3-2-1 Code It! Chapter 2 INTRO TO ICD-10-CM & ICD-
Institution
3-2-1 Code It! Chapter 2 INTRO TO ICD-10-CM & ICD-
ICD-10 Coordination and Maintenance Committee, - answer-The National Center for Health Statistics (NCHS) and the Centers for Medicare & Medicaid Services (CMS) are the U.S. Department of Health & Human Services (DHHS) agencies that comprise the ICD-10 Coordination and Maintenance Committee, which i...
3-2-1 Code It! Chapter 2 INTRO TO ICD-10-CM &
ICD-10-PCS CODING
ICD-10 Coordination and Maintenance Committee, - answer-The National Center for Health
Statistics (NCHS) and the Centers for Medicare & Medicaid Services (CMS) are the U.S.
Department of Health & Human Services (DHHS) agencies that comprise the ICD-10
Coordination and Maintenance Committee, which is responsible for overseeing all changes and
modifications to ICD-10-CM and ICD-10-PCS.
Medical Necessity - answer-the following criteria are used to determine medical necessity:
●Purpose: The procedure or service is performed to treat a medical condition.
●Scope: The most appropriate level of service is provided, taking into consideration potential
benefit and harm to the patient.
● Evidence: The treatment is known to be effective in improving health outcomes.
●Value: The treatment is cost-effective for this condition when compared to alternative
treatments, including no treatment.
Main Terms - answer-(e.g., conditions) are printed in boldfaced type and are followed by the
code.
Nonessential modifiers - answer-are qualifying words contained in parentheses after the main
term that do not have to be included in the documented diagnostic or procedural statement for
the code listed after the parentheses to be assigned
Subterms (or essential modifiers) - answer-qualify the main term by listing alternative sites,
etiology, or clinical status.
-A subterm is indented two spaces under the main term. -Second qualifiers are indented two
spaces under a subterm
-third qualifiers are indented two spaces under a second qualifier (Figure 2-3). Care must be
taken when moving from the bottom of one column to the top of the next column or when
turning to the next page of the index. The main term will be repeated and followed by —
continued. When moving from one column to another, watch carefully to determine whether the
subterm has changed or new second or third qualifiers appear
Tabular List of Diseases and Injuries - answer-contains 22 chapters. Chapters in ICD-10-CM
classify diseases and injuries according to specific body systems as well as etiology (cause of
disease)
NOTE: ICD-10, created by the WHO, has 22 chapters. ICD-10-CM excludes the ICD-10
chapter, Codes for Special Purposes, U00-U99. - answer-
The ICD-10-CM Official Guidelines for Coding and Reporting are organized into four sections
and one
, appendix. - answer-●Section I includes the structure and conventions of the classification and
general guidelines that apply to the entire classification and chapter-specific guidelines that
correspond to the chapters as they are arranged in the classification.
●Section II includes guidelines for selection of the principal diagnosis for nonoutpatient settings.
(Nonoutpatient settings include acute care hospitals, long-term care facilities, home health care
agencies, nursing homes, and so on.) (The selection of principal diagnosis is discussed in
Chapter 6.)
●Section III includes guidelines for reporting additional diagnoses (e.g., coexisting conditions,
complications) in nonoutpatient settings. (The coding of additional diagnoses is discussed in
Chapter 6.)
●Section IV includes guidelines for outpatient diagnosis coding and reporting. (Outpatient
diagnosis coding is discussed in Chapter 7.)
●Appendix I includes present on admission (POA) reporting guidelines. (POA reporting is
discussed in Chapter 20
ICD-10-CM Official Guidelines for Coding and Reporting - answer-The Official ICD-10-CM
Guidelines for Coding and Reporting (and the Official ICD-10-PCS Guidelines for Coding and
Reporting) are approved by the four organizations that make up the Cooperating Parties for the
ICD-10-CM /PCS. They include:
-The American Hospital Association (AHA),
-American Health Information Management Association (AHIMA)
-CMSand
-NCHS (National Center for Health Statistics)
ICD-10-CM Official Guidelines for Coding and Reporting (B) - answer-The Centers for
Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) are
the agencies in the U.S. Department of Health & Human Services (DHHS) that develop official
guidelines for coding and reporting using ICD-10-CM.
Conditions That Are an Integral Part of a Disease Process - answer-Signs and symptoms that are
associated with a disease process should not be assigned as additional codes (unless otherwise
instructed by ICD-10-CM) because they are included in the disease process.
Conditions That Are Not an Integral Part of a Disease Process - answer-Conditions that are not
considered an integral part of a disease process, such as additional signs and symptoms that may
not be associated routinely with a disease process, should be coded when present (e.g., severe
headache for which treatment or medical management is provided is coded when the patient is
diagnosed with pneumonia).
Multiple Coding for a Single Condition - answer-The etiology/manifestation coding convention
requires that two codes be reported to completely describe a single condition that affects
multiple body systems.
Code First notes - answer-are also located below certain ICD-10-CM codes in the tabular lists
that are not specifically
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