Think All ICD-9 Codes Expand Into Multiple Options? Think Again.

Here’s how you should report conditions both acute and chronic.

You may be operating under the notion that ICD-9 codes will always multiply into more definite options, and that’s the reason why the ICD-10-CM manual is so big. Though, that isn’t always the situation. Conditions necessitating two or more ICD-9 codes right now might be simplified into a single ICD-10 option.

Best bet: To determine whether you should report multiple codes or a single ICD-10- CM code, you need to read your coding guidelines. Keep an eye out for phrases like "use additional code" or "code first."

Capture Single Condition With Multiple Codes

True, you may find that a patient requires multiple ICD-10 codes to fully qualify the condition he or she has.

"Use additional code:" While you’re searching the Tabular List, you’ll find "use additional code" notes in conditions where you must use a secondary code to fully explain a condition. For example, you might nail on B95 (Streptococcus, staphylococcus, and enterococcus) as a secondary code to classify the bacteria causing the patient’s infection.

"Code first:" You might come across "code first" notes in the Alphabetic Index. This implies you must code the original condition first. For example, under the B39 (Histoplasmosis) category, you’ll see "code first associated AIDS (B20)."

"Code, if applicable, any causal condition first:" In case you see "Code, if applies, any causal condition first," then you may use this particular code as a main diagnosis while your physician hasn’t specified the causal condition. In case the physician has specified the causal condition, however, then you must code that as the principal diagnosis. For example, under N13.8 (Other obstructive and reflux uropathy), you’ll see "Code first, if applies, any causal condition, for instance enlarged prostate (N40.1)." That implies that in case the provider diagnosed an enlarged prostate, then you would code N40.1 as your main diagnosis.

Finally, you must be aware that you may require reporting multiple codes for late effects, complication codes, as well as obstetric codes.

Medical Billing and Coding Bonus concept: Suppose a patient has a condition that is both acute (subacute) and chronic. How must you report this? According to the ICD-10-CM Official Guidelines for Coding and Reporting, you must code both acute (subacute) and chronic. You should list the acute (subacute) code first. For example, a patient might have both acute thyroiditis (E06.0) along with chronic thryoiditis with transient thyrotoxicosis (E06.2). You would then report both codes with E06.0 listed first.

Medical Billing and Coding Tip: Report Multiple Conditions With Single Code

Though, rather than code multiple diagnoses for a condition, you may find that ICD-10- CM already has a single code that reflects a combination.

Combination codes (which are a single, unique code) identify:

• Two diagnoses
• A diagnosis with an associated secondary process (manifestation)
• A diagnosis with an associated complication