Friday, September 9, 2016

ICD-10-CM 2017 Guideline Changes: Zika, Hypertension, STEMI and more!

Issue 5 of “In the kNOW” will be reviewing I.C (Chapter-Specific Coding Guidelines).  These are the guidelines that address specific issues relevant to a particular ICD-10-CM chapter and are to be applied in all healthcare settings.  Some chapters may have no updates, while others will have a number of revisions.  So let’s begin.

First, there are 11 chapters that had no coding guideline changes for 2017.  They are chapters: 2, 3, 5, 6, 7, 8, 10, 11, 14, 17, and 20.

The addition to Chapter 1 guidelines for “Certain Infectious and Parasitic Diseases” (I.C.1.f) deals with the Zika virus.  Under this new guideline, coders are instructed to assign the code for Zika virus infection only for confirmed cases of the disease.  This is an exception to the inpatient guideline that states for suspected, possible, probable, or rule out diagnoses to code them as if they exist.  For Zika infections, only code confirmed cases.  A confirmed case can rely solely on the provider’s diagnostic statement and does not require documentation of the test.  If the physician documents suspected, possible, probable, or rule out Zika, then code the symptoms or Z20.828 for contact or exposure to other viral communicable diseases.  

Chapter 4 (Endocrine, Nutritional, and Metabolic Diseases) also saw revisions.  I.C.4.a.3 (Diabetes and use of insulin and oral hypoglycemics) and I.C.4.a.6 (Secondary diabetes) were both revised to include the new code Z79.84 (long-term use of oral hypoglycemic drugs).  This is to be used much like Z79.4 which depicts a patient’s long-term use of insulin.  

Several revisions occur in Chapter 9 (Diseases of the Circulatory System).  The first is under Hypertension at I.C.9.a that states that because the word “with” is used in the Alphabetic Index, a causal relationship can be assumed between hypertension and kidney involvement and hypertension and heart involvement.  Based on that direction (see further discussion of this topic in “In the kNOW- 3”), unless specifically stated in the documentation that the conditions are unrelated, those conditions are to be coded as related even if there is no physician documentation linking them.  For any other conditions that are not linked to hypertension by phrases such as associated with, due to, or with, there must be specific physician documentation that links them in order to be coded as related.  

I.C.9.a.1 Hypertension with heart disease reiterates the above point by restating that the conditions are coded as related unless the physician has specifically documented a different cause.  I.C.9.a.2 directs coders not to CKD (chronic kidney disease) as hypertensive if the physician has identified a different cause.  I.C.9.a.3 states that hypertensive heart and CKD are assigned using a combination code when the hypertension occurs with both heart and kidney disease.  I.C.9.a.10 is a new guideline addressing the coding of hypertensive crisis with codes from the I16 category.  An additional code should be used to code an identified hypertensive disease with the sequencing then based on the circumstances of the admission.  

A final change to the Chapter 9 guidelines is a small one at I.C.9.e.1 which addresses ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI).  The third paragraphs talks about assigning I21 category codes if, within or equal to four weeks from the onset of the MI, the MI meets the definition for “other diagnoses” as outlined in Section III- Reporting Additional Diagnoses”.  

Our next issue will continue to explore the Chapter-specific guideline changes to ICD-10-CM for 2017.

This link will direct you to the CMS webpage for everything ICD-10-CM related:


Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.


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