (hair) (rhinitis) J30.81 bee sting(anaphylactic shock) - see Toxicity, venom, arthropod, bee biological - see Allergy, drug dander(animal) (rhinitis) J30.81 dandruff(rhinitis) J30.81 dental restorative material(existing) K08.55 dermatitis - see Dermatitis, contact, allergic diathesis - see History, allergy drug, medicament & biological(any) (external) (internal) T78.40 correct substance properly administered - see Table of drugs and chemicals, by drug, adverse effect wrong substance given or taken NEC(by accident) - see Table of drugs and chemicals, by drug, poisoning due to pollen J30.1 dust(house) (stock) (rhinitis) J30.89 with asthma - see Asthma, allergic extrinsic eczema - see Dermatitis, contact, allergic epidermal(animal) (rhinitis) J30.81 feathers(rhinitis) J30.89 food(any) (ingested) NEC T78.1 anaphylactic shock - see Shock, anaphylactic, due to food dermatitis - see Dermatitis, due to, food dietary counseling and surveillance Z71.3 in contact with skin L23.6 rhinitis J30.5 status(without reaction) Z91.018 eggs Z91.012 milk products Z91.011 peanuts Z91.010 42 seafood Z91.013 specified NEC Z91.018 grain J30.1 grass(hay fever) (pollen) J30.1 asthma - see Asthma, allergic extrinsic hair(animal) (rhinitis) J30.81 history(of) - see History, allergy horse serum - see Allergy, serum inhalant(rhinitis) J30.89 pollen J30.1 kapok(rhinitis) J30.89 medicine - see Allergy, drug milk protein K52.2 nasal, seasonal due to pollen J30.1 pollen(any) (hay fever) J30.1 asthma - see Asthma, allergic extrinsic primrose J30.1 primula J30.1 purpura D69.0 ragweed(hay fever) (pollen) J30.1 asthma - see Asthma, allergic extrinsic rose(pollen) J30.1 seasonal NEC J30.2 tree(any) (hay fever) (pollen) J30.1 asthma - see Asthma, allergic extrinsic upper respiratory J30.9 urticaria L50.0 vaccine - see Allergy, serum Cleft (congenital) - see also Imperfect, closure alveolar process M26.79 branchial (cyst) (persistent) Q18.2 cricoid cartilage, posterior Q31.8 lip (unilateral) Q36.9 with cleft palate Q37.9 hard Q37.1 with soft Q37.5 soft Q37.3 with hard Q37.5 bilateral Q36.0 with cleft palate Q37.8 hard Q37.0 with soft Q37.4 soft Q37.2 with hard Q37.4 median Q36.1 nose Q30.2 palate Q35.9 with cleft lip(unilateral) Q37.9 43 bilateral Q37.8 hard Q35.1 with cleft lip (unilateral) Q37.1 bilateral Q37.0 soft Q35.5 with cleft lip (unilateral) Q37.5 bilateral Q37.4 medial Q35.5 soft Q35.3 with cleft lip(unilateral) Q37.3 bilateral Q37.2 hard Q35.5 with cleft lip(unilateral) Q37.5 bilateral Q37.4 penis Q55.69 scrotum Q55.29 thyroid cartilage Q31.8 uvula Q35.7 Complication(s) (from) (of) orthopedic - see also Disorder, soft tissue device or implant T84.9 bone device or implant - see Complication, bone, device NEC graft - see Complication, graft, bone breakdown T84.418 displacement T84.428 electronic bone stimulator - see Complications, electronic stimulator device, bone embolism T84.81 fibrosis T84.82 fixation device - see Complication, fixation device, internal hemorrhage T84.83 infection or inflammation T84.7 joint prosthesis - see Complication, joint prosthesis, internal malfunction T84.418 malposition T84.428 mechanical NEC T84.498 muscle graft - see Complications, graft, muscle obstruction T84.498 pain T84.84 perforation T84.498 protrusion T84.498 specified complication NEC T84.89 stenosis T84.85 tendon graft - see Complications, graft, tendon thrombosis T84.86 44 Contusion (skin surface intact) T14.8 finger(s) S60.00 with damage to nail(matrix) S60.10 index S60.02with damage to nail S60.12little S60.05with damage to nail S60.15middle S60.03with damage to nail S60.13ring S60.04with damage to nail S60.14thumb - see Contusion, thumb Cough (affected) (chronic) (epidemic) (nervous) R05 with hemorrhage - see Hemoptysis bronchial R05 with grippe or influenza - see Influenza, with, respiratory manifestations NEC functional F45.8 hysterical F45.8 laryngeal, spasmodic R05 psychogenic F45.8 smokers' J41.0 tea taster's B49 Dyspnea (nocturnal) (paroxysmal) R06.00 asthmatic(bronchial) J45.909 with exacerbation(acute) J45.901 bronchitis J45.909 with exacerbation(acute) J45.901 status asthmaticus J45.902 chronic J44.9 status asthmaticus J45.902 cardiac - see Failure, ventricular, left cardiac - see Failure, ventricular, left functional F45.8 hyperventilation R06.4 hysterical F45.8 newborn P28.89 orthopnea R06.01 psychogenic F45.8 shortness of breath R06.02 specified type NEC R06.09 Down syndrome Q90.9 meiotic nondisjunction Q90.0 mitotic nondisjunction Q90.1 mosaicism Q90.1 translocation Q90.2 45 Dysuria R30.0 psychogenic F45.8 Edema, edematous(infectious) (pitting) (toxic) R60.9 with nephritis - see Nephrosis allergic T78.3 amputation stump(surgical) (sequelae (late effect)) T87.89 angioneurotic(allergic) (any site) (with urticaria) T78.3 hereditary D84.1 angiospastic I73.9 Berlin's(traumatic) S05.8Xbrain(cytotoxic) (vasogenic) G93.6 due to birth injury P11.0 newborn(anoxia or hypoxia) P52.4 birth injury P11.0 traumatic - see Injury, intracranial, cerebral edema cardiac - see Failure, heart, congestive cardiovascular - see Failure, heart, congestive cerebral - see Edema, brain cerebrospinal - see Edema, brain cervix(uteri) (acute) N88.8 puerperal, postpartum O90.89 chronic hereditary Q82.0 circumscribed, acute T78.3 hereditary D84.1 conjunctiva H11.42cornea H18.2idiopathic H18.22secondary H18.23due to contact lens H18.21due to lymphatic obstruction I89.0 salt retention E87.0 epiglottis - see Edema, glottis essential, acute T78.3 hereditary D84.1 extremities, lower - see Edema, legs eyelid NEC H02.849 left H02.846 lower H02.845 upper H02.844 right H02.843 lower H02.842 upper H02.841 Examination (for) (following) (general) (of) (routine) Z00.00with abnormal findings Z00.01 abuse, physical(alleged), ruled out adult Z04.71 child Z04.72 46 adolescent(development state) Z00.3 alleged rape or sexual assault(victim), ruled out adult Z04.41 child Z04.42 allergy Z01.82 annual(adult) (periodic) (physical) Z00.00 with abnormal findings Z00.01 gynecological Z01.419 with abnormal findings Z01.411 antibody response Z01.84 blood - see Examination, laboratory blood pressure Z01.30 with abnormal findings Z01.31 cancer staging - see Neoplasm, malignant, by site cervical Papanicolaou smear Z12.4 as part of routine gynecological examination Z01.419 with abnormal findings Z01.411 child(over 28 days old) Z00.129 with abnormal findings Z00.121 under 28 days old - see Newborn, examination clinical research control or normal comparison(control) (participant) Z00.6 contraceptive(drug) maintenance (routine) Z30.8 device(intrauterine) Z30.431 dental Z01.20 with abnormal findings Z01.21 developmental - see Examination, child donor(potential) Z00.5 ear Z01.10 with abnormal findings NEC Z01.118 eye Z01.00 with abnormal findings Z01.01 following accident NEC Z04.3 transport Z04.1 work Z04.2 assault, alleged, ruled out adult Z04.71 child Z04.72 motor vehicle accident Z04.1 treatment(for) Z09 combined NEC Z09 fracture Z09 malignant neoplasm Z08 malignant neoplasm Z08 mental disorder Z09 specified condition NEC Z09 follow-up(routine) (following) Z09 chemotherapy NEC Z09 malignant neoplasm Z08 47 fracture Z09 malignant neoplasm Z08 postpartum Z39.2 psychotherapy Z09 radiotherapy NEC Z09 malignant neoplasm Z08 surgery NEC Z09 malignant neoplasm Z08 gynecological Z01.419 with abnormal findings Z01.411 for contraceptive maintenance Z30.8 health - see Examination, medical hearing Z01.10 with abnormal findings NEC Z01.118 following failed hearing screening Z01.110 immunity status testing Z01.84 laboratory(as part of a general medical examination) Z00.00 with abnormal findings Z00.01 preprocedural Z01.812 lactating mother Z39.1 medical(adult) (for) (of) Z00.00 with abnormal findings Z00.01 administrative purpose only Z02.9 specified NEC Z02.89 admission to armed forces Z02.3 old age home Z02.2 prison Z02.89 residential institution Z02.2 school Z02.0 following illness or medical treatment Z02.0 summer camp Z02.89 adoption Z02.82 blood alcohol or drug level Z02.83 camp(summer) Z02.89 clinical research, normal subject(control) (participant) Z00.6 control subject in clinical research(normal comparison) (participant) Z00.6 donor(potential) Z00.5 driving license Z02.4 general(adult) Z00.00 with abnormal findings Z00.01 immigration Z02.89 insurance purposes Z02.6 marriage Z02.89 medicolegal reasons NEC Z04.8 naturalization Z02.89 participation in sport Z02.5 paternity testing Z02.81 population survey Z00.8 48 pre-employment Z02.1 pre-operative - see Examination, pre-procedural pre-procedural cardiovascular Z01.810 respiratory Z01.811 specified NEC Z01.818 preschool children for admission to school Z02.0 prisoners for entrance into prison Z02.89 recruitment for armed forces Z02.3 specified NEC Z00.8 sport competition Z02.5 medicolegal reason NEC Z04.8 newborn - see Newborn, examination pelvic(annual) (periodic) Z01.419 with abnormal findings Z01.411 period of rapid growth in childhood Z00.2 periodic(adult) (annual) (routine) Z00.00 with abnormal findings Z00.01 physical(adult) - see also Examination, medical Z00.00 sports Z02.5 postpartum immediately after delivery Z39.0 routine follow-up Z39.2 prenatal(normal pregnancy) - see also Pregnancy, normal Z34.9pre-chemotherapy(antineoplastic) Z01.818 pre-procedural(pre-operative) cardiovascular Z01.810 laboratory Z01.812 respiratory Z01.811 specified NEC Z01.818 prior to chemotherapy(antineoplastic) Z01.818 psychiatric NEC Z00.8 follow-up not needing further care Z09 requested by authority Z04.6 radiological(as part of a general medical examination) Z00.00 with abnormal findings Z00.01 repeat cervical smear to confirm findings of recent normal smear following initial abnormal smear Z01.42 skin(hypersensitivity) Z01.82 special - see also Examination, by type Z01.89 specified type NEC Z01.89 specified type or reason NEC Z04.8 teeth Z01.20 with abnormal findings Z01.21 urine - see Examination, laboratory vision Z01.00 with abnormal findings Z01.01 49 Foreign body esophagus T18.108 causing injury NEC T18.108 food(bone) (seed) T18.128 gastric contents(vomitus) T18.118 specified type NEC T18.198 tracheal compression T18.100 food(bone) (seed) T18.120 gastric contents(vomitus) T18.110 specified type NEC T18.190 pharynx T17.208 causing asphyxiation T17.200 food(bone) (seed) T17.220 gastric contents(vomitus) T17.210 specified type NEC T17.290 injury NEC T17.208 food(bone) (seed) T17.228 gastric contents(vomitus) T17.218 specified type NEC T17.298 Fracture, traumatic (abduction) (adduction) (separation) - see also Fracture, pathological T14.8 ulna(shaft) S52.20bent bone S52.28coronoid process - see Fracture, ulna, upper end, coronoid process distal end - see Fracture, ulna, lower end following insertion of implant, prosthesis or plate M96.63head S52.00lower end S52.60physeal S59.00Salter-Harris Type I S59.01Type II S59.02Type III S59.03Type IV S59.04specified NEC S59.09specified NEC S52.69styloid process(displaced) S52.61nondisplaced S52.61torus S52.62proximal end - see Fracture, ulna, upper end shaft S52.20comminuted(displaced) S52.25nondisplaced S52.25greenstick S52.21Monteggia's - see Monteggia's fracture oblique(displaced) S52.23- 50 nondisplaced S52.23segmental(displaced) S52.26nondisplaced S52.26specified NEC S52.29spiral(displaced) S52.24nondisplaced S52.24transverse(displaced) S52.22nondisplaced S52.22upper end S52.00coronoid process(displaced) S52.04nondisplaced S52.04olecranon process(displaced) S52.02with intraarticular extension S52.03with intraarticular extension S52.03nondisplaced S52.02with intraarticular extension S52.03with intraarticular extension S52.03with intraarticular extension S52.03with intraarticular extension S52.03specified NEC S52.09torus S52.01Heart beat abnormality R00.9 specified NEC R00.8 awareness R00.2 rapid R00.0 slow R00.1 Heat(effects) T67.9 apoplexy T67.0 burn - see also Burn L55.9 collapse T67.1 cramps T67.2 dermatitis or eczema L59.0 edema T67.7 erythema - code by site under Burn, first degree excessive T67.9 specified effect NEC T67.8 exhaustion T67.5 anhydrotic T67.3 due to salt(and water) depletion T67.4 water depletion T67.3 with salt depletion T67.4 fatigue(transient) T67.6 fever T67.0 hyperpyrexia T67.0 prickly L74.0 prostration - see Heat, exhaustion 51 pyrexia T67.0 rash L74.0 specified effect NEC T67.8 stroke T67.0 sunburn - see Sunburn syncope T67.1 Hematuria R31.9 due to sulphonamide, sulfonamide - see Table of drugs and chemicals, by drug benign(familial) (of childhood) - see also Hematuria, idiopathic essential microscopic R31.1 endemic - see also Schistosomiasis B65.0 gross R31.0 idiopathic N02.9 with glomerular lesion crescentic(diffuse) glomerulonephritis N02.7 dense deposit disease N02.6 endocapillary proliferative glomerulonephritis N02.4 focal and segmental hyalinosis or sclerosis N02.1 membranoproliferative(diffuse) N02.5 membranous(diffuse) N02.2 mesangial proliferative(diffuse) N02.3 mesangiocapillary(diffuse) N02.5 minor abnormality N02.0 proliferative NEC N02.8 specified pathology NEC N02.8 intermittent - see Hematuria, idiopathic malarial B50.8 microscopic NEC R31.2 benign essential R31.1 paroxysmal - see also Hematuria, idiopathic nocturnal D59.5 persistent - see Hematuria, idiopathic recurrent - see Hematuria, idiopathic tropical - see also Schistosomiasis B65.0 tuberculous A18.13 Hydrops R60.9 abdominis R18.8 articulorum intermittens - see Hydrarthrosis, intermittent cardiac - see Failure, heart, congecausing obstructed labor(mother) O66.3 endolymphatic H81.0fetal - see Pregnancy, complicated by, hydrops, fetalis fetalis P83.2 due to ABO isoimmunization P56.0 alpha thalassemia D56.0 hemolytic disease P56.90 specified NEC P56.99 isoimmunization(ABO) (Rh) P56.0 52 other specified nonhemolytic disease NEC P83.2 Rh incompatibility P56.0 during pregnancy - see Pregnancy, complicated by, hydrops, fetalis Hypertension, hypertensive (accelerated) (benign) (essential) (idiopathic) (malignant) (systemic) I10 with heart involvement(conditions in I51.4 - I51.9 due to hypertension) - see Hypertension, heart kidney involvement - see Hypertension, kidney benign, intracranial G93.2 borderline R03.0 cardiorenal(disease) I13.10 with heart failure I13.0 with stage 1 through stage 4 chronic kidney disease I13.0 with stage 5 or end stage renal disease I13.2 without heart failure I13.10 with stage 1 through stage 4 chronic kidney disease I13.10 with stage 5 or end stage renal disease I13.11 cardiovascular disease(arteriosclerotic) (sclerotic) - see Hypertension, heart renal(disease) - see Hypertension, cardiorenal chronic venous - see Hypertension, venous (chronic) complicating childbirth(labor) O10.92 with heart disease O10.12 with renal disease O10.32 renal disease O10.22 with heart disease O10.32 essential O10.02 secondary O10.42 pregnancy O16.with edema - see also Pre-eclampsia O14.9gestational(pregnancy induced) (transient) (without proteinuria) O13.with proteinuria O14.9mild pre-eclampsia O14.0moderate pre-eclampsia O14.0severe pre-eclampsia O14.1with hemolysis, elevated liver enzymes and low platelet count(HELLP) O14.2pre-existing O10.91with heart disease O10.11with renal disease O10.31pre-eclampsia O11.renal disease O10.21with heart disease O10.31essential O10.01secondary O10.41puerperium O10.93 with 53 heart disease O10.13 with renal disease O10.33 renal disease O10.23 with heart disease O10.33 essential O10.03 secondary O10.43 due to endocrine disorders I15.2 pheochromocytoma I15.2 renal disorders NEC I15.1 arterial I15.0 renovascular disorders I15.0 specified disease NEC I15.8 encephalopathy I67.4 gestational(without significant proteinuria) (pregnancy-induced) (transient) O13.with significant proteinuria - see Pre-eclampsia Goldblatt's I70.1 heart(disease) (conditions in I51.4-I51.9 due to hypertension) I11.9 with heart failure(congestive) I11.0 kidney disease(chronic) - see Hypertension, cardiorenal intracranial(benign) G93.2 kidney I12.9 with heart disease - see Hypertension, cardiorenal stage 5 chronic kidney disease(CKD) or end stage renal disease (ESRD) I12.0 stage 1 through stage 4 chronic kidney disease I12.9 lesser circulation I27.0 newborn P29.2 pulmonary(persistent) P29.3 ocular H40.05pancreatic duct - code to underlying condition with chronic pancreatitis K86.1 portal(due to chronic liver disease) (idiopathic) K76.6 gastropathy K31.89 in(due to) schistosomiasis (bilharziasis) B65.9 postoperative I97.3 psychogenic F45.8 pulmonary(artery) (secondary) NEC I27.2 with cor pulmonale(chronic) I27.2 acute I26.09 right heart ventricular strain/failure I27.2 acute I26.09 of newborn(persistent) P29.3 primary(idiopathic) I27.0 renal - see Hypertension, kidney renovascular I15.0 secondary NEC I15.9 54 due to endocrine disorders I15.2 pheochromocytoma I15.2 renal disorders NEC I15.1 arterial I15.0 renovascular disorders I15.0 specified NEC I15.8 venous(chronic) due to deep vein thrombosis - see Syndrome, postthrombotic idiopathic I87.309 with inflammation I87.32with ulcer I87.33specified complication NEC I87.39ulcer I87.31with inflammation I87.33asymptomatic I87.30Injury - see also specified injury type T14.90 eye S05.9avulsion S05.7ball - see Injury, eyeball conjunctiva S05.0cornea abrasion S05.0laceration S05.3with prolapse S05.2lacrimal apparatus S05.8Xorbit penetration S05.4specified site NEC S05.8Xhead S09.90 with loss of consciousness S06.9specified NEC S09.8 Injury - see also specified injury type T14.90 Jaundice (yellow) R17 newborn P59.9 due to or associated with ABO antibodies P55.1 incompatibility, maternal/fetal P55.1 isoimmunization P55.1 absence or deficiency of enzyme system for bilirubin conjugation(congenital) P59.8 bleeding P58.1 breast milk inhibitors to conjugation P59.3 associated with preterm delivery P59.0 bruising P58.0 55 Crigler-Najjar syndrome E80.5 delayed conjugation P59.8 associated with preterm delivery P59.0 drugs or toxins given to newborn P58.42 transmitted from mother P58.41 excessive hemolysis P58.9 due to bleeding P58.1 bruising P58.0 drugs or toxins given to newborn P58.42 transmitted from mother P58.41 infection P58.2 polycythemia P58.3 swallowed maternal blood P58.5 specified type NEC P58.8 galactosemia E74.21 Gilbert syndrome E80.4 hemolytic disease P55.9 ABO isoimmunization P55.1 Rh isoimmunization P55.0 specified NEC P55.8 hepatocellular damage P59.20 specified NEC P59.29 hereditary hemolytic anemia P58.8 hypothyroidism, congenital E03.1 incompatibility, maternal/fetal NOS P55.9 infection P58.2 inspissated bile syndrome P59.1 isoimmunization NOS P55.9 mucoviscidosis E84.9 polycythemia P58.3 preterm delivery P59.0 Rh antibodies P55.0 incompatibility, maternal/fetal P55.0 isoimmunization P55.0 specified cause NEC P59.8 swallowed maternal blood P58.5 spherocytosis(congenital) D58.0 neonatal - see Jaundice, newborn nonhemolytic congenital familial(Gilbert) E80.4 nuclear, newborn - see also Kernicterus of newborn P57.9 obstructive - see also Obstruction, bile duct K83.1 post-immunization - see Hepatitis, viral, type, B post-transfusion - see Hepatitis, viral, type, B regurgitation - see also Obstruction, bile duct K83.1 serum(homologous) (prophylactic) (therapeutic) - see Hepatitis, viral, type, B 56 spirochetal(hemorrhagic) A27.0 symptomatic R17 newborn P59.9 Maltreatment adult abandonment confirmed T74.01 suspected T76.01 confirmed T74.91 history of Z91.419 neglect confirmed T74.01 suspected T76.01 physical abuse confirmed T74.11 suspected T76.11 psychological abuse confirmed T74.31 suspected T76.31 history of Z91.411 sexual abuse confirmed T74.21 suspected T76.21 suspected T76.91 child abandonment confirmed T74.02 suspected T76.02 confirmed T74.92 history of - see History, personal (of), abuse neglect confirmed T74.02 history of - see History, personal (of), abuse suspected T76.02 physical abuse confirmed T74.12 history of - see History, personal (of), abuse suspected T76.12 psychological abuse confirmed T74.32 history of - see History, personal (of), abuse suspected T76.32 sexual abuse confirmed T74.22 history of - see History, personal (of), abuse suspected T76.22 suspected T76.92 personal history of Z91.89 57 Murmur (cardiac) (heart) (organic) R01.1 abdominal R19.15 aortic(valve) - see Endocarditis, aortic benign R01.0 diastolic - see Endocarditis Flint I35.1 functional R01.0 Graham Steell I37.1 innocent R01.0 mitral(valve) - see Insufficiency, mitral nonorganic R01.0 presystolic, mitral - see Insufficiency, mitral pulmonic(valve) I37.8 systolic(valvular) - see Endocarditis tricuspid(valve) I07.9 valvular - see Endocarditis Nausea (without vomiting) R11.0 with vomiting R11.2 gravidarum - see Hyperemesis, gravidarum marina T75.3 navalis T75.3 Newborn(infant) (liveborn) (singleton) Z38.2 acne L70.4 abstinence syndrome P96.1 affected by(suspected to be) abnormalities of membranes P02.9 specified NEC P02.8 abruptio placenta P02.1 amino-acid metabolic disorder, transitory P74.8 amniocentesis(while in utero) P00.6 amnionitis P02.7 apparent life threatening event(ALTE) R68.13 bleeding(into) cerebral cortex P52.22 germinal matrix P52.0 ventricles P52.1 breech delivery P03.0 cardiac arrest P29.81 cardiomyopathy I42.8 congenital I42.4 cerebral ischemia P91.0 Cesarean delivery P03.4 chemotherapy agents P04.1 chorioamnionitis P02.7 cocaine(crack) P04.41 complications of labor and delivery P03.9 specified NEC P03.89 58 compression of umbilical cord NEC P02.5 contracted pelvis P03.1 delivery P03.9 Cesarean P03.4 forceps P03.2 vacuum extractor P03.3 environmental chemicals P04.6 entanglement(knot) in umbilical cord P02.5 fetal(intrauterine) growth retardation P05.9 malnutrition not light or small for gestational age P05.2 forceps delivery P03.2 heart rate abnormalities bradycardia P29.12 intrauterine P03.819 before onset of labor P03.810 during labor P03.811 tachycardia P29.11 hemorrhage(antepartum) P02.1 cerebellar(nontraumatic) P52.6 intracerebral(nontraumatic) P52.4 intracranial(nontraumatic) P52.9 specified NEC P52.8 intraventricular(nontraumatic) P52.3 grade 1 P52.0 grade 2 P52.1 grade 3 P52.21 grade 4 P52.22 posterior fossa(nontraumatic) P52.6 subarachnoid(nontraumatic) P52.5 subependymal P52.0 with intracerebral extension P52.22 with intraventricular extension P52.1 with enlargment of ventricles P52.21 without intraventricular extension P52.0 hypoxic ischemic encephalopathy [HIE] P91.60 mild P91.61 moderate P91.62 severe P91.63 induction of labor P03.89 intestinal perforation P78.0 intrauterine(fetal) blood loss P50.9 due to(from) cut end of co-twin cord P50.5 hemorrhage into co-twin P50.3 maternal circulation P50.4 placenta P50.2 ruptured cord blood P50.1 59 vasa previa P50.0 specified NEC P50.8 intrauterine(fetal) hemorrhage P50.9 intrauterine(in utero) procedure P96.5 malpresentation(malposition) NEC P03.1 maternal(complication of) (use of) alcohol P04.3 analgesia(maternal) P04.0 anesthesia(maternal) P04.0 blood loss P02.1 circulatory disease P00.3 condition P00.9 specified NEC P00.89 delivery P03.9 Cesarean P03.4 forceps P03.2 vacuum extractor P03.3 diabetes mellitus(pre-existing) P70.1 disorder P00.9 specified NEC P00.89 drugs(addictive) (illegal) NEC P04.49 ectopic pregnancy P01.4 gestational diabetes P70.0 hemorrhage P02.1 hypertensive disorder P00.0 incompetent cervix P01.0 infectious disease P00.2 injury P00.5 labor and delivery P03.9 malpresentation before labor P01.7 maternal death P01.6 medical procedure P00.7 medication P04.1 multiple pregnancy P01.5 nutritional disorder P00.4 oligohydramnios P01.2 parasitic disease P00.2 periodontal disease P00.81 placenta previa P02.0 polyhydramnios P01.3 precipitate delivery P03.5 pregnancy P01.9 specified P01.8 premature rupture of membranes P01.1 renal disease P00.1 respiratory disease P00.3 surgical procedure P00.6 urinary tract disease P00.1 uterine contraction(abnormal) P03.6 60 meconium peritonitis P78.0 medication(legal) (maternal use) (prescribed) P04.1 membrane abnormalities P02.9 specified NEC P02.8 membranitis P02.7 methamphetamine(s) P04.49 mixed metabolic and respiratory acidosis P84 neonatal abstinence syndrome P96.1 noxious substances transmitted via placenta or breast milk P04.9 specified NEC P04.8 nutritional supplements P04.5 placenta previa P02.0 placental abnormality(functional) (morphological) P02.20 specified NEC P02.29 dysfunction P02.29 infarction P02.29 insufficiency P02.29 separation NEC P02.1 transfusion syndromes P02.3 placentitis P02.7 precipitate delivery P03.5 prolapsed cord P02.4 respiratory arrest P28.81 slow intrauterine growth P05.9 tobacco P04.2 twin to twin transplacental transfusion P02.3 umbilical cord(tightly) around neck P02.5 umbilical cord condition P02.60 short cord P02.69 specified NEC P02.69 uterine contractions(abnormal) P03.6 vasa previa P02.69 from intrauterine blood loss P50.0 apnea P28.3 primary P28.3 obstructive P28.4 specified P28.4 born in hospital Z38.00 by cesarean Z38.01 born outside hospital Z38.1 breast buds P96.89 breast engorgement P83.4 check-up - see Newborn, examination convulsion P90 dehydration P74.1 examination 8 to 28 days old Z00.111 under 8 days old Z00.110 61 fever P81.9 environmentally-induced P81.0 hyperbilirubinemia P59.9 of prematurity P59.0 hypernatremia P74.2 hyponatremia P74.2 infection P39.9 candidal P37.5 specified NEC P39.8 urinary tract P39.3 jaundice P59.8 due to breast milk inhibitor P59.3 hepatocellular damage P59.20 specified NEC P59.29 preterm delivery P59.0 of prematurity P59.0 specified NEC P59.8 late metabolic acidosis P74.0 mastitis P39.0 infective P39.0 noninfective P83.4 multiple born NEC Z38.8 born in hospital Z38.68 by cesarean Z38.69 born outside hospital Z38.7 omphalitis P38.9 with mild hemorrhage P38.1 without hemorrhage P38.9 post-term P08.21 prolonged gestation(over 42 completed weeks) P08.22 quadruplet Z38.8 born in hospital Z38.63 by cesarean Z38.64 born outside hospital Z38.7 quintuplet Z38.8 born in hospital Z38.65 by cesarean Z38.66 born outside hospital Z38.7 seizure P90 sepsis(congenital) P36.9 due to anaerobes NEC P36.5 Escherichia coli P36.4 Staphylococcus P36.30 aureus P36.2 specified NEC P36.39 Streptococcus P36.10 group B P36.0 62 specified NEC P36.19 specified NEC P36.8 triplet Z38.8 born in hospital Z38.61 by cesarean Z38.62 born outside hospital Z38.7 twin Z38.5 born in hospital Z38.30 by cesarean Z38.31 born outside hospital Z38.4 vomiting P92.09 bilious P92.01 weight check Z00.111 Proteinuria R80.9 Bence Jones R80.3 complicating pregnancy - see Proteinuria, gestational gestational O12.1with edema O12.2idiopathic R80.0 isolated R80.0 with glomerular lesion N06.9 dense deposit disease N06.6 diffuse crescentic glomerulonephritis N06.7 endocapillary proliferative glomerulonephritis N06.4 mesangiocapillary glomerulonephritis N06.5 focal and segmental hyalinosis or sclerosis N06.1 membranous(diffuse) N06.2 mesangial proliferative(diffuse) N06.3 minimal change N06.0 specified pathology NEC N06.8 orthostatic R80.2 with glomerular lesion - see Proteinuria, isolated, with glomerular lesion persistent R80.1 with glomerular lesion - see Proteinuria, isolated, with glomerular lesion postural R80.2 with glomerular lesion - see Proteinuria, isolated, with glomerular lesion pre-eclamptic - see Pre-eclampsia specified type NEC R80.8 Spina bifida (aperta) Q05.9 with hydrocephalus NEC Q05.4 cervical Q05.5 with hydrocephalus Q05.0 dorsal Q05.6 with hydrocephalus Q05.1 lumbar Q05.7 with hydrocephalus Q05.2 lumbosacral Q05.7 63 with hydrocephalus Q05.2 occulta Q76.0 sacral Q05.8 with hydrocephalus Q05.3 thoracic Q05.6 with hydrocephalus Q05.1 thoracolumbar Q05.6 with hydrocephalus Q05.1 Trisomy (syndrome) Q92.9 autosomes Q92.9 chromosome specified NEC Q92.8 partial Q92.2 due to unbalanced translocation Q92.5 whole(nonsex chromosome) meiotic nondisjunction Q92.0 mitotic nondisjunction Q92.1 mosaicism Q92.1 specified NEC Q92.8 due to dicentrics - see Extra, marker chromosomes extra rings - see Extra, marker chromosomes isochromosomes - see Extra, marker chromosomes specified NEC Q92.8 whole chromosome Q92.9 meiotic nondisjunction Q92.0 mitotic nondisjunction Q92.1 mosaicism Q92.1 partial Q92.9 specified NEC Q92.8 13(partial) Q91.7 meiotic nondisjunction Q91.4 mitotic nondisjunction Q91.5 mosaicism Q91.5 translocation Q91.6 18(partial) Q91.3 meiotic nondisjunction Q91.0 mitotic nondisjunction Q91.1 mosaicism Q91.1 translocation Q91.2 20 Q92.8 21(partial) Q90.9 meiotic nondisjunction Q90.0 mitotic nondisjunction Q90.1 mosaicism Q90.1 translocation Q90.2 Vomiting R11.10 with nausea R11.2 asphyxia - see Foreign body, by site, causing asphyxia, gastric contents 64 bilious(cause unknown) R11.14 in newborn P92.01 following gastro-intestinal surgery K91.0 blood - see Hematemesis causing asphyxia, choking, or suffocation - see Foreign body, by site cyclical G43.A0 with refractory migraine G43.A1 intractable G43.A1 not intractable G43.A0 psychogenic F50.8 without refractory migraine G43.A0 fecal matter R11.13 following gastrointestinal surgery K91.0 psychogenic F50.8 functional K31.89 hysterical F50.8 nervous F50.8 neurotic F50.8 newborn NEC P92.09 bilious P92.01 periodic R11.10 psychogenic F50.8 projectile R11.12 psychogenic F50.8 uremic - see Uremia without nausea R11.11 Suicide, suicidal (attempted) T14.91 by poisoning - see Table of drugs and chemicals history of(personal) Z91.5 in family Z81.8 ideation - see Ideation, suicidal risk meaning personal history of attempted suicide Z91.5 meaning suicidal ideation - see Ideation, suicidal tendencies meaning personal history of attempted suicide Z91.5 meaning suicidal ideation - see Ideation, suicidal trauma - see nature of injury by sit Tachycardia R00.0 atrial(paroxysmal) I47.1 auricular I47.1 AV nodal re-entry(re-entrant) I47.1 Junctional (paroxysmal) I47.1 newborn P29.11 nodal(paroxysmal) I47.1 non-paroxysmal AV nodal I45.89 paroxysmal(sustained) (nonsustained) I47.9 with sinus bradycardia I49.5 65 atrial(PAT) I47.1 atrioventricular(AV) (re-entrant) I47.1 psychogenic F54 junctional I47.1 ectopic I47.1 nodal I47.1 psychogenic(atrial) (supraventricular) (ventricular) F54 supraventricular(sustained) I47.1 psychogenic F54 ventricular I47.2 psychogenic F54 psychogenic F45.8 sick sinus I49.5 sinoauricular NOS R00.0 paroxysmal I47.1 sinus [sinusal] NOS R00.0 paroxysmal I47.1 supraventricular I47.1 ventricular(paroxysmal) (sustained) I47.2 psychogenic F54 66 ATTACHMENT C: 2012 ICD-10-CM EXTERNAL CAUSE INDEX – Examples Note: This handout is to be used for the ICD-10-CM CE test only. This handout is NOT to be used for actual coding. Burn, burned, burning(accidental) (by) (from) (on) acid NEC - see Table of drugs and chemicals bed linen - see Exposure, fire, uncontrolled, in building, bed blowtorch X08.8 with ignition of clothing NEC X06.2 nightwear X05 bonfire, campfire(controlled) - see also Exposure, fire, controlled, not in building uncontrolled - see Exposure, fire, uncontrolled, not in building candle X08.8 with ignition of clothing NEC X06.2 nightwear X05 caustic liquid, substance(external) (internal) NEC - see Table of drugs and chemicals chemical(external) (internal) - see also Table of drugs and chemicals in war operations - see War operations. fire cigar(s) or cigarette(s) X08.8 with ignition of clothing NEC X06.2 nightwear X05 clothes, clothing NEC(from controlled fire) X06.2 with conflagration - see Exposure, fire, uncontrolled, building not in building or structure - see Exposure, fire, uncontrolled, not in building cooker(hot) X15.8 stated as undetermined whether accidental or intentional Y27.3 suicide(attempt) X77.3 electric blanket X16 engine(hot) X17 fire, flames - see Exposure, fire flare, Very pistol - see Discharge, firearm NEC heat from appliance(electrical) (household) X15.8 cooker X15.8 hotplate X15.2 kettle X15.8 light bulb X15.8 saucepan X15.3 skillet X15.3 stove X15.0 stated as undetermined whether accidental or intentional Y27.3 suicide(attempt) X77.3 toaster X15.1 in local application or packing during medical or surgical procedure Y63.5 heating appliance, radiator or pipe X16 homicide(attempt) - see Assault, burning hot 67 air X14.1 cooker X15.8 drink X10.0 engine X17 fat X10.2 fluid NEC X12 food X10.1 gases X14.1 heating appliance X16 household appliance NEC X15.8 kettle X15.8 liquid NEC X12 machinery X17 metal(molten) (liquid) NEC X18 object(not producing fire or flames) NEC X19 oil(cooking) X10.2 pipe(s) X16 radiator X16 saucepan(glass) (metal) X15.3 stove(kitchen) X15.0 substance NEC X19 caustic or corrosive NEC - see Table of drugs and chemicals toaster X15.1 tool X17 vapor X13.1 water(tap) - see Contact, with, hot, tap water hotplate X15.2 suicide(attempt) X77.3 ignition - see Ignition in war operations - see War operations, fire inflicted by other person X97 by hot objects, hot vapor, and steam - see Assault, burning, hot object internal, from swallowed caustic, corrosive liquid, substance - see Table of drugs and chemicals iron(hot) X15.8 stated as undetermined whether accidental or intentional Y27.3 suicide(attempt) X77.3 kettle(hot) X15.8 stated as undetermined whether accidental or intentional Y27.3 suicide(attempt) X77.3 lamp(flame) X08.8 with ignition of clothing NEC X06.2 nightwear X05 lighter(cigar) (cigarette) X08.8 with ignition of clothing NEC X06.2 nightwear X05 lightning causing fire - see Exposure, fire liquid(boiling) (hot) NEC X12 68 stated as undetermined whether accidental or intentional Y27.2 suicide(attempt) X77.2 local application of externally applied substance in medical or surgical care Y63.5 on board watercraft due to accident to watercraft V91.09 powered craft V91.03 ferry boat V91.01 fishing boat V91.02 jet skis V91.03 liner V91.01 merchant ship V91.00 passenger ship V91.01 unpowered craft V91.08 canoe V91.05 inflatable V91.06 kayak V91.05 sailboat V91.04 surf-board V91.08 water skis V91.07 windsurfer V91.08 fire on board V93.09 ferry boat V93.01 fishing boat V93.02 jet skis V93.03 liner V93.01 merchant ship V93.00 passenger ship V93.01 powered craft NEC V93.03 sailboat V93.04 specified heat source NEC on board V93.19 ferry boat V93.11 fishing boat V93.12 jet skis V93.13 liner V93.11 merchant ship V93.10 passenger ship V93.11 powered craft NEC V93.13 sailboat V93.14 machinery(hot) X17 matches X08.8 with ignition of clothing NEC X06.2 nightwear X05 mattress - see Exposure, fire, uncontrolled, building, bed medicament, externally applied Y63.5 metal(hot) (liquid) (molten) NEC X18 nightwear(nightclothes, nightdress, gown, pajamas, robe) X05 object(hot) NEC X19 69 pipe(hot) X16 smoking X08.8 with ignition of clothing NEC X06.2 nightwear X05 powder - see Powder burn radiator(hot) X16 saucepan(hot) (glass) (metal) X15.3 stated as undetermined whether accidental or intentional Y27.3 suicide(attempt) X77.3 self-inflicted X76 stated as undetermined whether accidental or intentional Y26 steam X13.1 pipe X16 stated as undetermined whether accidental or intentional Y27.8 stated as undetermined whether accidental or intentional Y27.0 suicide(attempt) X77.0 stove(hot) (kitchen) X15.0 stated as undetermined whether accidental or intentional Y27.3 suicide(attempt) X77.3 substance(hot) NEC X19 boiling X12 stated as undetermined whether accidental or intentional Y27.2 suicide(attempt) X77.2 molten(metal) X18 suicide(attempt) NEC X76 hot household appliance X77.3 object X77.9 stated as undetermined whether accidental or intentional Y27.0 therapeutic misadventure heat in local application or packing during medical or surgical procedure Y63.5 overdose of radiation Y63.2 toaster(hot) X15.1 stated as undetermined whether accidental or intentional Y27.3 suicide(attempt) X77.3 tool(hot) X17 Complication(delayed) of or following (medical or surgical procedure) Y84.9 with misadventure - see Misadventure amputation of limb(s) Y83.5 anastomosis(arteriovenous) (blood vessel) (gastrojejunal) (tendon) (natural or artificial material) Y83.2 aspiration(of fluid) Y84.4 tissue Y84.8 biopsy Y84.8 blood sampling Y84.7 transfusion procedure Y84.8 70 bypass Y83.2 catheterization(urinary) Y84.6 cardiac Y84.0 colostomy Y83.3 cystostomy Y83.3 dialysis(kidney) Y84.1 drug - see Table of drugs and chemicals due to misadventure - see Misadventure duodenostomy Y83.3 electroshock therapy Y84.3 external stoma, creation of Y83.3 formation of external stoma Y83.3 gastrostomy Y83.3 graft Y83.2 hypothermia(medically-induced) Y84.8 implant, implantation(of) artificial internal device(cardiac pacemaker) (electrodes in brain) (heart valve prosthesis) (orthopedic) Y83.1 material or tissue(for anastomosis or bypass) Y83.2 with creation of external stoma Y83.3 natural tissues(for anastomosis or bypass) Y83.2 with creation of external stoma Y83.3 infusion procedure Y84.8 injection - see Table of drugs and chemicals procedure Y84.8 insertion of gastric or duodenal sound Y84.5 insulin-shock therapy Y84.3 paracentesis(abdominal) (thoracic) (aspirative) Y84.4 procedures other than surgical operation - see Complication of or following, by type of procedure radiological procedure or therapy Y84.2 removal of organ(partial) (total) NEC Y83.6 sampling blood Y84.7 fluid NEC Y84.4 tissue Y84.8 shock therapy Y84.3 surgical operation NEC - see also Complication of or following, by type of operation Y83.9 reconstructive NEC Y83.4 with anastomosis, bypass or graft Y83.2 formation of external stoma Y83.3 specified NEC Y83.8 transfusion - see also Table of drugs and chemicals procedure Y84.8 transplant, transplantation(heart) (kidney) (liver) (whole organ, any) Y83.0 partial organ Y83.4 71 ureterostomy Y83.3 vaccination - see also Table of drugs and chemicals procedure Y84.8 Fall, falling(accidental) W19 building W20.1 burning(uncontrolled fire) X00.3 down embankment W17.81 escalator W10.0 hill W17.81 ladder W11 ramp W10.2 stairs, steps W10.9 due to bumping against object W18.00 sharp glass W18.02 specified NEC W18.09 sports equipment W18.01 person W03 due to ice or snow W00.0 on pedestrian conveyance - see Accident, transport, pedestrian, conveyance collision with another person W03 due to ice or snow W00.0 involving pedestrian conveyance - see Accident, transport, pedestrian, conveyance grocery cart tipping over W17.82 ice or snow W00.9 from one level to another W00.2 on stairs or steps W00.1 involving pedestrian conveyance - see Accident, transport, pedestrian, conveyance on same level W00.0 slipping(on moving sidewalk) W01.0 with subsequent striking against object W01.10 furniture W01.190 sharp object W01.119 glass W01.110 power tool or machine W01.111 specified NEC W01.118 specified NEC W01.198 striking against object W18.00 sharp glass W18.02 specified NEC W18.09 sports equipment W18.01 person W03 due to ice or snow W00.0 on pedestrian conveyance - see Accident, transport, pedestrian, conveyance earth(with asphyxia or suffocation (by pressure)) - see Earth, falling 72 from, off, out of aircraft NEC(with accident to aircraft NEC) V97.0 while boarding or alighting V97.1 balcony W13.0 bed W06 boat, ship, watercraft NEC(with drowning or submersion) - see Drowning, due to, fall overboard with hitting bottom or object V94.0 bridge W13.1 building W13.9 burning(uncontrolled fire) X00.3 cavity W17.2 chair W07 cherry picker W17.89 cliff W15 dock W17.4 embankment W17.81 escalator W10.0 flagpole W13.8 furniture NEC W08 grocery cart W17.82 haystack W17.89 high place NEC W17.89 stated as undetermined whether accidental or intentional Y30 hole W17.2 incline W10.2 ladder W11 lifting device W17.89 machine, machinery - see also Contact, with, by type of machine not in operation W17.89 manhole W17.1 mobile elevated work platform [MEWP] W17.89 motorized mobility scooter W05.2 one level to another NEC W17.89 intentional, purposeful, suicide(attempt) X80 stated as undetermined whether accidental or intentional Y30 pit W17.2 playground equipment W09.8 jungle gym W09.2 slide W09.0 swing W09.1 quarry W17.89 railing W13.9 ramp W10.2 roof W13.2 scaffolding W12 scooter(nonmotorized) W05.1 motorized mobility W05.2 73 sky lift W17.89 stairs, steps W10.9 curb W10.1 due to ice or snow W00.1 escalator W10.0 incline W10.2 ramp W10.2 sidewalk curb W10.1 specified NEC W10.8 stepladder W11 storm drain W17.1 streetcar NEC V82.6 with antecedent collision - see Accident, transport, streetcar occupant while boarding or alighting V82.4 structure NEC W13.8 burning(uncontrolled fire) X00.3 table W08 toilet W18.11 with subsequent striking against object W18.12 train NEC V81.6 during derailment(without antecedent collision) V81.7 with antecedent collision - see Accident, transport, railway vehicle occupant while boarding or alighting V81.4 transport vehicle after collision - see Accident, transport, by type of vehicle, collision tree W14 vehicle(in motion) NEC - see also Accident, transport V89.9 motor NEC - see also Accident, transport, occupant, by type of vehicle V87.8 stationary W17.89 while boarding or alighting B - see Accident, transport, by type of vehicle, while boarding or alighting viaduct W13.8 wall W13.8 watercraft - see also Drowning, due to, fall overboard with hitting bottom or object V94.0 well W17.0 wheelchair, non-moving W05.0 powered - see Accident, transport, pedestrian, conveyance occupant, specified type NEC window W13.4 in, on aircraft NEC V97.0 with accident to aircraft V97.0 while boarding or alighting V97.1 bathtub(empty) W18.2 filled W16.212 causing drowning W16.211 escalator W10.0 incline W10.2 74 ladder W11 machine, machinery - see Contact, with, by type of machine object, edged, pointed or sharp(with cut) - see Fall, by type playground equipment W09.8 jungle gym W09.2 slide W09.0 swing W09.1 ramp W10.2 scaffolding W12 shower W18.2 causing drowning W16.211 staircase, stairs, steps W10.9 curb W10.1 due to ice or snow W00.1 escalator W10.0 incline W10.2 specified NEC W10.8 streetcar(without antecedent collision) V82.5 with antecedent collision - see Accident, transport, streetcar occupant while boarding or alighting V82.4 train(without antecedent collision) V81.5 with antecedent collision - see Accident, transport, railway vehicle occupant during derailment(without antecedent collision) V81.7 with antecedent collision - see Accident, transport, railway vehicle occupant while boarding or alighting V81.4 transport vehicle after collision - see Accident, transport, by type of vehicle, collision watercraft V93.39 due to accident to craft V91.29 powered craft V91.23 ferry boat V91.21 fishing boat V91.22 jet skis V91.23 liner V91.21 merchant ship V91.20 passenger ship V91.21 unpowered craft canoe V91.25 inflatable V91.26 kayak V91.25 sailboat V91.24 powered craft V93.33 ferry boat V93.31 fishing boat V93.32 jet skis V93.33 liner V93.31 merchant ship V93.30 passenger ship V93.31 75 unpowered craft V93.38 canoe V93.35 inflatable V93.36 kayak V93.35 sailboat V93.34 surf-board V93.38 windsurfer V93.38 Foreign body entering through skin W45.8 can lid W45.2 nail W45.0 paper W45.1 specified NEC W45.8 splinter W45.8 Forces of nature X39.8 avalanche X36.1 causing transport accident - see Accident, transport, by type of vehicle blizzard X37.2 cataclysmic storm X37.9 with flood X38 blizzard X37.2 cloudburst X37.8 cyclone X37.1 dust storm X37.3 hurricane X37.0 specified storm NEC X37.8 storm surge X37.0 tornado X37.1 twister X37.1 typhoon X37.0 cloudburst X37.8 cold(natural) X31 cyclone X37.1 dam collapse causing earth movement X36.0 dust storm X37.3 earth movement X36.1 earthquake X34 caused by dam or structure collapse X36.0 earthquake X34 flood(caused by) X38 dam collapse X36.0 tidal wave B - see Forces of nature, tidal wave heat(natural) X30 hurricane X37.0 landslide X36.1 causing transport accident - see Accident, transport, by type of vehicle lightning causing fire - see Exposure, fire 76 mudslide X36.1 causing transport accident - see Accident, transport, by type of vehicle radiation(natural) X39.08 radon X39.01 radon X39.01 specified force NEC X39.8 storm surge X37.0 structure collapse causing earth movement X36.0 sunlight X32 tidal wave X37.41 due to earthquake X37.41 landslide X37.43 storm X37.42 volcanic eruption X37.41 tornado X37.1 tsunami X37.41 twister X37.1 typhoon X37.0 volcanic eruption X35 Incident, adverse device anesthesiology Y70.8 accessory Y70.2 diagnostic Y70.0 miscellaneous Y70.8 monitoring Y70.0 prosthetic Y70.2 rehabilitative Y70.1 surgical Y70.3 therapeutic Y70.1 cardiovascular Y71.8 accessory Y71.2 diagnostic Y71.0 miscellaneous Y71.8 monitoring Y71.0 prosthetic Y71.2 rehabilitative Y71.1 surgical Y71.3 therapeutic Y71.1 gastroenterology Y73.8 accessory Y73.2 diagnostic Y73.0 miscellaneous Y73.8 monitoring Y73.0 prosthetic Y73.2 rehabilitative Y73.1 77 surgical Y73.3 therapeutic Y73.1 general hospital Y74.8 accessory Y74.2 diagnostic Y74.0 miscellaneous Y74.8 monitoring Y74.0 prosthetic Y74.2 rehabilitative Y74.1 surgical Y74.3 therapeutic Y74.1 surgical Y81.8 accessory Y81.2 diagnostic Y81.0 miscellaneous Y81.8 monitoring Y81.0 prosthetic Y81.2 rehabilitative Y81.1 surgical Y81.3 therapeutic Y81.1 gynecological Y76.8 accessory Y76.2 diagnostic Y76.0 miscellaneous Y76.8 monitoring Y76.0 prosthetic Y76.2 rehabilitative Y76.1 surgical Y76.3 therapeutic Y76.1 Injury, injured(accidental(ly)) NOS X58 by, caused by, from assault - see Assault law-enforcing agent, police, in course of legal intervention - see Legal intervention suicide(attempt) X83.8 due to, in civil insurrection - see War operations fight - see also Assault, fight Y04.0 war operations - see War operations homicide - see also Assault Y09 inflicted(by) in course of arrest(attempted), suppression of disturbance, maintenance of order, by law-enforcing agents - see Legal intervention other person stated as accidental X58 intentional, homicide(attempt) - see Assault undetermined whether accidental or intentional Y33 78 purposely(inflicted) by other person(s) - see Assault self-inflicted X83.8 stated as accidental X58 specified cause NEC X58 undetermined whether accidental or intentional Y33 Run over(accidentally) (by) animal(not being ridden) NEC W55.89 machinery - see Contact, with, by specified type of machine transport vehicle NEC - see also Accident, transport V09.9 intentional homicide(attempt) Y03.0 motor NEC V09.20 intentional homicide(attempt) Y03.0 Status of external cause Y99.9 child assisting in compensated work for family Y99.8 civilian activity done for financial or other compensation Y99.0 civilian activity done for income or pay Y99.0 family member assisting in compensated work for other family member Y99.8 hobby not done for income Y99.8 leisure activity Y99.8 military activity Y99.1 off-duty activity of military personnel Y99.8 recreation or sport not for income or while a student Y99.8 specified NEC Y99.8 student activity Y99.8 volunteer activity Y99.2 Terrorism(involving) Y38.80 biological weapons Y38.6Xchemical weapons Y38.7Xconflagration Y38.3Xexplosion Y38.2Xdestruction of aircraft Y38.1Xmarine weapons Y38.0Xfire Y38.3Xfirearms Y38.4Xhot substances Y38.5Xnuclear weapons Y38.5Xspecified method NEC Y38.8XWalked into stationary object(any) W22.09 furniture W22.03 lamppost W22.02 wall W22.01 79 ATTACHMENT D: ICD-10-CM ALPHABETIC INDEX TO DISEASES and INJURIESExamples Note: This handout is to be used for the ICD-10-CM CE test only. This handout is NOT to be used for actual coding. Drug Poisoning Accidental Poisoning Intentional Poisoning Assault Poisoning Undetermined Adverse Effect Underdosing Dacarbazine T45.1X1 T45.1X2 T45.1X3 T45.1X4 T45.1X5 T45.1X6 Dactinomycin T45.1X1 T45.1X2 T45.1X3 T45.1X4 T45.1X5 T45.1X6 DADPS T37.1X1 T37.1X2 T37.1X3 T37.1X4 T37.1X5 T37.1X6 Dakin's solution T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Dalapon(sodium) T60.3X1 T60.3X2 T60.3X3 T60.3X4 Dalmane T42.4X1 T42.4X2 T42.4X3 T42.4X4 T42.4X5 T42.4X6 Danazol T38.6X1 T38.6X2 T38.6X3 T38.6X4 T38.6X5 T38.6X6 Danilone T45.511 T45.512 T45.513 T45.514 T45.515 T45.516 Danthron T47.2X1 T47.2X2 T47.2X3 T47.2X4 T47.2X5 T47.2X6 Dantrolene T42.8X1 T42.8X2 T42.8X3 T42.8X4 T42.8X5 T42.8X6 Dantron T47.2X1 T47.2X2 T47.2X3 T47.2X4 T47.2X5 T47.2X6 Daphne(gnidium) (mezereum) T62.2X1 T62.2X2 T62.2X3 T62.2X4 berry T62.1X1 T62.1X2 T62.1X3 T62.1X4 Dapsone T37.1X1 T37.1X2 T37.1X3 T37.1X4 T37.1X5 T37.1X6 Daraprim T37.2X1 T37.2X2 T37.2X3 T37.2X4 T37.2X5 T37.2X6 Darnel T62.2X1 T62.2X2 T62.2X3 T62.2X4 Darvon T39.8X1 T39.8X2 T39.8X3 T39.8X4 T39.8X5 T39.8X6 Daunomycin T45.1X1 T45.1X2 T45.1X3 T45.1X4 T45.1X5 T45.1X6 Daunorubicin T45.1X1 T45.1X2 T45.1X3 T45.1X4 T45.1X5 T45.1X6 DBI T38.3X1 T38.3X2 T38.3X3 T38.3X4 T38.3X5 T38.3X6 D-Con T60.91 T60.92 T60.93 T60.94 insecticide T60.2X1 T60.2X2 T60.2X3 T60.2X4 rodenticide T60.4X1 T60.4X2 T60.4X3 T60.4X4 T38.895 T38.896 T37.1X5 T37.1X6 DDAVP T38.891 T38.892 T38.893 T38.894 DDE(bis(chlorophenyl)-dichloroethylene) T60.2X1 T60.2X2 T60.2X3 T60.2X4 DDS T37.1X1 T37.1X2 T37.1X3 T37.1X4 DDT(dust) T60.1X1 T60.1X2 T60.1X3 T60.1X4 Deadly nightshade T62.2X1 T62.2X2 T62.2X3 T62.2X4 T62.1X1 T62.1X2 T62.1X3 T62.1X4 Deamino-D-arginine vasopressin T38.891 T38.892 T38.893 T38.894 T38.895 T38.896 Deanol(aceglumate) T50.991 T50.992 T50.993 T50.994 T50.995 T50.996 Debrisoquine T46.5X1 T46.5X2 T46.5X3 T46.5X4 T46.5X5 T46.5X6 Decaborane T57.8X1 T57.8X2 T57.8X3 T57.8X4 fumes T59.891 T59.892 T59.893 T59.894 Decadron T38.0X1 T38.0X2 T38.0X3 T38.0X4 T38.0X5 T38.0X6 ENT agent T49.6X1 T49.6X2 T49.6X3 T49.6X4 T49.6X5 T49.6X6 ophthalmic preparation T49.5X1 T49.5X2 T49.5X3 T49.5X4 T49.5X5 T49.5X6 topical NEC T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Decahydronaphthalene T52.8X1 T52.8X2 T52.8X3 T52.8X4 Decalin T52.8X1 T52.8X2 T52.8X3 T52.8X4 Decamethonium(bromide) T48.1X1 T48.1X2 T48.1X3 T48.1X4 T48.1X5 T48.1X6 berry 80 Poisoning Accidental Drug Poisoning Intentional Poisoning Assault Poisoning Undetermined Adverse Effect Underdosing Decholin T47.5X1 T47.5X2 T47.5X3 T47.5X4 T47.5X5 T47.5X6 Declomycin T36.4X1 T36.4X2 T36.4X3 T36.4X4 T36.4X5 T36.4X6 Decongestant, nasal(mucosa) T48.5X1 T48.5X2 T48.5X3 T48.5X4 T48.5X5 T48.5X6 T48.5X1 T48.5X2 T48.5X3 T48.5X4 T48.5X5 T48.5X6 Deet T60.8X1 T60.8X2 T60.8X3 T60.8X4 Deferoxamine T45.8X1 T45.8X2 T45.8X3 T45.8X4 T45.8X5 T45.8X6 Deflazacort T38.0X1 T38.0X2 T38.0X3 T38.0X4 T38.0X5 T38.0X6 Deglycyrrhizinized extract of licorice T48.4X1 T48.4X2 T48.4X3 T48.4X4 T48.4X5 T48.4X6 Dehydrocholic acid T47.5X1 T47.5X2 T47.5X3 T47.5X4 T47.5X5 T47.5X6 Dehydroemetine T37.3X1 T37.3X2 T37.3X3 T37.3X4 T37.3X5 T37.3X6 Dekalin T52.8X1 T52.8X2 T52.8X3 T52.8X4 Delalutin T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 Delorazepam T42.4X1 T42.4X2 T42.4X3 T42.4X4 T42.4X5 T42.4X6 Delphinium T62.2X1 T62.2X2 T62.2X3 T62.2X4 Deltamethrin T60.1X1 T60.1X2 T60.1X3 T60.1X4 Deltasone T38.0X1 T38.0X2 T38.0X3 T38.0X4 T38.0X5 T38.0X6 Deltra T38.0X1 T38.0X2 T38.0X3 T38.0X4 T38.0X5 T38.0X6 Delvinal T42.3X1 T42.3X2 T42.3X3 T42.3X4 T42.3X5 T42.3X6 Demecarium(bromide) T49.5X1 T49.5X2 T49.5X3 T49.5X4 T49.5X5 T49.5X6 Demeclocycline T36.4X1 T36.4X2 T36.4X3 T36.4X4 T36.4X5 T36.4X6 Demecolcine T45.1X1 T45.1X2 T45.1X3 T45.1X4 T45.1X5 T45.1X6 Demegestone T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 Demelanizing agents T49.8X1 T49.8X2 T49.8X3 T49.8X4 T49.8X5 T49.8X6 Demephion -O and -S T60.0X1 T60.0X2 T60.0X3 T60.0X4 Demerol T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Demethylchlortetracycline T36.4X1 T36.4X2 T36.4X3 T36.4X4 T36.4X5 T36.4X6 Demethyltetracycline T36.4X1 T36.4X2 T36.4X3 T36.4X4 T36.4X5 T36.4X6 Demeton -O and -S T60.0X1 T60.0X2 T60.0X3 T60.0X4 Demulcent(external) T49.3X1 T49.3X2 T49.3X3 T49.3X4 T49.3X5 T49.3X6 T49.3X1 T49.3X2 T49.3X3 T49.3X4 T49.3X5 T49.3X6 Demulen T38.4X1 T38.4X2 T38.4X3 T38.4X4 T38.4X5 T38.4X6 Denatured alcohol T51.0X1 T51.0X2 T51.0X3 T51.0X4 Dendrid T49.5X1 T49.5X2 T49.5X3 T49.5X4 T49.5X5 T49.5X6 Dental drug, topical application NEC T49.7X1 T49.7X2 T49.7X3 T49.7X4 T49.7X5 T49.7X6 Dentifrice T49.7X1 T49.7X2 T49.7X3 T49.7X4 T49.7X5 T49.7X6 Deodorant spray(feminine hygiene) T49.8X1 T49.8X2 T49.8X3 T49.8X4 T49.8X5 T49.8X6 Deoxycortone T50.0X1 T50.0X2 T50.0X3 T50.0X4 T50.0X5 T50.0X6 Deoxyribonuclease(pancreatic) T45.3X1 T45.3X2 T45.3X3 T45.3X4 T45.3X5 T45.3X6 Depilatory T49.4X1 T49.4X2 T49.4X3 T49.4X4 T49.4X5 T49.4X6 Deprenalin T42.8X1 T42.8X2 T42.8X3 T42.8X4 T42.8X5 T42.8X6 Deprenyl T42.8X1 T42.8X2 T42.8X3 T42.8X4 T42.8X5 T42.8X6 Depressant, appetite T50.5X1 T50.5X2 T50.5X3 T50.5X4 T50.5X5 T50.5X6 appetite(central) T50.5X1 T50.5X2 T50.5X3 T50.5X4 T50.5X5 T50.5X6 cardiac T46.2X1 T46.2X2 T46.2X3 T46.2X4 T46.2X5 T46.2X6 central nervous system(anesthetic) T42.71 T42.72 T42.73 T42.74 T42.75 T42.76 general anesthetic T41.201 T41.202 T41.203 T41.204 T41.205 T41.206 muscle tone T42.8X1 T42.8X2 T42.8X3 T42.8X4 T42.8X5 T42.8X6 combination specified NEC Depressant 81 Drug Poisoning Accidental Poisoning Intentional Poisoning Assault Poisoning Undetermined Adverse Effect Underdosing muscle tone, central T42.8X1 T42.8X2 T42.8X3 T42.8X4 T42.8X5 T42.8X6 psychotherapeutic T43.501 T43.502 T43.503 T43.504 T43.505 T43.506 Deptropine T45.0X1 T45.0X2 T45.0X3 T45.0X4 T45.0X5 T45.0X6 Dequalinium(chloride) T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Derris root T60.2X1 T60.2X2 T60.2X3 T60.2X4 Deserpidine T46.5X1 T46.5X2 T46.5X3 T46.5X4 T46.5X5 T46.5X6 Desferrioxamine T45.8X1 T45.8X2 T45.8X3 T45.8X4 T45.8X5 T45.8X6 Desipramine T43.011 T43.012 T43.013 T43.014 T43.015 T43.016 Deslanoside T46.0X1 T46.0X2 T46.0X3 T46.0X4 T46.0X5 T46.0X6 Desloughing agent T49.4X1 T49.4X2 T49.4X3 T49.4X4 T49.4X5 T49.4X6 Desmethylimipramine T43.011 T43.012 T43.013 T43.014 T43.015 T43.016 Desmopressin T38.891 T38.892 T38.893 T38.894 T38.895 T38.896 Desocodeine T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Desogestrel T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 Desomorphine T40.2X1 T40.2X2 T40.2X3 T40.2X4 Desonide T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Desoximetasone T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Desoxycorticosteroid T50.0X1 T50.0X2 T50.0X3 T50.0X4 T50.0X5 T50.0X6 Desoxycortone T50.0X1 T50.0X2 T50.0X3 T50.0X4 T50.0X5 T50.0X6 Desoxyephedrine T43.621 T43.622 T43.623 T43.624 T43.625 T43.626 Detaxtran T46.6X1 T46.6X2 T46.6X3 T46.6X4 T46.6X5 T46.6X6 Detergent T49.2X1 T49.2X2 T49.2X3 T49.2X4 T49.2X5 T49.2X6 external medication T49.2X1 T49.2X2 T49.2X3 T49.2X4 T49.2X5 T49.2X6 local T49.2X1 T49.2X2 T49.2X3 T49.2X4 T49.2X5 T49.2X6 medicinal T49.2X1 T49.2X2 T49.2X3 T49.2X4 T49.2X5 T49.2X6 nonmedicinal T55.1X1 T55.1X2 T55.1X3 T55.1X4 specified NEC T55.1X1 T55.1X2 T55.1X3 T55.1X4 Deterrent, alcohol T50.6X1 T50.6X2 T50.6X3 T50.6X4 T50.6X5 T50.6X6 Detoxifying agent T50.6X1 T50.6X2 T50.6X3 T50.6X4 T50.6X5 T50.6X6 Detrothyronine T38.1X1 T38.1X2 T38.1X3 T38.1X4 T38.1X5 T38.1X6 Dettol(external medication) T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Dexamethasone T38.0X1 T38.0X2 T38.0X3 T38.0X4 T38.0X5 T38.0X6 ENT agent T49.6X1 T49.6X2 T49.6X3 T49.6X4 T49.6X5 T49.6X6 ophthalmic preparation T49.5X1 T49.5X2 T49.5X3 T49.5X4 T49.5X5 T49.5X6 topical NEC T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Dexamfetamine T43.621 T43.622 T43.623 T43.624 T43.625 T43.626 Dexamphetamine T43.621 T43.622 T43.623 T43.624 T43.625 T43.626 Dexbrompheniramine T45.0X1 T45.0X2 T45.0X3 T45.0X4 T45.0X5 T45.0X6 Dexchlorpheniramine T45.0X1 T45.0X2 T45.0X3 T45.0X4 T45.0X5 T45.0X6 Dexedrine T43.621 T43.622 T43.623 T43.624 T43.625 T43.626 Dexetimide T44.3X1 T44.3X2 T44.3X3 T44.3X4 T44.3X5 T44.3X6 Dexfenfluramine T50.5X1 T50.5X2 T50.5X3 T50.5X4 T50.5X5 T50.5X6 Dexpanthenol T45.2X1 T45.2X2 T45.2X3 T45.2X4 T45.2X5 T45.2X6 Dextran(40) (70) (150) T45.8X1 T45.8X2 T45.8X3 T45.8X4 T45.8X5 T45.8X6 Dextriferron T45.4X1 T45.4X2 T45.4X3 T45.4X4 T45.4X5 T45.4X6 Dextro calcium pantothenate T45.2X1 T45.2X2 T45.2X3 T45.2X4 T45.2X5 T45.2X6 Dextro pantothenyl alcohol T45.2X1 T45.2X2 T45.2X3 T45.2X4 T45.2X5 T45.2X6 82 Drug Poisoning Accidental Poisoning Intentional Poisoning Assault Poisoning Undetermined Adverse Effect Underdosing Dextroamphetamine T43.621 T43.622 T43.623 T43.624 T43.625 T43.626 Dextromethorphan T48.3X1 T48.3X2 T48.3X3 T48.3X4 T48.3X5 T48.3X6 Dextromoramide T40.4X1 T40.4X2 T40.4X3 T40.4X4 T49.8X1 T49.8X2 T49.8X3 T49.8X4 T49.8X5 T49.8X6 Dextropropoxyphene T40.4X1 T40.4X2 T40.4X3 T40.4X4 T40.4X5 T40.4X6 Dextrorphan T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Dextrose T50.3X1 T50.3X2 T50.3X3 T50.3X4 T50.3X5 T50.3X6 T46.8X1 T46.8X2 T46.8X3 T46.8X4 T46.8X5 T46.8X6 Dextrothyroxin T38.1X1 T38.1X2 T38.1X3 T38.1X4 T38.1X5 T38.1X6 Dextrothyroxine sodium T38.1X1 T38.1X2 T38.1X3 T38.1X4 T38.1X5 T38.1X6 DFP T44.0X1 T44.0X2 T44.0X3 T44.0X4 T44.0X5 T44.0X6 DHE T37.3X1 T37.3X2 T37.3X3 T37.3X4 T37.3X5 T37.3X6 45 T46.5X1 T46.5X2 T46.5X3 T46.5X4 T46.5X5 T46.5X6 Diabinese T38.3X1 T38.3X2 T38.3X3 T38.3X4 T38.3X5 T38.3X6 Diacetone alcohol T52.4X1 T52.4X2 T52.4X3 T52.4X4 Diacetyl monoxime T50.991 T50.992 T50.993 T50.994 Diacetylmorphine T40.1X1 T40.1X2 T40.1X3 T40.1X4 T40.1X5 Diachylon plaster T49.4X1 T49.4X2 T49.4X3 T49.4X4 T49.4X5 T49.4X6 Diaethylstilboestrolum T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 Diagnostic agent NEC T50.8X1 T50.8X2 T50.8X3 T50.8X4 T50.8X5 T50.8X6 Dial(soap) T49.2X1 T49.2X2 T49.2X3 T49.2X4 T49.2X5 T49.2X6 T42.3X1 T42.3X2 T42.3X3 T42.3X4 T42.3X5 T42.3X6 Dialkyl carbonate T52.91 T52.92 T52.93 T52.94 Diallylbarbituric acid T42.3X1 T42.3X2 T42.3X3 T42.3X4 T42.3X5 T42.3X6 Diallymal T42.3X1 T42.3X2 T42.3X3 T42.3X4 T42.3X5 T42.3X6 Dialysis solution(intraperitoneal) T50.3X1 T50.3X2 T50.3X3 T50.3X4 T50.3X5 T50.3X6 Diaminodiphenylsulfone T37.1X1 T37.1X2 T37.1X3 T37.1X4 T37.1X5 T37.1X6 Diamorphine T40.1X1 T40.1X2 T40.1X3 T40.1X4 T40.1X5 Diamox T50.2X1 T50.2X2 T50.2X3 T50.2X4 T50.2X5 T50.2X6 Diamthazole T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Dianthone T47.2X1 T47.2X2 T47.2X3 T47.2X4 T47.2X5 T47.2X6 Diaphenylsulfone T37.0X1 T37.0X2 T37.0X3 T37.0X4 T37.0X5 T37.0X6 Diasone(sodium) T37.1X1 T37.1X2 T37.1X3 T37.1X4 T37.1X5 T37.1X6 Diastase T47.5X1 T47.5X2 T47.5X3 T47.5X4 T47.5X5 T47.5X6 Diatrizoate T50.8X1 T50.8X2 T50.8X3 T50.8X4 T50.8X5 T50.8X6 Diazepam T42.4X1 T42.4X2 T42.4X3 T42.4X4 T42.4X5 T42.4X6 Diazinon T60.0X1 T60.0X2 T60.0X3 T60.0X4 Diazomethane(gas) T59.891 T59.892 T59.893 T59.894 Diazoxide T46.5X1 T46.5X2 T46.5X3 T46.5X4 T46.5X5 T46.5X6 Dibekacin T36.5X1 T36.5X2 T36.5X3 T36.5X4 T36.5X5 T36.5X6 Dibenamine T44.6X1 T44.6X2 T44.6X3 T44.6X4 T44.6X5 T44.6X6 Dibenzepin T43.011 T43.012 T43.013 T43.014 T43.015 T43.016 Dibenzheptropine T45.0X1 T45.0X2 T45.0X3 T45.0X4 T45.0X5 T45.0X6 Dibenzyline T44.6X1 T44.6X2 T44.6X3 T44.6X4 T44.6X5 T44.6X6 Diborane(gas) T59.891 T59.892 T59.893 T59.894 Dibromochloropropane T60.8X1 T60.8X2 T60.8X3 T60.8X4 Dibromodulcitol T45.1X1 T45.1X2 T45.1X3 T45.1X4 T45.1X5 T45.1X6 Dibromoethane T53.6X1 T53.6X2 T53.6X3 T53.6X4 Dibromomannitol T45.1X1 T45.1X2 T45.1X3 T45.1X4 T45.1X5 T45.1X6 topical concentrated solution, intravenous sedative 83 Drug Poisoning Accidental Poisoning Intentional Poisoning Assault Poisoning Undetermined Adverse Effect Underdosing Dibromopropamidine isethionate T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Dibrompropamidine T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Dibucaine T41.3X1 T41.3X2 T41.3X3 T41.3X4 T41.3X5 T41.3X6 T41.3X1 T41.3X2 T41.3X3 T41.3X4 T41.3X5 T41.3X6 Dibunate sodium T48.3X1 T48.3X2 T48.3X3 T48.3X4 T48.3X5 T48.3X6 Dibutoline sulfate T44.3X1 T44.3X2 T44.3X3 T44.3X4 T44.3X5 T44.3X6 Dicamba T60.3X1 T60.3X2 T60.3X3 T60.3X4 Dicapthon T60.0X1 T60.0X2 T60.0X3 T60.0X4 Dichlobenil T60.3X1 T60.3X2 T60.3X3 T60.3X4 Dichlone T60.3X1 T60.3X2 T60.3X3 T60.3X4 Dichloralphenozone T42.6X1 T42.6X2 T42.6X3 T42.6X4 T42.6X5 T42.6X6 Dichlorbenzidine T65.3X1 T65.3X2 T65.3X3 T65.3X4 Dichlorhydrin T52.8X1 T52.8X2 T52.8X3 T52.8X4 Dichlorhydroxyquinoline T37.8X1 T37.8X2 T37.8X3 T37.8X4 T37.8X5 T37.8X6 Dichlorobenzene T53.7X1 T53.7X2 T53.7X3 T53.7X4 Dichlorobenzyl alcohol T49.6X1 T49.6X2 T49.6X3 T49.6X4 T49.6X5 T49.6X6 Dichlorodifluoromethane T53.5X1 T53.5X2 T53.5X3 T53.5X4 Dichloroethane T52.8X1 T52.8X2 T52.8X3 T52.8X4 Dichloroethyl sulfide, not in war T59.891 T59.892 T59.893 T59.894 Dichloroethylene T53.6X1 T53.6X2 T53.6X3 T53.6X4 Dichloroformoxine, not in war T59.891 T59.892 T59.893 T59.894 Dichlorohydrin, alpha-dichlorohydrin T52.8X1 T52.8X2 T52.8X3 T52.8X4 Dichloromethane(solvent) T53.4X1 T53.4X2 T53.4X3 T53.4X4 T53.4X1 T53.4X2 T53.4X3 T53.4X4 Dichloronaphthoquinone T60.3X1 T60.3X2 T60.3X3 T60.3X4 Dichlorophen T37.4X1 T37.4X2 T37.4X3 T37.4X4 T37.4X5 T37.4X6 Dichloropropene T60.3X1 T60.3X2 T60.3X3 T60.3X4 Dichloropropionic acid T60.3X1 T60.3X2 T60.3X3 T60.3X4 Dichlorphenamide T50.2X1 T50.2X2 T50.2X3 T50.2X4 T50.2X5 T50.2X6 Dichlorvos T60.0X1 T60.0X2 T60.0X3 T60.0X4 Diclofenac T39.391 T39.392 T39.393 T39.394 T39.395 T39.396 Diclofenamide T50.2X1 T50.2X2 T50.2X3 T50.2X4 T50.2X5 T50.2X6 Diclofensine T43.291 T43.292 T43.293 T43.294 T43.295 T43.296 Diclonixine T39.8X1 T39.8X2 T39.8X3 T39.8X4 T39.8X5 T39.8X6 Dicloxacillin T36.0X1 T36.0X2 T36.0X3 T36.0X4 T36.0X5 T36.0X6 Dicophane T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Dicoumarol, dicoumarin, dicumarol T45.511 T45.512 T45.513 T45.514 T45.515 T45.516 Dicrotophos T60.0X1 T60.0X2 T60.0X3 T60.0X4 Dicyanogen(gas) T65.0X1 T65.0X2 T65.0X3 T65.0X4 Dicyclomine T44.3X1 T44.3X2 T44.3X3 T44.3X4 T44.3X5 T44.3X6 Dicycloverine T44.3X1 T44.3X2 T44.3X3 T44.3X4 T44.3X5 T44.3X6 Dideoxycytidine T37.5X1 T37.5X2 T37.5X3 T37.5X4 T37.5X5 T37.5X6 Dideoxyinosine T37.5X1 T37.5X2 T37.5X3 T37.5X4 T37.5X5 T37.5X6 Dieldrin(vapor) T60.1X1 T60.1X2 T60.1X3 T60.1X4 Diemal T42.3X1 T42.3X2 T42.3X3 T42.3X4 T42.3X5 T42.3X6 Dienestrol T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 Dienoestrol T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 Dietetic drug NEC T50.901 T50.902 T50.903 T50.904 T50.905 T50.906 Diethazine T42.8X1 T42.8X2 T42.8X3 T42.8X4 T42.8X5 T42.8X6 topical(surface) vapor 84 Poisoning Accidental Drug Poisoning Intentional Poisoning Assault Poisoning Undetermined Adverse Effect Underdosing Diethyl barbituric acid T42.3X1 T42.3X2 T42.3X3 T42.3X4 T42.3X5 T42.3X6 carbamazine T37.4X1 T37.4X2 T37.4X3 T37.4X4 T37.4X5 T37.4X6 carbinol T51.3X1 T51.3X2 T51.3X3 T51.3X4 carbonate T52.8X1 T52.8X2 T52.8X3 T52.8X4 ether(vapor) T41.0X1 T41.0X2 T41.0X3 T41.0X4 T41.0X5 T41.0X6 oxide T52.8X1 T52.8X2 T52.8X3 T52.8X4 propion T50.5X1 T50.5X2 T50.5X3 T50.5X4 T50.5X5 T50.5X6 stilbestrol T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 toluamide(nonmedicinal) T60.8X1 T60.8X2 T60.8X3 T60.8X4 T49.3X1 T49.3X2 T49.3X3 T49.3X4 T49.3X5 T49.3X6 T37.4X1 T37.4X2 T37.4X3 T37.4X4 T37.4X5 T37.4X6 T52.8X1 T52.8X2 T52.8X3 T52.8X4 glycol(monoacetate) (monobutyl ether) (monoethyl ether) T52.3X1 T52.3X2 T52.3X3 T52.3X4 Diethylhexylphthalate T65.891 T65.892 T65.893 T65.894 Diethylpropion T50.5X1 T50.5X2 T50.5X3 T50.5X4 T50.5X5 T50.5X6 Diethylstilbestrol T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 Diethylstilboestrol T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 Diethylsulfone-diethylmethane T42.6X1 T42.6X2 T42.6X3 T42.6X4 T42.6X5 T42.6X6 Diethyltoluamide T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Diethyltryptamine(DET) T40.991 T40.992 T40.993 T40.994 Difebarbamate T42.3X1 T42.3X2 T42.3X3 T42.3X4 T42.3X5 T42.3X6 Difencloxazine T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Difenidol T45.0X1 T45.0X2 T45.0X3 T45.0X4 T45.0X5 T45.0X6 Difenoxin T47.6X1 T47.6X2 T47.6X3 T47.6X4 T47.6X5 T47.6X6 Difetarsone T37.3X1 T37.3X2 T37.3X3 T37.3X4 T37.3X5 T37.3X6 Diffusin T45.3X1 T45.3X2 T45.3X3 T45.3X4 T45.3X5 T45.3X6 Diflorasone T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Diflos T44.0X1 T44.0X2 T44.0X3 T44.0X4 T44.0X5 T44.0X6 Diflubenzuron T60.1X1 T60.1X2 T60.1X3 T60.1X4 Diflucortolone T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Diflunisal T39.091 T39.092 T39.093 T39.094 T39.095 T39.096 Difluoromethyldopa T42.8X1 T42.8X2 T42.8X3 T42.8X4 T42.8X5 T42.8X6 Difluorophate T44.0X1 T44.0X2 T44.0X3 T44.0X4 T44.0X5 T44.0X6 Digestant NEC T47.5X1 T47.5X2 T47.5X3 T47.5X4 T47.5X5 T47.5X6 Digitalin(e) T46.0X1 T46.0X2 T46.0X3 T46.0X4 T46.0X5 T46.0X6 Digitalis(leaf)(glycoside) T46.0X1 T46.0X2 T46.0X3 T46.0X4 T46.0X5 T46.0X6 lanata T46.0X1 T46.0X2 T46.0X3 T46.0X4 T46.0X5 T46.0X6 purpurea T46.0X1 T46.0X2 T46.0X3 T46.0X4 T46.0X5 T46.0X6 Digitoxin T46.0X1 T46.0X2 T46.0X3 T46.0X4 T46.0X5 T46.0X6 Digitoxose T46.0X1 T46.0X2 T46.0X3 T46.0X4 T46.0X5 T46.0X6 Digoxin T46.0X1 T46.0X2 T46.0X3 T46.0X4 T46.0X5 T46.0X6 Digoxine T46.0X1 T46.0X2 T46.0X3 T46.0X4 T46.0X5 T46.0X6 Dihydralazine T46.5X1 T46.5X2 T46.5X3 T46.5X4 T46.5X5 T46.5X6 medicinal Diethylcarbamazine Diethylene dioxide 85 Drug Poisoning Accidental Poisoning Intentional Poisoning Assault Poisoning Undetermined Adverse Effect Underdosing Dihydrazine T46.5X1 T46.5X2 T46.5X3 T46.5X4 T46.5X5 T46.5X6 Dihydrocodeine T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Dihydrocodeinone T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Dihydroergocornine T46.7X1 T46.7X2 T46.7X3 T46.7X4 T46.7X5 T46.7X6 Dihydroergocristine(mesilate) T46.7X1 T46.7X2 T46.7X3 T46.7X4 T46.7X5 T46.7X6 Dihydroergokryptine T46.7X1 T46.7X2 T46.7X3 T46.7X4 T46.7X5 T46.7X6 Dihydroergotamine T46.5X1 T46.5X2 T46.5X3 T46.5X4 T46.5X5 T46.5X6 Dihydroergotoxine T46.7X1 T46.7X2 T46.7X3 T46.7X4 T46.7X5 T46.7X6 T46.7X1 T46.7X2 T46.7X3 T46.7X4 T46.7X5 T46.7X6 Dihydrohydroxycodeinone T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Dihydrohydroxymorphinone T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Dihydroisocodeine T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Dihydromorphine T40.2X1 T40.2X2 T40.2X3 T40.2X4 Dihydromorphinone T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Dihydrostreptomycin T36.5X1 T36.5X2 T36.5X3 T36.5X4 T36.5X5 T36.5X6 Dihydrotachysterol T45.2X1 T45.2X2 T45.2X3 T45.2X4 T45.2X5 T45.2X6 Dihydroxyaluminum aminoacetate T47.1X1 T47.1X2 T47.1X3 T47.1X4 T47.1X5 T47.1X6 Dihydroxyaluminum sodium carbonate T47.1X1 T47.1X2 T47.1X3 T47.1X4 T47.1X5 T47.1X6 Dihydroxyanthraquinone T47.2X1 T47.2X2 T47.2X3 T47.2X4 T47.2X5 T47.2X6 Dihydroxycodeinone T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Dihydroxypropyl theophylline T50.2X1 T50.2X2 T50.2X3 T50.2X4 T50.2X5 T50.2X6 Diiodohydroxyquin T37.8X1 T37.8X2 T37.8X3 T37.8X4 T37.8X5 T37.8X6 T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Diiodohydroxyquinoline T37.8X1 T37.8X2 T37.8X3 T37.8X4 T37.8X5 T37.8X6 Diiodotyrosine T38.2X1 T38.2X2 T38.2X3 T38.2X4 T38.2X5 T38.2X6 Diisopromine T44.3X1 T44.3X2 T44.3X3 T44.3X4 T44.3X5 T44.3X6 Diisopropylamine T46.3X1 T46.3X2 T46.3X3 T46.3X4 T46.3X5 T46.3X6 Diisopropylfluorophos-phonate T44.0X1 T44.0X2 T44.0X3 T44.0X4 T44.0X5 T44.0X6 Dilantin T42.0X1 T42.0X2 T42.0X3 T42.0X4 T42.0X5 T42.0X6 Dilaudid T40.2X1 T40.2X2 T40.2X3 T40.2X4 T40.2X5 T40.2X6 Dilazep T46.3X1 T46.3X2 T46.3X3 T46.3X4 T46.3X5 T46.3X6 Dill T47.5X1 T47.5X2 T47.5X3 T47.5X4 T47.5X5 T47.5X6 Diloxanide T37.3X1 T37.3X2 T37.3X3 T37.3X4 T37.3X5 T37.3X6 Diltiazem T46.1X1 T46.1X2 T46.1X3 T46.1X4 T46.1X5 T46.1X6 Dimazole T49.0X1 T49.0X2 T49.0X3 T49.0X4 T49.0X5 T49.0X6 Dimefline T50.7X1 T50.7X2 T50.7X3 T50.7X4 T50.7X5 T50.7X6 Dimefox T60.0X1 T60.0X2 T60.0X3 T60.0X4 Dimemorfan T48.3X1 T48.3X2 T48.3X3 T48.3X4 T48.3X5 T48.3X6 Dimenhydrinate T45.0X1 T45.0X2 T45.0X3 T45.0X4 T45.0X5 T45.0X6 Dimercaprol(British anti-lewisite) T45.8X1 T45.8X2 T45.8X3 T45.8X4 T45.8X5 T45.8X6 Dimercaptopropanol T45.8X1 T45.8X2 T45.8X3 T45.8X4 T45.8X5 T45.8X6 Dimestrol T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 Dimetane T45.0X1 T45.0X2 T45.0X3 T45.0X4 T45.0X5 T45.0X6 Dimethicone T47.1X1 T47.1X2 T47.1X3 T47.1X4 T47.1X5 T47.1X6 Dimethindene T45.0X1 T45.0X2 T45.0X3 T45.0X4 T45.0X5 T45.0X6 Dimethisoquin T49.1X1 T49.1X2 T49.1X3 T49.1X4 T49.1X5 T49.1X6 Dimethisterone T38.5X1 T38.5X2 T38.5X3 T38.5X4 T38.5X5 T38.5X6 mesilate topical 86 TEST QUESTIONS Introduction to ICD-10-CM: Part 3 #1221412 Directions:  Before taking this test, read the instructions on how to complete the answer sheets correctly. If taking the test online, log in to your User Account on the NCCT website www.ncctinc.com.  Select the response that best completes each sentence or answers each question from the information presented in the module.  If you are having difficulty answering a question, go to www.ncctinc.com and select Forms/Documents. Then select CE Updates and Revisions to see if course content and/or a test questions have been revised. If you do not have access to the internet, call Customer Service at 800-875-4404. 1. Which chapter of the ICD-10-CM Tabular List contains codes for cleft palate? a. b. c. d. Chapter 16 Chapter 17 Chapter 18 Chapter 19 2. Which of the following code sets include codes for digestive system disorders of the newborn? a. b. c. d. P90 - P96 P80 - P83 P76 - P78 P70 - P74 3. Which chapter of the ICD-10-CM Tabular List contains codes for failure to thrive in the newborn? a. b. c. d. Chapter 16 Chapter 17 Chapter 18 Chapter 19 4. Codes for congenital chromosomal abnormalities such as Trisomy 21 are found in which of the following chapters of the ICD-10-CM Tabular List? a. b. c. d. Chapter 16 Chapter 17 Chapter 18 Chapter 19 87 5. Which of the following code sets includes codes for congenital malformations of the eye, ear, face, and neck? a. b. c. d. Q60 – Q64 Q50 – Q56 Q35 – Q37 Q10 – Q18 6. A patient has abnormal laboratory tests results on blood but no diagnosis. Which of the following code sets includes codes for these findings? a. b. c. d. R70 – R79 R40 – R46 R83 – R89 R25 – R29 7. Codes for a patient experiencing recurrent nose bleeds would be found in symptoms and signs involving the __________. a. b. c. d. circulatory and respiratory systems digestive system and abdomen nervous and musculoskeletal systems skin and subcutaneous tissue 8. Codes for a patient experiencing hemoglobinuria with no diagnosis would be found in abnormal findings on examination of __________. a. b. c. d. blood body fluids tissues urine 9. An adolescent boy receives an injury to his shoulder while playing softball. Which of the following chapters contains codes for this injury? a. b. c. d. Chapter 18 Chapter 17 Chapter 20 Chapter 19 10. Which of the following code sets includes codes for a broken nose? a. b. c. d. S00 – S09 S20 – S29 S40 – S49 S60 – S69 88 11. Which of the following code sets includes codes for a fracture of the coccyx? a. b. c. d. S20 – S29 S30 – S39 S60 – S69 S90 – S99 12. Which of the following code sets includes codes for sunburn to the shoulders? a. b. c. d. T14 T15 – T19 T26 – T28 T20 – T25 13. A patient with epilepsy has unknowingly taken less than the recommended dose of anti-seizure drugs. Which of the following code sets includes codes for this type of event? a. b. c. d. T36 – T50 T52 – T65 T66 – T78 T80 – T88 14. Codes used for injuries resulting from slipping, tripping, stumbling, and falls are found in which of the following chapters of the Tabular List? a. b. c. d. Chapter 18 Chapter 19 Chapter 20 Chapter 21 15. Codes used for assault are found in the chapter entitled __________. a. External Causes of Morbidity b. Factors Influencing Health Status and Contact with Health Services c. Injury, Poisoning, and Certain Other External Consequences of External Causes d. Symptoms, Signs, and Abnormal Clinical and Laboratory Findings 16. Which of the following code sets are used for operations of war, military operations, and terrorism? a. b. c. d. Y90 – Y99 Y70 – Y82 Y35 – Y38 X52 – X58 89 17. Codes used for examination encounters are found in which of the following chapters? a. b. c. d. 21 20 19 18 18. Which of the following are the codes used for estrogen receptor status? a. b. c. d. Z68 Z66 Z17 Z16 19. Which of the following codes are used for body mass index? a. b. c. d. Z68 Z66 Z17 Z18 Refer to the Chapter-Specific Coding Guidelines to answer questions 20 - 40 20. Codes from Chapter 16 are used in which of the following instances? a. b. c. d. For documentation of conditions on the maternal record For documentation of conditions only at the time of birth For documentation of conditions due to prematurity only For documentation of conditions present at birth and throughout life 21. How many times can a code from category Z38 be used? a. b. c. d. As many times as needed One Two Three 22. What is the default when a newborn has a condition that may be due either to the birth process or community acquired and the documentation does not state one or the other? a. Birth process b. Community acquired 90 23. Which of the following is TRUE regarding criteria used to identify a condition as clinically significant? a. b. c. d. The condition requires no diagnostic procedures The condition has no implications for future health care needs The condition needs increased nursing care and/or monitoring The condition requires short-term hospital length of stay 24. If a newborn has bacterial sepsis but there is no documentation of the condition being congenital or community acquired, which is the default? a. Community acquired b. Congenital 25. Which of the following is a TRUE statement regarding codes in Chapter 17? a. b. c. d. Codes from this chapter may be used throughout the life of the patient. Codes Q00 – Q99 are used only as the principal/first-listed diagnosis. Documentation is not necessary to use codes Q00 – Q99. For liveborn infants, the congenital anomaly is coded before the place of birth and type of delivery. 26. When is it acceptable to report codes that describe symptoms and signs? a. When a diagnosis has been confirmed by the provider b. When a diagnosis has not been confirmed by the provider 27. Which of the following is TRUE regarding the use of codes for repeated falls? a. Both R29.6 and Z91.81 may be assigned together when appropriate. b. Code R29.6 is used when a patient has fallen in the past and is at risk for future falls. c. Code R29.6 is used when a patient has fallen and the reason for the fall has been investigated in full. d. Code Z91.81 is used when a patient has no history of falls but is at risk for future falls. 28. When should code R53.2 be used? a. When an individual has quadriplegia due to extreme debility b. When an individual has quadriplegia due to an injury c. When an individual has quadriplegia due to a neurologic deficit 91 29. When is the 7th character A used with codes in Chapter 19? a. When the patient is receiving routine care during the healing or recovery process for the condition b. When the patient is receiving care for complications or conditions that arise as a direct result of the condition c. When the patient is receiving active treatment for the condition d. When the patient has a traumatic fracture 30. When is the 7th character D used with codes in Chapter 19? a. When the patient is receiving routine care during the healing or recovery process for the condition b. When the patient is receiving care for complications or conditions that arise as a direct result of the condition c. When the patient is receiving active treatment for the condition d. When the patient has a traumatic fracture 31. When is the 7th character S used with codes in Chapter 19? a. When the patient is receiving routine care during the healing or recovery process for the condition b. When the patient is receiving care for complications or conditions that arise as a direct result of the condition c. When the patient is receiving active treatment for the condition d. When the patient has a traumatic fracture 32. What is the default for coding a fracture that is not indicated as open or closed? a. Closed b. Open 33. What is the default for coding a fracture that is not indicated as displaced or not displaced? a. Displaced b. Not displaced 34. What is the distinction between burns and corrosions made by ICD-10-CM? a. b. c. d. Burn codes are used for chemical burns Burn codes are used for thermal burns Corrosion codes are used for electrical burns Corrosion codes are used for thermal burns 92 35. Which of the following is TRUE regarding the use of codes for adverse effects, poisoning, underdosing and toxic effects? a. b. c. d. Code directly from the Table of Drugs Use as many codes as necessary Use underdosing codes as the principal or first-listed codes When a harmful substance is ingested or comes in contact with a person, this is classified as a poisoning effect 36. Which of the following is not captured in codes used for external causes of morbidity? a. b. c. d. How the injury/condition happened Location/activity at the time of the event Patient status (civilian/military) Time of day the event occurred 37. Which of the following is a TRUE statement regarding the general use of external causes of morbidity codes? a. An external cause code can be the principal (first-listed) diagnosis. b. As many codes as needed may be used to fully explain each cause. c. External cause codes are used only for the initial injury or condition encounter. d. They may be used only with codes in the range of Z00 – Z99. 38. If multiple external cause codes are needed, which codes take priority overall all other external cause codes? a. b. c. d. Cataclysmic events Child and adult abuse Terrorism Transport accidents 39. Which of the following is a TRUE statement regarding the use of Z codes? a. b. c. d. Z codes are procedure codes used for specific encounters. The use of Z codes is limited to inpatient facilities such as hospitals. Z codes may only be used as first-listed or principal diagnosis. A corresponding procedure code must accompany a Z code to describe any procedure performed. 40. Which of the following is NOT a category of Z codes? a. b. c. d. Counseling Inoculations/vaccinations Cadaveric organ donations Contact/suspected exposure to communicable disease 93 Refer to Attachments A - D to answer questions 41 - 58 41. Which of the following codes is used for a newborn small for gestational age weighing 1623 grams? a. b. c. d. P05.11 P05.14 P05.16 P05.18 42. Which of the following is the code used for an infant with sacral spina bifida without hydrocephalus? a. b. c. d. Q05.5 Q05.6 Q05.7 Q05.8 43. Which of the following codes is used for a patient seeing the doctor because he has an awareness of his heart beat? a. b. c. d. R00.0 R00.1 R00.2 R00.8 44. The code used for gross hematuria is __________. a. b. c. d. R31.0 R31.1 R31.2 R31.9 45. What is the code used when Bence Jones proteins are identified in a urine specimen and the patient has no diagnosis? a. b. c. d. R80.8 R80.3 R80.2 R80.1 46. What is the code used when a patient has abnormal electromyogram test results? a. b. c. d. R94.01 R94.112 R94.131 R94.31 94 47. What code is used when a patient is returning for a follow up evaluation of a nonthermal blister of the right eyelid? a. b. c. d. S00.221A S00.221D S00.221S S00.221 48. A patient has long-term problems from scar tissue that developed following the removal of fish bones from her pharynx. What code is used for this encounter? a. b. c. d. T17.22 T17.22XA T17.22XD T17.22XS 49. During an initial encounter, a healthcare professional suspects an elderly adult has been physically abused. What code is used to document this diagnosis? a. b. c. d. T76.01 T76.11 T76.11XA T76.01XA 50. A patient sees his orthopedic surgeon for post-operative total knee problems. Following X-rays, the physician diagnoses the patient with a broken internal left knee prosthesis. What code is used to document this diagnosis? a. b. c. d. T84.013A T84.013D T84.013S T84.013 51. A young boy runs into a tree while sledding. His mother takes him to his pediatrician to look at a contusion on his arm. What code is used to document the accident? a. b. c. d. V00.221 V00.222A V00.221A V00.222 52. A television news reporter is injured when an incendiary bomb explodes when he was working in a war zone. After initial treatment at the site, he returns to the United States and has a follow up visit with his private physician. What code is used to document this encounter? a. b. c. d. Y36.310 Y36.310D Y36.3111 Y36.311D 95 53. During the routine administration of a vaccine to a child, the healthcare professional fails to follow sterile precautions. What code is used to document this incident? a. b. c. d. Y62.3 Y62.6 Y62.8 Y62.1 54. A young girl receives an injury while on a public tennis court. Which of the following codes is used to document the place of this occurrence? a. b. c. d. Y92.09 Y92.31 Y92.311 Y92.312 55. What is the code used for a routine health examination of a child where there are no abnormal findings? a. b. c. d. Z00.129 Z00.121 Z00.00 Z00.01 56. What is the code used to document a patient’s encounter for reforming the artificial opening of an ileostomy? a. b. c. d. Z43.0 Z43.1 Z43.2 Z43.3 57. What code is used to document a patient has an allergy to penicillin? a. b. c. d. Z88.1 Z88.0 Z88.2 Z88.3 58. A child has accidentally ingested a bottle of cough syrup containing dextromethorphan. What code from the Table of Drugs is used to document this occurrence? a. b. c. d. T48.3X1 T48.3X2 T48.3X3 T48.3X4 *End of Test* 96
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