Medical Coding And Billing Tutorials for Beginners | ICD-Chapter18 - 9

training myself and today we'll going to

discuss about ICD 10 CM chapter 18 which

is of symptoms science and abnormal

clinical and laboratory findings not

elsewhere classified and code series are

R00 to R 999. Okay. So basically we have

to use this code series when there is no

definitive diagnosis present. In that

cases mostly we need to code sign and

symptoms. But if definitive diagnosis is

there in that case we have to code

definitive diagnosis. No need to code

sign and symptoms. So what are the rules

and that I will see today. So topics

covered in this class are introduction

then ICD 10 CM code range mean

subchapters then ICD code coding

guidelines like use of symptom codes use

of symptom codes with a definitive

diagnosis code sometimes few symptoms

are present and few symptoms get their

definitive diagnosis also in that case

how to use both both the codes that

we'll see Then combination codes that

include symptoms then repeated false

coma sir is due to non-infectious

process death nois okay and nih ss

stroke scale that we'll see and lastly

we'll see how to solve questions and

answers so first introduction chapter 18

includes symptoms signs abnormal results

of clinical or other investigative

procedures

and illdefined conditions regarding

which no diagnosis classifiable

elsewhere is recorded. Okay. So means

this chapter consists course for those

conditions those sign and symptoms which

definitive diagnosis is not established.

Okay or physician is not able to

conclude what is the reason behind that

sign and symptoms.

For those sign and symptoms we have to

use this course. Okay. The conditions

and sign or symptoms include in

categories are R002 R 99 consist of

cases for which no more specific

diagnosis can be made even after all the

facts bearing on the case have been

investigated. Okay. sign or symptoms

existing at the time of initial

encounter that proved to be transient

and whose causes could not be

determined. Provisional diagnosis uh

diagnosis in patient who failed to

return for further investigation or

care. Cases referred elsewhere for

investigation or treatment before the

diagnosis was made. and cases in which

more precise diagnosis was not available

for any other reason. And lastly,

certain symptoms for which supplementary

information is provided that represent

important problems in medical care in

their own right. So in such conditions

we have to use sign and symptoms. The

sub chapters of chapter 13 are R002 R09

consist code for sign and symptoms

involving circulatory and respiratory

system. For digestive system and abdomen

we have R

10.19. For skin and subcutaneous tissue

R 20 to

R23 for nervous and muscularkeeletal

system R 25 to R 29. For urinary

resistive sign and symptoms R32, R39.

For cognition, precision, perception,

emotional state and

behavioral we have R 42, R46. Like this

we have different subchapters for

different code range for different types

of sign and symptoms. Okay.

Yeah. Nikita I have here it is sub

chapters of chapter 18 or 13 the slide

is showing 13

yeah I'll check yeah that's fine so now

we'll see how to use this course

different guidelines for it so first

guideline is use of symptom

codes that describe symptoms and signs

are acceptable for reporting purposes

when a related definitive diagnosis has

not been established or confirmed by the

provider. So as I said that when we need

to use sign and symptom codes whatever

patient comes with or whatever the

reason for encounter when there is no

definitive diagnosis provider is not

able to confirm the diagnosis or reason

exactly what disease or what condition

is responsible for that sign and

symptom. In that case we have to use

that particular sign and symptoms. For

example, patient admitted with hematuria

cystoscopy performed but no abnormality

show. Okay. Here cystoscopy also

performed to identify reason for

hematuria but there is no abnormality.

So now physician is not confirmed about

the cause of this hematuria. That's why

we have to use code for immaturia. Okay,

this is straightforward code. I'll show

you how to find this. Okay, can you

share the slides please? I don't see.

Sorry. Yeah, now I can. Okay. So to

search

heaturing if you go on term directly but

there is so many types okay or

specifications also available. So make

sure you are selecting correct code.

Right now in this scenario there is no

specification here just symmetry is

there that's why we choose this code.

This is called default code which is

present right after the main. Okay.

Okay. If gross immaturia is there we

have to select this code. So sometimes

gross

immatur 31.0 is for gross immaturia and

there are so many specifications. So if

nothing is mentioned just imagur is

mentioned you have to select this code

RS

31.9 traumatic immature traumatic

immatur okay so this is how you have to

find and another example patient

admitted with visual

hallucinations agitation and

stuperical disorder is suspected but the

responsible consultant is unwilling to

make a diagnosis at the time. Okay. So

the consultant is not sure about the

diagnosis. Right? That's why we need to

go all these conditions or symptoms sign

and symptoms. So first is visual

hallucination then our 45.1 restlessness

and agitation then stuper. So these all

are straightforward course you have to

go select accordingly you can see

hallucination visual okay now I am in

front of the book now uh how should I so

this is about visual hallucination

agitation code also you will get

directly

R45.1 okay and stoper also same R 40.1

okay so this is how you select the sign

and symptoms. Just make sure that you

are selecting proper codes by reading

the documentation carefully. Then next

guideline, use of symptom codes with

definitive diagnosis codes. Codes for

signing symptoms may be reported in

addition to a related definitive

diagnosis when the sign or symptoms is

not routinely associated with that

diagnosis. Okay. The definitive

diagnosis code should be sequenced

before the symptom codes. Symptoms or

sign and symptoms that are associated

routinely with disease process should

not be assigned as additional course

unless otherwise instructed by the

classification. This is the example.

Patient admitted for treatment of

hypertension while on the board. Patient

suffer a heavy nose bleed for for which

their nose has to be packed. Okay. So

here what happened? Patient is here for

hypertension and at that time the

patient suffer from nose bleed but nose

bleed is not associated with

hypertension. Right? Means nose bleed is

not a sign or symptom of hypertension.

That's why we have to code it

separately. getting yes.

If any other other symptom will be

there, we have to code only

hypertension. Okay. And here this

guideline definitive diagnosis should be

sequenced before symptom code like this

because here hypertension is definitive

diagnosis. We have to code it as a first

listed diagnosis and then we have to

code symptoms which are not associated

with that diagnosis. Okay, next

guideline. Combination codes that

include symptoms. IC NCM contains a

number of combination codes that

identify both the definitive diagnosis

and common symptoms of that diagnosis.