Title: Module 14 Coding Diseases
Course: Introduction to Coding and Classification Systems > Section: Module 14: Coding Diseases of the Circulatory System and Neoplasms

Introduction

You are on the last leg of your journey! This week you will cover Chapter 28 Diseases of the Circulatory system and Chapter 29 Neoplasms. You will need to read the next two chapters carefully as coding for circulatory and neoplastic diseases are very challenging. Some of the guidelines from ICD-9 are not the same here, so focus attention on timeframes for myocardial infarctions (four weeks), hypertension, heart failure, and rheumatic heart disease, and pay close attention to instructional terms. Concentrate on the diagnosis codes only.

In chronic rheumatic heat disease the heart valves are often involved. ICD-10-CM presumes certain mitral valve disorders are rheumatic in origin, therefore when a diagnosis statement includes more than one condition affection the mitral valves ,one or which is presumed to be rheumatic, all are then classified as rheumatic.

NOTE: It is imperative to review the complete documentation in the health record when a site is not identified, whether the MI is a STEMI or NSTEMI myocardial infarction, site of infarction, acute or subsequent, and complication to code correctly. Diagnosis statements that do not mention the affected wall should be clarified by reviewing the EKG report.

Heart failure has two main categories- systolic and diastolic. Congestive heart failure (CHF) is included in the codes for systolic and diastolic heart failure. Read through the textbook to determine the difference between left and right sided heart failure and how to code this when it is document as such. Right-sided heart failure ordinarily follows left-sided heart failure and is coded as one code.

Hypertension is classified as to either essential (primary) or secondary in ICD-10-CM. Hypertension described as accelerated, benign, essential, idiopathic, malignant or systemic is coded to Essential (primary) Hypertension. Secondary hypertension is the result of another disease or condition and can be brought under control when that condition is cured or controlled. Secondary hypertension requires two codes: one for the underlying cause and one for the secondary hypertension.

Neoplasms are coded using two axes: behavior and anatomical site. There are five behavior groups and a sixth for unspecified behavior. The Neoplasm Table will assist the coder in assigning the code according to behavioral type, and then the coder must go the Tabular List to determine the correct code according to instructional notes. Read through the behavior classification section in your textbook for extended descriptions on each of the behavior categories used in ICD-10-CM.

Coding neoplasms require knowing the terminology referring to metastatic, metastasis, metastatic to, metastatic from, multiple metastatic sites, single metastatic site, no site stated. Directions include when the morphology type is not stated or the only code that can be obtained is C80.0 or C80.1 code as a primary malignant neoplasm unless is one of the specified stated sites for secondary neoplasms.

NOTE: The basic rule for selection the principal diagnosis is the same as all others, that is, the principal diagnosis is the condition found after study to have occasioned the current admission or encounter. And consider the thrust of the treatment whether treating a primary site or secondary site on this admission.

When the episode of care involves the treatment solely for chemotherapy, immunotherapy or radiation therapy the principal is assigned a Z code and not the neoplasm code.

Course Outcomes

- Recognizes the basic coding steps for coding medical diagnosis in both ICD-9-CM and ICD-10-CM. (1)
- Comprehends the basic coding guidelines established by the American Hospital Association for both ICD-9-CM and ICD-10CM. (2)
- Converts medical documentation into both ICD-9-CM and ICD-10-CM codes. (3)
- Interprets medical documentation to assign accurate codes for reimbursement of health care services. (4)
- Applies the official coding guidelines to the coding of medical diagnosis for all body systems (circulatory, respiratory, musculoskeletal, urinary, blood-forming organs, reproductive, gastrointestinal, etc.) (5)
- Demonstrates thorough understanding of selection of the principal diagnosis and any secondary diagnosis associated with the episode of care or hospital admission. (6)
- Demonstrates thorough understanding of the proper sequencing of diagnosis codes for maximum reimbursement of the health care services provided. (7)
- Performs accurate diagnosis code assignment for all body systems based upon the documentation provided in the health record. (8)

Objectives

After completing Module 14 you should be able to:

- Classify and code disorders related to the heart and the rest of the circulatory system.
- Distinguish between the different conditions regarded as ischemic heart disease.
- Classify heart failure by category and location.
- Distinguish between primary and secondary hypertension.
- Explain the various classifications of neoplasm.
- Locate codes for neoplastic diseases.
- Code for malignant, benign, carcinoma, in situ, undetermined, unspecified, and uncertain behavior.
- Know the definitions related to the term " metastatic".

Readings and Resources

- Chapters 28 and 29 and even numbered exercise questions to prepare for Test 14
- Review coding guidelines for circulatory and neoplasm coding

Discussion

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Test
The above link takes you to the test page. There are 20 questions worth two points each.You have one hour to complete the open book exam. You also have the opportunity to retake the test if you feel you can improve your score.