ICD - 10

1
??.????????? ?????????
????????????????? (Summary sheet) ??????? ICD10
ICD9 CM (2010) ??????????????????.
2
Principal Diagnosis -
??????????????????????? ????????????????????
???????????????????????? ???????????????
?????????????? ??????
- ????????????/?????????????????????
- ????????????????????????
- ????????? gt ?????????? gt ??????????
- Acute ????????? Chronic
3
Principal Dx

• ???? Sepsis ????? Source of infection ??????
  Infection ?????????????????? Principal Dx ????
  Ac. Pyelo-nephritis/ Pneumonia ??????? Sepsis
  ???? Comorbidity

• ??????.???????? 2,500 ???? ????????? Preterm ????
  Small for gestational age ???? Principal Dx

?????/auditor ??????????????????????????????.?????
??????????????????????????????????????????
???????????? ??????????????? ICD10 ICD9CM
4
Summary Sheet
Comorbidity- ????????????????????????????????????
???????????????????????????????????????
?????????? ?????????????? ???????????????????
(????????????????? ???? Acute respiratory
failure, Hypokalemia ???????????? ???? Anemia
???????????????, Thrombocytopenia
????????????????????)
5
Complication- ?????????????????????????????????
????????????????? ????????????????????????????????
??????????????????
??????????????????????????????????????????????????
????????????? ??????????????????????? ???? DRG
version 4 ???????? RW ?????????????????? ??? DRG
5 ???????? RW ????
6
Summary Sheet
Other- ????????????????????? ????????????????????
???? ???????????????????? ???? Anemia
?????????????????, Dental caries
?????????????????????, hypokalemia
???????????????????? KCl ???????
External cause- ????????????????????????????????
???? ?????????????????????????
???????????????????? etc
7
Operations- ???????? 2 ????
1. In operation room ??????????????????????
???????????????????????? ??????????????????????
Principal Dx ???????????????????
?????????????????????? ????????????? ?????? DRG
version 5 ??????????????????????????
????????????????? ???????? ?? Excisional
debridement 2 ???? 3 ?????????????? Burn
862221, 862222, 862223 ????????????????? ???
RW ???????????????????? (1.5819 3.6586 9.3234)
8
??????????????????????????????????? / DRG
- ??????????????????????? ???? Ligation of
esophageal varices by Endoscope (4233) ??????
Esophagoscope (4223) Control of esophageal
bleeding by endoscope approach (4233)
????????????????????????????? ICD 9 CM ????????
- Auditor ????????????????????????????????????????
???????? ????????????????????? ???? operative
note ????????????????????????
9
??????????????????????????????????? / DRG
- Operation ??????? ?????????????????????????? OR
???? ????????? ER ward
- Procedure ?????????? RW - Ventilator lt/gt96 hr
9671, 9672 , Streptokinase IV (9910),
Hemodialysis, Peritoneal dialysis, Blood
transfusion, Lumbar puncture (0331), Gavage
feeding (9635) ??????, Parenteral nutrition
(9915), CPAP (9390), CPR (9960)
10
9604 intubation 9391 Intermittent
breathing
9670 Mechanical ventilation of unsp duration
9671 Mechanical ventilation lt96 hr
9672 Mechanical ventilation gt96 hr
???????????????? tube ?? off tube ?????????????
Refer, tracheostomy ??????????????????????????????
????????????.????? ??????????????????????????????
????????? ????????????
11
Principal Dx ??????????????
???????????????????????????????
??????????????????????????????????????????????????
????????????????????????????????????
?????????????????????? PDx ?????????? O800 ????
SDx (????????????????????????)
???? NIDM with pregnancy, Normal Labor
?????????.2,500 gm
PDx NIDM with pregnancy O241
SDx Spontaneous vertex delivery O800

Single live birth Z370
12
PDx ????????????????????????????????
????????????? ??????
1. ???????????????? Operative delivery
2. Condition ?????? ???? DM, PROM
3. ????????
4. Outcome of delivery
5. Procedure C/S, Forceps extraction, etc
13
Ex ??????????????????????????????????????????
???????????????? ?????????????????????????????????
????????????? ????????????????? ??????? 3,900 gm
PDx Obstructed labor due to CPD
O654
SDx Pregnancy preexisting gestational DM
O244
Single live birth
Z370
Op low cervical cesarean section
741
14
PDx ????????????????? ????????????? ??????
1. ??????????? lt2,500 ???? ????? Ballard score
??????? Preterm (lt37 wk) ???? SGA(gt37 wk) ???
PDx Preterm ??.1,700 gm P071 ???? Light for GA
P050 ??????????? or Small for GA P051 wt
ht lt10 percentile
2. Birth asphyxia
3. Disease in NB
15
PDx ????????????????? ????????????? ?????? (2)
4. Single born in hospital
5. Newborn affected by maternal condition -
PROM, DM, C/S etc
6. Procedure - Phototherapy, Lumbar puncture, on
ventilator lt or gt96 hr, CPAP, gavage feeding
16
???????????? C/S, BW 1,200 gm, Apgar 3,5,7
??????????????????????? 7 ??? Ballard score 31
wk. ?? Chest X-ray hypoaeration ground glass
compatible RDS
PDx Preterm 1,200 gm
P071
SDx Severe birth asphyxia
P210
Respiratory distress syndrome
P220
Acute respiratory failure
P285
Single born in hospital
Z380
Newborn affected by cesarean section
P034
Proc On Ventilator gt96 hr
9672
17
???????????? C/S, BW 2,200 gm, Apgar 3,5,7
??????????????????????? 7 ??? Ballard score 39
wk. ?? Chest X-ray hypoaeration ground glass
compatible RDS
PDx Light for gestational age
P051
SDx Severe birth asphyxia
P210
Respiratory distress syndrome
P220
Acute respiratory failure
P285
Single born in hospital
Z380
Newborn affected by cesarean section
P034
Proc On Ventilator gt96 hr
9672
18
PDx ?????? HIV disease
????????? B200 B24 ???????????????????? ICD ??
65
Eg ??.HIV ?????? Cryptococcal meningitis
PDx B205 (Other mycosis)
SDx B451, G021 75
?????.????????????????????????????????? HIV
??????????????????? HIV ?????????? Z21 1018
19
PDx ?????? Malignancy
????? Primary malignancy ????????????
??????????????? ???????????????.??????????????????
?????????????????????????? ???????????????????????
.?? ????
PDx ALL (C910)
SDx Febrile neutropenia (D70, R509)
20
PDx ?????? Malignancy
??????.?????? ?????????????????? ???? Secondary
malignant neoplasm ???????? PDx
????????????????????.????. ???????????????????????
???????????????????????? ???? Ca breast metase to
lung ??.????????? ???????????????????????
PDx Secondary malignant neoplasm of lung(C780)
SDx Acute respiratory failure (J960)
Malignant neoplasm of breast (C509)
21
??????? Condition ????????????? PDx
- Condition ????????????????? ???? Respiratory
failure, Congestive heart failure, Volume
overload, Septic shock, Dehydration, Pulmonary
edema, etc. (except Chronic renal failure
??????????????????????????????)
- ??????????? ICD10 ??????????????????? ????
D630, D638 (Anemia in neoplasm Anemia in
chronic disease)
22
Anemia
??? Hb lt13.5 gm Hct lt39 vol
???? Hb lt12 gm Hct lt36 vol
???? 1 mo 5 ?? Hb lt 11 gm Hct lt33 vol
NB 28 day Hb lt13.5 gm Hct lt40 vol
?????????????????? ???????????? Other Dx ??????
D62 (anemia due to acute blood loss)
23
Anemia - ??? Hb lt13.5 gm Hct lt39 vol
???? Hb lt12 gm Hct lt36 vol
???? 1 mo 5 ?? Hb lt 11 gm Hct lt33 vol
D500, D508, D509 Iron deficiency anemia

• PE ?? signs of iron deficiency (glossitis,
  angular cheilitis, hair loss, koilonychia-spoon
  shaped nails) ??????? RBC morphology hypochromic
  microcytic ?? MCV lt 80

• D500 ????????? Chronic blood loss

24
Anemia - ??? Hb lt13.5 gm Hct lt39 vol
???? Hb lt12 gm Hct lt36 vol
???? 1 mo 5 ?? Hb lt 11 gm Hct lt33 vol
D630 Anemia in Neoplasm
???? Malignancy ??????????????? BM ????????? SDx
???????? MCV gt 80

• D638 Anemia in Chronic disease ?????? MCV gt 80
  ???????????? HIV diseases, TB, CRF, Cirrhosis

25
186
Diabetes mellitus
Without coma
Complication
Type of DM E10.. -DM type 1 (IDDM) E11..-
DM type 2 (NIDM) E12..-Malnutrition-related
DM E13..-Other specified DM E14..-Unspecified DM
.0 with coma
.1 with ketoacidosis
.2 with renal comp.
.3 with ophthalmic comp.
.4 with neurological comp.
.5 with peripheral circulatory comp.
.6 with other specified
.7 with multiple comp.
.8 with unspecified comp.
.9 without complications
26
DM with renal complication (.2)

• Dx ??????????.????????????? proteinuria 2
  ?????? ???????????????????????????????????????????
  ???

• ????????????? microalbuminuria ????????? 2
  ??????????? ????????????????????????????????????

DM with chronic renal failure (E119 N189) ? DM
with renal complication (E112)
27
Diabetes with neurological complication (.4)

• ???????????????????????????????? ???? ???? pain
  sensation ???? ?? reflex ???? ????????????????????
  ?? polyneuropathy ????????

28
Diabetic with peripheral circulatory complication
(.5)

• ???????????????????????? peripheral vascular
  disease ???????? ?????? ?????? Dorsalis pedis/
  posterior tibial artery ?????????????????????
  ?????????????????? vascular insufficiency ????
  ????? discoloration ??????????????????? gangrene

29
Diabetic Foot

• ??????????????????? complication ??? DM

???? circulatory complication ??????????????
gangrene ???? pulse ?????
Neuropathy ?????????? sensation ????
????????????????????????????????? ???????????
Post-traumatic wound infection ??????? external
cause ????
30
PDx Diabetic gangrene / ulcer
???????????????????????????????????????????
neurological and/ or peripheral circulatory
complication
?????????????????????? neurological / vascular
system

• PDx E10-11(.4) with neurological complication

or E10-11(.5) with peripheral circulatory comp.
or E10-11(.7) with multiple complications

• SDx G632 Diabetic polyneuropathy

or I792 Peripheral angiopathy
31
PDx Diabetic gangrene / ulcer
???????? ??????? DM type 2 ????????????????
?????? red swelling necrotic tissue pustules
?????????? ???????? dorsalis pedis a.
??????????????

• PDx Necrotizing fasciitis of foot M7267

SDx Diabetes mellitus type 2 with peripheral
complication
E115 I7927
32

• ???????? Diabetic foot ????????????????????????
  neurological vascular system ????????????????
  E10-11 (.4) (.5) (.7) ??? ????????? Cellulitis
  ??????????????????????? ???????

PDx L031 Cellulitis of foot SDx E119
Diabetes mellitus type 2 without
complication
33
DM with multiple complications ???????????????????
?????????????????????????????????? ????????
??.?????????????? 2 ??????????????????????????
?????? ????? ????????????? ??? peripheral
vascular disease
PDx E117 Diabetess mellitus type 2 with
multiple complications
SDx N083 Glomerular disorders in DM
H3609 Diabetic retinopathy
I792 Peripheral angiopathy in dis classified
elsewhere
34
Hyperglycemia Hypoglycemia in DM

• ??????????????????? hyperglycemia ??????????????
  Coma ????????? Hyperglycemia ?????????????????????
  ???????????

• Hypoglycemia without coma

PDx E160 Drug induced hypoglycemia without coma
SDx E119 Non insulin dependent DM
Y423 Insulin oral hypoglycemic drugs causing
adverse effects in therapeutic use
35
DM type 2 with hypoglycemia with coma
PDx E110 DM type 2 with coma
SDx Y423 Insulin oral hypoglycemia drugs
causing adverse effects in therapeutic use
Hypoglycemia in non DM ????????????
PDx E160 Drug induced hypoglycemia, no coma
SDx T383 Poisoning by insulin oral hypogl drugs
X44 Accidental poisoning by other drug
X64 Intentional self-poisoning by other drug
36
????????????????????????????
Dx Dyspepsia, Gastritis, Peptic ulcer
Dyspepsia ????????????????????????????????????????
??? Gastroscope /GI study
Gastritis, Peptic ulcer ??????????? Scope/GI
study ??????
??????????????????? Gastroscope
37
????????????????????????????
Dx Dyspepsia, Gastritis, Peptic ulcer
????????????????????????????????????????????? ???
Dx Hematemesis, melena, G.I.bleeding
????????????? Gastritis
?. ????????????? ?? Scope ???? ac.gastritis ???
Dx Acute hemorrhagic gastritis (K290)
????????????????????? K292
38
????????????????????????????
Dx Dyspepsia, Gastritis, Peptic ulcer
?. ?????? acute ??? chronic ??????????????
endoscope / Patho
?. ????????????????? Gastritis ??????? K297
?. ??? Dx Portal hypertension (hypertensive
gastropathy) ???? ?????????? K296 ???? PDx ???
Portal hypertension (K766) ???? SDx
39
Electrolyte imbalance
??????????????? SDx ??????????????
????????????????????? ???????????????????????
other Dx
Hyponatremia (lt135) E871 ???? (lt130 mEq/L) E871
Hypernatremia (gt150) E870 Alkalosis E873
Hypokalemia (lt3.5) E876
Hyperkalemia (gt5.5) E875
Acidosis (pHlt7.35, HCO3 lt12) E872
40
Acute renal failure (N170 N179)

• ??????????????????????????????????????????
  ?????? Shock, Hypovolemia ????????????? N170
  Acute tubular necrosis ??? shock ???
  ??????????????????? patho

• ???? Acute on top Chronic renal failure
  ????????????? acute ???? chronic (N17.., N18..)
  ???????????????????????? Cr gt 1 mg/dl
  ???????????????????????????

41
??? Dx ???? Hypertensive renal disease (I120,I129)
1. ?? Hx ???????????????????? ????????????????????
???? ????????????????????
2. ??????? Cr ??????????????? ???????????????????
???????? admission ???
3. ?????? proteinuria ????????????????? active
urine sediment proteinuriagt1 gm/d
???????????????????????????
Hypertension ???????? ???? Chr.renal failure,
AGN, Lupus nephritis ??????? I151 (2ry to renal
disease)
42
??? Dx Chronic renal failure (N180 N189)

• Cr gt1.5 mg/dl ???? GFR (Glomerular filtration
  rate) ??????? 60 ml/min (Chronic kidney disease
  stages 3-5)??????????????????? 3 ?????

• ?????????????????????????? ????????????????????
  ?????? renal failure unspecified

???? N185 End stage renal disease (ESRD) ???????
Crgt 5mg/dl ???? Creatinine clearance lt 15 ml/min
??????? 3 mo.
43
??? Dx Chronic renal failure (N180 N189)

• Chronic kidney disease stage 1 -5 (N181 N185)
  or Chronic renal failure ??? GFR

Stage 1 N181 (Crgt1.5 GFR gt90 ml/min
Stage 2 N182 (Crgt1.5 GFR 60-89 ml/min
Stage 3 N183 (Crgt1.5 GFR 30-59 ml/min
Stage 4 N184 (Crgt1.5 GFR 15-29 ml/min
Stage 5 N185 (Crgt5 GFR 15 ml/min
44
??? Dx Chronic renal failure (N180 N189)

• ????????? SDx ???????????? CRF ??????
  Hyponatremia, Hypokalemia, Metabolic acidosis,
  Hypocalcemia, Hyperphosphatemia, Hyperuricemia
  ???????????? Lab ???????????????????????????
  ????????????? ????????????????????????????? Other
  Dx ??????????????????????

??????? Crlt5.0 ??????????? ??? Dx Extrarenal
azotemia R392
45
??? Dx Volume Overload (E877)
1) ???????????? ??? ??????
2) ????????????????? crepitation ???? 2 ????
3) Jugular venous pressure ???
4) ????????????? bilateral pulmonary congestion
???????????????????????????????? Volume overload
?????? ARF, CRF, ESRD, ???????????????????????????
???
??????? Dyspnea Orthopnea CHF (I500)
46
???? CAPD
PDx N180 (ESRD), N188, N189 (CRF)
SDx Z492 (care of CAPD)
5493 Creation of cutaneous peritoneal fistula/
Tenckhoff insertion
5498 Peritoneal dialysis ????????????????????
?????????????????????????????????
47
???? CAPD
PDx N185, N189
SDx Z992 (status on CAPD)
5498 Peritoneal dialysis
3927 Arteriovenostomy for renal dialysis
3995 Hemodialysis
48
???? CAPD
?? Infection of Tenckhoff peritonitis
PDx T857 (Infection of other device, implants,
graft)
SDx Z992 (status on CAPD)
Cause Y841 (Later complication of renal
dialysis)
Proc 9782 (removal Tenckhoff)
49
??????? Dx Sepsis ??????? criteria gt 2 ???
1. BTgt380 c or lt360 c
2. PR gt90/min
3. RRgt20/min ???? PaCO2 lt32 mmHg
4. wbc lt4,000 or gt12,000 or band form gt10
???????
a. ????????????????????????? ???????????????????
??????????? ????
b. ????????????????????????????????????
???????????????????????????????????????.??????????
? ????????????????????????
50
Systemic infection ?????? Sepsis/Septicemia
?????????? Leptospirosis, Scrub typhus, Dengue
infection, Viral infection
???? Sepsis ???? PDx ??????????? Immune ???
???????????? source of infection ????? source of
infection ???? Pneumonia ??????? PDx Pneumonia
(J189) SDx Sepsis (A419) ????????????????
Hemoculture ???? ????????? specific ???????
51
??? Dx Pneumonia (J11..-J18..)
1) ?????????????????????????????? ???

• New pulmonary infiltration

• Acute onset (duration lt 2 wk)

• Symptoms signs of lower respiratory tract
  infection 3 ?? 5 ?????? ??? gt38.5C, ?????????,
  dyspnea, pleuritic chest pain, consolidation or
  crackles

52
??? Dx Pneumonia (J11..-J18..)
2) ?????? film ???? ??????????????????????????????
?????????????????? clinical ??????????????????????
????????????????????????????? pneumonia ???? film
follow up ????????????????????????
53
??? Dx Pneumonia (J11..-J18..)
3) ????????????????????/nasopharyngeal
swab??????? ????????????????? PCR for influenza,
Burkholderia pseudomallei ????????????????
????????????????????? Colonization
????????????????????????????????? /pleural
effusion
54
??? Dx Chronic obstructive pulmonary disease
1) ???? case ???????????????????????? known case
COPD ???????????????????????? ????????????
2) ???? case ???? ????? spirometry ????????? Dx

• J440 COPD with ac.bronchitis, J440J209

• J441 COPD with acute exacerbation

??? lower tract infection ?????????????? ??? PDx-
J441 Comp J209 or J189
55
??? Dx Acute respiratory failure (J960)
1) ?????????????????? ??? ???/?????????? ??????
??? ??????????????????????????
2) PaO2 lt55 ???? PaCO2 gt45 mmHg
3) ??????????? blood gas ?????? O2 satlt88 ???
????????????????????? Non-invasive ventilator
???? Endotracheal tube with mechanical ventilator
56
????????????????????????? 5
Chest pain

• History

• Investigation - EKG, cardiac enzyme, CPK,
  Troponin-T

• Treatment

• Summary discharge

57
????????????????????????? 5
ACS Acute Coronary Syndrome
??????? ???? unstable angina high risk ??????
angina ??????????? congestive heart failure
?????? Troponin ???
???????????? discharge ????????????????? Unstable
angina ???? Acute myocardial infarction
58
????????????????????????? 5
??? Dx Unstable angina (I200)
1) ???????????????????????????????????
2) ?? EKG ???????????????? ????? ST depression,
T-wave inversion
3) Unstable angina ?????? biomarkers ????
necrosis ???? Troponin-T ???? negative (lt0.03)
??? gt0.03 ??????????? Dx ???? Myocardial
infarction ?????????? NSTEMI ???? STEMI ???????
EKG
59
????????????????????????? 5
Acute Myocardial infarction (I210-219)
1) ??????????????????????????????????
2) Troponin-T ???,CPK ???, EKGST-elevation, Q
wave
???????????????????????????????????????
Infarction??????? anterior, inferior, other sites
(I210,I211,I212)
??? EKG ????? ST-elevation ???? Dx
Ac.Subendocardial myocardial infarction (I214)
NSTEMI
60
????????????????????????? 5
Artherosclerotic heart disease (I251)
????????????????????? ????

• Coronary angiogram ???? significant stenosis

• echocardiogram ?? wall abnormality

• ?????? Stress perfusion scan ???????

• Cardiac catheterization ???? stenosis

61
????????????????????????? 5
Acute Myocardial Infarction (I210-I219)
Artherosclerotic heart disease (I251)

• ??????????????? AMI ?? Ix ????????????????????
  visit ???????? ??? AMI ???? PDx ???? I251 ???? SDx

• ??????????? cath /Ix ???????? AMI ?? admit
  ????????? ?????????????????? ??? I251 ???? PDx
  ???? SDx ????????? I258, I252 (Chr.ischemic
  heart, Old MI)

62
????????????????????????? 5
Dx Old myocardial infarction (I252)

• ???? EKG ?? Q wave

• ?? Hx ???? MI ?????? ????????????????????????????
  ???????

• ???????? MI ???? (Recurrent) ????? 28 ?????? Dx
  ???? Subsequent myocardial infarction (I220-I229)

63
????????????????????????? 5
???????????.????????? chest pain ????????
?????.???????????????? ?? cardiac enzyme ????
EKG ???? monitor ????
??? PDx Precordial pain (R072) ???? Observation
for suspected myocardial infarction (Z034)
64
???? Trauma
1) ?????????????????????????????
????????????????? ????????????????
2) ????????????????????????????????? ?????????
3) ????????????? ?????????? Close or Open Fx
????????????????????? Open ????????????? Closed Fx
4) ??????? External cause ????????????????????????
???????????? ?????????????? ??? activity ?????????
65
???? Trauma
Ex ??? MC ?????????????????? Dx Focal cerebral
contusion, Fx lower tibia, laceration of thigh
????????? ??????????????????????
PDx S0630 Traumatic intracerebral hematoma
SDx S8230 - Closed fracture lower tibia
J960 Acute respiratory failure
S711 Open wound of thigh
Ext V2842 ??? MC ??????????????????
66
??? Dx Necrotizing fasciitis (M726..)
1) ?????????????????????????? ?????????????????
hemorrhagic bleb, ?????????? ?????????????????????
??????????????????
2) ?????????? Ultrasound high resolution
??????????? fluid ?????? fascia
3) ?????????????????? excisional debridement
?????????????? excisional debridement ??? Dx
Cellulitis
?????????????????? ?????????????????????
refer/not improve/dead
67
??? Dx Appendicitis
1) ??? clinical ?????????????
2) ?????????????????????
3) ????????????????????????? critieria ??????
- ??????????????????????????? Improve/approve
- ???????????????????????????????? ????
????????????????????????? ??????????????? Dx ????
U/S, CT
68
???? rupture appendicitis (K352,K353) ????
perforate of intestine (K631) ???????? ????
peritonitis ???? ???????????????????? K650, K658,
K659
??????? rupture ??? auditor ?????? operative note
???????????? purulent discharge/ purulent fibrin
??????????/ localized peritonitis ???????? PDx
???? ??? RW ?????????? 1.1468 ???? 1.4891
69
??? Dx Primary peritonitis
1) ???????????????????????????????????????????????
?
2) ?????????????????????????????? ??????????
fluid ??????????? ????????? K650, K659 ???? PDx
???
3) ??? try tapping ???? fail ??????????? Acute
abdominal pain (R104, R100)
70
(No Transcript)
71
RW2.3897
72
RW8.9257
73
RW 1.6968
74
RW5.8650
75
I D
270 Drainage of face floor of mouth
280 I D of tonsils peritonsillar
structures
8604 I D of skin subcutaneous tissue
4901 I D perianal abscess
0609 Other incision of thyroid field
8302 I D muscle (Myotomy) ???? Pyomyositis
76
????????????????????????? 17
Debridement
Layer Site Condition ICD 9 CM
Skin Abdomen 543
Nail 8627
Other Excisional 8622
Nonexcisional 8628
Muscle Hand 8236
Other 8345
Bone Skull Open fracture 0202
Other 0125
Other Open fracture 796 0-9
Other 776 0-9
77
8.6318
78
40.0223
79
?? 3 ??????????????????? 4-5 ??????
Audit UR HA
????????????? ?????????
????????