Combination Codes

1
Combination Codes

• HS317b Coding Classification of Health Data

2
Combination Codes

• Dagger/Asterisk Dual Combination
• Combination Code
• Two codes to explain disease process
• Diagnosis Type 3

3
Possible combinations

• Infections
• Pneumonia
• Septicemia
• HIV
• Musculoskeletal

4
Infection Dual Combination

• Identify infectious organism manifestation in a
  local system chapter.
• Both must be used together
• Example Ms. B was diagnosed with a candidial
  infection of the vulva and vagina
• B37.3 Candidiasis of vulva and vagina (N77.1)
• N77.1 Vaginitis, vulvitis and vulvovaginitis in
  infectious and parasitic diseases classified
  elsewhere

5
Infection Combination Code

• One code will indicate manifestation and organism
• Example
• Patient was diagnosed with streptococcal
  pharyngitis
• J02.0 Streptococal pharyngitis

6
Infection Two Codes

• Use two codes to identify disease and infectious
  organism
• Example patient was confirmed to have acute
  cystitis caused by E.Coli
• N30.0 Acute Cystitis
• B96.2(3) Escherichia coli
• (any Dx between B95-B97 Dx Type 3)

7
Human Immunodeficiency Virus

• MRDx must be B24 HIV disease
• Manifestation that is being treated will be
  sequenced immediately following B24
• B24 HIV
• F02.4 Dementia in human immunodeficiency virus
  HIV disease

8
HIV Mutually Exclusive

• B24 Human immunodeficiency virus HIV disease
  (never use Dx Type 2)
• Z21 asymptomatic human immunodeficiency virus
  HIV infection status
• R75 nonconclusive serologic evidence of HIV

9
Anemia Neoplasms

• D63.0 Anaemia in neoplastic disease (C00-D48)
• Use only if anemia is unspecified.

10
Pneumonia COPD

• Combination Code
• Patient comes into hospital with COPD and
  pneumonia (or any other acute lower respiratory
  tract infection)
• J44.0 Chronic obstructive pulmonary disease with
  acute lower respiratory infection

11
FYI - COPD

• J44.0 Chronic obstructive pulmonary disease with
  acute lower respiratory infection
• J44.1 Chronic obstructive pulmonary disease with
  acute exacerbation, unspecified
• J44.8 Other specified chronic obstructive
  pulmonary disease
• J44.9 Chronic obstructive pulmonary disease,
  unspecified

12
Pneumonia COPD

• When infection is a significant condition in its
  own right an additional code must be used to
  specify the type of infection for epidemiological
  purposes. The condition must be assigned to a
  diagnosis type 1
• J18.9 (1) Pneumonia, unspecified

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Example

• A 68 year old man with severe COPD contracted
  the common cold. His condition worsened and he
  was admitted. Chest X-ray revealed pneumonia.
  He was subsequently admitted for COPD
  exacerbation and pneumonia.

14
Example

• M - J44.0 Chronic obstructive pulmonary disease
  with acute lower respiratory infection
• 1 - J18.9 Pneumonia, unspecified

15
Sepsis Pneumonia

• Patient was being treated in ICU for pneumonia
  and staphylococcus aureus septicemia
• Folio lookup pneumonia septicemia-
• septicemia A41 J17.0 (note even though A41
  does not have a dagger it is considered a
  dagger/asterisk relationship)

16
Lobar Pneumonia

• Lobar pneumonia when pneumonia is documented as
  complete consolidation of an entire lobe.
• Apical, basilar and massive
• J18.1 Lobar pneumonia, unspecified when organism
  is unknown.
• If organism identified code to pneumonia with
  organism
• Combination Code, i.e. J13 Pneumonia due to
  Streptococcus pneumonia

17
Bronchopneumonia

• When inflammation is scattered here and there
  throughout the lungs, often with bilateral
  involvement.
• Terms catarrhal, confluent, diffuse,
  disseminated (focal), lobular (segmental) and
  patchy
• J18.0 Bronchopneumonia, unspecified

18
ARDS Respiratory Failure

• Acute respiratory failure (J96.0) is an inherent
  part of the J80 Adult respiratory distress
  syndrome.
• Syndrome can include sepsis, systemic
  inflammatory response syndrome
• One code J80 needs to be coded

19
Mechanical Ventilation

• Mandatory to code if duration is gt 96 hours.
• Indicate through procedure code with attribute
  extended for gt 96 hours
• 1.GZ.31.CA-ND - EX

20
Bleeding Esophageal Varices

• Patient with known alcoholic cirrhosis of the
  liver admitted with bleeding esophageal varices

21
Bleeding Esophageal Varices

• Varix
• esophagus (ulcerated) I85.9
• bleeding I85.0
• congenital Q27.8
• in (due to)
• alcoholic liver disease K70 I98.2
• cirrhosis of liver K74 I98.2
• schistosomiasis B65 I98.2
• toxic liver disease K71 I98.2

22

• K70.3 Alcoholic cirrhosis of liver
• I98.2 Oesophageal varices in diseases classified
  elsewhere
• K92.0 Haematemesis

23
Gastrointestinal Bleeding

• Look for combination codes
• If no combination, code disease and add as
  Diagnosis type 3
• K92.0 Haematemesis
• K92.1 Melena
• K92.2 Gastrointestinal haemorrhage, unspecified

24
Pathological Fractures

• No known traumatic injury
• Documented as a result of an underlying disease
  (neoplasm, osteoporosis, Pagets disease or an
  endocrine disorder)

25

• Fracture
• bone T14.2
• in (due to) neoplastic disease NEC (see also
  Neoplasm) (8000/1) D48.0 M90.7
• M90.7 Fracture of bone in neoplastic disease
  (C00-D48)

26
Spinal disease myopathy

• Displacement
• -vertebra
• lumbar, lumbosacral (with) M51.2
• myelopathy M51.0 G99.2
• neuritis, radiculitis, radiculopathy or
  sciatica M51.1 G55.1

27
Sandwiching Codes

• Peritonitis due to peritoneal dialysis catheter
  exit site infection. The physician ordered skin
  and peritoneal fluid cultures (positive for
  staphylococcus) to confirm the cause of the
  peritonitis

28
Codes

• T85.7 Infection and inflammatory reaction due to
  other internal prosthetic devices, implants and
  grafts
• K65.9 Peritonitis, unspecified
• B95.3 Streptococcus pneumoniae as the cause of
  diseases classified to other chapters
• Y84.1 Kidney dialysis

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Classification based on MRDx

• MCC 4 Diseases and Disorder of the Respiratory
  System
• MCC 16 Blood and blood forming organs and
  Immunological Disorders
• MCC 18 Multisystemic or unspecified site
  infections
• MCC 24 HIV Infections (AIDS)
• No complexity assigned

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MCC 4 Respiratory System

• Factors that can influence CMG assignment
• Tuberculosis, Respiratory Failure or respiratory
  infections and inflammations associated with
  Cystic Fibrosis (Dagger/asterisk codes) (CMG 487
  CF)
• CMG 135 Tracheostomy

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MCC HIV

• Assignment of CMG based on manifestation
  diagnosis
• Respiratory Disorders will assign case to CMG 860
  Respiratory Tract Disorders with HIV
• No complexity level assigned