Chronic Conditions and Combination Codes in ICD-10 By Valerie Fernandez, MBA, CPC, CPC-H, AHIMA ICD-10 Trainer combination code is a single ICD-10-CM code that is used to report two diagnoses or a diagnosis with associated complications. When using these codes, the ability to identify the disease process and the link between the coded conditions is necessary, and the provider’s documentation must be robust enough to support the selection. If it is not, the coder should request clarification. The code book index provides assistance by listing manifestations along with the primary diagnosis. Diabetes mellitus diagnosis codes reflect combinations based on whatever organ system is adversely impacted by the disease. examples include: • “Diabetes Type I with ophthalmic complications with mild non-proliferative diabetic retinopathy without macular edema,” e10.321 • “Diabetes Type II with neurological complications with diabetic polyneuropathy,” e11.42 It is important to document diabetes as Type I or Type II. use of insulin, type, and dosage should always be part of a comprehensive medical record. Pregnancy complications that include gestational diabetes are reported using the diagnosis codes in the obstetrical section of the code book. Diagnosis code O24.410, “gestational diabetes mellitus in pregnancy diet controlled,” is one example. Complications related to insulin pump use, such as device failure, are reported using codes such as “mechanical complication of other specified internal and external prosthetic devices, implants and grafts epidural and subdural infusion catheter,” T85.610a. The seventh character represents the episode of care. Letter “a” is for an initial encounter; “D” indicates subsequent encounter; and “s” specifies sequela, adverse effects, or late effects. an overdose or underdosing of insulin is reported using codes from the Drug and Chemical Table. • T38.3X1a Poisoning accidental (unintentional) • T38.3X2a Poisoning Intentional (self-harm) • T38.3X3a Poisoning assault 38 HBma BILLINg • JaNuaRY.FeBRuaRY.2014 • T38.3X4a Poisoning undetermined • T38.3X5a adverse effect • T38.3X6a underdosing Diagnosis codes from the “injury,” “poisoning,” and certain other “consequences of external” causes also utilize the seventh character for episode of care. Throughout the code book, you will be able to identify patterns such as the one for episode of care. Diabetes can be induced from medication or can be caused by another condition such as cystic fibrosis or a malignant neoplasm of the pancreas. In this instance, the underlying condition would be listed first, followed by the code for secondary diabetes. Three examples are: “Cystic fibrosis with other manifestations,” e84.8; “Diabetes with underlying condition with hyperglycemia,” e08.65; and “sequela from the poisoning,” T38.3X5s. If the patient has had a pancreatectomy, this should be reported using Z90.410. Routine, regular use of insulin is recorded using Z79.4. The concept of controlled versus non-controlled diabetes is not an option in ICD-10-Cm. Instead, terms like “diet controlled” and “insulin controlled” are used. If the provider documents “Type 2 Dm poorly controlled,” that will translate to ICD-10 code e11.65, which is “Type 2 diabetes mellitus with hyperglycemia.” a provider can improve documentation of diabetes by adding a few words to the note. utilizing the words “with,” “due to,” or “secondary to” enables the provider to indicate complications related to the diabetes, such as “Diabetes with chronic kidney disease,” e11.22. Documenting the stage of kidney disease (stage I through V) or end stage renal disease enables the coder to identify the accurate code. Hypertension is also documented by indicating comorbidities. unspecified codes exist in ICD-10-Cm, but it is important to demonstrate medical necessity by accurately reporting the condition and its manifestations. examples include “Hypertension due to endocrine disorders,” I15.2 and “Hypertension with cardiorenal disease,” I13.10. A
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